1. CHILD AND ADOLESCENT NUTRITION

2. Definition: Nutrition = modifications of food`s components in the body to maintain life. The processes of growth, maintenance of organs and systems are due to dietary nutrients, plastics, energy and biocatalyst.

3. CHILD AND ADOLESCENT NUTRITION Nutritional needs: - quantity (energy, calorific value); - quality.

4. Quantitative nutritional needs (energy) Life processes in the body are made of energy expenditure. The main energy sources are carbohydrates and lipids. Energy needs: - maintenance needs - needs for thermoregulation - physical activity or muscle activity - needs for growth

5. ENERGY NEEDS 1. Maintenance needs for basal metabolism = needs and the needs of operation: a) basal metabolism (MB) = total body energy expenditure for breathing, heart contractions, secretions, etc.. M.B. MB 2 x baby = adult. M.B. lower in premature and dystrophic. M.B. increase in feverish.

6. Maintenance needs b) Operational needs = needs for food specific dynamic action (SDA) and losses through excretion. SDA = calories expended in food digestion and utilization. higher energy expenditure after ingestion of protein and lower fat and carbohydrate intake after small increase in weight → high protein regimens.

7. Maintenance needs  similar diets meals → consuming lower calorie when the number is higher. Losses increased excretion: - artificial nutrition (hyperosmolar formulas) - diarrhea.

8. ENERGY NEEDS 2. The needs for thermoregulation depends on: - large body size in relation to weight; - skin thinness; - ambient temperature. 3. Physical activity and muscle activity requires energy to the intensity and duration of effort.

9. ENERGY NEEDS 4. Growth needs vary with: - age (the higher the more the child is less) - child health, - individual peculiarities. The caloric needs are covered by the body by burning food that provides on average: 4 kcal per 1 gram of protein; 4 kcal per 1 gram carbohydrates; 9 kcal per 1 gram fat.

10. Growth Needs Child's overall energy ratio diminishes with age: - in the first trimester of life: 110-120 kcal / kg / day; - in the second quarter: 100-110 kcal / kg / day; - third and fourth quarter: 90-100 kcal / kg / day; - child 1-3 years: 90 kcal / kg / day; - preschool: 80 kcal / kg / day; - school: 50-60 kcal / kg / day. Before puberty, growth is accelerating the need to increase caloric intake. - in the first trimester of life: 110-120 kcal / kg / day; - in the second quarter: 100-110 kcal / kg / day; - third and fourth quarter: 90-100 kcal / kg / day; - child 1-3 years: 90 kcal / kg / day; - preschool: 80 kcal / kg / day; - school: 50-60 kcal / kg / day. Before puberty, growth is accelerating the need to increase caloric intake.

11. Growth Needs Hiperglucidic scheme and / or infant hiperlipidic ↓ stimulates lipidogenesis ↓ ± hyperplasia, hypertrophy of adipose cells ↓ early obesity Hiperglucidic scheme and / or infant hiperlipidic ↓ stimulates lipidogenesis ↓ ± hyperplasia, hypertrophy of adipose cells ↓ early obesity

12. Growth Needs Hypocaloric diets: → malnutrition → depressants sympathetic nervous system → saving operating needs and thermogenesis. Optimal caloric intake: carbohydrates 45% of total calories, 33-40% lipids, 12-15% protein.

13. QUALITATIVE NUTRITIONAL NEEDS Plastic factors: protein and some minerals; Plastic factors: protein and some minerals; Factors energy: carbohydrates and lipids; Biocatalyst factors: vitamins, minerals, water. Protein: - necessary for growth, - sole source of nitrogen and indispensable amino acids. Carbohydrates: - elements easily digestible energy, - necessary for lipid metabolism.

14. QUALITATIVE NUTRITIONAL NEEDS Lipids: - important source of energy in a small footprint - soluble vitamins and unsaturated fatty acids. Qualitative nutritional needs of infants: Breast feeding Bottle feeding Protein 2 – 2,5 g/kg/day 3 – 3,5 g/kg/ day Lipid 4 – 6 g/kg/ day Carbohydrate 10 – 12 g/kg/day

15. QUALITATIVE NUTRITIONAL NEEDS "food balance" = optimal ratio between the principles of food: P: L: G = 1:2:4 (newborn and infant). P: L: G = 1:2:4 (newborn and infant). P: L: G = 1:1,2:3,5 (child 1-3 years). P: L: G = 1:1,2:3,5 (child 1-3 years).

