1. Nutrients That Promote Growth & Regulate Body Functions
Chapter 14
Nutrients That Promote Growth & Regulate Body Functions
(Proteins, Vitamins, Minerals, and Water)
©2015 Cengage Learning.

2. Growth Growth is the result of: An increase in the number of cells
An increase in the size of cells
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3. Proteins Yield amino acids Are either complete or incomplete
Complete proteins yield all the essential amino acids.
Incomplete proteins are lacking
one or more essential amino acids.
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Non-dairy sources of complete protein include any meats, fish, or eggs. Soybeans (tofu, tempeh, soy milk) also contain all of the essential amino acids, but may interfere with iron absorption if consumed in very large amounts.
Food sources that are incomplete proteins:
Many options are possible including whole grains (e.g., rice, pastas, corn, barley, wheat), legumes (e.g., lentils, peanuts, dried peas), beans (e.g., navy, chick pea, soy, black, kidney), seeds (e.g., pumpkin, sunflower, walnuts), and some vegetables.

4. Proteins
Incomplete proteins can be combined to provide all of the essential amino acids:
Supplementary proteins = incomplete protein plus a small amount of complete protein
Complementary proteins = two or more incomplete proteins, when combined, form a complete protein
Supplementary proteins are made by adding a small amount of complete protein, such as cheese, milk, yogurt, or eggs to an incomplete protein (usually plant-based, such as pasta, rice, barley) to form a complete protein.

5. Proteins as Regulators
Proteins are involved in a variety of regulatory processes:
Energy metabolism
Fluid distribution
Hormone production
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6. How Much Protein Is Needed?
Infants: Protein Needed
0 to 6 mo g/day
7 to 12 mo g/day
Children:
1 to 3 yr g/day
4 to 8 yr g/day
Males: over 18 yr g/day
Females: over 18 yr g/day
Why do infants and toddlers need more protein than adults?
Infants and toddlers are undergoing rapid growth which translates into a greater protein need per pound of body weight.

7. Protein Requirements Are Easy to Meet
Food Protein
2 cups of milk grams
1 slice whole wheat bread grams
1 ounce meat grams
1 slice provolone cheese grams
1 egg grams
3 wheat crackers grams
2 oz. cooked pasta grams
TOTAL = grams
Why are young children at risk for developing iron-deficiency anemia?
Young children are not particularly fond of red meats which are typically high in iron because they tend to be more difficult to chew. Because few other food sources provide as much iron (heme iron), children may be at greater risk for a deficiency.
Child who consumes milk and not other foods…
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8. Children on Vegetarian Diets
Vegan—nuts, seeds, legumes, fruits and vegetables
Lacto-vegetarian—in addition, dairy products
Ovo-vegetarian—in addition, egg products
Lacto-ovo vegetarian—in addition, both dairy and egg products
Can all of a child’s protein, iron and calcium needs be met if he or she follows a vegetarian diet?
You need to understand type of vegetarian child is and how to provide the needs of the child in a balanced way
Can be a challenge, especially for vegan
Ask parents for suggestions and help
Yes, all of a child’s needs for protein, iron, and calcium can be met with careful meal planning. Children who follow a lacto-ovo-vegetarian diet (includes milk and eggs) or lacto-vegetarian diet (includes only dairy products) will have a strong source of calcium. Children who follow an ovo-vegetarian diet (includes only eggs, no dairy products) or vegan diet (no animal products) may be at greater risk of a calcium deficiency unless they drink calcium-fortified soy milk or take a calcium supplement. Iron deficiency is more likely if no animal products are consumed. However, most grain products, such as breads, cereals, and crackers are fortified with iron. Also, including a source of vitamin C with meals will boost iron absorption.

9. Vitamins Vitamins are needed in small amounts (Table 14-3).
Large doses of some vitamins can be toxic.
Vitamins are classified as:
Water soluble
Fat soluble
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10. Vitamins Water soluble vitamins: Fat soluble vitamins:
are not stored in the body and must be consumed daily
include Vitamin C, thiamin, niacin, riboflavin, vitamin B6 and B12, pantothenic acid, folacin, and biotin.
Fat soluble vitamins:
are stored in the body and can be toxic if consumed in large supplement doses
include vitamins A, D, E, and K
Why is the vitamin folacin receiving so much public attention? What role does it play in the human body and what are its food sources?

