9. Reference: Nutrient requirement and RDA for Indians , ICMR , 1990 Nutrient Requirements of Young Children is Manifolds of Adult Requirements Nutritional requirement of preschoolers
10. Gaps in Mean Intake of Nutrients amongst Children in India Micronutrient deficiencies represent a hidden form of hunger with severe consequences on physical growth, immune functions, cognition and productivity 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) 30
12. Deficiency of Nutrients and Physical Development Micronutrient Deficiency Effects Vitamin D and calcium Deficiency affects bone development Potassium, zinc, magnesium and copper Deficiency disturbs the growth hormones and affect growth Manganese Deficiency leads to skeletal abnormalities including retarded growth Vitamin E Deficiency affects muscle development
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15. 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
27. Differing characteristics -3 and -6 Essential Fatty Acid Deficiencies Guthrie H, Picciano, Mary. Human Nutrition. Lipids p128 1995 Omega-3 ( -Linolenic Acid) Omega-6 (Linoleic Acid) Clinical Features Normal skin, growth, reproduction Reduced learning Abnormal electroretinogram Impaired vision Polydipsia Growth retardation Skin lesions Reproductive failure Fatty liver Polydipsia Biochemical markers Decreased 18:3 -3 and 22:6 -3 Increased 22:4 -6 and 22:5 7 Increased 20:3 -9(only if -6 also low) Decreased 18:2 -6 and 20:4 -6 Increased 20:3 -9 (only if -3 also low)
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30. DHA DHA is one of the primary structural component of brain tissue and retina Docosahexaenoic acid (DHA) is an omega-3 essential fatty acid DHA and Brain DHA and Retina
31. DHA Aids Brain Cell Maturation Improved maturation of astrocytes with higher concentrations / levels of DHA Animal studies have indicated a causal connection between DHA availability & cognitive or behavioral performance A - Less astrocytes maturation when cultured in serum deficient conditions. B, C, D - Improved maturation of astrocytes as DHA is supplemented in increasing concentrations.
32. 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
33. 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
34. from a vegetarian source DHA in ActiGrow DHA from fish oil Significance Free of high levels of mercury, oceanic pollutant and toxins High mercury levels Undesirable levels of mercury and oceanic pollutant have the potential 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 content Higher EPA content Not desirable during growing phase
Children form one third of our population and all of our future. The best global indicator of children’s well–being is growth. Unsatisfactory feeding practices can affect their physical growth and mental development. Impaired growth and development in children can affect the rest of their lives and compromise academic performance and the ability to contribute to society. More than half of all child deaths are associated with malnutrition, which weakens the body's resistance to illness. Poor diet, frequent illness and inadequate or inattentive care of young children can lead to malnutrition. Children have the right to a caring, protective environment, nutritious food and basic health care to protect them from illness and promote growth and development. References: Bull WHO . 2000; 78(10):1222-1233.
Nutritional adequacy is one of the key determinants of the health and well being of the children. Under-nourishment not only retards physical development but also hampers the learning and cognitive process, leading to sluggish educational, social and economic development. Malnourished children are less likely to perform well in school and more likely to grow into malnourished adults, at greater risk of disease and early death. WHO (2002) data indicates that 0.8 million deaths are due to iron deficiency and an equal number of deaths are due to vitamin A deficiency with 25 million DALY’s lost due to iron deficiency, 18 million due to vitamin A and 2.5 million lost due to iodine deficiencies.1 Multiple micronutrients deficiencies (MMND) contribute significantly to the global burden of diseases. The importance of nutrition as a foundation for healthy development is underestimated. Poor nutrition leads to ill health and ill health causes further deterioration of nutritional status. Vitamin A, iodine, iron, and zinc deficiencies are still widespread and are a common cause of excess morbidity and mortality, particularly among young children. Malnutrition remains one of the most common causes of morbidity and mortality among children throughout the world. According to WHO, there are about 10.8 million child deaths a year globally. This number is attributed to iron, vitamin A, and zinc deficiencies. Iron deficiency affects 2 billion people, is responsible for one- fifth of early neonatal mortality, and kills 80,000 people/day. Micronutrient deficiencies damage one-third of world population, resulting in 2 billion people living below their physical and mental potential. In South Asian region, nearly 5 million children are dying every year, and up to 3 million of these deaths are directly or indirectly associated with malnutrition. Malnutrition in children remains a silent emergency in India, where more than half of all children under the age of five are malnourished and 34% of newborns are significantly underweight. Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India. The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate (55%) and Kerala among the lowest (27%). References: http://www.unicef.org/nutrition/index.html. Accessed on: March, 20, 2008. Public health implication . 2002;375-412. Bulletin of the World Health Organization . 2000;78(10):1222-1233. Journal of Clinical and Diagnostic Research . 2007;1:483-487. http://www.unicef.org/india/children_2356.htm. Accessed on: March, 20, 2008.
