Toddlers & children & adolescents Flashcards
(180 cards)
1
Q
What are the 3 main changes that occur in toddlers (what characterises them)?
A
- growth velocity plateaus (= reduction in appetite)
- Rapid increase in gross & fine motor skills
- Dramtic development in language
2
Q
What characterises preschool age children?
A
+ Increasing autonomy
+ broader social circumstances
+ increasing language skills & expanding ability to control behaviour
3
Q
Why is Nutrient adequacy for under 5s important?
A
+ adequate energy & nutrients to achieve full growth & development protentional
+ undernutrition during these years will lead to impairment in cognitive development
+ growth occurs in spurts & appetite variable
+ innate ability to self-regulate calorie intake
4
Q
What is the recommended period for continuing BF?
A
12m (MOH) – 2y (WHO)
5
Q
What feeding skills do toddlers have between 12-18 months?
A
move tongue side-to-side and can chew food with rotary movement
refined pincer grasp; pick up small objects & put them in their mouth
6
Q
What feeding skills do toddlers have between 18-24 months?
A
well-developed chewing = handle all food textures
7
Q
What feeding skills are developed in toddlers?
A
Increasing fine motor & visual coordination
8
Q
What precautions should be taken when feeding toddlers?
A
- high chair
- supervision
- no eating on the run
- avoid hard foods or food can be shaped to plug airways (hard lollies, popcorn, nuts, whole grapes & hot dogs
- offer walk/ milk with meals
9
Q
What is typical toddler behaviour?
A
- Strong independence
- emergence of “no”
- EASILY DISTRACTED
- Learning to self-regulate
- Overstimulation (= overtired)
- Shyness & fear of strangers
- Biting, pinching & hair pulling
10
Q
Toddlers typically experience food jags what are these?
A
strong food preference vs dislikes (refuse foods previously like)
11
Q
What are some recommendations to deal with food jags?
A
serve new foods along with familiar foods
Model healthy eating behaviour
Don’t force a toddler to eat
12
Q
What are 3 characteristics of a toddlers appetite?
A
+Decrease in food & appetite (slowing growth & distractions)
+ toddler needs small portion sizes (1 TBS per year of life)
+ routine & regular meals are important (should not “graze”)
13
Q
What feeding skills develop in pre-schoolers?
A
+ refinement of utensil use
+ choking less of a concern
+ better fine motor skills
14
Q
When is the optimal time to get children involved in food preparation & cooking?
A
Pre-school years
15
Q
What physical changes occur is preschool years?
A
- growth Rate slows
- body becomes slimmer
- straighter
- protruding stomach flattens
- limb lengthen
16
Q
How is appetite regulated in preschoolers?
A
+ food environment; parental behaviour & SES
+ food preference development, appetite & satiety (prefer sweet, salty is learned; prefer energy-dense food; preferences = unlearned)
+ Kids able to adjust calorie intake based on needs
+ external cues override hunger & satiety signals
+ no effect of portion size on calorie intake
17
Q
What is the division of responsible (who decides what during feeding?)
A
- parents decide:
What, where & when - Children decide
whether & how much
18
Q
What is the impact of restrictive feeding?
A
girls of restrictive parents ate too much & reported negative emotions about eating when given free access to treats
19
Q
What are evidence-based portion sizes for toddlers?
A
- Meet EAR & not exceed energy requirements
2. Broke into food groups
20
Q
What is the issue with portion size estimates for toddlers?
A
a lot of misinformation ( overestimates)
21
Q
How many kcal per kg do children need compared to adults
A
72 kcal/ kg vs 30-35 kcal per kg
22
Q
Young children have smaller stomach volumes; what is the key to meeting nutrient needs?
A
Nutrient density & high frequency (don’t graze)
23
Q
What is the protein sparing effect?
A
Used for growth & tissue repair rather than energy
24
Q
What are the protein recommendation for children?
