儿童营养与相关疾病课件

ChildrenNutritionandRelativeDiseasesGroupmembersSuNanXianYixinSunYanMaLanfang

ChildrenNutritionand

RelativeDiseasesInfantfeedingandIntroductionofsolidsMalnutritionRicketsOfVitaminDDeficiencyNormalnutritionalrequirements

Infantsandchildrenhaveahighmetabolicrate,largecalorificrequirements,andcorrespondingrapidfluidturnover.Asatisfactorydietaryintakeshouldmeetthenormalrequirementsforenergyandprotein,togetherwithprovidinganadequatesupplyofvitaminsandtrace（微量）elements.Infantsandchildrenarevulnerabletounder-nutritionbecauseof:Lownutritionalstoresoffatandprotein;Growthcreatinghighnutritionaldemands(at4monthsofage,30%ofaninfant’senergyintakeisusedforgrowth,butat3yearsofagethishasfallento2%);Braingrowth:thebrainisproportionallylargerininfantsandisgrowingrapidlyduringthelasttrimester（孕期后三个月）andfirst2yearsoflife.Itisvulnerabletoenergydeprivation（剥夺）duringthisperiod.InfantfeedingAninfant’sprimarysourceofnutritionismilk,eitherhumanbreastmilkorso-called“formula”（配方）milkbasedonmodified（改良的）cow’smilk.Cow’smilkand

Modifiedcow’smilkformulas

Unmodified,whole,pasteurized（巴氏消毒的）cow’smilkisunsuitableasamaindietforinfantsundertheageof1yearbecause:Itcontainstoomuchproteinandsodium.ItisdeficientinironandvitaminsModifiedcow’smilkformulashaveamodifiedcaseintowheyratio（酪蛋白和乳清蛋白比例）,reducedmineralcontent,andarefortified（加强的）withironandvitamins.BreastfeedingThisisthepreferredmethodformostinfants.Ingeneral,thereisnodoubtthat“breastisbest”.DisadvantagesofbreastfeedingVolumeofintakeuncertainTransmissionofdrugsNutrientdeficiencies:InsufficientvitaminKtopreventhaemorrhagic（出血的）diseaseofthenewbornVitaminDdeficiency(rickets佝偻病)mayoccurifthereisprolongedbreast-feedinganddelayedweaning（断奶）WeaningTheintroductionofsolidfoods(weaning)isusuallyundertakenbetween3and4monthsofage.Atthisagetheinfantcancoordinateswallowingandhasreasonableheadcontrol.After6monthsofage,breastmilkalonebecomesnutritionallyinadequateandcontinuedbreastfeedingwithoutintroductionofsolidswillleadtoenergy,vitamin,andirondeficiency.Introductionofsolids6-7monthsAbletochew,Introducelumpy（块状）foodsandvarietyoftastesandtextures（材质）8-9monthsBreadandbutter,fruit12monthsAdultfoodinsmallbitsMalnutritionmalnutritionCaloricmalnutritionProteinmalnutritionCaloric-Proteinmalnutrition

InChinaCaloricmalnutritionCaloric-ProteinmalnutritionProteinmalnutritionClinicalSyndromesofprotein-energymalnutrition

Marasmus(消瘦）kwashiorkor(恶性营养不良)Marasmus(消瘦）

wasted(weightlessthan60%ofmeanforage)wizenedappearance（干瘪的）Withdrawn（孤僻的）Apathetic（冷漠的）ManagementNutritionmaybesuppliedEnterally,viathegastrointestinaltract:preferredParenterally,directlyintothecirculationRicketsOfVitaminDDeficiency

It’sageneralandchronicnutritionaldisease.（全身慢性营养性疾病）Ca、PmetabolismdisorderDeficiencyofvitaminD

ChangesofbonesSkinundertheeffectOfultravioletlightplacentaSourceofvitaminDfoodlittlelittleMainsource胎盘DeficiencyofvitaminDinperinatalperiod（围产期）DecreasedexposuretothesunFastgrowSomediseasesdisturbtheabsorptionofvitaminDVitDdeficiencyLowCaPTHPreabsorptioninkidneyOsteoclasthyperplasiaSerumCalevelrisetonormalornearnormalLowlevelofserumPandCaosteomalaciaBonesareinadequatelymineralizeddeformityOsteoidaccumulationALPSerumP破骨细胞增生骨质矿化不全骨质软化畸形类骨质堆积Neuromuscularsymptoms(asaresultofhyperexcitability)

1.Irritable（烦躁的）、easycrying2.Hidrosis（多汗）followingbaldocciput

(theinfantalwaysrubitsheadagainstbedsbecauseofhidrosis)Ⅱskeletalchanges1.Osteomalacia（骨质软化）Craniotabes（颅骨软化）

Bowingoflegs

(causedbyweightbearing)2.Osteoidaccumulation（类骨质堆积）BowedlegsO型腿（膝内翻）KnockkneesX型腿（膝外翻）handandfootbracelet手镯、脚镯Squarehead方颅pigeonbreast鸡胸Harrison'sgroove肋膈沟X-rayimagingDecreasedbonedensityPeriosteumthicken（骨膜增厚）Epiphysealplatewiden（骺板变宽）Cuppedmetaphyses（骨骺端杯口样变）ricketsnormalEpiphysealplatewiden骺板增厚Cuppedmetaphyses骨骺杯口样变BloodbiochemistrySerumcalcium:lowornormalSerumphosphorus:lowSerumparathormone(PTH):elevatedSerumalkalinephospha