11. Vitamins Vitamins support growth
DNA and RNA production
Cell division
Bone and blood formation
Vitamins are involved in regulating body functions
Bone development
Energy metabolism
Neuromuscular function

12. Should Children Take Vitamin Supplements?
Families should always check first with the child’s physician.
Vitamin supplements provide small amounts of many vitamins, but not always in the amounts required. For example, only 10 percent of a child’s calcium requirement may be met with a vitamin supplement. This may give parents false assurance that children’s intake is adequate.

13. Should Children Take Vitamin Supplements?
Vitamin supplements may be helpful for some children who are picky eaters.
Essential nutrients, such as protein and fiber, accompany the vitamins found in food sources but are absent in supplements.
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14. Minerals Provide no energy Are inorganic substances that are
only needed in small amounts
Are essential for:
building of body tissues (e.g., bone, teeth, blood)
regulating body functions (e.g., energy metabolism, neuromuscular function)
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15. Bone and Tooth Formation
What minerals are required for healthy bone and tooth formation?
Calcium
Phosphorus
Fluoride
What food sources supply each of these minerals?
What problems can occur from an excess intake of flouride?
Excess fluoride can cause fluorosis− a discoloration (white or brown spots) that forms on teeth

16. Calcium Most children today do not get enough calcium in their diet.
What factors may be contributing
to this change?
What sources other than milk
supply calcium?
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Alternative non-dairy sources of calcium can be found in salmon, broccoli, collard greens, kale, Chinese cabbage, and soy products such as tofu and miso. However, the amount of calcium derived from these foods is significantly less than what is found in dairy products.

17. Calcium 5 adequate vitamin C and D ▼ large dose
Factors that increase the absorption of dietary calcium:
5 adequate vitamin C and D
5 increased need
Factors that decrease the absorption of dietary calcium:
▼ large dose
▼ high dietary fiber
▼ high intake of protein

18. Iron Iron plays a critical role in the formation of blood cells.
Inadequate iron can contribute to iron-deficiency anemia.
Dietary iron is not well-absorbed by the body. Iron absorption is improved when vitamin C is present in a meal.
But a lack of iron in the blood can lead to iron-deficiency anemia, which is a very common nutritional deficiency in children.
The body needs iron to make hemoglobin. If there isn't enough iron available, hemoglobin production is limited, which in turns affects the production of red blood cells (RBCs). A decreased amount of hemoglobin and RBCs in the bloodstream is known as anemia. Because RBCs are needed to carry oxygen throughout the body, anemia results in less oxygen reaching the cells and tissues, affecting their function.
Iron-deficiency anemia (IDA), often caused by insufficient iron intake, is the major cause of anemia in childhood. It has become much less common in the United States over the past 30 years, primarily due to iron-fortified infant formulas and cereals.
Iron-deficiency anemia doesn't develop immediately. Instead, a person progresses through stages of iron deficiency, beginning with iron depletion, in which the amount of iron in the body is reduced while the iron in RBCs remains constant. If iron depletion isn't corrected, it progresses to iron deficiency, eventually leading to IDA.
Caring for Your Child
The effects of IDA will depend on the duration and severity of the anemia. If left untreated, it may lead to behavioral or learning problems. These may not be reversible, even with later iron supplementation.
But in most cases, IDA is preventable by following some basic recommendations:
Infants younger than 1 year old should drink only breast milk or an infant formula supplemented with iron. It is important for breastfed infants to receive iron-fortified solid foods starting at about 6 months of age.
Kids under 2 years old should have no more than 24 ounces of cow's milk a day. As noted earlier, milk can inhibit absorption of iron, and drinking too much milk can dampen a child's appetite for other iron-rich foods. In addition, too much cow's milk has been shown to irritate the gastrointestinal tract, which may cause intestinal bleeding — a cause of iron loss.
Iron-fortified products such as cereal can be a great way to get kids — especially those under 2 years old — to get more iron.
A variety of foods can provide great sources of iron: lean meats; egg yolks; broccoli, spinach, and other green leafy vegetables; dried peas and beans; blackstrap molasses; raisins; and whole-grain bread.
Make sure kids or teens on a vegetarian diet get enough iron. Because iron from meat sources is more easily absorbed than iron from plant sources, you may need to add iron-fortified foods to their diet.
Proper nutrition, which includes a diet rich in iron, is important for all kids. Establishing good eating habits early in life will help to prevent iron deficiency and iron-deficiency anemia.

