Life Cycle Nutrition: Mother and Infant

Chapter 13 Life Cycle Nutrition: Mother and Infant

• Describe the roles of nutrition before and during pregnancy • Summarize the evidence against alcohol use during pregnancy • List the effects of diabetes, hypertension, and preeclampsia on pregnancy • Explain how nutrition supports lactation

• Identify nutrition practices that promote an infant’s well- being • List five feeding guidelines that encourage normal eating behavior and autonomy in a child • Describe the challenges associated with childhood obesity

• Establish healthy eating habits before pregnancy • Mothers-to-be: The embryo and fetus require good nutrition • Embryo: The stage of human gestation from the third to the eighth week after conception • Fetus: The stage of human gestation from eight weeks after conception until the birth of an infant • Fathers-to-be: Diet influences fertility

• Prepregnancy weight • Maintain appropriate body weight before pregnancy • A woman who begins her pregnancy underweight and who fails to gain sufficiently during pregnancy is very likely to bear a baby with a dangerously low birthweight • Low birthweight can potentially impact the infant’s future health • A high-birthweight infant can necessitate cesarean section • Maternal obesity increases a child’s risk for obesity, heart disease, and type 2 diabetes

• Placenta • Supplies depot and waste-removal system for the fetus • Blood containing waste and blood containing nutrients never mix • Influences lactation • The umbilical cord is used as a conduit • The amniotic sac surrounds the fetus

• A zygote begins as a single cell and rapidly divides after fertilization • A zygote is a newly fertilized ovum • Implantation • Occurs within two weeks of fertilization • The fetus develops significantly by the eighth week of conception

• Fetal period: Months 2 to 9 of pregnancy • Gestation duration: 40 weeks • Split into trimesters • Contains critical periods • Periods of time specific to the development of specific organs • High-risk pregnancy • Risk factors that increase the chances of premature delivery, difficult birth, retarded growth, birth defects, and early infant death • Prenatal medical care required

1) A newly fertilized 3) A fetus after 11 weeks ovum, called a zygote, is of development is just about the size of the over an inch long. period at the end of this Notice the umbilical cord sentence. Less than 1 and blood vessels week after fertilization, connecting the fetus the zygote has rapidly with the placenta. Petit Format/Nestle/Science Petit Format/Nestle/Science Source divided many times and Source has become ready for implantation.

4) A newborn infant after 2) After implantation, 9 months of the placenta develops development measures and begins to provide close to 20 inches in nourishment to the length. The average developing embryo. birthweight is about 71⁄2 An embryo 5 weeks pounds. From 8 weeks after fertilization is to term, the infant has Petit Format/Nestle/Science about 1⁄2 inch long. Michael Clement/Masterfile Source grown 20-fold in length and 50-fold in weight. Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. High-Risk Pregnancy (Slide 1 of 2)

• Prepregnancy B M I either less than 18.5 or less than/equal to 25 • Insufficient or excessive pregnancy weight gain • Nutrient deficiencies or toxicities; eating disorders • Poverty, lack of family support, low level of education, limited food availability • Smoking, alcohol, or other drug use • Age, especially 15 years or younger or 35 years or older • Twins or triplets

• Many previous pregnancies (3 or more in mothers younger than age 20; 4 or more in mothers age 20 or older) • Short or long intervals between pregnancies (less than 18 months or more than 59 months) • Previous history of problems such as low- or high- birthweight infants • Pregnancy-related hypertension or gestational diabetes • Diabetes; heart, respiratory, or kidney disease; genetic disorders; special diets and medications

• Energy • Needs vary with the progression of pregnancy • Daily requirements • Carbohydrates are used by the fetal brain as fuel • Protein is essential for fetal growth • Consumption of supplements is discouraged • Essential fatty acids • Omega-3 and omega-6 fatty acids assist in brain growth, function, and structure

Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure 13.3: Comparison of Selected Nutrient Recommendations for Nonpregnant, Pregnant, and Lactating Women

aValues for other nutrients are listed at the back of the book, pages A and B. bEnergy allowance during pregnancy is for the 2nd trimester; energy allowance during the 3rd trimester is slightly higher. No additional allowance is provided during the 1st trimester. Energy allowance during lactation is for the first 6 months; energy allowance during the second 6 months is slightly higher.

