Nutrition

INTRODUCTION
• Balanced and sufficient nutritional intake is
most essential for children to promote optimal
growth and development, to protect and
maintain health, to prevent nutritional
deficiency conditions and various illnesses and
to reserve for starvation and dietary stress.
The word nutrition is derived from the word
'nutricus' which means to suckle at the breast.

DEFINITION
• Nutrition is defined as combination of
dynamic process by which the consumed food
is utilized for nourishment and structural and
functional efficiency of every cell of the body.
It is the science of food and its relationship to
health.

• The term 'food' refers to anything which
nourishes the body. It includes solids,
semisolids and liquids which can be consumed
and which help to sustain the body and keep it
healthy.

• Food and nutrition are different and having
different meaning, Food is defined as what
one feeds on and is a composite mixture of
many nutrient substances ranging from a
fraction of a gram in some cases to hundred of
grams in others. Food stuff is defined as
anything which can be used for food

NUTRITIONAL REQUIREMENTS IN
CHILDREN
Nutritional requirements may vary from one
individual others and depends upon metabolic
and genetic difference No single food meets
all the essential requirements for children
except mother's milk, which provides all
nutritional substances to the infant till 6
months of age.

• After wards healthy dietary habits depend
upon cultural and influence and contribute to
personal and social enjoyment So, to fulfil the
nutritional requirements, child's diet should
be planned by the parents and family
members with different types of food items to
provide balanced and nutritious diet.

• The child's diet should contain sufficient
amount of fluids calories, protein fats,
carbohydrates, vitamins, minerals and salts to
meet their daily nutritional needs. Food items
should be digestible, palatable, attractive,
choiceable and easily available.

• Nutritional requirements should be
maintained with margin of safety and with
right balance. A deficit or excess in nutrients
could be harmful and should be avoided. The
'recommended daily intake' of nutrients with
sufficient amounts to be provided to maintain
needs of the body and good health,

Water
Water is most important for maintenance of life. It
constitutes about 70% of body weight in children.
The total water content of the body is
comparatively higher in infants than in adults.
Water is required for digestion, metabolism, renal
excretion temperature regulation, transportation
of cellular substances, maintenance of fluid
volume and growth of children.

• The daily requirement of water is fulfilled by
fluid intake, food and oxidation processes in
the body. Water is absorbed throughout the
intestinal tract. The balance of water depends
on the protein & electrolyte intake, solute
load, metabolic and respiratory rates and
body temperature. Evaporation from the lungs
& skin accounts for 40 to 50 % water loss & 3
to 10% by fecal loss.

• The water and electrolyte balance by varying
amount and concentration of urine. Excess
loss of water can cause dehydration whereas
an excess intake can result in water
intoxication. Loss of water or dehydration is an
important cause of death in children even
than starvation. Water intoxication may found
as edema, circulatory failure, abdominal
distress or convulsions.

• Calories
The energy value of foods is measured in terms of
'large' calorie or kilocalorie. The production of
energy varies during the oxidation of different
foods. Children required more calories per kg of
body weight than adults. Calorie requirements
gradually decrease from infancy to adulthood.
The average energy expenditure is 50% in basal
metabolism 12% in growth, 25% for physical
activity, 8% in fecal loss and 5% for specific
dynamic action.

• The calorie requirements of children depend
upon body size and surface area, rate of
growth, level of physical activity, food habits
and climate. In a balanced diet, 50% of
calories is provided by carbohydrates, 15% by
proteins and 35% by fat. Deficiency of calorie
intake leads to loss of weight, growth failure
and protein-energy malnutrition. An excess
intake of calorie results in increased weight
gain and obesity.

• Proteins
Proteins are essential for synthesis of body
tissues in growth, and during maintenance
and repair. They help in the formation of
digestive juices, hormones, plasma proteins,
enzymes, hemoglobin and immunoglobulins.
They are needed for maintenance of osmotic
pressure and acid base equilibrium.

• Proteins also act as source of energy, when
the calorie intake is inadequate. Excess
proteins, which are not used for building
tissues or providing energy, converted by the
liver into fat and stored in body tissues.

• Proteins are made up of simpler substances
called amino acids. There are 24 amino acids
to be needed by the human body, of which '9'
are called essential amino acids, because the
body cannot synthesize them in amounts of
their need and therefore must be supplied in
the diet.

• Both essential and nonessential amino acids
are required for synthesis of tissue proteins.
Proteins are obtained from two main dietary
sources, i.e. animal origin and vegetable
origin. Proteins of animal sources are
biologically complete protein with all essential
amino acids and more easily digestible.

• Proteins of vegetable sources are incomplete
and lack of one or more amino acids. The
combination of vegetable proteins may
provide all the essential amino acids. This is
the reason that vegetarian diet should have
mixing of 3 to 4 types of pulses or
combination of wheat and legumes.

• Protein requirements depend upon the age,
sex, physical and physiological factors. It is
found maximum in neonates and early infancy
but gradually decreases as age increases. Extra
amount of protein should be provided during
illness to compensate the destruction or
degeneration of body tissue, e.g. in blood loss,
surgery, etc.

• Deficiency of protein intake in food results in
growth failure and protein-energy
malnutrition.

• Carbohydrates
Carbohydrates are main source of energy and
supply bulk in the diet. They contribute taste
and texture of foods. They are digestion and
absorption of other foods. carbohydrate
intake in diet allows the use of protein for
tissue synthesis, otherwise protein is also used
for energy production and fat is metabolized
with production of ketone bodies.