16. Proteins - not stored in the body → required daily intak - protein diet free total → more than 48 hours in infants and young children factors that alter protein intake: - adaptability of the body; - carbohydrate intervention as saving factor protein; - biological value and protein digestibility (90% for animal and 50-80% for vegetable). factors that alter protein intake: - adaptability of the body; - carbohydrate intervention as saving factor protein; - biological value and protein digestibility (90% for animal and 50-80% for vegetable).

17. Proteins Sources: meat, cheese, fish, liver, eggs pasta, vegetables, fruits (smaller amounts) Essential amino acids (9) phenylalanine, lysine, leucine, isoleucine, threonine, tryptophan, methionine, valine, histidine Sources: meat, cheese, fish, liver, eggs pasta, vegetables, fruits (smaller amounts) Essential amino acids (9) phenylalanine, lysine, leucine, isoleucine, threonine, tryptophan, methionine, valine, histidine - body can not synthesize or manufacture them in sufficient quantity; - must exist in certain proportions for protein resynthesis health state. - body can not synthesize or manufacture them in sufficient quantity; - must exist in certain proportions for protein resynthesis health state.

18. Proteins  essential amino acid needs in infants = 10 x adult proper diet → at least 50% of the total protein are animal Amino acid semiesential: under certain conditions the body's ability to synthesize from their precursors.

19. Proteins Cystine, taurine (derived from methionine) and tyrosine (derived from phenylalanine) should be considered essential amino acids in the neonatal period and low birth weight baby. Non-essential amino acids: alanine, arginine, glutamine, glycine, glutamic acid, asparagine, aspartic acid, cysteine (cystine), tyrosine, proline, serine →contribute to meeting the needs of the body nitrogen

20. Proteins In breast fed infants protein requirement is lower than in the bottle fed (high biological value and digestibility of human milk proteins rapidly). For ideal maximum use of the protein → 32-35 kcal compared to 1 g protein.

21. Proteins Plastic roles: - constitution of cells, - composition: hormones, enzymes, factors coagulation - renewal of cells and tissues, - physical strength and intellectual - processes of the body's defenses against infection and poisoning.

22. Proteins Functional Roles: - circulating bilirubin, metals (Fe, Cu, Zn, Co, I), metabolites and blood gases; - fluid exchange between capillaries and cell gap, device is muscle contraction; - fluid exchange between capillaries and cell gap, device is muscle contraction; - maintenance of colloid-osmotic pressure of plasma; - maintenance of colloid-osmotic pressure of plasma; - acid-base balance. - acid-base balance.

23. Proteins Excess protein - exceeds the capacity of the kidney excretory → ↑ glomerular filtration → kidney hypertrophy. - causes hypertrophy of cell → fat storage → obesity in adults. - hyperammonemia → low IQ.

24. Proteins Protein deficiency: - slow growth rate; - slow growth rate; - reduction of enzymatic synthesis, hormonal and humoral immunologic factors; - reduction of enzymatic synthesis, hormonal and humoral immunologic factors; - clinical: swelling hypoproteinemia and protein malnutrition (kwashiorkor). - clinical: swelling hypoproteinemia and protein malnutrition (kwashiorkor).

25. Carbohydrates - energy substrate for all cells, - plastic role in human body structure serve to biosynthesis of: -glycogen, -galactocerebrosis brain -glucoproteins, -glucolipids, -amino acids -fatty acids. - energy substrate for all cells, - plastic role in human body structure serve to biosynthesis of: -glycogen, -galactocerebrosis brain -glucoproteins, -glucolipids, -amino acids -fatty acids.

26. Carbohydrates Food carbohydrates: - monosaccharides (glucose, fructose and galactose) - glucose polymers - disaccharides (lactose, sucrose and maltose) - polysaccharides (starch and glycogen).