• Folate • Helps prevent neural tube defects (N T Ds) • The brain and spinal cord abnormalities that may appear at birth • The neural tube, comprising the embryonic tissue, later forms the spinal cord • Common types of N T Ds are anencephaly and spina bifida

• Vitamin B12 • Assists folate in the manufacture of new cells • Found in meat, eggs, milk, and milk products

• Personal or family history of a pregnancy affected by a neural tube defect • Maternal diabetes • Maternal use of certain antiseizure medications • Mutations in folate-related enzymes • Maternal obesity

Natural Folate Sources Fortified Folic Acid Sources

Liver (3 oz) 221 μg DFEb Highly enriched ready-to-eat cereals (3⁄4 c) 680 μg DFEc Lentils (1⁄2 c) 179 μg DFE Pasta, cooked (1 c) 154 (average value) μg DFE Chickpeas or pinto beans (1⁄2 c) 145 μg Rice, cooked (1 c) 153 μg DFE DFE Asparagus (1⁄2 c) 134 μg DFE Bagel (1 small whole) 156 μg DFE Spinach (1 c raw) 58 μg DFE Waffles, frozen (2) 78 μg DFE Avocado (1⁄2 c) 61 μg DFE Bread, white (1 slice) 48 μg DFE Orange juice (1 c) 74 μg DFE N A Beets (1⁄2 c) 68 μg DFE N A

aFolate amounts for these and thousands of other foods are listed in the U S D A Nutrient Database, https://ndb.nal.usda.gov/ndb/search/list.

bDietary folate equivalent (see Chapter 7). cFolic acid in cereals varies; read the Nutrition Facts panel of the label. Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Nutrition during Pregnancy (Slide 3 of 5)

• Choline • Structural integrity of cell membranes • Synthesis of an important neurotransmitter • Metabolism of lipids • Vitamin D and calcium • Necessary for fetal bone growth and tooth development • Calcium absorption doubles during pregnancy • Vitamin D plays a vital role in calcium absorption

• Iron • Helps increase blood volume • Fetal absorption increases in second and third trimesters • Consumption of supplements required • Transfer is regulated by the placenta • All women are advised to consume: • Foods containing heme iron • Additional sources of iron • Foods that enhance iron absorption

• Zinc • Vital for protein synthesis and cell development • Abundant in protein-rich foods • Prenatal supplements are specifically designed to provide the nutrients needed during pregnancy • Folate • Iron • Calcium

• Special Supplemental Nutrition Program for Women, Infants, and Children (W I C) • Nutritious foods • Nutrition education • Referrals to health and social services • Supplemental Nutrition Assistance Program (S N A P) • Assists low-income families in the purchase of groceries

• Benefits of proper weight gain • Low risk of surgical birth • Increased chances of delivering a healthy birthweight infant • Weight loss during pregnancy is not recommended • Sudden and significant weight gain is dangerous • May indicate the onset of preeclampsia

Prepregnancy Weight Recommended weight Recommended weight gain for single birth gain for twin birth

Underweight (BMI ,18.5) 28 to 40 lb (12.5 to 18.0 Insufficient data to make kg) recommendation

Healthy weight (BMI 18.5 25 to 35 lb (11.5 to 16.0 37 to 54 lb (17.0 to 25.0 to 24.9) kg) kg)

Overweight (BMI 25.0 to 15 to 25 lb (7.0 to 11.5 31 to 50 lb (14.0 to 23.0 29.9) kg) kg)

Obese (BMI $30) 11 to 20 lb (5.0 to 9.0 kg) 25 to 42 lb (11.0 to 19.0 kg)

Source: Institute of Medicine, Weight Gain during Pregnancy: Reexamining the Guidelines (Washington, D.C.: National Academies Press, 2009).