A
2-3y 14g/day 4-8y 20 g/day or 2-3y 1.08g/kg 4-8y 0.91g/kg
25
What are the role of fats?
+ provides energy
+ membranes of all cells
+ omega-3 & omega-6 are essential for brain, nerve function & healthy skin
+ transport fat soluble vitamins
26
What fats is it most important to maximise?
maximise omega-3, DHA & EPA
| Ratio between omega-3s and omega-6s
27
What is the AMDR for fat & sat/trans fat for children under 14?
20-35% tot energy (sat/ trans fat 10% or less)
28
Are children meeting guidelines for fat?
No they are consuming too much saturated fat
29
What do children get most of their carbohydrates from?
Mostly from refined cereals & free sugars (monosaccharides & disaccharides added to food)
30
What is the AMDR for carbohydrates?
45-65%
31
Do childen consume to many free sugars?
Yes.
5-18 years 13% of tot energy
Free sugars should be less than 10% of total energy
32
What is fibre and the recommendations for 2-8 year olds?
1. non digestible carb that helps with GI & prebiotics
2-3 years 14g/day
4-8years 18 g/day
33
What are the fluid recommendations for children?
+ 70% water
+ maintain normal hydration, BP & fluid balance
+ sources water, milk, diluted fruit juices, soups, sauces, F& V
+ milk between meals; water with meals (500ml of milk per day)
+ consume fruit juice with meals
+ not tea/ coffee before 13 years
34
What are the 4 nutrients of concern in children?
Iron
zinc
Ca2+
Vit D
35
What is the role of calcium?
1. essential for teeth & healthy bones
2. regulates muscle contraction
3. nerve conductivity
4. blood clotting
36
What is the role of Vitamin D?
Vit D plays a role in Ca2+ absorption & bone health (direct & indirect)
37
What is the role of iron?
1. carrying oxygen in haemoglobin & myoglobin
2. energy metabolism
3. immune system
38
What is the role of zinc?
structural role in growth hormone & insulin & enzyme functions
39
What are the sources of zinc?
Best:
meat, fish, shellfish & eggs (good sources in wheat & cereals)
Low bioavailability:
lentils, beans, leafy veges, potatoes
40
What are some Anti- inhibitors of iron & zinc absorption?
+ phytate is found cereals, legumes, nuts & seeds
| + tannins found in tea + coffee
41
What % of 1-2 year olds have been reported as iron deficient & what % are not meeting requirements?
16%
| 18%
42
Why is iron deficiency high in infants/toddlers?
increased deficiency as less fortified cerals & cows milk introduced too early
43
What is the top contributor to energy, sat fat, calcium, Vit D & A & zinc in 2-4 year olds?
Milk
| + 84% consumed milk (27% whole; 57% reduced fat; 15% flavoured)
44
What % of toddlers consume veggies (excluding potato)
60%
45
What % of toddlers consume sugar sweetened beverages?
30%
46
Why should children below 5 not consume sugar sweetened beverages?
1. Increase dental carriers
2. increase calories
3. reduce appetite
47
When should a toddler move from highchair to table?
+ between 18m-3y
+ When they can sit up right (for long periods) if they try & climb out
+ accelerated by older siblings
+ right height to use intensils etc (booster pad)
48
What % of children have dental carriers?
41%
49
What populations have a higher prevalence of dental carries?
+ more in other ethnicities + less in communities with fluoridation
50
Why do we have a high prevalence of dental carries in NZ children?
1. lack of fluoridation
2. Plunket education,
3. shortage of dentist
4. poorer beverage choice in northland
51
What are some interventions for dental carries in NZ?
+ banned sweetened beverages advertisement
+ sugar tax
+ Increase dental resources in high risk area
+ free tooth brushes
+ water fluoridation
+ culturally relevant & entertaining health messages
+ supervised tooth brushing programme in schools
+ health warning on sugar
52
What are the MOH interventions for dental carries in NZ?
