ZB

Preschool Nutrition: Growth, Diet, and Case Study (Zhou 2012)

The Preschool Years: Nutrition, Growth, and Dietetics

  • Audience and scope

    • Prescribed reading: Zhou Topic 4 Nutrition During the Preschool Years
    • Focus: age 1–5 years; growth patterns, development, nutritional requirements, common concerns, factors influencing food choices, food behaviours, sources of information for parents

  • Unit learning outcomes (highlights)

    • Explain physiological changes during growth, development and ageing and their influence on nutrition needs
    • Justify the basis for nutritional recommendations at each lifespan stage
    • Identify common nutrition issues at each lifespan stage
    • Apply practical, evidence-based solutions to nutritional problems to promote optimal nutrition at each stage

  • Case study: Jack (15 months) – key data (from Page 4/61)

    • Anthropometrics: weight = 12.6\text{ kg}, length = 78\text{ cm}
    • Feeding history and current habits
    • Bottle-fed from 2 weeks due to breastfeeding difficulties; always a very hungry baby; started solids (baby cereal) at 2 months
    • Now crawls; enjoys TV; mesmerised by TV
    • Transitioned from formula to cow’s milk in a bottle
    • Daily routine (approximate timetable)
    • 6:00 am: 250 ml bottle
    • 8:00 am: breakfast (2 Salada biscuits with Vegemite)
    • 10:00 am: 250 ml bottle
    • 12:00 pm: lunch (mashed potato and pumpkin, 1/2 cup)
    • 3:00 pm: fruit juice drink
    • 4 tsp yoghurt
    • 5:30 pm: mashed vegetables (1/2 cup)
    • 7:00 pm: 250 ml bottle before bed
    • Current concerns/themes
    • Prolonged bottle use and transition issues
    • High TV exposure; potential influence on appetite/food exposure
    • Shift from formula to cow’s milk; potential iron considerations and energy adequacy

  • Case study 5 objectives (Page 5)

    • Assess Jack’s growth
    • Identify major nutritional issues for Jack including: physiological demands of age; positive and negative aspects of his dietary pattern; past/dietary pattern contributing nutritional risk
    • Propose a daily menu plan and lifestyle advice to address nutritional problems

  • Growth and body composition (Pages 6–8)

    • Lean body mass (FFM) increases, especially in limbs
    • Fat mass decreases; subcutaneous fat higher in girls than boys
    • Total body water (TBW) ~ water distribution shifts to intracellular with age; extracellular-to-intracellular balance evolves
    • Growth slows (lower rate as preschool years progress)
    • Bone growth: increased stature/height
    • Brain growth: about 75% complete by age 2 years
    • Incremental growth patterns (graphs in the slides)
    • Average rate of change in body composition for boys (g/d): FM, FFM, TBW, BMC, WT, etc.; FFM tends to rise rapidly in early months/years; BMC increases with age

  • Growth and body composition – interpretive data (Pages 7–8)

    • Progressive increases in weight, height and bone mineral content (BMC) through 0–5 years
    • TBW reflects maturation and lean mass accrual; pattern illustrated by mg/d scaling in BMC and TBW measures

  • Developmental changes and mealtimes (Pages 9–11)

    • Periods of life when chewing and swallowing mature, with ability to chew and swallow reaching maturity over preschool years
    • Hand/mouth coordination improves; fork/spoon use develops
    • Mealtime routines become more important: location, atmosphere, and adult modelling affect acceptance of new foods
    • Language development around food: asking for foods, expressing likes and dislikes
    • Eating together and family meals
    • Eating the same food as family
    • Conversation at table
    • Eating at table with no TV

  • Energy requirements and components (Page 11)

    • Total energy expenditure comprises four components:
    • BMR (basal metabolic rate): depends on lean mass; no sex difference
    • Growth energy: efficient growth energy use (<10% of energy intake, EI)
    • Physical activity energy expenditure
    • Diet-induced thermogenesis
    • Implications for preschoolers: energy needs are driven by growth and activity; energy balance is influenced by feeding patterns and activity levels

  • Methods to estimate energy requirements (Page 12)

    • Three methods used to estimate energy requirements (ER)
    • Observed food intake of healthy preschool-aged children
    • Doubly-labelled water method: 2H2^{18}O ext{ vs } 1H2^{16}O (gold standard used in NRV development)
    • BMR equations
    • NRV Estimated Energy Requirements (summary ranges)
    • 1–2 years: Boys 3.5–4.4\text{ MJ/day}; Girls 3.2–4.2\text{ MJ/day}
    • 3–5 years: Boys 4.2–8.1\text{ MJ/day}; Girls 3.9–7.5\text{ MJ/day}
    • Note: these are ranges reflecting inter-individual variation and activity levels