Growth of a child is considered to be a relatively smooth process traditionally—rapid growth during infancy followed by steady growth in midchildhood and finally the pubertal spurt during adolescence as shown in the graph. Hence it is vital to provide adequate diet during these stages so as to achieve full potential for height. Nutrition is important for the skeletal and muscle development , which is a part of the growth process. Deficiency of any nutrients may affect the growth and muscle development which are often irreversible. References: Sarma KVR. Micronutrients—An essential aide to daily growth in children. Indian J Pediatr . (in press). Arch Dis Child . 1996;75:427–431. Ann Hum Biol . 1988;15:103–109.
The development of the CNS in man begins in the embryo and continues for several years of postnatal life. Human brain development follows a highly ordered sequence of events. Proper development and maturation of the brain is necessary for the acquisition of the full repertoire of integrated functions and behaviors that make us human. The brain growth across the years is as shown in the graph. When a baby is born, the body weight is only 5% of an adult but the brain size is 70% of the adult brain. Infact, the brain weight increases 4-5 folds during the last trimester of pregnancy. During first year of life 15% brain growth occurs and the remaining 10% of brain growth occurs during preschool years. The critical periods of brain development are as shown in the graph 2. The graph shows that, the childhood is a critical period of brain and cognition development. Nutrition is one of the most important environmental factors influencing the morphological and functional development of the brain. Daily intake of all nutrients is essential for the proper functioning of the brain, especially during the critical childhood period as there is maximum brain development during this stage. References: American psychologist . 2001;56(1):5-15. Nutrition and Cognition in Children. Proceedings of the Unilever Pre-Congress Workshop. 18th International Nutrition Congress, Durban. 2005.
Many factors influence how much and how rapidly a child grows, and how tall he or she will be as an adult. Some of these factors can be controlled and others cannot. Human growth rate is determined by a complex interaction of physical, endocrine and nutritional factors, of which growth hormone (GH) and nutrition are some of the key determinants of child growth. Nutrition: Many reviews have revealed that inadequate nutrition results in growth retardation along with low weight/height/weight-for-height for the age. Good nutrition is the most essential component for a person to attain his/her weight and height parameters for age. Infections: Frequent common childhood infections like diarrhea and respiratory infection are known to affect growth. Incidence of chronic disorders can also affect the process of growth. In cases of unexplained growth failure, a long-term observation may reveal underlying chronic conditions such as ‘asymptomatic’ celiac disease. A total recovery from chronic disease will allow the catch-up growth to take place. Socioeconomic Status: A higher socioeconomic status includes higher income that is associated with better education, resulting in better nutrition, better child care and prompt medical and social attention. All these factors may influence the so-called secular changes (A secular change is a decrease over time in the average age at which physical maturation takes place) that include increase in size, rate of growth and timing of pubertal development. Urbanization: Urbanization is thought to play an important role in achieving a taller stature which might probably be a result of sufficient food supply, adequate health and sanitation services, education, recreation and welfare. This association has been observed in Europe, the United States and Australia, but not in the slums of South America or in Africa. Psychosocial Stress: Acute stress has been shown to elicit a burst in the secretion of growth hormone (GH), but a chronic exposure to stress that is caused by psychosocial deprivation suppresses the growth hormone secretion, resulting in a failure to grow. The rate of GH secretion returns to normal when the stress is removed and is followed by a period of catch-up growth. Season and Climate: Periods of more rapid growth where the growth rate is three times greater than the rate at the period of slowest growth has been observed. These periods of growth rate are thought to be synchronized with the seasons and the most rapid growth is seen to be in spring. A lower food supply during the rainy season may be responsible for the changes in growth rate in the tropical zones. People living in high altitude, where they are exposed to lower oxygen saturation have been found to have a shorter stature. Physical Activity: Contradictory reports on the effects of physical activity on height, puberty and skeletal maturation are found in the literature, without a clear positive or negative effect on height. References: Pediatr Res . 2007 Mar 15; (Epub ahead of print). Ann Hum Biol . 2006;(335–6):604–619. Lancet . 1980;ii:1097–1099. J Bone Miner Res . 2005;2012:2082–2089. Am J Phys Anthropol . 2002;1193:211–223. Acta Obstet Gynecol Scand . 2005;847:645–649.