+ brush teeth 2x a day
+ regular checkups
+ water or milk
+ healthy snacks
+ lift the lip to check for signs of tooth decay
+ parents brush until 8 years
+ spit out toothbaste; don’t rinse with water
+ avoid sugar sweetened beverages
+ only serve juice at mealtimes & dilute 1:10; no more than ½ cup; 100% fruit juice
53
What are two parental feeding strategies & there impacts?
+Parent modelling of health eating behaviours
(positive impact on F & V intake & less unhealthy snack intake)
+ restrictive parenting practices (limit/ eliminate palatable foods = poorer child eating outcomes (neg feelings & unhealthy foods)
54
What are parenting styles measures off?
measures of attitudes; beliefs & behaviours
55
What are parenting styles a spectrum of?
Spectrum of responsiveness (degree of acceptance & sensitive) & demandingness (extent of control + expectations
56
What are the 4 parenting styles?
1. Authoritarian
2. permissive
3. authorities -> good (warm; militariant)
4. neglectful
57
What is responsiveness (parenting styles)?
how the parents encourage child eating in a responsive child-centred way
58
What are two examples of responsiveness?
+ arranging food to make it interesting & complimenting the child
+ showing disapproval for child not eating or physical struggle
59
What is demandingness?
how much the parent encourages the child to eat
60
What are some parental feeding practices?
```
+ prompt to eat
+ pressure to eat certain foods/ quantities
+ restriction of food/ portion sizes
+ reasoning
+ punishing
+ making food available & accessible
+ rewards (instrumental feeding)
```
61
Should food rewards be used?
No. decrease preference food kids like & increase preference for reward food
62
Should non-food rewards be used?
benefits:
+ extrinsic motivation to taste novel foods (stickers)
+ Large significant differences in exposure
63
What are the overall recommendations for encouraging food exposure?
+ provide a variety of healthy foods for meal time = choice
+ recognise emotional aspect of eating
+ use authoritative feeding practices
+ neutralise palatable foods
64
What % of NZ population is school aged?
73%
65
What are UNICEF's 4 children's rights?
1. Non discrimination
2. Ensure the best interests of child
3. Right to life, survival & development
4. Respect for the views of the child
66
What are the 3 crucial phases to health in school aged children?
1. 5-9 Years (middle childhood growth):
vulnerable to infection & malnutrition which could adversely affect development
2. 10-14 (adolescent spurt):
BMI increases rapidly; need to get sufficient nutrition
3. 15-19(Adolescent growth phase)
Further brain reconstruction, increased exploration & experimentation
initiation of life-long behaviours that determine health
67
What are 11 ways that cognitive development occurs in school aged children?
1. self-efficacy: gaining knowledge of what to do
2. Change to concrete operations from egocentrism & magical thinking (more rational reasoning)
3. develop sense of self
4. peer relationships more important
5. Involved in food prep (improve self-esteem & confidence)
6. Masters utensil use
7. Parents major influences on child’s likes + dislikes
7. Parental modelling is important for healthy eating patterns
8. Outside influence more important (media)
9. Snacking significant sources of calories
10. Parental responsive feeding style (when & what; child chooses how much)
11. More aware of body image (dieting occurs (esp if mother projects)
68
How does growth change in school aged children?
1. velocity slows down
2. steady increase in height
3. growth spurt coincides with increased appetite
4. growth remains plastic (changes according to environment )
69
How changes occur in school aged children in regards to physiological development?
1. Muscular strength, motor coordination & stamina increase
2. More complex pattern movements
3. Boys have more lean body mass
4. Body fat reduces a minimum (around 6y) before increasing for adolescent (BMI/ Adiposity rebound)
70
What does a BMI rebound before 5 indicate?
risk for overweight/ obesity
71
Why is it important to monitor growth in school-aged children?