  • Fat and essential fatty acids (Pages 14–16)

    • Fat as a concentrated energy source: 37\text{ kJ/g}
    • Fat recommendations by age:
    • 0–2 years: full-fat preferred
    • >2 years: reduced-fat options acceptable
    • Energy share from fat:
    • 0–2 years: fat should supply about 40\% of energy requirements
    • 2–5 years: fat should supply about 30\% of energy requirements
    • Fat is essential for growth and development; essential fatty acids critical for CNS and cell structure; fat-soluble vitamin absorption
    • Example calculation (Fat – Review Question 5, Page 15)
    • A 2-year-old on NRV energy = 4400\text{ kJ/day}; fat contribution @ 40% = 0.40\times 4400 = 1760\text{ kJ}
    • Fat energy per gram = 37\text{ kJ/g}
    • Fat intake range: 1760/37 \approx 47.6\text{ g/day} (β‰ˆ 48 g/day)
    • If fat is 30%: 0.30\times 4400 = 1320\text{ kJ}; 1320/37 \approx 35.7\text{ g/day} (β‰ˆ 36 g/day)
    • Fat-food sources (full-fat dairy and fats):
    • 250 ml full-fat cow’s milk: 10 g fat
    • 1 slice (20 g) full-fat cheese: 6 g
    • 200 g full-fat yoghurt: 5.6 g
    • 1 tbsp margarine: 15 g
    • Total fat from these items: β‰ˆ 36.7 g

  • Energy and macronutrient profile in Australian children (Page 17)

    • Mean energy intakes and % energy from macronutrients (AHS 2011–2013)
    • For age groups studied (4–8 years and 2–3 years), approximate values:
    • Energy (kJ): 6044–7637 (girls 4–8), 5850–6427 (males 4–8); similar ranges for 2–3 years
    • Protein: ~16–17% of energy
    • Fat: ~30% of energy
    • Saturated fat: ~13% of energy
    • Carbohydrates: ~50% of energy
    • Sugar: ~24–25% of energy
    • Starch: ~25–27% of energy

  • Food group contribution to energy (CNPAS 2007; Page 18) and (AHS 2011–2012; Page 19)

    • Key food group energy contributions (percent of total energy) by age and sex groups
    • Non-core foods contributed a notable share of energy in some age groups
    • Examples by category (illustrative):
    • Cereals and cereal products typically contribute a substantial portion
    • Milk products contribute a large share of energy and calcium
    • Meat and poultry contribute a smaller share than cereals/milk
    • Fruit, vegetables, and snacks each contribute smaller percentages depending on age group
    • Notable trend: higher reliance on non-core foods and beverages in older preschoolers and during transitions to school age

  • Obesity and energy balance (Page 20)

    • Obesity definition: chronic imbalance between energy intake and energy expenditure
    • Major contributors to energy imbalance: low physical activity, sedentary behaviours, high energy density snack foods and beverages
    • Psychosocial and medical consequences include risks for diabetes, CVD, hypertension and related conditions
    • US study (Kids’ Obesity Risk Starts Before Age Five): links between early junk-food intake and later obesity risk; specifics: hyperactivity and related issues observed in some cohorts

  • Growth charts and BMI-for-age (Pages 21–23)

    • Growth charts use percentile ranks to describe stature-for-age and weight-for-age in boys (and girls)
    • BMI-for-age categories (CDC growth charts):
    • Underweight: < 5th percentile
    • Healthy weight: 5th to < 85th percentile
    • Overweight: 85th to < 95th percentile
    • Obese: β‰₯ 95th percentile
    • BMI-for-age interpretation depends on age and sex; percentile changes over time indicate growth trajectory
    • Example: CDC BMI-for-Age plots show centiles such as 3rd, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th; values reflect age-specific distributions

  • Dietary fibre (Page 24–25)

    • Fibre intake data (g/day) for age groups
    • CNPAS 2007 vs AHS 2011–2012: fibre intake around 16.7–20.1 g/day depending on age/sex
    • NRV (AI) for fibre: 14 g/day (1–3 yrs) and 18 g/day (4–8 yrs)
    • Reported intakes generally exceed NRV/AI in some groups but not uniformly across all age groups
    • Food sources contributing to fibre (examples):
    • 1 slice mixed grain bread β‰ˆ 1.4 g
    • 1 apple β‰ˆ 3.5 g
    • 1 Weet-Bix β‰ˆ 1.5 g
    • 1/2 cup mixed vegetables β‰ˆ 4.2 g
    • Total example meal fiber β‰ˆ 10.6 g

