Exam 4- Childhood/Adolescence Flashcards by Sabrina Belisle

Toddlers (1-3 years)

Growth rate slows down
- appetite/food intake compared to infancy
Transition to independent feeding
- can still choke
-small stomach= frequent snacks
Strong likes & dislikes; distinct food preference
- food jags (eat same food all the time)
- neophobia (fear of new foods)
Wide variation in physical activity (PA)

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Early Childhood (4-8 years)

Period of lowest growth rate

Transition from feeding skills to eating habit

Knowledge/belief of food influenced by
- parents, siblings, teachers
- media
Wide variation in PA (screen time)

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Growth:

toddlers thru adolescence

Influence of genetic potential ↑
Gender difference becomes apparent
- boys slightly taller and heavier than girls
Adolescent growth spurt
- girls begin and end earlier than boys
- peak height velocity (PHV) girls-12, boys-14
- total height gain: boys>girls
Body composition:
- pre-puberty % body fat: boys-15%, girls-19%
- during puberty: girls gain proportionately more fat due to estrogen & progestrone
- after puberty % body fat: boys-15% girls-23%

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Growth (BMI)

toddlers thru adolescence

Normal BMI change with age

  - 50th %tile values for boys:
    16. 5 at age 2, 15.5 at age 6, ~20 at age 15

BMI curve: U-shape
- decreased at age 2-5, lowest (nadir) at 4-8, increases (rebound) afterwards, continue to increase thru adolescence

BMI nadir and rebound

  - girls earlier than boys
  - heavy children earlier than light children
  - earlier rebound  linked to increased risk of obesity

Overweight/obesity definition

  - based on percentiles, not absolute BMI (kg/m2) 
  - relationship to adult definitions

   At age 20                               Boys      Girls    Adult
   50th percentile BMI                 23           21.8    
   85th percentile BMI (OW)        27          26.5         25
   95th percentile BMI (OB)        30.5         31.8          30

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Categories of BMI status

< 5th percentile: underweight
5-84th percentile: healthy weight
85-94th percentile: overweight
≥95th percentile: obesity

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DRI: Energy and Macronutrients

toddlers (1-3)

Same EER equation as infants’
but +20 kcal for growth
Fat: 30-40%
CHO: 45-65%
Protein:   5-20%
Protein RDA: 1.05 g/kg BW

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DRI: Energy and Macronutrients
Early Childhood (4-8 years)

girls:
EER = 135.3 – 30.8 x age + PA x
           [(10.0 x wt) + (934 x ht) + 20
boys:
EER = 88.5 – 61.9 x age + PA x
           [(26.7 x wt) + (903 x ht) + 20
age 4-18 yr
       Fat: 25-35%
      CHO: 45-65%
      Protein: 10-30%
Protein RDA (4-8):   0.95  g/kg BW

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DRI: Micronutrients (RDA/AI)

Calcium

toddlers: 700

4-30: 1000

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DRI: Micronutrients (RDA/AI)

Iron

infants: 11
toddlers: 7
early childhood: 10
adults: M:8 and W: 18

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Nutrients of concern

Vitamin A
iron
calcium 
zinc
Vitamin D 
(40% of toddlers take supplement but not really recommended)

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Actual intake from NHANES Survey

% of children drinking milk decreased from 85% (1976-80) to 77% (2001-06)
- intake of milk decreased while fruit juice increased

Juice consumption increased from 30% (1976-80) to >50% (2001-06)
- AAP and DGA recommends 4-6 oz/day for 1 y.o. (actual is 10-12 oz/day)

Soft drink increased from 7 oz/day (1976-80) to ~8 oz/day (2001-06)

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Eating Patterns of Children

Meals at home decrease, Meals away from home increase

 - meals with families at home have higher diet quality 
 - calorie intake away from home increase from 23% in 1977 to 34% in 2006
 - fast food was the largest contributor, 13% of calories

Meal patterns and meal frequency

 - of children skip breakfast (NHANES 1999-2006)
 - snacking  from 4x per day (1977-78) to 5x per day (2006-10) 
 - of calories come from snacks; largest increases in salty snacks &amp; candy

Portion sizes
- when larger entrée portions are offered, children age 3-5 y consume more of the entrees and less of “other” (e.g., F & V)

Beverage consumption

Development of eating habits food preference lecture

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Growth and Feeding/Eating Characteristics: Adolescence

Adolescence (9-13 & 14-18)
Growth spurt; sexual maturation
- appetite increases during growth spurt
↑ Meals/snacks away from home
- skipping breakfast
-decreased milk, increased sweetened beverages
Eating habit strongly influenced by peers
-maybe sudden/dramatic (e.g. vegetarian)
Wide variation in PA (screen time & sports)

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Puberty

process of physically developing from child to adult, physical growth and sexual maturation
F: 10.5 -14
M:12-16.5
Timing of growth spurt correlate closely to stages of sexual maturation
Progression of puberty: sequence of pubertal events is consistent, but age of onset, magnitude and duration vary greatly among individuals - “early”, “average” and “late” maturers

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Tanner stages

A scale to assess the characteristics & degree of sexual maturation of adolescents, regardless of chronological age.
Girls: based on breast development and pubic hair
Boys: based on genital and pubic hair development
- Separate stage established for each of the 2 characteristics

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Tanner stage categories

Stage ranges from 1 to 5     
Girls: B1 to B5 and PH1 to PH5 
Boys: G1 to G5 and PH1 to PH5     
- Stage 1: pre-pubertal
- Stage 2: onset: earliest visible signs
- Stage 5: mature, adult development

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Tanner stages - girls - common characteristics