Nutritional status of children during the critical period is of paramount importance for later physical, mental and social development. Children need a wide range of nutrients to perform various functions in the body and to lead a healthy life. The pattern of the changing food intake of children during the years of growth presents many interesting facets. During infancy and adolescence, when physical growth is most rapid, nutritional requirements are high and, in a child with good physical and psychological health, appetite increases and food intake becomes greater. However, during the latter part of the first year and through the pre-school years, demands for growth are some what lessened. At the same time development and maturation are progressing rapidly. The child in this post-infancy period is exploring his world, adding many new accomplishments, becoming independent in eating and in general activity, learning bowel control, and exerting his will in making selections. In the later mid-childhood there is increased need of nutrients as there is increased physical activity and as well as over all growth. Adequate nutrition from fetal stage, in childhood, during adolescence, pregnancy and lactation is of fundamental importance for human development. Nutrition is also important for the skeletal development, which is a part of the growth process. Deficiency of nutrients can adversely affect the linear growth, cognition and muscle development which are often irreversible. Inadequate nutrient intake during childhood leads to undernutrition, which results in growth retardation, reduced work capacity, poor mental and social development, high rates of illness and also difficulty in school. References: The World Health Report 2002. Reducing risks, promoting healthy life: Overview, Geneva, World Health Organisation, 2002 (WHO/WHR/02.1). Am J Clin Nutr . 1998;68:S470–S475. Eu J Clin Nutr . 2000;54:S114–S119. Br J Nutr . 1994;72:601–610 Brit J Nutr . 1979;41:431–440. Nutr Rept Int . 1981;24:2. Nutr Res . 1982;2:147–153.
Preschoolers require more nutrients than adults. The figure above shows the comparison between the nutritional requirement of children and adults. The nutritional requirements per kg body weight of children is higher than that of adults. This may be due to the high amount of physical activity that children perform throughout the day and also the nutrients required for the active growth phase in children. Reference: 1. Nutrient requirement and RDA for Indians, ICMR, 1990.
Studies have shown that the nutrient intake, especially the micronutrient intake of Indian school going children do not meet the Recommended Dietary Allowances suggested by Indian Council of Medical Research. Countrywide surveys conducted by the National Nutrition Monitoring Bureau (NNMB, 1998) showed that Indian diets were qualitatively adequate in proteins but deficient in some micronutrients. Thus, if caloric needs are met, protein requirements too are fulfilled, but the requirement of several micronutrients remains unmet. While dietary deficiencies of vitamin A and riboflavin are seen in all age, sex and physiological groups, those of other micronutrients, such as iron, calcium, thiamine, niacin and vitamin C are seen high in children. The graph clear indicates that the mean intake of nutrients by children in India is below the RDA. References: National Nutrition Monitoring Bureau (ICMR). 1996. Nutrition . 2006;22:S1–S7. Nutrition . 2006;22:S15–S25.
Broadly, nutrients are classified into two types, macronutrients and micronutrients. Macronutrients are n utrients of which the body requires relatively large amounts like carbohydrates, fat, and proteins, some vitamins and water. To enable body to use these macronutrients as well as for growth and development, there is a group of nutrients required in very minute amounts. These nutrients are called micronutrients. Vitamins and minerals are micronutrients. Macronutrients are those nutrients that together provide the vast majority of metabolic energy. Carbohydrates can be broadly classified into monosaccharide, disaccharides and polysaccharides. Proteins are complex organic compounds with nitrogen as an integral part. Each gram of protein provides 4 kcal of energy. Amino Acids are the building blocks of proteins. All meat and other animal products are sources of complete protein. Protein in foods (such as grains, fruits and vegetables) is either low, incomplete protein or lack one of the essential amino acids. Fats are complex molecules comprised of fatty acids and glycerol and are concentrated sources of energy, providing 9 kcal of energy per gram. Fatty acids are generally classified as saturated and unsaturated (monounsaturated and polyunsaturated). Micronutrients are required daily in small quantities--in milligrams (one thousandth of a gram) to micrograms (one millionth of a gram). They include vitamins and trace minerals that enable the body to use macronutrients. Vitamins are organic compounds other than proteins, carbohydrates and fats which occur in small quantities in food stuffs and are necessary for growth and maintenance of the body. Although vitamins are needed in small amounts by the body, they must be present in the diet as they are essential for health and well being of the body. Their absence or improper utilization can cause deficiency disorders. There are two types of vitamins, they are fat-soluble vitamins and water soluble vitamins. Minerals represent an important class of micronutrients and many of them are essential for the normal functioning and growth of the human body. Reference: Available at: http://www.merck.com/mrkshared/mmanual_home2/sec12/ch152/ch152a.jsp. Accessed on: November, 7, 2006.