• Excess carbohydrates are stored in the liver
and muscle. Carbohydrates play an important
part in infant nutrition as they spare proteins
to be fully utilized for growth and various
repair processes. Carbohydrates are
consumed as monosaccharides (glucose,
fructose, galactose), disaccharides (lactose,
sucrose, maltose, isomaltose) and
polysaccharides (starch, dextrin, glycogen,
gum, fibers, cellulose).

• All carbohydrates are ultimately oxidized and
converts to glucose. Glucose is used as fuel by
brain and muscle or converted to glycogen
and stored in liver and muscle. Excess
carbohydrates are converted to fat. The source
of carbohydrate of infant's diet is in the form
of lactose found in both human and cow's
milk that should be provided up to 6 months.

• Afterwards cereals, legumes, fruits, tubers,
pulses and vegetables are the main sources.
Lack of adequate carbohydrate intake may
produce symptoms of starvation, under
nutrition, constipation, fatigue, loss of body
protein, ketosis, depression and carbohydrate
malnutrition. Excess carbohydrate to obesity,
,ischemic heart disease etc .

• Fat
Fat supplies 40 to 50% energy needed for
infant. It provides protection and support for
organs and insulation of the body as adipose
tissue. It acts as carriers of fat-soluble vitamins
and components of cells and tissue. Fats and
oils are concentrated sources of energy and
make the foods palatable. Fats and oils are
termed as lipids.

• Lipids are classified as simple, compound and
derived. Simple lipids are monoglycerides,
diglycerides and triglycerides, which are
combination of glycerol and fatty acids.
Compound lipids are combination of simple
lipids with nonlipid substance such as
glycolipids, phospholipids and lipoproteins.

• Fats are available from both animal and vegetable
sources. About 98% of neutral fats are
triglycerides and other 2% include free fatty
acids, monoglycerides, diglycerides, cholesterol
and phospholipids. Fatty acids are divided into
saturated and unsaturated fatty acids, which are
further divided in monounsaturated and
polyunsaturated fatty acids. Polyunsaturated fatty
acids are mostly available in vegetable oils and
the saturated fatty acids available in the animal
oils.

• Exceptionally, fish oils contain poly and
monounsaturated fatty acids whereas coconut
and palm oils have extremely high percentage
of saturated fatty acids. Essential fatty acids
are those that cannot be synthesized in the
human body and should be derived only from
food. The most essential fatty acid is linoleic
acid, which is abundantly available in
vegetable oils.

• It helps in maintenance of good health.
Saturated fat should not be more than 10% of
total fat intake. More fat intake in diet may
results in indigestion as it remains longer in
the stomach.

• Excess fat intake leads to excess accumulation
of adipose tissue, obesity, NIDDM, cancer,
atherosclerosis and hypertension. Deficiency
of all essential fatty acids may result in growth
retardation and skin disorders, susceptibility
to infections, neurological and visual problems
and decreased myocardial contractility. The
ICMR has recommended a daily fat intake of
25 g/ day in young children and 22g / day in
older children.

• Vitamins
Vitamins are organic substances and essential
micronutrients for maintenance of normal health. They
are available in many foods in small amounts. .
Balanced diet supplies all the vitamins needed for a
healthy individual. Vitamins act as cofactor in many
enzyme systems and essential for energy production,
hemopoiesis, reproduction, neurological functions,
hydroxylation and synthesis of fats, amino acids,
nucleic acids and nucleoprotein. They enable the body
to use other nutrients and help in maintenance and
protection of good health.

• Vitamins are classified into two groups, i.e.
fat-soluble and water-soluble vitamins. Fat-
soluble vitamins are linA, D E and K. They are
stored in body fat and needed only in minimal
amount in daily diet. Excess intake of these
may produce toxic effects. The water-soluble
vitamins are vitamin B and C. They are not
stored in the body and required in adequate
amount in daily diet to prevent deficiency
conditions.

• Water soluble vitamins are easily destroyed
during food processing, preparation and
storage. Each vitamin has a specific function to
perform and deficiency of any particular
vitamin may result in specific deficiency

• Many factors are responsible for the vitamin
deficiency conditions. They include poor
dietary intake, faulty absorption, increased
loss in chronic diarrhea, greater demand
during fever, infections and metabolic diseases
and poor utilization in chronic liver diseases.

• Vitamin requirements are more in preterm
babies. Infants get adequate vitamins from
mother during lactation. Dietary intake of
vitamins may be low or marginal during
infancy and childhood. The minimum intake
for the maintenance of health in respect of
many of the vitamins has been determined.

• Minerals
Minerals are inorganic elements, required by
human body for growth, repair and
regulations of vital body functions. They act as
catalysts in biochemical reactions. More than
50 minerals are found in the human body, all
of which must be derived from foods. A well-
balanced diet supplies sufficient quantities of
minerals.

• Minerals are required for maintenance of
osmotic pressure, supply of necessary
electrolytes for the actions of muscles and
nerves and for hemopoiesis. Minerals are
classified as macrominerals when the daily
requirement is 100 mg or more and as
microminerals when less than 100 mg is
required daily.

• Macrominerals are calcium, phosphorus,
sodium, potassium and magnesium.
Microminerals or trace elements required by
the body in quantities of less than few mg per
day and include iron, iodine, fluorine, zinc,
copper, cobalt etc

• Minerals deficiencies are less among
vegetarians than nonvegetarians. Adequate
amount of protein in daily diet prevents
minerals deficiencies.

Conclusion
• The health and nutritional status of an infant and
subsequent growth and development through
childhood depend upon successful feeding
practices. The socioeconomic status and
education of the mother and family members
have been known to influence child's feeding
behavior. Nutritional counseling is the important
responsibility of the nurse to promote the
nutritional status of the children and to prevent
nutritional deficiency diseases.