INTRODUCTION

Dr Nicola Flynn
• Research Associate Under Dr Dilip Mahalanabis Society for applied
studies, Salt Lake Kolkata.
• Consultant Pediatrician & Neonatologist, Ruby General Hospital,
Kolkata.
Nutrition In
C i d
h l e
r n
 Child’s Health and Future

• Children, our future, form

one third of our population.
• Growth is the best global
indicator of children’s well-
being.
• Adequate food intake is
essential for proper growth.
• Low food intake can affect
their physical and mental
growth.

Impaired growth and development in children can affect the

rest of their lives
 Malnutrition and Child
According to WHO and UNICEF estimates, 60% of child deaths are
malnutrition associated.

• Asia has largest number of

malnourished children
• India accounts for 40% of
malnourished children in
the world
• UNICEF estimates that
malnutrition affects
physical and mental
function of 2 billion
children.
1 in 3 of the world's malnourished children lives in India1
 Child and Physical Development

• Rapid growth happens

between infancy and
adolescence
Boys
Girls

• Nutrition is vital during the

growth phase

• Inadequate nutrition affects

growth and muscle
development
 Child and Mental Development
Brain Growth Across the Years

10
80

%of Brain dev lopm ent

60
40
20
0
2 5wks3 0wks3 5wks4Timep 0wkseriod 1yr5 yrs

10
80
%of Brain dev lopm ent

60
40
20
0
2 5wks3 0wks3 5wks4Timep eriod0wks 1yr5 yrs

Critical Periods for Brain Growth

Factors that Affect Child Growth
 Nutrition and Child Development

Nutritional status of children during the critical period

is of paramount importance for later physical, mental &
social development.

Outcomes of inadequate diet

• Poor growth
• Poor cognition
• Poor muscle development
• Reduced work capacity
• Poor social development
• High rates of illness
• Difficulty in school
Nutrient Requirements of Young Children is
Manifolds of Adult Requirements

Nutritional requirement of preschoolers

Reference: Nutrient requirement and RDA for Indians , ICMR , 1990

 Gaps in Mean Intake of Nutrients amongst
Children in India

30

Graph depicting the micronutrient intake of Indian children (Boys and girls) in the age group of 7–15
years as compared to 100% RDA as per NNMB 1996 Data. (RDA marked as dotted line)

Micronutrient deficiencies represent a hidden form of hunger with severe

consequences on physical growth, immune functions, cognition and productivity
 Nutrients

Macronutrients Micronutrients

carbohydrates Proteins Fats Minerals Vitamins

Monosaccharide Complete Saturated Fat soluble

proteins vitamins

Disaccharide Water
Incomplete
proteins Soluble
Unsaturated Vitamins

Poly Unsaturated
Polysaccharide

Mono Unsaturated
 Deficiency of Nutrients and Physical
Development
Micronutrient Effects
Deficiency
Vitamin D and Deficiency affects bone
calcium development
Potassium, zinc, Deficiency disturbs the growth
magnesium and copper hormones and affect growth
Manganese Deficiency leads to skeletal
abnormalities including retarded
growth
Vitamin E Deficiency affects muscle
development
 Deficiency of Nutrients and Mental
Development
Micronutrient Deficiency manifestations

• Reduction of the brain content of neurotransmitters.

Vitamin B1
• Reduced levels of brain GABA, glutamate and aspartate

• Impaired performance on psychomotor tests, neuromotor

Vitamin B2
incoordination and personality changes
• Loss of memory, nervousness, easy distractibility and
Vitamin B3
schizophrenia
• Depression, irritability, loss of memory, inability to
Vitamin B6
concentrate, peripheral neuritis

Vitamin B12 • Loss of memory, disorientation and emotional instability

• Memory loss, forgetfulness, depression, irritability,

Folic acid
introversion, lack of confidence
• Reduced score for IQ, memory, abstract thinking and non-
Vitamin C
verbal intelligence, altered behavior
Vitamin E • Poor memory and attention span
 Deficiency of Nutrients and Mental
Development
Micronutrient Deficiency manifestations
• Poor somatic and central nervous system growth,
sluggishness, inactivity, lethargy, poor concentration,
impaired cognition and incoordination.
Iodine
• Sequel leading to minimal brain function to a syndrome of
severe intellectual disability.
• Global loss of 10–15 intellectual quotient
• Listlessness, apathy, lack of vigor and enthusiasm, lower
scores on motor development and cognitive tests and poor
Iron
school grades-
• Less myelinization and altered neurotransmitter function
• Lethargy, decreased visual memory, impaired cognitive
Zinc
development and neuropsychological problems
Selenium • Depression, low mood, low energy level, anxiety and stress
Choline • Poor memory and mental functioning
• Short memory span, poor ability for discrimination,
DHA aggression, hostility, learning disability, dyslexia? attention
deficit disorder
 Deficiency of Nutrients and Immunity

