1. Lecture The role of nutrition in maintaining and enhancing health.

2. Energy is used continuously in the body and is fundamental to physiologic processes. Requirements of individuals vary in relation to a wide variety of factors, making energy metabolism an issue of great importance to the pediatrician.

3. 3 Metabolism Metabolism: all chemical reactions occurring in an organism Anabolism: chemical reactions that expend energy to make new chemical bonds Catabolism: chemical reactions that harvest energy when bonds are broken

5. Nutrition is a science that deals with the relation of food substance to living things. In the study of nutrition, the following items must be considered: a)bodily requirement for various substances; b)function in body; c)amount needed; d)level below which poor health results.

6. Feeding a Healthy Young Child

7. Planning Children’s Meals

8. A complete diet must supply the elements; carbon, hydrogen, oxygen, nitrogen, phosphorus, sulfur, and at least 18 other inorganic elements. The major elements are supplied in carbohydrates, lipids, and protein. In addition, at least 17 vitamins and water are necessary. If an essential nutrient is omitted from the diet, certain deficiency symptoms appear.

9. Children normally need a certain number of calories each day (energy allowance) that their bodies use as energy for normal daily activities (walking, breathing, etc.). This ranges for boys from 2000 calories for a 7-10 year old, 2500 calories for an 11-14 year old, 3000 calories for a 15-18 year old.

10. For girls the ranges are from 2000 calories for a 7-10 year old, to 2200 calories for an 11-18 year old. These are only estimates and some children need more (fast metabolism) or less (slow metabolism) of an energy allowance for daily activities.

11. Metabolism will be studied in various parts. Interrelationships will be pointed out as they are encountered. Just as there are three basic biomolecules - carbohydrates, lipids, and proteins, the metabolism of each of these will be studied individually.

12. Techniques are available for short- and long-term measurements of energy expenditure, which serve different purposes. The principal techniques are suitable for the age range from birth to adolescence. The theory of energy metabolism is briefly discussed, including a summary of the different working definitions. The principles and practicalities of classical indirect calorimetry, the doubly labeled water method, the bicarbonate method, and heart rate monitoring are then described.

13. Protein A protein is a complex high molecular weight organic compound consists of amino acids joined by peptide bonds.

14. Protein Makes up cell structure Makes up cell structure Helps develop, repair, and maintain tissues Helps develop, repair, and maintain tissues Produces hemoglobin, enzymes, and many hormones Produces hemoglobin, enzymes, and many hormones Maintains normal blood osmotic pressure Forms antibodies Forms antibodies Can be energy source Can be energy source Breaks down into amino acids to be used Breaks down into amino acids to be used by the body

15. In human nutritional needs, proteins come in two forms: complete proteins contain all eight of EAA that humans cannot produce themselves, all meat and other animal products are sources include beef, lamb, pork, poultry, fish, shellfish, eggs, milk, and milk products complete proteins incomplete proteins incomplete proteins lack or contain only a very small proportion of one or more EAA Protein in foods (such as grains, fruits, and vegetables) are either low, are considered incomplete proteins

16. HEMOGOLBIN The hemoglobin molecule consists of the protein globin which is composed of four subunit polypeptide chains (2 alpha and 2 beta), each of which contains a single heme group with its single iron atom for the transport of oxygen.

17. MYOGLOBIN

18. 20 AMINO ACIDS

19. PROTEIN METABOLISM

20. Proteins have a variety of structures so have a variety of functions in the body. enzymes, many hormones, antibodies, hemoglobin, cytochromes, support (collagen), movement (actin,myosin) Amino acids form hormones, neurotransmitters. Thyroxine, epinephrine, dopamine (from tyrosine)

21. Amino acids can be a source of energy. Dietary proteins contain about the same amount of energy per gram as carbohydrates. Dietary proteins contain about the same amount of energy per gram as carbohydrates. the non-nitrogen part of amino acids can be oxidised directly in cell respiration or after conversion to ketone bodies. the non-nitrogen part of amino acids can be oxidised directly in cell respiration or after conversion to ketone bodies. Normally about 12% of our daily energy needs come from amino acids. Normally about 12% of our daily energy needs come from amino acids. Excessive use of amino acids for energy causes a deficiency of tissue proteins and an excess of ketone bodies. Excessive use of amino acids for energy causes a deficiency of tissue proteins and an excess of ketone bodies.