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Earliest sign of puberty
- breast budding, usually obvious; onset of B2
- average age 10½ y.o. (age range 9-13 y.o)
Breast development- B2 to B5 takes ~4 years
Peak Height Velocity
- occurs before menarche
- usually during stages 2-3
Menarche
- average age 12½ y.o.
- usually during stages 3-4
Other signs of puberty e.g., acne

Tanner stages - boys - common characteristics

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Earliest sign of puberty
- testes enlarges, usually subtle; onset of G2      
- average age: no data
Genital development
- G2 to G5 about 3 y
PHV    
- usually during stages 3-4
Other signs of puberty: voice deepening, mustache, etc

DRI: Energy and Macronutrients- adolescence

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Energy: same as 3-8 but +25 kcal for growth 
Protein RDA: 
9-13: 0.95 g/kg 
14-18: 0.85 g/kg 
AMDR: 
Fat: 25-35%
CHO: 45-65%
Pro: 10-30%

DRI: Micronutrients (RDA/AI)- calcium

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9-18: B:1300 G:1300

18+: 1000

DRI: Micronutrients (RDA/AI)- iron

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9-13: 8
14-18: B: 11, G:15
Adults: B:8, G: 18

Energy & nutrient requirement influenced by growth rate and physical activity level

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chronological age is a poor indicator of requirement
2 girls of the same age have very different requirement if one is pre-pubertal and the other is during puberty - adolescence: high risk of developing obesity and eating disorder

Adolescence - a critical stage of bone Ca accretion

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½ of adult boss mass accrued, peak bone mass reached 20-25 years of age
Ca absorption rate highest
average Ca intake: 800-1200 mg in adolescent boys, 500-800 mg in girls

Adolescence and Fe

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high requirement during growth spurt (Increased LBM and blood volume)
highest requirement: PHV in boys and after menarche in girls
iron intake: 32% adolescent boys and 83% adolescent girls are below RDA
Fe-deficiency anemia higher in adolescents than pre-pubertal children

Nutrients of concern- adolescence

``` Vitamin A, D, E Folate Iron Zinc Magnesium Calcium overnutrition: too much sodium and sat fat, 1 in 5 overweight/obese ```

Tips to Promote Healthy Eating in Adolescence

Parents can: -have healthy snacks readily available ◦Help them learn more about nutrition in a peer-oriented fashion -take their suggestions when preparing foods at home ◦Try to have an least 1 family meal at home per day -will adopt if they know how it will affect sports, academic performance and body look

Genetic Predisposition for food preferences

Unlearned ( innate ) Taste Preferences

Newborns-children food preference

Newborns have a preference for sweet taste and an aversion for bitter tastes -preference for salty foods at 4 mo -energy dense foods -accept familiar foods and reject new flavors (neophobia)

Impact of Innate Taste Preferences

Advantageous from an evolutionary standpoint - energy-dense food ↑ chance for survival - potential toxins are often bitter/sour and unfamiliar Potential obstacle for promoting healthy eating in the current obesogenic environment - unfamiliar sweet/salty/energy-dense foods readily accepted; prone to over-consumption when large portions offered Aversion to bitter/sour and neophobia - intro of certain foods (e.g., vegetables) difficult; acceptance/preference for novel flavors need to be learned

Flavor Learning Early in Life: Acceptance of new foods promoted by

Prenatal exposure to flavors in amniotic fluid - taste and smell functional in fetus - fetus regularly swallows amniotic fluid Postnatal exposure to flavors in breast milk - many flavors of maternal diet appear in breast milk, e.g. garlic - breast milk provides a “flavor bridge” that familiarize infants with a variety of flavors

Breastfed infants more likely to

- accept new food at first exposure | - prefer & consume more new food when introduced repeatedly

Carrot Flavor Study: hypothesis

prenatal and early postnatal exposure affects food acceptance

Carrot Flavor Study: Study design

Treatment: exposure to carrot flavor - carrot juice 300 ml/day given to mothers during pregnancy and/or lactation - pregnancy: during the last 3 wk of the 3rd - lactation: during the first 2 mo of lactation Control: water 3 groups total: WC, CW, WW Outcome measure: infants acceptance of carrot flavored cereal at weaning (5 mo)

Results- Carrot Flavor Study

- significantly less negative faces in WC and CW groups vs WW - mothers perception: increased in WC and CW - intake greatest in CW, lowest in WW * Food Acceptance Can be Changed by Repeated Exposure

Acceptance of foods with less intrinsic appeal to children (e.g., veges ) are

- affected by their experience to those foods - enhanced by repeated exposure (10-16 times) in a non-coercive setting * Simply offering new foods are not enough, having children “taste” the food is necessary

Vegetable Intervention Study: hypothesis

repeated exposure changes acceptance

Vegetable Intervention Study: treatment

Treatment: repeated exposure to a disliked vegetable - offer a disliked veg (“target veg”) to 2-6 y.o. children daily for 14 days - target veg chosen from: carrot, cucumber, tomato, celery, green pepper, red pepper A 2nd “treatment” group: the “information” group - nutrition advice & nutritional education leaflet to parents Control: receives nothing

Vegetable Intervention Study: outcome measure

taste test on target vegetable pre and post intervention

Vegetable Intervention Study: results

*p<0.05 and ***p<0.001 comparing pre- and post- | vege intake: exposure=significant increase in target vege consumed, info and control didn't change much

Repeated Exposure Works -Personal Experiences

``` Brown rice Degree of sweetness and saltiness Works in adults too! -Immigrants -Tomato (a NS431 student!) ```

environmental impact to food preference

- advertising | - foods available in the home/school

Exam 4- Childhood/Adolescence Flashcards

(41 cards)