• Some weight is lost at delivery • More weight is lost in the weeks that follow • Blood volume returns to normal • The body expels accumulated fluids • Weight gain beyond the needs of pregnancy • Increased chances of weight retention and weight gain in the following years • Cumulative weight gain • Avoided by maintaining healthy weight before pregnancy

• Benefits of physical activity • Improves fitness • Facilitates labor • Helps prevent or manage gestational diabetes • Reduces psychological stress • Choose low-impact activities • Seek medical advice • Pregnant women with medical conditions or pregnancy complications

Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure 13.6: Guidelines for Physical Activity during Pregnancy DO • Do exercise regularly (most, if not all, days of the week) • Do warm up with 5 to 10 minutes of light activity • Do 30 minutes or more of moderate physical activity • Do cool down with 5 to 10 minutes of slow activity and gentle stretching • Do drink water before, during, and after exercise • Do eat enough to support the additional needs of pregnancy plus exercise • Do rest adequately

DON’T • Don’t exercise vigorously after long periods of inactivity • Don’t exercise in hot, humid weather • Don’t exercise when sick with fever • Don’t exercise while lying on your back after the first trimester of pregnancy or stand motionless for prolonged periods • Don’t exercise if you experience any pain or discomfort • Don’t participate in activities that may harm the abdomen or involve jerky, bouncy movements • Don’t scuba dive

• Special case of intense nutrient needs • Many pregnant teens have deficiencies of vital nutrients • Pregnant adolescents • Less likely to receive prenatal care • More likely to smoke • Risks associated with teen pregnancy • Stillbirths, preterm births, and low-birthweight infants

• Is there an ideal physical activity for pregnant women? There might be. Swimming and water aerobics offer advantages over other activities during pregnancy. Water cools and supports the body, provides a natural resistance, and lessens the impact of the body’s movement, especially in the later months. Water aerobics can help reduce the intensity of back pain during pregnancy. Other activities considered safe and comfortable for pregnant women include walking, light strength training, rowing, yoga, and climbing stairs

• Start now! Ready to make a change? If you weren’t exercising regularly before you became pregnant, talk to your doctor before undertaking an activity. Track your activity daily using the Diet and Wellness Plus Activity Tracker in MindTap

• Do not reflect physiological needs • Caused by hormone-induced changes in taste and sensitivities to smells • Some pregnant women respond by consuming nonfood items • Known as pica

• Aversions are caused by normal hormonal changes • Morning sickness • Heartburn or indigestion • Change in muscle tone • Crowding of intestinal organs by growing fetus

• To alleviate the nausea of pregnancy: • On waking, get up slowly • Eat dry toast or crackers • Chew gum or suck hard candies • Eat small, frequent meals whenever hunger strikes • Avoid foods with offensive odors

• To prevent or alleviate constipation: • Eat foods high in fiber • Exercise daily • Drink at least 8 cups of liquids a day • Respond promptly to the urge to defecate • Use laxatives only as prescribed by a physician

• To prevent or relieve heartburn: • Relax and eat slowly • Chew food thoroughly • Eat small, frequent meals • Drink liquids between meals • Avoid spicy or greasy foods • Sit up while eating • Wait an hour after eating before lying down • Wait 2 hours after eating before exercising

• Do not smoke cigarettes • Can kill an otherwise heathy fetus or newborn • Reduces blood supply to the fetus • Increases the risk of: • Complications during delivery • Sudden infant death syndrome (S I D S) • Nonsmoking pregnant women • Exposure to environmental tobacco smoke increases the risk of low birthweight and S I D S

• Fetal growth restriction • Preterm birth • Low birthweight • Premature separation of the placenta • Miscarriage • Stillbirth • Sudden infant death syndrome • Congenital malformations

• Medicinal drugs and herbal supplements taken during pregnancy can cause birth defects • O T C drugs and medication must be prescribed by a physician • Herbal supplements have not been tested for safety or effectiveness during pregnancy and must be avoided