+ identify problems before out of control ( obesity is very hard to reverse)
+ no Growth-standards for school-age children (references only)
+ bMI changes constantly throughout childhood (don’t have overweight cutoffs)
Under 5th = underweight
over 95th = obese
So only way to know if BMI is normal
72
What are NZ food & nutrition guidelines for young people (school-aged children)?
1. Eat a variety of food groups daily (F & V; increase wholegrains with age, include milk & protein)
2. Eat enough for activity, growth & to maintain a healthy body size (eat all meals and snacks)
3. Choose foods that are low in fat, sugar & salt
4. Drink plenty of water & low fat milk (limit SSB)
5. no alcohol
6. Eat meals with family
7. Envolve child in cooking & prep
8. Ensure food is safe
9. Be Physically active (60min mod/ vigorous a day; limit sedentary behaviour)
73
What are 4 determinants of PA?
1. girls less active
2. decreases with age
3. obese children less active
4. less active if cold
74
What meal patterns are recommended for school-age children?
1. 3 meals + 2 small snacks at regular times
2. Grazing not recommended (dental issues & non-nutritious)
3. Nutritious breakfast, healthy lunch & family dinners
75
What are shared family meals associated with?
1. 12% reduction for overweight
2. 20% reduction for eating unhealthy foods
3. 35% reductions in odds for disordered eating
76
What is breakfast associated with?
better nutrient intake & healthier body weight (16% energy; 1/3 of calcium, iron, thiamine, riboflavin, folate & zinc)
77
What is the issue with skipping breakfast?
adversely effects cognitive performance (esp. attention & memory)
78
What % of children don't have breakfast at home?
18%
79
What is associated with with high rates of breakfast consumption?
Higher education
80
What are the most commonly eaten lunch foods (in order)?
+ sandwiches, + fruit + biscuits, crisps & snacks + sweetened beverages, + pies & sausage rolls, + yoghurt, + confectionary…
81
What considerations should be taken into account with snacks for school aged children?
1. Important for growth spurts
2. Size & timing of snacks to be considered (shouldn’t interfere with appetite)
3. energy dense; nutrient-poor are inappropriate (marketed as beneficial)
4. contribute 12% to daily intake (only 8% protein, calcium, iron, vit A)
5. this can contribute to excess energy intake
6. high sodium
82
What does Eating for healthy children (MOH revised in 2017) gives recommendation for ?
1. for meal times
2. making meals fun
3. getting children involved etc.
83
What are the determinants of dietary Choices?
+ Income
+ Education (education to make good choices)
+ Housing (storage, power, food prep areas, appliances)
+ Cultural
+ Availability of community services & facilities (accessibility of supermarket)
84
How much of weekly budget is typically spent eating out?
1/3
85
Are children meeting veggies, fruit, milk & MFPE guidlines?
1. 40% meeting veges
2. 69% meeting fruit
3. ~100% eat every day (43% eat white bread)
4. 64% drink milk once a week (21% never)
5. 51% consume 2+ serving MFPE daily
86
What is the Prevalence of inadequate micronutrient intakes in school aged children?
```
+ 10% low Vit A
+ 37% low folate
+ Little vit D naturally in food (cut-off 50 nmol/L Maori & pacific at risk)
+ calcium = 65% inadequate intake
+ 48% low selenium (lower South Island)
+ iron (1.3% inadequate LOW)
+ zinc 16% concerning
```
87
What is food insecurity?
limited/ uncertain availability of nutritionally adequate & safe foods
or limited ability to acquire foods that meet cultural needs
88
What is the cause of food insecurity?
Insufficient money
89
What is food insecurity associated with?
+ obesity
+ poorer health
+ development/ behavioural problems
+ reduced school performance
90
Who is at most risk of food insecurity?
Low SES, Maori & Pacifica (2x poverty rate)
91
What % of NZ children experience poverty?
35%
| 3 out of 5 children in persistent poverty
92
What is the impact of school feeding programmes?