The deficiency of growth nutrients adversely affects growth and some of the affects are as mentioned in the table. Reference: Nat Med J India . 2003:298–302.
Deficiency of certain micronutrients adversely affects the brain and cognition development and some of the affects are as mentioned in the table above. References: Ind Ped . 2003;40:213–220. Curr Opin Clin Nutr Metab Care . 2007;10(3):342–347. J Nutr . 2000;130:553–558 J Nutr . 2003;133:3927S–3931S Prostaglandins Leukot Essent Fatty Acids . 2006;75(4-5):329–349.
Deficiency of certain micronutrients adversely affects the brain and cognition development and some of the affects are as mentioned in the table above. References: J Neurol Neurosurg Psychiatry . 2005;76(2):291–292. Indian J Pediatr . 2004;71:59–62. Food Nutr Bull . 1999;20(1). Annu Rev Nutr . 1994;14269–14296 J Nutr . 1995;125:2212S–220S.
Deficiency of immuno nutrients weakens the immune system, and makes the body vulnerable to infections. The affects of immuno nutrient deficiencies are as mentioned in the table. References: Langseth L. Nutrition and Immunity in man ILSI, Europe. ILSI press 1999. Human Vitamin and Mineral Requirements. Report of a joint FAO/WHO expert consultation, Bangkok, Thailand.
Studies show that frequent illness adversely affects growth & development of children and that children of age between 2-10 years need with all essential nutrients in required quantity for: Optimal immunity Faster recovery Healthy physical growth Mental development References: 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
Docosahexaenoic acid, also known as DHA, is an omega-3 fatty acid. The brain is 60% structural lipid and uses arachidonic acid (AA) and DHA for growth, function and structural integrity. DHA is an essential building block of the brain, absence of DHA may impair intelligence. DHA comprises 60% of the PUFAs in retinas. It has been scientifically proven to aid the development of eyes and nervous system. DHA deficiency during childhood may have devastating consequences to the developing nervous system. Studies on EFA nutritional status in Indians show that omega-3 fatty acid may be inadequate in Indian diet.
DHA aids brain cell maturation and hence brain growth. There was improved maturation of astrocytes with higher concentrations/levels of DHA. In laboratory studies done in India astrocytes or brain cells were cultured in serum deficient conditions (A). After that DHA was supplemented in different doses and the maturation of the astrocytes increased along with the increase in DHA concentrations. This improved maturation of astrocytes may lead to brain growth in general.
The cell membrane of the brain cells are made up of phospholipid in 2 layers. The core of this bilayered phospholipid membrane is very rich in DHA. Studies have shown DHA to be helping neurotransmission. G-proteins are structures present on the cell membrane and that aid in movements of nutrients in and out of the cell. DHA has been found in studies to assist G-protein coupled neurotransmission. It increases the level of “feel good” neurotransmitter serotonin and the “memory boosting” chemical acetylcholine. The cell membrane of the brain cells are made up of phospholipid in 2 layers. The core of this bilayered phospholipid membrane is very rich in DHA. Reference: J. Nutr . 2007;137:855–859.
Alpha Linolenic Acid (ALA) is the precursor which a healthy human will convert into eicosapentaenoic acid (EPA), and later into docosahexaenoic acid (DHA). Relative excess of LA (linolenic Acid) in the diet tends to inhibit endogenous conversion of ALA to EPA and DHA. Some studies have shown that body conversion of ALA to EPA and DHA is inefficient. One study suggests that as little as 0.2% of ALA is converted to DHA. Studies conducted indicate that high doses of ALA may provide limited amount of EPA, but are a poor source of DHA. Hence, it becomes important to directly consume DHA during crucial periods of brain growth.
DHA from a vegetarian source i.e oil extracted from the marine micro algae, Crypthecodinium cohnii is used as a source of DHA. The features of DHA are as mentioned in the table above.
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