22. Dietary Protein, Amino Acid Pool & Metabolic Pathways Unlike carbohydrate or fat there is no specific storage depot for proteins or amino acids. Instead the amino acid pool of the blood plasma acts as a reservoir which each tissue can draw upon. Each tissue makes those specific proteins which it needs, controlled by the active genes in that tissue.

23. The liver is the major organ involved in protein metabolism especially for deamination, urea synthesis and gluconeogenesis A normal diet should contain sufficient protein for metabolic needs Complete proteins with 9 essential amino acids which the body cannot synthesize, e.g. phenylalanine. Most plant proteins are incomplete

24. Metabolic Pathways of Proteins & Amino Acids

26. Protein & Amino Acid Anabolism PROTEIN SYNTHESIS occurs on ribosomes in every cell and is stimulated by Anabolic Hormones PROTEIN SYNTHESIS occurs on ribosomes in every cell and is stimulated by Anabolic Hormones - Insulin-like Growth Factor(IGF) - Thyroxine (in growing children) - Insulin - Estrogen & Testosterone Weight-bearing exercise causes Weight-bearing exercise causes anabolism & growth of muscle. Non essential amino acids can be synthesized by TRANSAMINATION (transfer of an amino group to a keto acid to create an amino acid).

27. Answers for Metabolic Pathways 1. GLYCOLYSIS 2. KREBS (TCA) CYCLE 3. OXIDATIVE PHOSPHORYLATION 4. GLYCOGENOLYSIS 5. GLYCOGENESIS 6. GLUCONEOGENESIS 7. LIPOLYSIS (LIPID MOBILISATION) 8. LIPOGENESIS 9. PROTEIN HYDROLYSIS (PROTEIN MOBILISATION) 10. PROTEIN SYNTHESIS 11. BETA OXIDATION 12. KETOGENESIS 13. DEAMINATION

28. RECOMMENDED NUTRITIONAL INTAKECOMPOSITION 55% to 65% Carbohydrate 25% to 30% Fat 10% to 15% Protein

29. SOME CONCLUSIONS ABOUT PROTEIN Dietary supplementation of protein beyond that necessary to maintain nitrogen balance does not provide additional ergogenic benefit. Dietary supplementation of protein beyond that necessary to maintain nitrogen balance does not provide additional ergogenic benefit. Ingesting carbohydrate/protein prior to exercise may reduce catabolism whereas ingesting carbohydrate / protein following exercise may promote glycogen resynthesis, a more anabolic hormonal environment, and recovery. The extent to which these strategies affect training adaptations is unknown.

30. Ergogenic Properties of Protein Builds fat-free muscle mass. Builds fat-free muscle mass. Strength athletes need 1.4 to 1.8 g per kg body weight. Strength athletes need 1.4 to 1.8 g per kg body weight. Endurance athletes need 1.2 to 1.4 g per kg body weight. Endurance athletes need 1.2 to 1.4 g per kg body weight. Diets exceeding 1.8 to 2.0 g per kg body weight per day have not been proven to provide additional benefits and may damage kidney function. Diets exceeding 1.8 to 2.0 g per kg body weight per day have not been proven to provide additional benefits and may damage kidney function.

31. Protein deficiency can lead to symptoms such as fatigue, insulin resistance, hair loss, loss of hair pigment, loss of muscle mass, low body temperature, and hormonal irregularities. Severe protein deficiency is fatal.