Micronutrient deficiency Effects

Vitamin A Impairs immuno competence, therefore it can

increase the risk of infection
Vitamin E Impair several aspects of the immune response,
including B- and T-cell mediated immunity
Vitamin C Impaired inflammatory responses & function of
phagocytes
Zinc Impaired lymphocyte responsiveness & T cell
development
Selenium Impaired antibody production
 • Frequent illness adversely affects growth &
development of children1

• Growing children need the BEST nourishment with

all essential nutrients in recommended quantity2 for
 Optimal immune function
 Faster recovery
 Healthy physical growth
 Mental development

• Journal of Nutrition. 1999;129:531-533.

• Healthy Nutrition: An Essential Element of a Health-Promoting School. WHO, FAO and Education
International, 1998. WHO Information Series on School Health – Document 4. Geneva: WHO
 Essential Fatty Acids

The Essential Fats are a group of fatty acids

that are essential to human health.

• Omega-3 (ω3) – Linolenic acid

• Omega-6 (ω6) – Linoleic acid
 Structure of EFAs

LINOLEIC ACIDS (Omega 6)

Eighteen-carbon essential fatty acids that
contain two double bonds.
• 18:2 (9,12)

– LINOLENIC ACIDS (Omega 3)

Eighteen-carbon essential fatty acids that
contain three double bonds
18:3 (9,12,15)
 Function of EFAs
• Formation of healthy cell membranes
• Proper development and functioning of the brain
and nervous system
• Production of hormone-like substances called
Eicosanoids
–Thromboxanes
–Leukotrienes
–Prostaglandins
Responsible for regulating blood pressure, blood viscosity,
vasoconstriction, immune and inflammatory responses.
 Omega-3s

• Sources:
Walnuts
Wheat germ oil
Flaxeed oil/canola oil
Fish liver oils/Fish eggs
Human Milk
Organ meats
Seafood/Fatty fish
- albacore tuna
- mackerel
- salmon
-sardines
 Benefits of Omega-3s
• Lower PG2s • Enhance thermogenesis and
• Anti-inflammatory lipid metabolism
• Lower triglyceride and • Benefits vision and brain
cholesterol levels function
• Cancer prevention • Decrease Skin inflammation
• Renal maintenance • Inhibit platelet adhesion
• Increase insulin sensitivity
 Reports of ω-3 Deficiency
• Holman and colleagues reported a case of peripheral
neuropathy and blurred vision in a child receiving total
parenteral nutrition devoid of omega-3 fatty acids for 5
months.1
-Holman et al. AM J Clin Nutr 35:617, 1982

• Bjerve and his coworkers reported linolenic acid deficiency in

nine patients fed by gastric tube for 2.5 to 12 years, who had
received only 0.025% to 0.09% of their total kilocalories as
omega-3 fatty acids.

-Bjerve et al. Am J Clin Nutr 45:66, 1987.

 Omega-6s

Sources:
Corn oil
Peanut oil
Cottonseed oil
Soybean oil
Many plant oils

Platelet aggregation, cardiovascular

diseases, and inflammation
 Benefits of Omega-6s
Specifically, omega-6 fatty acids
with a high GLA content may
help to:
• Reduce inflammation of
rheumatoid arthritis
• Relieve the discomforts of
PMS, endometriosis, and
fibrocystic breasts.
• Reduce the symptoms of
eczema and psoriasis.
• Clear up acne and rosacea.
• Prevent and improve diabetic
neuropathy.
• Excessive amounts of omega-6
(PUFA) and a very high
omega-6/omega-3 ratio has
been shown to promote the
pathogenesis of many
diseases:
-cardiovascular disease
-cancer
-Inflammatory and
autoimmune diseases
 Essential Fatty Acid Deficiency Side
Effects
•high blood pressure
• hemorrhagic dermatitis •high triglycerides
• skin atrophy •hemorrhagic folliculitis
• scaly dermatitis •hemotologic disturbances
• dry skin (ex: sticky platelets)
• weakness •immune and mental
• impaired vision deficiencies
• tingling sensations • impaired growth
• mood swings
• edema
Dermatitis, Atopic in an Infant and on a Young Girl's Face
 Differing characteristics ω-3 and ω-6
Essential Fatty Acid Deficiencies