27. Carbohydrates Glucose: - in fruits, vegetables, honey, - fetal transplacental transfer of glucose - dependent of mother glycemia; - fetal transplacental transfer of glucose - dependent of mother glycemia; - control of glucose homeostasis is fully in 2-5 weeks after birth, including premature; - control of glucose homeostasis is fully in 2-5 weeks after birth, including premature; - glucose polymers are an adequate source of carbohydrate for premature infants and infants with malabsorption, and is easily hydrolyzed in the gut. - glucose polymers are an adequate source of carbohydrate for premature infants and infants with malabsorption, and is easily hydrolyzed in the gut.

28. Carbohydrates Fructose: in fruits, vegetables, honey or derived from hydrolysis of sucrose. Galactose: in fruits, vegetables, honey or derived from hydrolysis of sucrose. Galactose: - derived from hydrolysis of milk lactose, - favorably influence brain development in newborn and infant. - derived from hydrolysis of milk lactose, - favorably influence brain development in newborn and infant.

29. Carbohydrates Lactose: - quantities in human milk > cow's milk only, - important role in infant brain development. Sucrose: - high power sweetening - child with customary sweetness, - promote obesity.

30. Carbohydrates Maltose: - the seeds sprouted grains - produced by hydrolysis of starch - slowly hydrolyzed by maltase → 2 glucose molecules - is well tolerated. Starch: - cereals, tubers, roots, bananas, - its hydrolysis is initiated by salivary and pancreatic amylase.

31. Carbohydrates Glycogen: - storage form of carbohydrate in the liver and muscle - starch-like structure - hydrolyzed by the same enzymes. Fiber: - wall polysaccharides in plant - resist the hydrolytic action of human digestive enzymes, - digestibility dependent chemical structure, how to prepare, while standing in the intestinal flora and colon.

32. Carbohydrates The main action of dietary fiber: - increases fecal volume and accelerates intestinal transit bowl; - regulates appetite - effect of satiety; - amended by binding to intestinal bacterial flora; - increased excretion of fat, protein and calories in the stool; - increases fecal volume and accelerates intestinal transit bowl; - regulates appetite - effect of satiety; - amended by binding to intestinal bacterial flora; - increased excretion of fat, protein and calories in the stool;

33. Carbohydrates The main action of dietary fiber: - increase the removal of cations by reducing the absorption of Zn, Fe, Ca, Mg, Na and K; - binds cholesterol and bile acids in the gut; - decrease the absorption of carbohydrates through the formation of gels and modulates tissue sensitivity to insulin. Sources of dietary fiber: bran cereals, fruits, vegetables.

34. Carbohydrates The quantity and quality of carbohydrate intake during the first months of life is crucial for life and any error during the formation of brain cells is irreparable.

35. Carbohydrates Carbohydrate needs: - premature: 6 -8 g / kg / day (first week - transient lactase deficiency), then 12 g / kg / day; - new - born IUGR: 18-25 g / kg / day in the neonatal period to combat hypoglycemia; - infant and young child: 12 g / kg / day; - preschool: 10 g / kg / day; - school: 8 g / kg / day.

36. Carbohydrates Deficiency of carbohydrate, in terms of adequate intake of protein, determined using protein for energy purposes by their gluconeogenesis and avoid the structural role. Excess sugar leads to obesity and diabetes mellitus by insulin depletion. Excess milk lactose in some formulas produce osmotic diarrhea. Excess starch creates imbalance of nutritional factors with development dystrophy by hypoproteinemia.

37. Lipids  energy and nutrients with plastic role (the nervous system myelination) dietary fat: - triglycerides, - phospholipids - cholesterol - metabolic derivatives of fats.

38. Lipids Triglycerides (TG) - most of the food ration; - have animal origin (milk, butter, egg yolk, meat, offal) and vegetable (soybean oil, corn, sunflower, olive); - TG animal nature prevails in saturated fats such as vegetable and in the predominant polyunsaturated fatty acids.

39. Lipids Saturated fatty acids: increased plasma cholesterol levels and promote atherosclerosis. Unsaturated fatty acids: - monounsaturated: oleic acid (role in myelination) - polyunsaturated (omega-6 series - linoleic and gamma-linoleic acid and omega 3 series - alpha linolenic acid). - considered essential, - structural components of membranes, - precursors of prostaglandins, leukotryenes and trombhexanilor → growth and cell function.