19. Building Blood
Every red blood cell in the body contains iron in its hemoglobin -- the pigment that carries oxygen to the tissues from the lungs.
Red blood cells bring oxygen to body tissues.
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20. Iron-deficiency Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells.
There are many types of anemia.
Iron deficiency anemia is a decrease in the number of red blood cells in the blood due to a lack of iron.
Why are young children at risk for developing iron-deficiency anemia?
Young children are not particularly fond of red meats which are typically high in iron because they tend to be more difficult to chew. Because few other food sources provide as much iron (heme iron), children may be at greater risk for a deficiency.
A child who still prefers milk to solid foods and replaces solid foods with milk may also develop anemia.
©2012 Cengage Learning.
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21. Iron-deficiency Anemia
Most prevalent nutritional problem in children in U.S.
Twice as likely to occur in poor families
Children may have trouble concentrating, which may affect brain development
Diets need sufficient amounts of iron to prevent it
Infants need vitamin supplements
and young children need a lot of iron to grow and develop.
The iron that full-term infants have stored in their bodies is used up in the first 4 to 6 months of life.
Premature and low-birth-weight babies are at even greater risk for iron-deficiency anemia. These babies don't have as much iron stored in their bodies as full-term infants.
Iron-fortified baby food or iron supplements, when used properly, can help prevent iron-deficiency anemia in infants and young children. Talk with your child's doctor about your child's diet.
Young children who drink a lot of cow's milk may be at risk for iron-deficiency anemia. Milk is low in iron, and too much milk may take the place of iron-rich foods in the diet. Too much milk also may prevent children's bodies from absorbing iron from other foods.
Children who have lead in their blood also may be at risk for iron-deficiency anemia. Lead can interfere with the body's ability to make hemoglobin. Lead may get into the body from breathing in lead dust, eating lead in paint or soil, or drinking water that contains lead.

22. Causes of IDA insufficient iron in the diet
poor absorption of iron by the body
ongoing blood loss, most commonly from menstruation or from gradual blood loss in the intestinal tract
periods of rapid growth
Causes of IDA
Iron-deficiency anemia can be the consequence of several factors, including:
insufficient iron in the diet
poor absorption of iron by the body
ongoing blood loss, most commonly from menstruation or from gradual blood loss in the intestinal tract
periods of rapid growth
A diet low in iron is most often behind IDA in infants, toddlers, and teens. Kids who don't eat enough or who eat foods that are poor sources of iron are at risk for developing the condition. Poverty is a contributing factor to IDA because families living at or below the poverty level may not be getting enough iron-rich foods.
Iron deficiency can also cause the body to absorb more lead, which increases the risk of lead poisoning in kids, especially those living in older homes. The combination of IDA and lead poisoning can make kids very ill and can put them at risk for learning and behavioral problems.
During infancy and adolescence, the body demands more iron. Kids are at higher risk for IDA through these periods of rapid growth because they may not be getting enough iron in their diet to make up for the increased needs.
In infants, discontinuing iron-fortified formula and introducing cow's milk before 12 months can lead to IDA. Cow's milk is low in the iron necessary for infant growth and development and it often replaces the consumption of iron-rich foods. Milk decreases the absorption of iron and can also irritate the lining of the intestine, causing small amounts of bleeding. This slow, gradual loss of blood in the stool — combined with low iron intake — may eventually result in iron deficiency and anemia.
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More Risks By Age
Prematurity and low birth weight are other factors that put an infant at risk for IDA. Before birth, full-term, normal-weight babies have developed iron stores that can last them 4 to 6 months. Because preemies don't spend as much time in the uterus getting nutrients from the mother's diet, their iron stores are not as great and are often depleted in just 2 months.
Kids between 1 and 3 years old are at risk of iron deficiency and iron-deficiency anemia, even though it isn't a period of exceptional growth. Most toddlers are no longer consuming iron-fortified formula and infant cereal, and they aren't eating enough iron-rich foods to make up the difference. Toddlers also tend to drink a lot of cow's milk, often more than 24 ounces a day, an amount that injures the lining of the stomach causing chronic blood loss leading to iron deficiency.
During the first stages of puberty, when a lot of growth occurs, boys are at risk of iron deficiency anemia. But adolescent girls are at higher risk than boys for IDA because of smaller iron stores and the iron lost in the blood in their monthly menstrual flow. Many girls also tend to consume a diet low in iron.
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23. Iron-deficiency Anemia
Inadequate iron can contribute to iron-deficiency anemia.
Dietary iron is not well-absorbed by the body.
Including vitamin C in a meal improves the absorption of iron.
©2012 Cengage Learning.
All Rights Reserved.