  • Fluid and beverages (Pages 26–28)

    • Dehydration risk reduced with adequate fluids; water preferred
    • Milk and dairy alternatives should be limited to around 600 ml/day total
    • Fruit juices and sweetened beverages should be limited
    • 1995 NNS data (2–4 yrs): about 25% of total energy from drinks came from non-core beverages (fruit drinks, cordials, soft drinks)
    • Obesity and beverage choices: obese preschoolers tend to consume more energy from non-core beverages
    • Example beverages:
    • Fruit juice (1 cup): ~362 kJ; sugar ~19 g
    • Soft drink (1 cup): ~436 kJ; sugar ~27 g
    • Practical concerns: encourage water; limit juice and non-core beverages

  • Constipation (Pages 29–30)

    • Definition: pain and discomfort with passing hard stools
    • Causes: inadequate fibre/fluids, poor toilet habits, insufficient physical activity
    • Prevalence (Mugie 2011 systematic review): range 0.7%–29.6% across populations; median around 12%; data limited for Australia; female gender, older age, SES and education may influence prevalence

  • Minerals: Calcium (Pages 32–33)

    • Calcium requirements: 1–3 years EAR ~360 mg/day; 4–8 years EAR ~520 mg/day
    • Mean calcium intakes (mg/day) by age/sex (CNPAS 2007 and AHS 2011–2012):
    • 2–3 year old males: ~830 mg/day (CNPAS) / ~775 mg/day (AHS)
    • 4–8 year old males: ~842 mg/day (CNPAS) / ~805 mg/day (AHS)
    • 2–3 year old females: ~780 mg/day (CNPAS) / ~768 mg/day (AHS)
    • 4–8 year old females: ~745 mg/day (CNPAS) / ~676 mg/day (AHS)
    • Calcium food sources (examples):
    • 250 mL full-fat cow’s milk β‰ˆ 300 mg
    • 20 g cheese β‰ˆ 130 mg
    • 200 g full-fat yoghurt β‰ˆ 340 mg
    • Total β‰ˆ 770 mg from listed items

  • Iron: requirements, intake and sources (Pages 34–37)

    • High iron requirements during growth; daily need around 0.5 mg/day during growth periods (note: this is a simplification for presentation; the slide indicates ongoing expansion of blood volume necessitating iron)
    • Food sources and iron content (examples):
    • 50 g cooked beef β‰ˆ 1.5 mg
    • 50 g cooked chicken β‰ˆ 0.45 mg
    • 1 hard-boiled egg β‰ˆ 0.85 mg
    • 1 Weet-Bix β‰ˆ 1.3 mg
    • 1 slice brown bread β‰ˆ 0.5 mg
    • Total from these items β‰ˆ 4.6 mg
    • Iron intake vs NRV by age group (CNPAS 2007; AHS 2011–2012):
    • 2–3 years: male NRV ~8.3 mg/day (CNPAS) / ~7.9 mg/day (AHS)
    • 4–8 years: male NRV ~10.5 mg/day (CNPAS) / ~9.6 mg/day (AHS)
    • 2–3 years: female NRV ~7.8 mg/day (CNPAS) / ~7.1 mg/day (AHS)
    • 4–8 years: female NRV ~9.2 mg/day (CNPAS) / ~8.0 mg/day (AHS)
    • Iron intake distribution by food groups (4–8 yrs; 2–3 yrs): cereals contribute the largest share of iron intake (β‰ˆ 40% for both boys and girls); meat products contribute around 10–12%; toddler formulas contribute around 8%; non-haem sources supplement total iron intake
    • Iron deficiency anaemia (IDA) – prevalence and risks (Page 38–39)
    • IDA is the most common nutritional deficiency with consequences including delayed cognitive/physical development, hyperactivity, mood changes, fatigue, and reduced resistance to infections
    • Risk factors include excessive cow’s milk intake (>600 ml/day), low dietary iron intake, blood loss from the GIT, displacement of iron-rich foods, vegetarian/vegan diets
    • A Melbourne-based InFANT study (Atkins, 2016) found mean iron intake around 6.6\text{ mg/day} in toddlers; about 18.6\% of toddlers at risk of inadequate iron intake; major sources included cereals (43%), meat/meat products (10%), toddler formula (8%)
    • Iron deficiency anaemia prevalence data by age group are presented in the study table (Hb and ferritin biomarkers) with age-related differences; ferritin and Hb values rise with age; ferritin <10 Β΅g/L and Hb thresholds define iron deficiency anaemia for children
    • Iron fortified milk and fortified products (Page 44)
    • Iron content in fortified milk around 1.5 mg/100 ml; 250 ml cup provides about 3.8 mg iron; Recommended daily iron intake (RDI) about 9 mg/day
    • Practical implications for Jack (case-based): ensure adequate iron intake; monitor cow’s milk consumption to avoid displacing iron-rich foods; consider iron-rich foods and fortified options; limit juice consumption to protect appetite for iron-rich meals