40. Lipids Important role in: - diencefalo-pituitary hormones, the serum lipoproteins; - diencefalo-pituitary hormones, the serum lipoproteins; - trophicity of the skin and appendages; - trophicity of the skin and appendages; - structural and functional integrity of the arterial wall and platelets. - structural and functional integrity of the arterial wall and platelets.

41. Lipids Linoleic acid: - olive oil, soy, corn, sunflower, cotton, - reduce plasma levels of LDL cholesterol. Linolenic acid: - fish oil, corn, soybean, sunflower, - major component of the phospholipids of brain and retinal cell membranes.

42. Lipids Cholesterol: - component of all cell membranes - in myelin structure, steroid hormones, vitamin D, - role in the formation of bile salts. Food sources: milk, butter, cream cheese, offal, egg yolk.

43. Lipids Fiber increases intestinal elimination of cholesterol ingested. Cholesterol food shortage → nerve structures are not affected (endogenous synthesis). Fat needs: - infant: 4-6 g /kg /day; - child 1-3 years: 4-5 g /kg /day; - school: 2 g /kg /day.

44. Lipids Deficiency of fat: → reduce energy intake disrupts the growth process, decreases absorption of fat soluble vitamins. Linolenic acid deficiency: - peripheral neuropathy - reduction of visual acuity, - trophic disorders of the skin and hair, - adesivity platelet growth.

45. Lipids Linoleic acid deficiency: - dermatitis, - trophic appendages disorders, - hypertension, - hyperlipidemia and hypercholesterolemia.

46. Lipids Excess fat: increased intake of calories obesity → often associated with hypertension. Establishing a fair ration of fat quantity and quality is the most effective prevention of adult atherosclerosis.

47. Water and Mineral Salts Needs The presence of water: - most urgent need of body - greater need as the body is younger: newborn: 180-200 ml / kg / day infant: 150ml/kg/day, child 1-3 years: 100-125ml/kg/day. Fluid balance = balance between intake and excretion of fluids.

48. Water and Mineral Salts Needs Contribution: - fluid intake; - water from food constitution; - water from combustion. Losses: - urine; - faeces; - sweating; - skin perspiration; - breathing.

49. Water and Mineral Salts Needs Distribution of body fluids in newborn and infant: water = 75% total body weight, → 40% of the total water in the extracellular fluid. Dehydration occurs due to extracellular water.

50. Water and Mineral Salts Needs The need for water increases in the following conditions: - ambient temperature increase; - in newborn; - phototherapy; - fever; - diarrhea / vomiting; - decrease in ambient humidity; - feeding with formula milk high calories and hyperosmolar type.

51. Mineral Salts Roles: structure: are used in cell cytoplasm, the skeletal structure, Hb, endocrine glands etc. regulator and biocatalysts: - maintain osmotic pressure, - maintaining acid-base balance, - regulating the activity of the nervous system, myocardium, muscle, - activation of digestive enzymes. regulator and biocatalysts: - maintain osmotic pressure, - maintaining acid-base balance, - regulating the activity of the nervous system, myocardium, muscle, - activation of digestive enzymes.

52. Mineral Salts Actions: synergistic (Ca and P, Cu and Fe) = contribution of an ion demand increases synergistically of another one; antagonistic (Na, K, Ca and Mg) = an increased intake of other ion remove it. Nutritional sources: - animal products - vegetable products - drinking water. antagonistic (Na, K, Ca and Mg) = an increased intake of other ion remove it. Nutritional sources: - animal products - vegetable products - drinking water.

53. Mineral Salts Food intake is necessary for the formation of new tissues and to cover loss of skin, hair, tears, urine and faeces. Body needs are great: - during periods of accelerated growth, - during exercise, - in fever.

54. Mineral Salts Sodium principal cation of extracellular fluid Roles: - osmotic pressure regulation, - maintaining acid-base balance, - maintain water balance in the body - neuro-muscular excitability, - cardiac contraction. Sources: milk, meat, eggs, vegetables, cooking salt. Losses: heavy sweating, severe diarrhea Excess → fluid retention, hypervolemia, hypernatremia and swelling in young infants.