24. Symptoms fatigue and weakness pale skin and mucous membranes
rapid heartbeat or a new heart murmur (detected in an exam by your child's doctor)
irritability
decreased appetite
dizziness or a feeling of being lightheaded
Rarely, a person with IDA may experience pica,
Symptoms
Many kids with iron deficiency don't show any symptoms because the body's iron stores are depleted slowly. As the anemia progresses, you may recognize some of the following symptoms in your child:
fatigue and weakness
pale skin and mucous membranes
rapid heartbeat or a new heart murmur (detected in an exam by your child's doctor)
irritability
decreased appetite
dizziness or a feeling of being lightheaded
Rarely, a person with IDA may experience pica, a craving to eat nonfood items such as paint chips, chalk, or dirt. Pica may be caused by a lack of iron in the diet.
©2012 Cengage Learning.
All Rights Reserved.

25. Diagnosis and Treatment
Blood tests
Diet changes alone usually aren't enough to replenish depleted iron stores.
Multivitamins with iron aren't adequate for kids with IDA who have such low iron stores, so a separate daily iron supplement may be required.
To diagnose iron deficiency, one of these blood tests will probably be done:
A complete blood count (CBC) may reveal low hemoglobin levels and low hematocrit (the percentage of the blood made up of RBCs). The CBC also gives information about the size of the RBCs; those with low hemoglobin tend to be smaller and each cell contains less hemoglobin.
Even though most cases of IDA are the result of poor dietary iron intake, diet changes alone usually aren't enough to replenish depleted iron stores. Likewise, multivitamins with iron aren't adequate for kids with IDA who have such low iron stores, so a separate daily iron supplement may be required.
It's extremely important to remember that your child should not be given potent iron supplements without first consulting a doctor. Taking too much iron is a major cause of serious poisoning in children, according to the American Academy of Pediatrics (AAP).
Iron is best absorbed on an empty stomach, because it can occasionally cause stomach upset. Kids who experience stomach problems when taking iron supplements may need to take them with a small amount of food. Iron should not, however, be given with milk or caffeinated beverages, which will interfere with absorption. Vitamin C enhances iron absorption, so try to include plenty of sources of vitamin C in your child's diet.
©2012 Cengage Learning.
All Rights Reserved.

26. IDA is Preventable
Infants younger than 1 year old should drink only breast milk or an infant formula supplemented with iron.
Breastfed infants should receive iron-fortified solid foods starting at about 6 months of age.
Kids under 2 years old should have no more than 24 ounces of cow's milk a day.
Use Iron-fortified products such as cereal.
A variety of foods can provide great sources of iron.
Infants younger than 1 year old should drink only breast milk or an infant formula supplemented with iron. It is important for breastfed infants to receive iron-fortified solid foods starting at about 6 months of age.
Kids under 2 years old should have no more than 24 ounces of cow's milk a day. As noted earlier, milk can inhibit absorption of iron, and drinking too much milk can dampen a child's appetite for other iron-rich foods. In addition, too much cow's milk has been shown to irritate the gastrointestinal tract, which may cause intestinal bleeding — a cause of iron loss.
Iron-fortified products such as cereal can be a great way to get kids — especially those under 2 years old — to get more iron.
A variety of foods can provide great sources of iron: lean meats; egg yolks; broccoli, spinach, and other green leafy vegetables; dried peas and beans; blackstrap molasses; raisins; and whole-grain bread.
Make sure kids or teens on a vegetarian diet get enough iron. Because iron from meat sources is more easily absorbed than iron from plant sources, you may need to add iron-fortified foods to their diet.
Proper nutrition, which includes a diet rich in iron, is important for all kids. Establishing good eating habits early in life will help to prevent iron deficiency and iron-deficiency anemia.
©2012 Cengage Learning.
All Rights Reserved.

27. Water Water plays important roles in the body:
Fluid replacement
Temperature regulation
Building body tissues
A child’s need for water is
influenced by:
Environmental temperature
Body surface
Activity
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28. Case Study
Mealtimes were frustrating for Akecheta's mother. Her four-year-old son often refused to drink his milk and begged for juice instead. He complained “that his stomach hurt” and would cry until his mother gave in to his requests. She was becoming extremely frustrated and finally decided to take him to the local health clinic for advice.
After several visits and tests, the physician assistant determined that Akecheta was lactose intolerant and allergic to citrus fruits. Even small amounts of milk or cheese seemed to upset his stomach and orange juice caused him to break out in hives.

29. Questions for Case Study
What nutrients will Akecheta lack if these food groups are eliminated from his diet?
Would you expect symptoms of a deficiency to appear immediately or long term? Explain.
Suggest several foods that have the same nutrient-strength and could be served in place of citrus fruits and dairy products?
Should Akecheta be given nutrient supplements to offset potential deficiencies? Why or why not?