• Drugs of abuse easily cross the placenta and impair fetal growth and development • Consumption results in cases of preterm births, low-birthweight infants, and sudden infant deaths • Environmental contaminants such as lead may lead to low-birthweight infants with delayed mental and psychomotor development • Exposure to mercury: Harm caused to the developing fetal brain and nervous system • Nevertheless, consumption of fish is recommended

• Foodborne illnesses can leave a pregnant woman exhausted and dangerously dehydrated • Vomiting and diarrhea • Pregnant women are more likely than others to contract listeriosis • A serious foodborne infection caused by the bacterium Listeria monocytogenes, which is found in soil and water • Can cause miscarriage, stillbirth, or severe brain or other infections in fetuses and newborns • Can be avoided by following safe practices

Suggested Quantity Choice of Fish Best choices Anchovy, Atlantic croaker, Atlantic Eat 2–3 servings/week mackerel, black sea bass, butterfish, catfish, clam, cod, crab, crawfish, flounder, haddock, hake, herring, lobster, mullet, oyster, Pacific chub mackerel, perch, pickerel, plaice, pollock, salmon, sardine, scallop, shad, shrimp, skate, smelt, sole, squid, tilapia, trout, tuna (canned light), whitefish, whiting

Suggested Quantity Choice of Fish Poor choices King mackerel, marlin, orange roughy, Avoid eating shark, swordfish, Gulf of Mexico tilefish, tuna (bigeye)

• Vitamin–mineral overdoses are toxic • Vitamin A in excess may cause malformations of the cranial nervous system in the fetus • Restrictive dieting can be hazardous • Some diets may lack nutrients vital to fetal growth • Sugar substitutes are acceptable if used within F D A guidelines • Caffeine in small amounts is allowed • Two cups of coffee are recommended per day

• Alcohol crosses the placenta freely and is directly toxic • Can halt the delivery of oxygen through the umbilical cord • A few minutes of alcohol exposure during fetal brain growth can exert a major detrimental effect • Interferes with placental transport of nutrients to the fetus and can cause malnutrition in the mother • Before fertilization, damage can be caused to the ovum or sperm in the mother- or father-to-be, leading to abnormalities in the child

• Drinking alcohol during pregnancy threatens the fetus • Fetal alcohol spectrum disorders (F A S D): A spectrum of physical, behavioral, and cognitive disabilities • A more severe form is fetal alcohol syndrome (F A S): The cluster of symptoms including brain damage, growth restriction, mental retardation, and facial abnormalities seen in an infant or child • Alcohol-related neurodevelopmental disorder (A R N D): Behavioral, cognitive, or central nervous system abnormalities • Alcohol-related birth defects (A R B D): Malformations in the skeletal and organ systems such as the heart, kidneys, eyes, ears

• How much alcohol is too much? • Damaging effects are dose dependent, becoming greater as the dose increases • Abstinence is the only acceptable course of action for pregnant women

• Pregnant women with unmanaged type 1 or type 2 diabetes may experience: • Severe hypoglycemia or hyperglycemia • Preterm labor • Pregnancy-related hypertension • Infants of such women may: • Be large • Suffer physical and mental abnormalities • Suffer other complications such as respiratory distress

• Some women are prone to develop a pregnancy-related form of diabetes • Gestational diabetes: Abnormal glucose tolerance appearing during pregnancy • Diabetes risk later in life • Increased odds of surgical birth, high infant birthweight, and high risk of illness and mortality

• Chronic hypertension: In pregnant women, hypertension that is present and documented before pregnancy; in women whose prepregnancy blood pressure is unknown, the presence of sustained hypertension before 20 weeks of gestation • Present after pregnancy as well • Gestational hypertension: High blood pressure that develops in the second half of pregnancy and usually resolves after childbirth

• Hypertension poses several risks for the mother and fetus • Increases the risk of preeclampsia • Preeclampsia usually occurs in the first pregnancy and appears after 20 weeks of gestation • Involves high blood pressure and protein in the urine • Conditions may progress to eclampsia • A severe complication during pregnancy in which seizures occur