55. Mineral Salts Potassium cation of the fundamental cell Roles: - muscle contraction, - conduct of neuromuscular impulse - cardiac rate. cation of the fundamental cell Roles: - muscle contraction, - conduct of neuromuscular impulse - cardiac rate. K + Na + Cl contributing to the maintenance: - acid-base balance, - osmotic pressure - fluid balance.

56. Mineral Salts Potassium Sources: milk, meat, fruit (peaches), vegetables (carrots). Deficit: - in acidosis, - as corticosteroids, -clinical: nausea, vomiting, bloating, tachycardia, neuromuscular instability. Excess: - in renal failure, - drug administration, → atrium-ventricular block.

57. Mineral Salts Chlorine extracellular anion, Roles: - osmotic pressure regulation, - acid-base balance of extracellular fluid, - hydrochloric acid in gastric juice structure. Sources: milk, meat, eggs and cooking salt. Deficit in: -vomiting, -profuse sweating, -prolonged treatment with ACTH. → hypochloraemic alkalosis.

58. Mineral Salts Calcium the main constituent of the skeleton Roles: -contractibility and neuromuscular excitability; -permeability of cell membranes; -blood clotting; -activation of enzymes (trypsin, pancreatic lipase). Maintaining serum calcium: The balance between skeletal fixation and release are regulated by parathyroid hormone in the presence of vitamin D and tireocalcytonin (hypocalcemya hormone). the main constituent of the skeleton Roles: -contractibility and neuromuscular excitability; -permeability of cell membranes; -blood clotting; -activation of enzymes (trypsin, pancreatic lipase). Maintaining serum calcium: The balance between skeletal fixation and release are regulated by parathyroid hormone in the presence of vitamin D and tireocalcytonin (hypocalcemya hormone).

59. Mineral Salts Calcium Sources: milk and dairy products. Deficit: → tetany, → rickets, → osteoporosis. Excess dietary calcium has no effect attributes on body, homeostasis is well regulated.

60. Mineral Salts Iron In the composition: -hemoglobin -myoglobin -of many enzymes and catalysts. Fetal iron reserves: proportional to the duration of pregnancy: n.b at term → 250 mg (4-6 months are exhausted) premature n.b → 125 mg (to cover 2-3 months). In the composition: -hemoglobin -myoglobin -of many enzymes and catalysts. Fetal iron reserves: proportional to the duration of pregnancy: n.b at term → 250 mg (4-6 months are exhausted) premature n.b → 125 mg (to cover 2-3 months).

61. Mineral Salts Iron Iron needs depend on: -stocks in the body -form of contribution (only 5-10% is absorbed from ingested iron). Fe rich foods: liver, meat, eggs, fish, cereals, beans, spinach, tomatoes, fruit.

62. Mineral Salts Iron Recommended dietary intake: 0-6 months → 6 mg / day; 6 months-10 years → 10 mg / day; adolescents - girls → 12-24 mg / day; - boys → 9-18 mg / day. Iron deficiency - etyopathogenic mechanisms: -martial deficiency intake -martial deperdition -martial diversion

63. Mineral Salts – Iron Deficiency Low Iron Intake Low iron reserves at birth: - prematurity; - W.b < 3 000g; - twinning; - feto-fetal transfusion enzygotic twins; - feto-maternal transfusion; - martial deficiency in pregnant women (multiparous);

64. Mineral Salts – Iron Deficiency Low Iron Intake Low iron reserves at birth: - perinatal loss (placenta previa, placental detachment); - neonatal hemorrhage (hemolytic disease of the note, cord bleeding, early ligation of the umbilical cord); - neonatal hemorrhage (hemolytic disease of the note, cord bleeding, early ligation of the umbilical cord); - exanguino-transfusion. - exanguino-transfusion.