32. Protein-energy malnutrition (PEM) contains 3 forms. kwashiorkor (KW), marasmus marasmic KW PEM represent a group of pathologic conditions associated with a nutritional and energy deficit occurring mainly in young children from developing countries at the time of weaning. frequently associated with infections, mainly gastrointestinal infections.

33. Kwashiorkor occurs in areas of famine, limited food supply and low levels of education lead to inadequate knowledge of proper diet. Early symptoms are fatigue, irritability, and lethargy. As protein deprivation continues, growth failure, loss of muscle mass, generalized swelling (edema), decreased immunity occur. A large, protuberant belly is common. Skin conditions (such as dermatitis, changes in pigmentation, thinning of hair, and vitiligo) are seen frequently. Shock and coma precede death.

34. protuberant belly

35. loss of hair pigment

36. swelling (edema)

37. 6 个月大 ，出生时有 8 斤半。由于母乳少，出生几天就给孩子 冲奶粉食用，两个月后，体重是 14 斤, 现在却仅有 12 斤。乌黑 的头发也渐渐稀疏变黄再变白 。 Skin pigmentation

38. Marasmus resulting from an insufficient nutritional intake associated with acute conditions (gastroenteritis) or chronic conditions (eg, tuberculosis, HIV infection). Marasmus results from a negative energy balance. a decreased energy intake increased energy expenditure, or both, Children adapt to an energy deficit with a decrease in physical activity, lethargy, a decrease in basal energy metabolism, slowing of growth, and finally weight loss. Pathophysiological changes associated with nutritional and energy deficits can be described as (1) body composition changes, (2) metabolic changes, and (3) anatomic changes.

39. Body composition Body mass: Body mass is significantly decreased Fat stores can decrease to as low as 5% of the body weight and be macroscopically undetectable. The remaining fat is usually stored in the liver body water: The proportion of water increases proportion of extracellular water also increases resulting in edema. protein mass can decrease up to 30% The muscle fibers are thin, Muscle cells are atrophic

40. Other organ mass: The brain, skeleton, and kidney are preserved, whereas the liver, heart, pancreas, and digestive tract are first affected.

41. This is typically a disease of impoverished countries, because of drought or political turmoil. Improving calorie and protein intake will correct it treatment is not started too late. Full height and growth potential will never be achieved in children Severe kwashiorkor may leave a child with permanent mental and physical disabilities.

42. Monkey face

45. Excess protein can cause problems as well, such as causing the immune system to overreact, liver dysfunction from increased toxic residues, bone loss due to increased acidity in the blood diet high in meat could lead to high cholesterol or other diseases, such as gout. Another potential problem is that may put a strain on the kidneys. Side Effects

46. Carbohydrate balance in children. Lipid balance in children.

47. Milk and sour milk products Milk is one of the most valuable products of feed. It has all necessary substances for normal growth and development of organism. Milk has near 100 different components, and near 20 amino acids. Milk fat has a lot of high insatiable fat acids, vitamins. It is in emulsification case. Milk has cholesterol and lecetin, which are in good balance condition. In milk present milk sugar – lactose, which help mastering of calcium. Milk has different mineral substances, the optimal concentration of calcium and phosphorus. In milk present vitamins A, D, B2, B6. Sour milk products are cream, sour cream, cheese, yoghurt. It is mastering better than milk (after one hour mastering 91 % of sour milk products and only 32 % of milk).

48. Milk and sour milk products

49. Meat and meat products In food use meet of cattle, live-stock, pigs, rabbits, birds, meat products. It is the main source of proteins, it has fats, extractive and mineral substances, vitamins. Boiled meat has a better effect on digestive organs than grilled and stew. Veal, beef, rabbit, chicken, turkey digestive better than meat from pig, goose, duck.