• Hypertension • Protein in the urine • Upper abdominal pain • Severe and constant headaches • Swelling, especially of the face • Dizziness • Blurred vision • Sudden weight gain (1 l b/day)

• Preparation begins before birth • Read books, consult a certified lactation consultant, and learn about nutritional requirements • Insufficiency is rare • Consequences include infant dehydration, malnutrition, and brain damage • Warning signs are dry diapers and infrequent bowel movements

• A nursing mother produces about 25 ounces of milk a day, with considerable variation • Energy cost: • 500 calories per day above a woman’s need • Fluid needs: • Prevent dehydration by ensuring extra fluid intake • Variations in breast milk: • Nutritional deprivation of the mother reduces the quantity of milk • Not the quality of milk • Infants with strong family histories of food allergies generally benefit from breastfeeding

• Lactation and weight loss: • Depend on the mother’s gestational weight gain and the duration and intensity of breastfeeding • Do not affect the quantity or quality of milk

• Some substances impair maternal milk production or enter breast milk and interfere with infant development • Alcohol and illicit drugs • Alcohol concentration peaks within one hour • Illicit drug users should not breastfeed • Tobacco and caffeine • Production of milk and its fat content are less • Chemicals in cigarettes are transferred to the infant • Excess caffeine can make the infant jittery and wakeful • Medications • A physician must be consulted as danger levels vary • Oral contraceptives may suppress milk output

• Environmental contaminants • Benefits of breastfeeding outweigh any minor risks from environmental hazards • Maternal illness • Common cold: The mother can continue nursing • Tuberculosis: The mother can continue nursing once she is treated and is no longer infectious • H I V: If safe alternatives are available, the mother is advised not to breastfeed • The World Health Organization (W H O) recommends exclusive breastfeeding for the first six months in the absence of suitable alternatives

• An infant’s growth is directly affected by the infant’s nutrition status • Growth is faster during the first year in terms of height and weight • High basal metabolic rate • Energy nutrients, vitamins A and D, calcium, and water are of special importance

Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure 13.10: Nutrient Recommendations for a 5-Month-Old Infant and an Adult Male Compared on the Basis of Body Weight

• The A A P and the Academy of Nutrition and Dietetics recommend exclusive breastfeeding • An infant’s consumption of human milk with no supplementation of any type for 6 months and breastfeeding with complementary foods for at least 12 months • It excels as a source of nutrients • Contains abundant oligosaccharides, alpha-lactalbumin, and lactoferrin • Alpha-lactalbumin: The chief protein in human breast milk • Lactoferrin: A factor in breast milk that binds iron and keeps it from supporting the growth of the infant’s intestinal bacteria

• Vitamins and minerals in breast milk • Vitamin D concentration is low, requiring mothers to take supplements • Supplements for infants • Vitamins D and K, iron, and fluoride • Immune factors • Colostrum: A milklike secretion from the breasts during the first day or so after delivery before milk appears; rich in protective factors • It protects against common illnesses of infancy

• Is an acceptable alternative to breastfeeding • Mothers often wean their children onto infant formula • Wean: To gradually replace breast milk with infant formula or other foods • Is a substitute for breastfeeding • Milk is diluted, digestibility is improved, and carbohydrate and nutrients are added to make the proportions comparable to those of human milk • Special formulas have been designed to meet the dietary needs of infants based on hydrolyzed protein • Hydrolyzed protein: Commercial protein ingredient made by way of hydrolysis, a type of chemical reaction that splits molecules, in this case long protein chains, into smaller fragments

• Is a transition to cow’s milk • Not appropriate for children who are less than a year old • Those younger than 6 months of age can suffer intestinal bleeding, which can lead to or aggravate iron deficiency

Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure 13.11: Percentages of Energy- Yielding Nutrients in Breast Milk, Infant Formula, and Cow’s Milk