65. Mineral Salts – Iron Deficiency Low Iron Intake Low intake: - greater weight gain needs → ↑ Fe ↓ dissatisfied reserves and intake (preterm infants with rapid growth rate); - excessive extension of the system lactate (bottlefed infants cow milk / standard milk powder); - other food mistakes: - excess flour - diversification of food without eggs, meat, vegetables rich in iron;

66. Mineral Salts – Iron Deficiency Low Iron Intake Low intake: - rapid growth and teen menstrual losses not covered by food intake; - cyanogen congenital heart disease (right-left shunt) with hypochromic anemia and polycythemia; - cyanogen congenital heart disease (right-left shunt) with hypochromic anemia and polycythemia; - difficulties in food intake (severe encephalopathy).

67. Mineral Salts – Iron Deficiency Low Iron Intake Intestinal malabsorption of iron: -chronic digestive disorders -malabsorption syndromes -prolonged diarrhea -celiakie -mucoviscidosis -gastric resection.

68. Mineral Salts – Iron Deficiency Iron Losses - repeated small hemorrhages (small and repeated melena, recurrent nosebleeds, frequent harvesting of blood from small infants); - gastrointestinal bleeding (cow's milk protein allergy, parasitic infestations, digestive abnormalities). - gastrointestinal bleeding (cow's milk protein allergy, parasitic infestations, digestive abnormalities). Other causes: bleeding after surgery or trauma, renal (hematuria, hemoglobynuria). Other causes: bleeding after surgery or trauma, renal (hematuria, hemoglobynuria).

69. Mineral Salts – Iron Deficiency Excessive Iron Utilisation - chronic inflammation (Crohn's disease, rheumatoid arthritis); - chronic inflammation (Crohn's disease, rheumatoid arthritis); - infections (tuberculosis, septicemia, osteomyelitis, urinary tract infections); - infections (tuberculosis, septicemia, osteomyelitis, urinary tract infections); - hemosiderosis; - hemosiderosis; - malignancies. - malignancies.

70. Mineral Salts – Iron Prevention of iron deficiency anemia Antenatal (maternal) prophylaxis: - mother's diet (green vegetables and fruits, eggs, meat); - systematic control of hemoglobin (Hb) of V-VI months of pregnancy; - administration of iron preparations in the last trimester of pregnancy.

71. Mineral Salts – Iron Prevention of iron deficiency anemia After birth (infant) prophylaxis: -late umbilical cord ligation after the cessation of its pulsations (ensures the transfer of 40-60 mg iron); - early and prolonged breast feeding; - diversification of food (at 4 - 4 1 / 2 months for infants fed standard formula or cow's milk, from 5-6 months for those breas/bottlefed) with vegetable soup, meat, liver, egg yolk, green vegetables, cereals fortified with Fe; -late umbilical cord ligation after the cessation of its pulsations (ensures the transfer of 40-60 mg iron); - early and prolonged breast feeding; - diversification of food (at 4 - 4 1 / 2 months for infants fed standard formula or cow's milk, from 5-6 months for those breas/bottlefed) with vegetable soup, meat, liver, egg yolk, green vegetables, cereals fortified with Fe;

72. Mineral Salts – Iron Prevention of iron deficiency anemia After birth (infant) prophylaxis: - additional 1-2 mg Fe + + / kg / day to 6-8 weeks to a year to premature twins, SGA, maternal hemorrhage at birth, digestive disorders, recurrent infections, children with high growth; - systematic prophylaxis with 10 to 25 mg Fe / day (or 1-2 mg / kg) for all term infants with normal weight at 6 months (for at least 3 months). - systematic prophylaxis with 10 to 25 mg Fe / day (or 1-2 mg / kg) for all term infants with normal weight at 6 months (for at least 3 months).

73. Mineral Salts Magnesium intracellular cation, Roles: - decreases the excitability of the neuro-muscular - reduces myocardial excitability and conduction - vascular trophic action - the elements of the blood physiology - to bone - favoring the action of vitamin D and bone matrix formation, ossification stimulates collagen - stimulates the formation of Ig, serum complement and phagocytosis.

74. Mineral Salts Magnesium Sources: meat, milk, nuts, peas. Deficit → hypomagnesemia: - convulsions, - osteoporosis - diarrhea, - E.K.G. changes, - resistance to the action of vitamin D. Excess: increased drug intake - rarely (compensatory mechanisms occur: diarrhea and magnesiuria).