Improved educational outcomes:
1. School attendance
2. Math achievement
3. Decreased tardiness
4. Mood, cognition
* Primarily in children at nutritional risk
93
What are the guiding principles of school feeding programmes?
1. variety from 4 food groups
2. min sat fat, salt 7 added sugar
3. only water & milk for drinks
4. standard & large portion sizes (1.5x)
5. 75% must be green items
94
What behaviours increased success with the school feeding programmes?
1. encourage & praise to try new foods
2. Talk about what's healthy (+ why)
3. adults eat alongside
4. allow students to graze
5. staff talk positively about kia
95
What are 6 practical activities that help with the
```
+ appropriate time
+ Encourage to eat more
+ Time only to eat
+ Reward positive eating behaviour
+ healthy eating benefits in curriculum
+ adult role models
```
96
What is the cost of school feeding programmes
Yr 1-8: $5 student a day
| Yr 9+ $7 student a a day
97
Who consumed most from school feeding programme?
The most disadvantaged learners
98
What was the benefits of school feeding programme?
Consumed more vegetable items Fewer snacks Improved feelings of fulness Improved wellbeing
99
What are the implications of childhood obesity?
+ Psychosocial: poor self-esteem; depression & sleep disorders
+ Pulmonary: sleep apnoea; asthma; exercise intolerance
+ GI: gallstones.
Renal: Glomerulosclerosis
+ musculoskeletal
+ endocrine issues (reproductive; type 2 diabetes)
+ cancers
+ CVD disease
100
What are the characteristics of obese children?
1. taller
2. higher bone mass
3. look older (treated differently)
4. earlier sexual maturity
5. High risk for predictors of adult disease (hyperlipidaemia; hypertension; poor glucose tolerance; elevated liver enzymes)
101
What should be used to detect changes in adiposity?
Frequent monitoring of BMI
102
What are the 2 main predictors of childhood obesity?
```
BMI rebound: early before 5.5 years
Maternal obesity (strongest predictor)
```
103
What are the 3 main contributing factors to childhood obesity?
1. Energy Intake
2. Environmental:
+ prevalence fast food outlet; marketing; physical re options
+ Economic
3. Parental health:
+ breastfeeding & nutrition pregnancy
+ maternal smoking
+ Parental obesity
104
What are some secondary contributing factors to childhood obesity?
1. PA: reducing PA in low-income countries is a concern
2. Sleep: less sleep reduces PA & appetite
3. Other: medical; genetics
4. Television/ screen time: not in bedroom (reduced EE; increased dietary intake & disruption of sleep)
105
What is the childhood obesity plan?
22 Initiatives; 3 key themes:
1. Targeted interventions for obese
2. Increase support for those at risk
3. Broad approaches for general population
106
What are the achievements to date of the childhood obesity plan?
+ 95% were identified & referred to professionals
+ health star rating
+ Play sport programme in 44 schools
+ DHB’s SSB free
+ MOH; posted clinical guidelines for weight management in NZ children
+ ERO has published reports on food, nutrition & PA in NZ schools & preschools
107
How can the food industry play a role in reducing childhood obesity?
+ reduce fat, sugar & salt content
+ ensure healthy & nutritious sources available & affordable
+ practice responsible marketing (large effects)
108
how is food marketing regulated for children in NZ?
Self-regulatory system to restrict marketing of unhealthy food & drinks up to 14 years (duty of care to 18y)
109
How does World Cancer research recommend regulating food marketing to children?
+ implement Gov-led mandatory restriction (self-regulatory ineffective)
+ all forms should be restricted on all media to 18 years
+ Use nutrient profile to decide what foods should be restricted
+ children must be given priority when conflicting information
110
What are the 4 stages of the childhood obesity plan?
1. Monitor
2. Assess
3. manage
4. Maintain
111
What happens in the monitor stage of the childhood obesity plan?
1. regularly measure BMI
2. extra support: provide nutrition & PA advice if trending towards
3. potentially refer to dietitian
4. discuss current & long-term health risks
112
What are the steps of the assess stage of the childhood obesity plan?