  • Vegetarian diets (Pages 46–49)

    • Types of vegetarian diets: Lacto-ovo (includes dairy and eggs), Pescovegetarian (includes fish), Vegan (no animal products)
    • Considerations for toddlers/preschoolers
    • Animal products are primary sources of Vitamin B12; vegans are at risk of B12 deficiency; EPA/DHA intake is often lower in vegetarians/vegans and may require supplementation
    • Iron status can be lower in vegetarian children; attention to iron-rich plant foods and iron absorption enhancers
    • Calcium, zinc, and protein considerations; complementary proteins to ensure complete amino acid profiles
    • Recommendations for vegetarian feeding in children (summarised):
    • Include complementary proteins (varied plant-based proteins) to achieve complete amino acid profiles
    • Diets including eggs and dairy are less likely to be inadequate; use of calcium-fortified soy milk is encouraged for dairy exclusions
    • Supplement with B12 in vegan diets
    • Use soybean or canola oil, nut butters, and iron absorption enhancers such as Vitamin C-rich foods with meals
    • References cited: Pawlak & Bell (2017); Amit (2010); Schurman (2017)

  • Australian Dietary Guidelines 2013 (Pages 49–53)

    • Guideline 1: Achieve and maintain a healthy weight; be physically active; eat varied nutritious foods to meet energy needs
    • Guideline 2: Children should eat enough nutritious foods to support growth and development; be active daily; growth should be checked regularly
    • Guideline 3: Encourage consumption of five food groups daily: Vegetables/legumes, Fruit, Grain foods (mostly wholegrain/high fibre), Lean meats/pish/eggs/nuts/seeds/legumes, Milk/yoghurt/cheese and alternatives; Water should be the main drink; low-fat dairy appropriate except not for children under 2
    • Guideline 4: Limit saturated fat, added salt, added sugars and alcohol; choose healthier fats (polyunsaturated/monounsaturated) over saturated fats; avoid adding salt; limit added sugars in beverages; avoid alcohol during pregnancy; support breastfeeding
    • Guideline 5: Food safety – care for food, prepare and store properly
    • Serves recommendations (Page 51): daily serves from Five Food Groups by age/sex; allowance for additional serves for more active or older children/adolescents; specific serve counts vary by age group and gender; includes examples for vegetables, fruit, grains, and lean meats
    • Compliance data (Page 52): measurement criteria for guideline adherence; % meeting guidelines for age groups 2–3 yrs and 4–8 yrs across categories like fruit, vegetables, cereals, meat, milks, and sodium/sugar/sat fat targets

  • Sources of nutrition information (Pages 58–60)

    • Parents commonly consult: Printed resources, Internet resources, Professional support, Informal networks (family, friends, other parents), Personal knowledge/cultural traditions
    • Practical sources listed for preschoolers:
    • National Health and Medical Research Council (NHMRC)
    • Better Health Channel (Victoria) – eating tips for preschoolers
    • Maternal and Child Health Care Nurses and other health services

  • Jack case-study – lifestyle advice & practical plan (Pages 61–67)

    • Goals for intervention
    • Assess growth trajectory; identify physiological demands for his age; capitalize on positives of current diet; address negatives; adjust past patterns contributing nutritional risk
    • Lifestyle recommendations (condensed)
    • Do not strictly control portions or meal frequency; encourage self-regulation
    • Increase iron-rich foods; limit cow’s milk; avoid fruit juice; increase fruit and vegetable variety
    • Turn off TV during meals; promote active play and caregiver interaction
    • Build a daily/weekly plan that mirrors family meals with iron-rich foods included
    • Suggested daily plan (illustrative, Page 67)
    • 6:00 a.m.: ~150 ml infant formula or cow’s milk; breakfast with 1–2 Weet-Bix with milk
    • 9:00 a.m.: Dried fruit, cheese, small slice of meat
    • 12:00 p.m.: Vegetables with meat or lentil puree; tofu; ~200 g yogurt
    • 3:00 p.m.: Whole fruit; crackers
    • 5:30 p.m.: Vegetables with meat or iron-rich alternative; family-style meal
    • 7:00 p.m.: Milk if necessary; brush teeth afterwards; avoid giving milk or juice in bed
    • Water should be available throughout the day
    • Growth monitoring guidance (Pages 61–63)
    • Use WHO standards for length-for-age and weight-for-age percentiles (birth to 2 years; updated growth curves)

