Nutrition for Growth: Childhood through Early Adulthood

Pediatric Nutrition Resources for Physicians
- Identify the Clinical Nutrition Books used in this presentation.
- Describe the Recommended Dietary Allowances (RDAs).
- Describe the 2020-2025 Dietary Guidelines for Americans (DGA).
Growth and Body Composition
Infants and Children
- Distinctive nutrition needs of infants & children.
- Diets to meet the needs of children.
Adolescents
- Distinctive nutrition needs of adolescents.
- Diets to meet the needs of adolescents.
Application of Concepts
- Construct a diet for an overweight child with insulin resistance.
- Construct a diet for an eating disorder in an adolescent athlete.

Definition: The amounts of selected nutrients considered adequate to meet the known nutrient needs of healthy people.
Basis: RDAs are established based on scientific knowledge and presented by the Food and Nutrition Board (FNB) of the National Academy of Sciences (NAS).

Percent of the U.S. Population Ages 1 and Older who are Below and At or Above Each Dietary Goal.
- Visual representation of intake:
- Intake At/Above Recommendation:
  - Various categories including total vegetables, fruits, grains, dairy, protein foods.
- Intake Below Recommendation:
  - Categories showing deficiency compared to goals.
Important Notes:
- Recommended daily intake of whole grains should be at least half of total grain consumption.
- Limit refined grains to no more than half of total grain consumption.
Data Source: Analysis of What We Eat in America, NHANES 2013-2016 for ages 1 and older.

Estimated Average Requirements
- Table showing requirements across various nutrients (calcium, protein, vitamins, minerals) for different life stages from infants to older adults.
- These requirements are expressed in mg/d and include age-specific adjustments.
- Noteworthy vitamins/minerals have specific dietary equivalents (e.g., Vitamin A as retinol activity equivalents, Vitamin E as alpha-tocopherol).
- Specific health risks are noted for vitamin deficiencies, focusing on implications for various age groups.

Publication: Jointly by U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS).
Relevance: Required to be published every 5 years, these guidelines help individuals and families consume a healthy diet.
Core Principles:
- Promote healthy dietary patterns across all life stages.
- Tools provided include food group recommendations and the Healthy Eating Index.
Key Messages:
- Follow a healthy dietary pattern.
- Limit foods high in added sugars, saturated fat, and sodium.
- Customize choices based on personal preferences and cultural considerations.

Food Groups:
1. Vegetables of all types
2. Fruits, especially whole
3. Grains, at least half whole grains
4. Dairy including low-fat options
5. Protein foods such as lean meats and plant-based alternatives
6. Healthy oils including those from seafood and plants.

Growth Chart Utility: Tools by CDC for monitoring growth in infants, children & adolescents—Boys and Girls (2-20 years).
Body composition: Discusses similarities and constants in body composition between sexes until age 6 before diverging significantly during later growth stages.
Monitoring systems include BMI, height, and weight assessments with attention to conditions caused by malnutrition.

Nutritional requirements exceed those of adults per unit of weight due to growth and development.
Key Recommendations:
- Preterm infants may need 2-4 mg/kg/day iron.
- Full-term infants should receive elemental iron starting at 1 mg/kg/day after 4 months.
- Vitamin D supplementation recommended for all breastfed infants at 400 IU daily.

Distribution of macronutrients for children should be approximately:
- 45-65% from carbohydrates
- 25-40% from fats
- 10-35% from proteins
Quantity of microminerals like iron, calcium, and vitamin D also emphasized.

Increased nutritional requirement due to rapid growth and sexual maturation.
Recommendations based on activity levels, obesity prevention, and chronic health conditions such as diabetes.
Meal Patterns: Emphasis on balanced intake from all DGA food groups; multivitamin supplementation may be needed in absence of a balanced diet.
Special attention to body image and risks of eating disorders among adolescents, particularly in female athletes.

Case Study of an Overweight Child with Insulin Resistance - An 11-year-old boy with concerns around weight gain, family history of diabetes, and dietary habits. Recommendations focus on structured meal patterns, physical activity, and engagement of family in healthful eating behaviors.
Case Study of an Eating Disorder in an Adolescent Athlete - A 15-year-old girl experiencing significant weight loss and potential eating disorders, prompting review of her dietary intake, energy balance, and psychological support interventions.

Good nutrition forms the basis of healthy growth through the life stages, with parents playing a key role in modeling appropriate eating habits and choices.
Challenges in maintaining adequate nutrition arise from socioeconomic factors, peer influences, and psychological impacts on dietary behaviors.
Emphasizing nutrient-dense choices and regular, balanced meals can help mitigate the risks associated with childhood and adolescent obesity.