1. Full history necessary (identify clinical, social & behavioural factors)
2. Consider co-morbidities, families history, PA, diet, sleep, psychological issue
3. Clinical exam: anthropometry, skin infection, BP, liver enzyme, sleep apnoea
4. Lab tests: lipid profile; sleep study (BEARS: bed time issues; daytime sleepiness; awake at night; during of sleep; snoring)
113
What are the steps of the Manage stage of the childhood obesity plan?
Aim: slow weight gain so the child can grow into it
+ set realistic goals aimed at changes in food, activity & behaviour
+ Jointly agreed lifestyle changes (practitioner, child + whanau)
+ Plan for regular review & progress monitoring
+ Activity: opportunities in & outdoors; active transport; limit screen time; age-appropriate sleep
+ use Behavioural strategies: self-monitoring; goal setting; contracting; problem solving
114
What's the mantain stage of the childhood obesity plan?
1. Maintain contact
2. continue to monitor growth
3. identify & monitor guidelines
115
What are the general guidelines for approaching childhood obesity?
+ avoid making child feel stigmatized
+ avoid jargon
+ confident, caring approach
+ value child & respect parents
116
What are the main characteristics of adolescence?
+ independent: PA and food are choices
+ social pressures: body image, alcohol, and drug use
+ increasing personal interest & misinformation (fad dieting; ed)
+ concerns: over nutrition
+ Puberty causes sexual maturation, anthropometry changes
+ sequence of puberty is consistent (but timeline not)
+ Biological age should be used instead of chronological age
117
What is puberty?
Maturation of the reproductive system
118
How do we measure biological age during puberty?
5 tanner stages
| based on menarche, breast development, pubic hair & changes in genitals
119
When does peak growth velocity occur in females?
12-16 years
| 25cm taller & 16kg
120
What %BF do girls need for menarche & what % BF do girls need to maintain normal menstruation?
17%
| 25%
121
When does peak growth velocity occur in males?
14-17.5 years
| 28cm taller & 20kg
122
Why does Excessive exercise slow down growth spurts?
intensive training sessions may stop a child from meeting there energy requirements
123
When does the mass of bone mass accretion occur?
+ 90% accreted by 18y
| + 24% gained in 4 year period of peak growth velocity
124
What brain development occurs during puberty?
+ regions associated with movement shrink because they become more efficient
+ regions associated with memory, decision making & emotional responses develop & grow
125
What psychological/ cognitive development occurs during puberty?
+ a sense of personal identity
+ moral & ethical value system
+ feelings of self-esteem/ self-worth
+ a vision of occupational aspirations
126
What are the 3 periods of cognitive development in adolescence & their characteristics?
11-14 years (Early):
+ concrete black & white thinking, egocentrism & impulsive dominant
15-17 years (mid):
+ emotional & social independence
+ peer influence on food choice peaks
+ able to think abstractly but unable to apply
18-21 years (late)
+ less prevalent body image issues
+ stronger sense of individuality & values
+ more induvial autonomy
127
What is the issue with the wide chronological range of biological changes that occur in adolescence?
+ males may use steroids
+ may develop eating issues & poor body image
+ Peer influences stronger than family
128
What are influences of food choices during adolescence?
1. Food availability
2. Preference
3. parental modelling
4. peer attitudes
5. behaviours
6. convenience
7. personal/ cultural beliefs
8. mass media
9. body image
10. PA
11. vegeterianism
129
What is the effect of busy lives of food practices during adolescence?
snacking
meal skipping
eating away from home
fewer family meals
130
What is snacking associated with?
1. picky eater
2. watching TV
3. gain weight
4. less F & V
5. more Fats food
6. more SSB
131
Why is meeting energy needs crucial in adolescence?
1. greatest during adolescence (except pregnancy & lactation)
2. linear growth & sexual maturation can be delayed by Calorie deficit (can be caught up if acute)
132
What is low energy availability?