Omega-3 (α-Linolenic Acid) Omega-6 (Linoleic Acid)

Clinical Normal skin, growth, reproduction Growth retardation

Features Reduced learning Skin lesions
Abnormal electroretinogram Reproductive failure
Impaired vision Fatty liver
Polydipsia Polydipsia

Biochemical Decreased 18:3 ω-3 and 22:6 ω -3 Decreased 18:2 ω-6 and 20:4 ω-6
markers Increased 22:4 ω-6 and 22:5 ω 7 Increased 20:3 ω-9 (only if ω -3 also
Increased 20:3 ω-9(only if ω -6 also low) low)

Guthrie H, Picciano, Mary. Human Nutrition. Lipids p128 1995

 Who are at risk for deficiency?
• Acrodermatitis
• Long-term TPN patients Enteropathica
without adequate lipid • Hepatorenal Syndrome
• Cystic Fibrosis • Sjogren-Larsson
• Low Birth Weight Infants Syndrome
• Premature infants • Multisystem neuronal
• Severely malnourished degradation
patients • Crohn’s disease
• Patients on Long-term • Cirrhosis and alcoholism
MCT as fat source • Reye’s Syndrome
• Patients with fat • Short bowel syndrome
malabsorption
 Recommendations: Infants & Children

• The American Academy

of Pediatrics recommends AI for Infants and Children
that infant milk formula 0-6 mos 0.5 g/day of n-3 PUFA
should provide at least 7-12 mos 0.5 g/day of n-3 PUFA
2.7% of total kilocalories 1-3 yrs 0.7 g/day of α-linolenic acid
in the form of linoleic
4-8 yrs 0.9 g/day of α -linolenic acid
acid.
Boys
9-13 yrs 1.2 g/day of α -linolenic acid
• Of note, human milk
provides 3.5% to as high 14-18 yrs 1.6 g/day o α-linolenic acid
as 12% of total Girls
kilocalories in the form of 9-13 yrs 1.0 g/day of α -linolenic acid
linoleic acid depending 14-18 yrs 1.1 g/day of α -linolenic acid
on the fat composition of
the maternal diet.
Food and Nutrition Board, Institute of Medicine (FNBIOM,2001)
 DHA
Docosahexaenoic acid (DHA) is an omega-3 essential fatty
acid

DHA and Brain DHA and Retina

DHA is one of the primary structural component of brain tissue and retina
 DHA Aids Brain Cell Maturation
Improved maturation of astrocytes with higher
concentrations / levels of DHA

A - Less astrocytes maturation when cultured in serum deficient conditions.

B, C, D - Improved maturation of astrocytes as DHA is supplemented in
increasing concentrations.

Animal studies have indicated a causal connection between DHA

availability & cognitive or behavioral performance
 DHA and Neurotransmission
DHA is an important constituent of the brain cell
membrane, which have a role in neurotransmission

G-proteins are structures that are present on the cell membrane &
assist in movement of nutrients
Human Beings are Poor DHA Synthesizers

Less than 0.2% of ALA is converted to DHA in the hepatocyte

Hence, it becomes important to directly consume DHA

during crucial periods of brain growth
 from a vegetarian source
DHA in ActiGrow DHA from fish Significance
oil
Free of high levels of High mercury Undesirable levels of mercury and
mercury, oceanic levels oceanic pollutant have the potential
pollutant and toxins to damage the tissues
More stable Less stable The oxidative stability of long chain
polysaturated fatty acids (PUFA)
and DHA containing fish and algae
oils varies widely according to their
fatty acid composition. DHA from
algal sources is found to be ten
times more stable than fatty acids
derived from fish oils.
Desirable EPA Higher EPA Not desirable during growing
content content phase
Thank You