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Nutrition

in Children and Youth


Dagmar Schneidrov
Department of Child and Youth Health
3rd Faculty of Medicine
Charles University in Prague
Nutrition and Health

Childhood and adolescence =


key periods for growth and
development
Ensure daily energy and nutrients
requirements for health, growth
and development and health in
adulthood
Inadequate intake of nutrients

(esp. 0-2 years ) might cause


irreversible changes
Current Research
Physiology:
- nutrients relevant for metabolism and
development of brain, intestinal flora and
bones
Epidemiology:

- nutrient intake, eating habits, attitudes


in preschool, school children
- prevalence of nutrition related disorders
(obesity, eating disorders)
Public Health, Health Promotion Projects:

- effectiveness of intervention programmes


(in preschool, school children)
Brain and cognition

Most intensive development of NS


in prenatal period and up to 3 years
Decreased intake of energy and
essential nutrients in first years
important impact on structural and
functional development of CNS
Relationship between the intake of
some nutrients and cognitive
functions studied in detail
Iodine

Important for synthesis of thyreoid


gland hormones
Prenatal iodine deficiency impact
on cognitive development
(e.g.learning disabilities)
Less evidence on relationship
between deficit in children and
cognitive development
Folic acid (vitamin B9)

B-group vitamins (B1, B2, B6, B9,


B12) required for the synthesis of
various neurotransmitters
Folic acid deficiency in early
pregnancy risk of neural tube
defects
1996 FDA a flour supplementation
programme in the USA reduced the
incidence of malformations by 13%
Fatty acids (omega 3, 6)

Omega 3,6 polyunsaturated fatty


acids (DHA) found in
phospholipids in CNS (brain,
retina)
Play a role in cognitive
development
Deficiency rare neurological and
visual disorders (esp. in premature
infants)
Iron

Metabolism of neurons, cognitive


functions and behaviour
Iron deficiency: -
impaired brain function:
* poor spatial memory in adolescents
* cognitive performance , attention
- impaired immunocompetence:
* decreased resistance to
infections - anaemia
Zinc

Key role in growth of cells and CNS


development
Modulates the transmission of
nerve signals
Deficiency in prenatal and
postnatal period: malformations
of NS
Deficiency in childhood:

- impact on cognitive and motor


functions in vulnerable children
Breakfast short-term
impact
Breakfast replenishes
carbohydrate reserves after
fasting overnight beneficial
effects on brain functions:
* learning ability (attention,
memorization)
* performance at school
* behaviour
Intestinal flora
(immunity)
0-5 years development of intestinal
flora
BM important for the development of
immune system (L. bifidus, growth
factors, trans-oligosacharides), protection
against infections, allergies
IF ferments non-digestable
carbohydrates (fiber), results in formation
of short-chain fatty acids (SCFA) which
provide colonocytes with energy
Bone growth
0-2 years very fast growth (esp.in
length)
11-13 years (prepuberty) intensive bone
mineralization - half the mass of calcium of
the adult is laid down
9-14 years the period of peak bone
growth adolescents acquire 25% of their
final bone mass
Intense bone turnover in children, who
replace 50 to 100% of their skeleton in
a year, compared to 10% in adults
Bone growth

The construction of bone outweighs its


destruction allows the bones to
increase in length and get stronger
Calcium requirement of children (3-8
years) per unit bodyweight are 2 to 4
times greater than that of adults
Intake of calcium and phosphorus
Ca/P > 1 (cola beverages P>Ca)
Calcium deficiency
Has no immediate direct impact on growth
(cannot be identified by growth curves)
Main effect - reduces mineralization and
results in a lower peak bone mass
US study children who were deprived of
cows milk over a long period were more
liable to experience fractures
Spanish study a significant inverse
relationship between the prevalence of
fractures amongst school children and the
calcium content in tapwater
Bone growth
Calcium Vitamin D
Phosphorus Vitamin A
Fluoride Vitamin K
Protein
Vitamin C
Osteoporosis prevention

Nutritional status of mother in last


trimester of pregnancy (highest
accumulation of calcium)
Genetic factors (60-80 %)
Hormonal factors (puberty)
Nutritional factors (esp. consumption
of dairy products and other food rich
in calcium see next slide)
Physical exercise (increases bone
density)
Food rich in calcium

Milk, dairy products (cheese,


yoghurt)
Sardines, herrings, sea-weed
Poppy, sesame seeds
Molasses
Appricots, figs
Cabbage, savoy cabbage, Brussels
sprouts, broccoli, pulses
Multiple deficiencies (Fe, Ca,
Zn, Mg, I, vit. B6, vit. C, folic
acid)
Delayed growth and development
Rachitis (infants)
Anaemia (6-24 months, puberty)
Delayed menarch in girls (eating
disorders)
Decreased resistance to infections
Fatigue, low mental performance
Emotional disorders
Nutrient intake in preschool
children (Makov et al., 2005)
Evaluation of average daily energy and
nutrient intake in 91 preschool children
from kindergartens in Teplice, German
RDI used
Adequate intake of Ca, Fe, vit. B1, B2,
energy, fat (29.5% - increased
saturated fatty acids)
Sign. increased intake of proteins
(2.45 g/kg compared to RDI 0.9 g/kg )
Sign. decreased intake of vit. C (67%
of RDI)
Nutrient intake in school children
(Brzdov et al., 2000)
Survey in a representative sample of 980
children (junior and senior school age) from
CR - 24 hour recall and food frequency ques.
(focused on dietary sources of vitamins and
Ca)
Inadequate intake of vit. C (80 and 50%
of RDI in junior and senior school age), vit.
E (69, 60%), Ca (66, 54%)
Recommended : - increase consumption
of vegetable, fruit and milk products
- focus on nutrition education (food
pyramid)
Health promotion
projects (methods
recommended by MoH)
Children:
A little pyramid (Pyramidek) Health Institute
Brno
Fruits and vegetables 5 times a day MF MU Brno
Complex system of intervention in school catering
National Institute of Public Health Prague
Lets slim with Bumbrlnek Health Institute Brno
Lets eat and live healthy Health Institute Plze
What is wrong and good for us HI Plze
Well be healthy in the 21st century MF MU Brno
Optimalization of physical activity in school children
Pedagogical FacultyLiberec
A little pyramid
(Pyramidek) Health
Institute Brno