Inadequate energy to support the functions required by the body to support optimal health & performance
133
What are the facts of the female athlete triad ?
```
+ altered menstrual cycle
+ fatigue, low energy
+ altered mood, poor concentration
+ under-performance; failing to improve
+ injuries
+ loss of enjoyment from sport
```
134
Who are most at risk of female athlete triad?
1. participants of sports that emphasis thinness (associated with body image) -> take extreme measures to control body fat
135
What is Relevant energy deficiency in sport (RED-S)?
+ includes the triad but also includes effects on other functions:
immunological, GI, CVD, psych, growth/ development, metabolic, endocrine…
+ also highlights males can experience as well
+ to conserve energy expenditure functions that are not needed for life shut down (to maintain cellular maintenance, locomotion, thermoregulation… etc
136
What may prolonged Relevant energy deficiency in sport (RED-S) cause?
+ disability
+ osteoporosis (loss of quality of life)
+ sport performance will decrease
+ decreased CV function
137
Who is most at risk of Relevant energy deficiency in sport (RED-S)?
+ people with personality traits such as perfectionism
+ social pressure & from coaches & parents
+ recreational (45/47% non-elite at risk) because have less support
= endurance & sports with emphasis on fitness
138
How do we prevent Relevant energy deficiency in sport (RED-S)?
+ ensure they are aware how to meet their nutrient requirements
+ peak season energy intake should be higher
+ avoid large periods without eating…
139
What are protein requirements associated with in adolescents?
Requirements closely linked to body size & age (males accumulate lean body mass)
140
Who have higher iron during adolescence?
```
+ follow restricted diets
+ young women with high menstrual losses
+ pregnant teens
+ some athletes
+ 80% higher for vegeterians
```
141
When should iron intake be the highest?
During periods of rapid growth
142
What is the prevalence of iron deficiency in females?
11% (12.4% in least deprived)
| 5% deficient with anaemia (11% maori)
143
When is calcium requirements the highest?
Highest in people aged 12-18 years – 1300 mg
144
How much does calcium absorption increase during peak growth?
30%-50-60% (peaks early adolescent in males; menarche in females)
145
What increases calcium excretion & reduces deformation?
High sodium & protein increases calcium excretion
| vit D reduces iron absorption
146
What are the 4 stages of the bone remodelling cycle?
1. Initiation: osteoclast precursors are called to the bone by osteocytes in bones through chemical messengers they attach to the bone & mature
2. Mature Osteoclasts break down bone to release calcium into the bloodstream (occurs when blood calcium is low as essential for cardiac transactility & nerve transmission) -> take precedence over skeletal needs
3. Osteoblasts reform bone (takes longer so lose bone for most of adult life)
4. Osteocytes mineralise bone
147
What is the mechanism behind osteoporosis
1. Bone is broken down until it becomes brittle & weak (higher turnover -> becomes very porus)
148
How many men & women suffer from osteoporosis?
1 in 3 women
| 1 in 5 women will suffer in their lifetime
149
How much does the risk of a second fracture increase after the first?
80%
150
Why do the risk factors for osteoporosis occur in adolescence?
over 90% adult bone mass has accrued
151
Why is there a sharp decline in bone mass at menopause?
Loss of oestrogen
152
Why are females 2x more likely to have a bone fracture?
Lower peak bone mass
153
How much can 10% increase in bone mass delay osteoporosis?
13 years
154
When does bone velocity peak in boys & girls respectively?
(precedes peak bone growth 6months after)
Boys: 14.05
Girls: 12.5
155
How much of bone is accumulated during peak bone velocity?
1/4
156
Why is there more fractures in adolescence?
Rate of accretion surpasses rate of mineralisation so higher risk of fractures for a transient period
157
How does physical activity affect bone mass (loss & accretion)?
