Energy balance in children. Protein balance in children.

1. Energy balance in children. Protein balance in children. Ass.prof. Luchyshyn N.Yu.

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. 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 3

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: • bodily requirement for various substances; • function in body; • amount needed; • 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 • 􀂊 Helps develop, repair, and maintain tissues • 􀂊 Produces hemoglobin, enzymes, and many hormones • 􀂊Maintains normal blood osmotic pressure • 􀂊 Forms antibodies • 􀂊 Can be energy source • 􀂊 Breaks down into amino acids to be used • by the body

15. In human nutritional needs, proteins come in two forms: complete proteins incomplete proteins 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 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 avariety 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 pergram as carbohydrates. • • the non-nitrogen part of amino acids can be oxidised directly incell respiration or after conversion to ketone bodies. • • Normally about 12% of our daily energy needs come fromamino acids. • • Excessive use of amino acids for energy causes a deficiency oftissue proteins and an excess of ketone bodies.

22. Dietary Protein, Amino Acid Pool &Metabolic Pathways • Unlike carbohydrate or fat there is no specificstorage depot for proteins or amino acids. • Instead the amino acid pool of the blood plasmaacts as a reservoir which each tissue can drawupon. • •Each tissue makes those specific proteins which itneeds, controlled by the active genes in that tissue.

23. The liver is the major organ involved in proteinmetabolism especially for deamination, ureasynthesis and gluconeogenesis • A normal diet should containsufficient protein for metabolic needs • Complete proteins with 9 essential amino acidswhich 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 onribosomes in every cell and is stimulatedby Anabolic Hormones • - Insulin-like Growth Factor(IGF) • - Thyroxine (in growing children) • - Insulin • - Estrogen & Testosterone • • Weight-bearing exercise causes • anabolism & growth of muscle. • Non essential amino acids can be synthesized byTRANSAMINATION (transfer of an amino groupto 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 thatnecessary to maintain nitrogen balance does not provideadditional ergogenic benefit. • Ingesting carbohydrate/protein prior to exercise mayreduce catabolism whereas ingesting carbohydrate/proteinfollowing exercise may promote glycogen resynthesis, amore anabolic hormonal environment, and recovery. • Theextent to which these strategies affect training adaptations isunknown.

30. Ergogenic Properties of Protein • 􀂊 Builds fat-free muscle mass. • 􀂊 Strength athletes need 1.4 to 1.8 g per kgbody weight. • 􀂊 Endurance athletes need 1.2 to 1.4 g perkg body weight. • 􀂊 Diets exceeding 1.8 to 2.0 g per kg bodyweight per day have not been proven toprovide additional benefits and maydamage 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). Marasmusresults 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. Side Effects 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.