Educational programmme for


kindergartens - basics on healthy
nutrition and promotion of physical
activity
Curricula teaching methods -
play, competitions, fairy tales,
stories, arts (e.g. food pyramid)
http://www.pyramidacek.cz
Interactive
Programmes
in Nutrition
Education
Sklov L., Komrek L., Kernov V.,
Rov J.

National Institute of Public Health


Centre of Health and Living Conditions
Pyramid of Healthy
Nutrition
Programme for Children

Education programme for food


choice
Set up a food pyramid
Set up a diet

www.szu.cz zdrav/pro dti


Websites
(education of parents,
teachers, children,
physicians, nurses)
www.vyzivadeti.cz
Manual for teachers on nutrition
(Health promotion in schools)
Best school lunch
(General Health Insurance Comp. Competition,
CR)
Obesity and overweight
in children and youth
EU Community projects
Children, Obesity and
Associated Avoidable Chronic
Diseases
coordinator: European Heart Network, Brussel
(CZ: Czech Heart Association srdce)
2004 - 2007

Overweight Prevalence (%)


U
ni
te
d
St

10
15
20
25

0
5
at
C es
an
ad
a
M
al
ta
Sp
Po ain
rt
ug
al
Th I
e G taly
fo re
rm ec
er e
W
Yu
En l e a
go
sl g s
av Sc lan
R ot d
ep
Sl la n
ub o d
lic ve
o f H n ia
M un
ac ga
ed ry
on
C ia
ro
a
Fi tia
nl
a
N nd
or
D wa
en y
m
Sw ark
B ed
el
children

gi A en
um u
s
(F tria
re
nc
B F h
el
gi G ran )
um e c
r e
(F m a
le n
Sw m y
it ish
N zer )
C eth la
ze e nd
ch rla
R nd
ep s
ub
l
Po ic
la
Scandinavia

Es n d
R to
North America

us
si U ni
United Kingdom
in 31 countries grouped by region
Prevalence of overweight

an kr a
Fe ain
de e
ra
t
La ion
(South) Western Europe

Li tv
(Central) Western Europe

th i a
ua
(Northwest) Eastern Europe
(Southwest) Eastern Europe

ni
a
Source: HBSC
PERCENTAGE OF OVERWEIGHT AND OBESE CHILDREN
Reference data: WHO and IOTF recommendations
Age 7 11 years

% 35

30
25
USA
20
Europe
15 Czech Rep.
10
5
0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

Report of the International Obesity Task Force, 2004


Overweight and obesity
in adolescents (13 17 years)
The International Obesity Task Force
(www.iaso.org)

UK

obezita
GR
nadvha+obezita

CZ

0 10 20 30 40
Overweight and obesity
in Czech adult population
International Obesity Task-Force, 2005
www.iaso.org

BMI = weight (kg)/


height2(m) 80
70
60
1 .Norm 18,5 - 24,9
50
2. Overweight 25 - 29,9
40 mui
3. Obesity I 30 - 34,9
4. Obesity II 35 - 39,9 30 eny
5. Obesity III 40 and 20
more 10
0
BMI 2 BMI 3 BMI
2+3
Obesity - etiology
Genetic factors

Metabolic factors
Socioeconomic
factors
Nutritional habits
Physical activity
Multifactorial disease
Obesity
Genetic factors High blood
Hormonal factors pressure
Socioeconomic, High cholesterol
psychological Diabetes (II type)
factors
CVD
Eating habits
(increased energy tumors
intake) Risk of
Physical activity preliminary death
(decreased low in adulthood
energy output) higher by 50-80%
Prevention of obesity
Excl. breastfeeding for 6 months and
sustained BF until 2 years
Monitoring of growth and nutritional
status (preventive pediatric
examinations early detection)
Education of parents and children on:
- healthy nutrition and eating habits
(regular eating regimen in smaller
portions, healthy composition of a diet
- food pyramid), warning about dieting
- regular physical activity (balance
between energy input and output)
Nutritional Counselling
(HPH Health Promoting Hospitals/WHO)
Evaluation of history data, incl.
weight (questionnaires)
Assessment of eating habits and
food consumption (24 hours recall)
Assessment of physical activity
(questionnaires)
Analysis of data (PC programme
energy, nutrient intake)
Individual counselling based on
current guidelines on healthy
nutrition (food pyramid)
Treatment of obesity

Group weight reduction courses


for children and parents,
adolescents (STOB
www.stob.cz)
Health promotion projects of MoH
(e.g. Lets slim with
Bumbrlnek)
Spa treatment
Group weight reduction
courses (www.stob.cz)
3 months courses for children and
parents/grandparents, adolescents
Cognitive behavioural approach
modified for children (plays, contests)
Elaboration of individual regimen of
healthy eating and physical
activity
Evaluation of questionnaires before
and after treatment (effectiveness)
Follow-up, controls
www.hravezijzdrave.cz
References

WHO/Nutrition School-age children


and adolescents: http://www. who.int/
nutrition/publications /
schoolagechildren /en/
WHO/Global Strategy on Diet, Physical
Activity and Health/Childhood
overweight and obesity:
http://www.who.int/dietphysicalactivit
y/childhood/en/