1. non-weight bearing individuals rapidly lose bone mass (shows the important of skeletal loading)
2. Bone mineral acquisition require varying forces of intensity & dynamic
3. Bone mass is positively correlated with childhood PA & nutrition (site-specific)
4. Effect of exercise most obvious during pubertal growth
158
What is the relationship between obesity & bone mass density?
Increases the risk of LOWER EXTREMITY fractures
159
Why does oestrogen inhibit bone remodelling?
Effects:
1. osteocytes
2. osteoblasts
3. t-cells
4. osteoclasts
160
What does oestrogen deficiency/ ovarian insufficiency cause?
Lower bone mineral density
161
What is the effect of amenorrhea on bone mass density
+ 6 months due to weight loss, ED & stress cause BMD > 2 SD
+ affects vertebral BMD most
+ osteopenia more severye if ED during adolescence
162
What is the relationship between rat contraception & bone health?
+ oral estrogen pills are not protective (lower in oral contraceptive users)
+ inhibit bone remodelling if already have enough estrogen
163
What is the calcium EAR based on?
Skeletal accretion -> need to absorb 440mg so EAR set at 1050 mg/ day; RDI = 1300 mg to account for bioavailability
164
What enhances & inhibits calcium excretion?
Vit D enhances absorption
Iron inhibits absorption (don’t consume together)
Sodium & protein increase calcium excretion
165
What are some secondary factors that decrease bone mass?
caffeine, alcohol, cigarette smoking, SSB
166
What are some secondary factors that increase bone mass?
Energy & protein intake; diets high in V & F
167
What are the 5 types of vegetarian diets?
1. Pescatarian
2. Lacto-vegetarian
3. Ovo-vegetarian
4. Lacto-ovo vegetarian
5. Vegan
168
What are the primary reasons for being vegetarian?
```
+ health beliefs
+ religious beliefs
+ animal rights
+ dislike meat
+ exert independence
```
169
What are the eating for healthy vegetarians guidelines?
```
3 serves veges; 2 servings fruit
6 servings fruit/ veges a day
2-3 serving milk/ alternatives
2 servings legumes, eggs, nuts & seeds
* OUTDATED
```
170
Why are the eating for healthy vegetarians guidelines outdated?
+ Latest recommendations recommend more veges
+ Match nutrient recommendations better
+ Servings sizes have been adjusted
+ children & vegetarian recommendations haven’t been updated
171
What can we replace protein with (plant sources)?
legumes, nuts, seeds, breads & cerals, soy foods & wholegrains
172
What is the bioavailability of non-harm iron & some sources?
Bioavailability for non-haem iron is 5-12%
Non Haem sources: fortified cerals, legumes, veges, cashew nuts & eggs
173
How can we reduce physic acid from inhibiting zinc absorption?
1. Fermenting, heating, soaking & sprouting seeds & legumes reduce amount of phytic acids
2. Yeast based/ leavened breads
3. Take iron away from zinc to help absorption
174
What are some zinc sources?
Pumpkin seeds
| Cheese
175
What is the role of zinc?
Important for growth, development, lean muscle mass & sexual maturation (males requirements are higher)
176
What is the association between veganism & fractures?
1. Vegans had a greater risk of fractures (43% increase in number)
2. 231% higher risk of hip fractures (independent of calcium intake??)
177
What are some deficiency symptoms of low B12?
```
Fatigue
Pale
Neurological changes
Weight loss
Loss of appetite
Anaemia
```
178
What fatty acids are an issue for vegans & how can this be remedied?
1. EPA & DHA lower/absent in vege/ vegan diets
2. ALA can be converted to EPA & DHA but very inefficient
3. Vegetarians should double ALA to promote conversion
3. Sat & trans-fat, alcohol should be limited as they reduce the conversion of ALA
179
How s vegetainsim associated with disordered eating?
more likely to report frequent:
chronic dieting
purging
laxative use
180
What are some sources of ALA?
soybean oil, rapeseed oil, walnut oil etc.