50. Meat

51. Meat

52. Grain products (grain, bread) Cereals make from grain-crops. It has a lot of carbohydrates, some quantity of proteins, and small quantity of fats. Cereals has phosphor and calcium, iron, magnesium, vitamins of B group. There are rise, oats, millet, buckwheat, barley cereals. Bread has 40-50 % of carbohydrates, 5- 8 % of protein. In bread are present proteins. Brown bread has more influence on stomach secretion than white bread; fresh bread has more influence on stomach secretion than stale bread and piece of dried bread.

53. Grain products

54. Vegetables, fruits and small fruits (berries) Vegetables is the main source of carbohydrates in a case of sugar, starch, pectin. In carrot is present near 6 % of carbohydrates, in beetroot present near 8 % of carbohydrates. There is 75-95 % of water in vegetables. Vitamins and mineral substances are present in a big quantity in vegetables too. Vegetables stimulated stomach secretion, motor function of digestive tract, production of bile. It is help to mastering proteins, fats, carbohydrates and vitamins. Fruits and small fruits (berries) have a lot of vitamins, mineral salts. There are near 85 % of water in fruits and small fruits (berries). It has organic substances, pectin.

55. Berries

56. Berries

57. Proteins contains

58. Acquiring of food Mastering of food is a ratio between quantity of nutrition which are master by organism to common quantity of food which we eat. Near 95 % of animal products are mastering, near 80 % of plant products are mastering, near 82-90 % of mix products are mastering. Mastering of protein from animal products is 97 %, from plant is 85 %, and from mix food is 92 %. Food must be good chew; it must be good surrounding condition for eating.

59. Isodynamic of nutritious substances, their caloric coefficient We eat protein, carbohydrates, fats. Products of it hydrolyzing go into energy of organism. Amino acids, fat acids, monosaccharides connect in energy metabolism. It all has own energy value. Caloric coefficient of fat is 9,0 kcal/g, protein is 4,0 kcal/g, carbohydrates is 3,75 kcal/g. But we must remember, that we must eat fats, protein, carbohydrates, because in this case, when we eat only one products, may be only energy substitution and our organism need all nutrition for vital activity.

60. Principles of putting of nutritive rations Caloricity of daily ration must be equal to energy spend of organism. Person of I professional group need 40 kcal/kg of weight; person of II professional group need 43 kcal/kg of weight; person of III professional group need 46 kcal/kg of weight; person of IV professional group need 53 kcal/kg of weight; person of V professional group need 61 kcal/kg of weight.

61. Regime of nutrition If we eat 4 times per day: breakfast must have 25-30 % of daily caloricity, lunch (after dinner eating) or before supper eating must have 10-15 %, dinner must have 40-45 % daily caloricity, supper must have 20 % of daily caloricity. If we eat 3 times per day: breakfast must have 30 % of daily caloricity, dinner must have 45-50 % daily caloricity, and supper must have 20-25 % of daily caloricity. Time between breakfast and dinner must be to 5-6 hours; time between dinner and supper must be 6-7 hours. Optimal duration between eating is 4-5 hours, at night is 8-10 hours.

62. Completeness and coordinateness of ration Our food must have optimal ratio of protein, fats, carbohydrates, vitamins, mineral substances. Optimal norm of protein is 1,5 g/kg of weigh per day. Protein must give 14-15 % of daily caloricity. Optimal norm of fat is 1,5 g/kg of weigh per day. Fat must give 28-30 % of daily caloricity. Average norm of carbohydrates is 400- 500 gram per day. They provide 50-60 % of daily caloricity. Ratio of protein : fat : carbohydrates is 1 : 0,8 : 3 or 1 : 1 : 4 for peoples, which has high mental activity; 1 : 1 : 5 for peoples with physical activity.

63. Individual-physiologic peculiarities of organism into consideration Breakfast must begin from salad, which activate digestive secretion. Then must be food with the main source of energy and nutrition's, on the end must be tonic drink (tea, coffee, cacao). Dinner must begin from salad (when you have less of appetite). We must remember than dinner does not begin from food, which decrease stomach secretion. Supper must consist food which good digest (fish, milk, and eggs), drinks, which do not stimulate central nerve system.