• Readiness to accept solid foods develops in stages • Usually between 4 and 6 months of age • Caregivers must practice responsive feeding • Responsive feeding: An interactive feeding process in which a young child signals hunger and satiety vocally, through facial expressions, and through motor actions; the caregiver recognizes these cues and responds promptly

• Nutrient needs • Iron, zinc, and vitamin C • Physical readiness • Swallowing ability develops around 4 to 6 months • Crackers and finger foods can be introduced at 8 to 12 months • Need to detect and control allergic reactions • Introducing peanut-based foods earlier rather than later can prevent peanut allergy

Age Physical and Satiety Hunger Foods (mo) Developmental Signals Signals Introduced Milestones into the Diet 0–4 Turns head toward any Seals lips Wakes and Breast milk or object that brushes together. moves around. infant formula cheek. Initially swallows Turns head Sucks on fist. using back of tongue; away. Stops Cries or gradually begins to sucking. fusses. swallow using front of Falls asleep Opens mouth tongue as well. Strong when full while feeding reflex (extrusion) to push to indicate food out during first 2 to wanting more 3 months

Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Table 13.13: Infant Development and Recommended Foods (Slide 2 of 4) Age Physical and Satiety Hunger Signals Foods (mo) Developmental Signals Introduced Milestones into the Diet 4–6 Extrusion reflex Sucks Cries or fusses. Iron-fortified diminishes, and slowly or Indicates desire for cereal mixed ability to swallow stops food by smiling or with breast milk, nonliquid foods sucking. cooing during formula, or develops. Sits erect Turns head feeding. water. Pureed with support at 6 away and Indicates desire for meats, legumes, months. Begins leans back food by opening vegetables, and chewing. Brings hand mouth and leaning fruit to mouth. Grasps forward objects with hand 6–8 Able to feed self with Slows Reaches for spoon Textured fingers. Develops eating. or vegetables and pincher (finger to Pushes food. Points to food fruit thumb) grasp. Begins food away to drink from cup

Age Physical and Satiety Hunger Foods Introduced (mo) Developmental Signals Signals into the Diet Milestones 8–10 Begins to hold Shuts Reaches for Breads and cereals from own bottle. mouth and grabs table. Sits unsupported tightly or spoon and Yogurt. pushes food. Shows Pieces of soft, cooked food away excitement vegetables and fruit when food is from table. presented Small amounts of finely cut meats, fish, casseroles, cheese, eggs, and legumes

Age Physical and Satiety Hunger Foods Introduced (mo) Developmental Signals Signals into the Diet Milestones 10–12 Begins to master May begin Indicates Increasingly varied foods spoon. using words desire for in larger portion sizesa Spills less such as “no,” specific “all done,” or food with “get down.” words Plays with or or sounds throws food when done aPortions of foods for infants and young children are smaller than those for an adult. For example, a grain serving might be 1⁄2 slice of bread instead of 1 slice or 1⁄4 cup of rice instead of 1⁄2 cup.

Source: Adapted in part from R. Perez-Escamilla, S. Segura-Perez, and M. Lott, Feeding guidelines for infants and young toddlers, Nutrition Today 52 (2017): 223–231; American Academy of Pediatrics, Pediatric Nutrition, 7th ed., ed. R. E. Kleinman (Elk Grove Village, Ill. IL: American Academy of Pediatrics, 2014), pp. 123–139.

• Infant foods should provide variety, balance, and moderation • To avoid contamination, infants should not be fed directly from the jar • Foods to omit: • Food with salt and sugar • Baby food “desserts” • Sugar alcohols • Salted canned foods • Honey and corn syrup

• Unpasteurized milk, milk products, or juices • Raw or undercooked eggs, meat, poultry, or fish • Raw sprouts • Milk anemia: Iron-deficiency anemia caused by drinking so much milk that iron-rich foods are displaced from the diet

• First year of life lays the foundation for future health • Encourage healthy eating habits • Avoid concentrated sweets and empty-calorie foods • Encourage physical activity • Babies regularly put to bed with bottles sometimes have teeth decayed all the way to the gum line • Nursing bottle tooth decay