75. Trace - elements Zinc Roles: - synthesis of amino acids, lecithin and surfactant; - promotes membrane glucose transport, adipocytes, and its use by the cellular response to insulin; - prolongs the action of insulin; - stimulates pituitary gonadotropin, GH hormone, androgen.

76. Trace - elements Zinc Roles: - surgical wound healing and burns stimulating collagen synthesis and fibroblast proliferation; - adjusting the sense of smell and taste; - adjusting the sense of smell and taste; - night vision (maintain plasma vit. A). Sources: meat, liver, fish, milk, egg yolk, cereals, water. - night vision (maintain plasma vit. A). Sources: meat, liver, fish, milk, egg yolk, cereals, water.

77. Trace elements Zinc Deficit: - hypogonadal dwarfism - anorexia, - hipoosmie - alopecia, keratitis, skin ulceration - delayed skeletal ossification - mental slowness, - iron deficiency anemia. Excess: - keeping food in galvanized vases - drinking water consumption of zinc pots.

78. Trace - elements Iodine essential in the synthesis of thyroid hormones. Sources: fish, vegetables, nuts, iodized salt. The recommended intake of iodine supplementation: - during pregnancy - lactating women. essential in the synthesis of thyroid hormones. Sources: fish, vegetables, nuts, iodized salt. The recommended intake of iodine supplementation: - during pregnancy - lactating women.

79. Trace - elements Fluorine Roles: - the skeletal structure, enamel - in preventing tooth decay. Supplementing the diet of pregnant women in the fetus increases its content. Sources: foods of plant origin, animal, water. Deficit → cavities. Excess → fluorosis (damage to tooth enamel).

80. Trace - elements Selenium Roles: - the structure of cell membranes, mitochondria, microsomes and lisosomes - stimulates growth - promotes IgM synthesis - absorption of vitamin E - the Krebs cycle - in heme catabolism. Sources: meat, kidney, saltwater fish, milk, cereals and mushrooms.

81. Trace - elements Selenium Deficit: - hemolysis - cardiomyopathy - ↑ incidence of breast cancer and digestive tract. Chronic excess: - photodermatosis - alopecia - trophic nail disorders - respiratory and liver chronic disorders

82. VITAMINS essential cofactors in a variety of metabolic pathways essential cofactors in a variety of metabolic pathways Classification: - fat soluble - water soluble. Needs vary with age and / or existence of disease. Additional Compulsory vitamin D early in life; vitamin K (K 1 ) in the newborn, 1 mg IM.

83. VITAMINS Dietary sources of fat-soluble vitamins: Vit. A (retinol): fortified milk, eggs, liver, butter, carrots, cabbage Vit. A (retinol): fortified milk, eggs, liver, butter, carrots, cabbage Vit. D: fortified milk, fish, egg yolk Vit. D: fortified milk, fish, egg yolk Vit. E: oil seeds / grains, nuts, beans, soybeans, green leafy vegetables Vit. E: oil seeds / grains, nuts, beans, soybeans, green leafy vegetables Vit. K: cow's milk, green leafy vegetables, liver, vegetable oils Vit. K: cow's milk, green leafy vegetables, liver, vegetable oils

84. VITAMINS Food sources of water soluble vitamins: Vit. B 1 (thiamin): milk, meat, cereals, legumes Vit. B 2 (riboflavin): milk, meat, eggs, green vegetables, cereals Vit. B 2 (riboflavin): milk, meat, eggs, green vegetables, cereals Vit. B 3 (niacin, nicotinamide, PP): meat, fish, milk, green vegetables, whole grains Vit. B 3 (niacin, nicotinamide, PP): meat, fish, milk, green vegetables, whole grains Vit. B 5 (pantothenic acid): meat, milk, eggs, vegetables, whole grains Vit. B 5 (pantothenic acid): meat, milk, eggs, vegetables, whole grains