  • Case study – assessment tasks (Pages 62–67)

    • For Jack: assess growth, identify physiological demands, evaluate dietary patterns (positive/negative aspects), identify risk factors (current/past patterns), provide lifestyle advice and a daily menu to address issues

  • Case study – growth standards and interpretation (Pages 63–64)

    • WHO child growth standards are used for length-for-age and weight-for-age percentiles (birth to 2 years; with age-appropriate graphs)
    • Provides percentile bands (e.g., 3rd, 15th, 50th, 85th, 97th) to interpret growth trajectory

  • Final notes on content integration (Pages 55–57)

    • Factors influencing children’s eating behaviours (multifactorial): gender, birth weight, temperament, feeding style, exposure to flavours, early feeding experiences, complementary feeding, socio-economic status, media exposure, and environment
    • Genetic predisposition and family environment influence child eating behaviours; parental feeding practices shape food choices and preferences
    • Overt vs covert control in feeding: covert (healthy food availability) is generally more effective than overt restriction
    • Modelling and family meals positively influence dietary quality; structured meals and monitoring have beneficial associations with healthier eating patterns

  • Practical implications for exam preparation

    • Understand how growth and energy needs drive preschool nutrition (BMR, growth needs, PA, thermogenesis)
    • Be able to explain NRV and ER ranges for 1–5 year olds and how to apply them in meal planning
    • Recognize the roles of fats, essential fatty acids, and the energy distribution in young children
    • Know calcium and iron requirements, iron-rich foods, and common risks like excessive cow’s milk and iron-deficient intake
    • Be able to discuss how to interpret growth charts (length/weight percentiles, BMI-for-age) and the limitations/uses in early childhood
    • Be familiar with guidelines for fluid intake and beverage choices; risks associated with juice and non-core beverages
    • Understand the dietary guidelines for Australians: the five food groups, limiting added sugars/salt/fat, and food safety
    • Be prepared to discuss different vegetarian patterns and nutritional considerations for preschoolers
    • Know common nutritional concerns in preschoolers (constipation, obesity risk) and lifestyle interventions to address them

  • Summary of key numerical constants and references (LaTeX-friendly)

    • Energy estimates (NRV ER ranges):
    • 1 ext{-}2 ext{ yrs:} ext{Boys } 3.5{-}4.4\text{ MJ/day}, ext{Girls } 3.2{-}4.2\text{ MJ/day}
    • 3 ext{-}5 ext{ yrs:} ext{Boys } 4.2{-}8.1\text{ MJ/day}, ext{Girls } 3.9{-}7.5\text{ MJ/day}
    • Fat energy share:
    • 0{-}2 ext{ yrs}: 40\%\text{ of energy}
    • 2{-}5 ext{ yrs}: 30\%\text{ of energy}
    • Calcium EAR (mg/day): 1–3 yrs: 360\text{ mg/day}; 4–8 yrs: 520\text{ mg/day}
    • Iron NRV ranges (mg/day):
    • 2–3 yrs:
      • Males: 8.3\text{ mg/day (CNPAS)}, 7.9\text{ mg/day (AHS)}
      • Females: 7.8\text{ mg/day (CNPAS)}, 7.1\text{ mg/day (AHS)}
    • 4–8 yrs:
      • Males: 10.5\text{ mg/day (CNPAS)}, 9.6\text{ mg/day (AHS)}
      • Females: 9.2\text{ mg/day (CNPAS)}, 8.0\text{ mg/day (AHS)}
    • Fibre AI: 14{–}18\text{ g/day} depending on age group
    • Non-core beverage energy share (illustrative): higher in older preschoolers; 1995 NNS data indicate ~25% energy from drinks in 2–4 yrs group

  • Quick references and resources (for study and practice)

    • NHMRC dietary guidelines for children and adults
    • CDC Growth Charts (BMI-for-age percentiles) for interpretation
    • Australian dietary guidelines (2013) – serves per day from Five Food Groups
    • Better Health Channel – preschool nutrition tips
    • InFANT study findings on iron intake in toddlers

  • Notes on formatting and exam-ready content

    • Use well-structured bullet points, clearly separating age-related recommendations and case-study insights
    • Include LaTeX-formatted equations for any numerical relationships (e.g., energy calculations, BMI formula) as shown in the content
    • Keep practical recommendations explicit (what to do with a preschooler’s breakfast, lunch, snacks, and beverages) and align with guidelines