• Foster a sense of autonomy to provide a foundation for later assertiveness • Feeding guidelines • Discourage unacceptable behavior • Let young children explore and enjoy food • Don’t force food on children • Provide nutritious foods • Limit sweets • Make mealtimes enjoyable

• Trends in childhood obesity • Rates may be growing • Challenges of obesity • Physical • Risk of chronic diseases • Emotional • Discrimination and rejection • Identifying childhood obesity • Accurate calculation of a child’s body mass index (B M I) and the interpretation of it using a growth chart

Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Table C13.1: Physical Complications of Obesity during Childhood • These conditions increase a child’s risks for chronic diseases now and into adulthood: • Abnormal blood lipid profile • High total cholesterol • High triglycerides • High L D L cholesterol • High blood pressure • High fasting insulin • Structural changes to the heart • Asthma • Breathing difficulties (sleep apnea) • Fatty liver Sources: U.S. Preventive Services Task Force, Screening for obesity in children and adolescents: US Preventive Services Task Force Recommendation Statement, 2017; L. Hurt and coauthors, Diagnosis and screening for obesity-related conditions among children and teens receiving Medicaid—Maryland, 2005–2010, Morbidity and Mortality Weekly Report 63 (2014): 305–308.

• Type 2 Diabetes • Connected to obesity • Ethnicity and a family history of having type 2 diabetes increase the risk • Children may lack the symptoms of type 2 diabetes • Heart Disease • Atherosclerosis begins in youth • High blood cholesterol • Family history • Sedentary lifestyle

• High blood pressure • Childhood hypertension if left untreated can damage the heart • Can be improved by aerobic activity and limiting salt intake

Disease Total LDL Risk Cholesterol Cholesterol (mg/dL) (mg/dL) Acceptable <170 <110

Borderline 170–199 110–129

High ≥200 ≥130

Note: Adult values appeared in Chapter 11.

• Calories and cautions • Family influence and snacking • Physical activity • Limit “screen time” • Food advertising • Television and Internet “advergames” promote the consumption of foods to children

Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Figure C13.2: Factors Affecting Childhood Weight Gain Food Factors • Eating when not hungry; eating while watching T V or doing homework • Exposure to advertising that promotes high-calorie foods • Fast-food meals more than once a week • Frequent meals of fried or sugary foods and beverages • Frequent snacks consisting of high-energy foods, such as candies, cookies, crackers, fried foods, and ice cream • Irregular or sporadic mealtimes; missed meals

Activity/Sleep Factors Family and Other Factors • Insufficient sleep • High birth weight • Lack of access to recreational • Low-income family facilities • Not breastfed • Less than 20 minutes of physical • Overweight family members, activity, such as outdoor play, each particularly parents day • Tall for age • More than an hour of sedentary activity, such as television, each day

Source: Centers for Disease Control and Prevention, Youth Risk Behavior Survey, available at www.cdc.gov.

• Parents are influential in shaping the self-concepts, weight concerns, and eating habits of children • Focus on healthy food choices and physical activity • School-based programs that reinforce appropriate diet and physical activity should be encouraged • Lifestyle changes first, medications later • Treatment involving a diet and physical activity • Obesity surgery for the severely obese • Set achievable goals • Children must be given positive support

• Diet moderation • Limit saturated and trans fats • Choose foods rich in nutrients with age-appropriate calories • Avoid the “children’s menu” and sugar sweetened beverages • Choose healthier substitutes • Benefits of physical activity • Better cardiovascular profile • Recommendation: 60 minutes per day • Adequate sleep • Less likely to consume added calories

Age Group Recommended Sleep Hours

Toddlers 11 to 14 hours

Preschoolers 10 to 13 hours

School-Age Children 9 to 11 hours

Teenagers 8 to 10 hours

Source: Data from Sleep Duration Recommendations, National Sleep Foundation, sleepfoundation.org. Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.