85. VITAMINS Food sources of water soluble vitamins: Vit. B 6 (pyridoxine): meat, liver, milk, whole grains, soybeans Vit. B 8 (biotin): liver, egg yolk, peanuts Vit. B 8 (biotin): liver, egg yolk, peanuts Vit. B 9 (folic acid / folate): green leafy vegetables, cereals, liver, nuts Vit. B 9 (folic acid / folate): green leafy vegetables, cereals, liver, nuts Vit. B 12 (cobalamin): milk, meat, eggs Vit. B 12 (cobalamin): milk, meat, eggs Vit. C (ascorbic acid): citrus, tomatoes, cabbage Vit. C (ascorbic acid): citrus, tomatoes, cabbage

86. VITAMIN D Sources: exogenous, provided by food: - animal (vitamin D 3 - cholecalciferol) - vegetable (vitamin D 2 - ergocalciferol) endogenous: cutaneous precursor of vitamin D (7- dehydrocholesterol) + UV → cholecalciferol (vitamin D 3 ), metabolized in the liver.

87. VITAMIN D In the first two years of life requires daily administration of vitamin D is rickets prevention. The main causes of increased prevalence of rickets: - incorrect or incomplete implementation of prevention with vitamin D; - waiver of prophylaxis with vitamin D after age 1 year; - sufficient sunshine; - high degree of pollution; - unbalanced diet, especially excess flour;

88. Prevention of rickets Antenatal prophylaxis - in the last trimester of pregnancy: Vitamin D: 1000 - 2000 IU daily orally or 4000 - 5 000 IU per week per os or 200 000 IU orally at the beginning of the seventh month of pregnancy. calcium 1-2 g / day, 10 days per month, per os. Vit D not be administered parenteral (may cause fetal aortic stenosis). calcium 1-2 g / day, 10 days per month, per os. Vit D not be administered parenteral (may cause fetal aortic stenosis).

89. Prevention of rickets Postnatal prevention(fractional, physiological, modern) from the 7th-10th day of life by 18 - 24 months daily vitamin D, 400-800 IU / day (~ 500 IU / day) per os. After the age of two years - from September to late April: from the 7th-10th day of life by 18 - 24 months daily vitamin D, 400-800 IU / day (~ 500 IU / day) per os. After the age of two years - from September to late April: Vitamin D - 500 IU / day, daily Vit.A + D 2 - 4000 - 5 000 IU, orally, at 7-10 days. Vitamin D - 500 IU / day, daily Vit.A + D 2 - 4000 - 5 000 IU, orally, at 7-10 days.

90. Prevention of rickets Only fractional administration of vitamin D is physiological because: - it ensures a good, especially if taken with a meal; - transport system is not required nor the activation of vit. D; - target organs are not subject to adjustment jumps; - there is no danger of intoxication. - it ensures a good, especially if taken with a meal; - transport system is not required nor the activation of vit. D; - target organs are not subject to adjustment jumps; - there is no danger of intoxication.

91. Prevention of rickets Higher doses of vitamin D (2000 IU / day): - children with low birth weight / premature - children with pigmented skin - children receiving chronic anticonvulsant / with corticosteroids. There is no need to take calcium when feeding baby milk contains less than 500 ml / day.

92. Prevention of rickets Supplementation with calcium intake: - pregnant in last trimester of pregnancy - premature - children receiving < 500 ml milk per day. Dose: 50mg/kg/day elemental calcium.

93. Recommended dietary vitamins intake VITAMINS InfantToddler Vitamin A 1000 UI/day 2000 UI/ day Vitamin D 400-800 UI/ day 400-500 UI/ day Vitamin E 3-5 mg/ day 5-10 mg/ day Vitamin K 5 µg/ day 5-65 µg/ day Vitamin B 1 0.30-0,50 mg/ day 1-2 mg/ day Vitamin B 2 0,40-0,60 mg/ day 1 mg/ day Vitamin B 3 6-8 mg/ day 10-20 mg/ day

94. Recommended dietary vitamins intake VITAMINS InfantToddler Vitamin B 5 2-3 mg/day 5-7 mg/day Vitamin B 6 0,30-0,50 mg/day 1-2 mg/day Vitamin B 8 1 mg/day 2 mg/day Vitamin B 9 20-50 µg/day 75-200 µg/day Vitamin B 12 0,50-2 µg/day 2 µg/day Vitamin C 30-50 mg/day 50-60 mg/day