营养障碍疾病医疗管理分析.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,资料仅供参考,不当之处，请联系改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,资料仅供参考,不当之处，请联系改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,资料仅供参考,不当之处，请联系改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,资料仅供参考,不当之处，请联系改正。,Objectives and Demands,The principles of infant feeding and introducing supplemental foods into a babys diet,The diagnosis,treatment and prophylaxis of Protein-energy,malnutrition,The diagnosis and treatment of obesity in children,To master,Nutritional Requirements and Infant Feeding,营养基础及婴儿喂养,Introduction,Low nutritional stores,High nutritional demands for growth,Rapid neuronal development,Infants and children are more vulnerable to poor nutrition than are adults,dietary reference intakes,（,DRIs,）,平均需要量,EAR(estimated average requirement),推荐摄入量,RNI(recommended nutrient intake),适宜摄入量,AI(adequate intake),可耐受最高摄入量,UL(tolerable upper intake level),一个人群的,RNI=EAR+2SD,requirements of energy,Including:,basal metabolism 50%,for thermic effect of food(TEF)78%,for physical activity,for excreta 10%,for growth,requirements of nutriment,Energy,Macronutrient:,protein,、,fat,、carbohydrate,Micronutrient:mineral、vitamin,Other element:food fiber、,water,Changes in energy and water requirements with age,Age,(,year),Energy（kcal/kg）,Water（ml/kg）,Infant 110 150,13 100 125,47 90 100,79 80 75,1012 70 75,1315 60 50,Adult 4050 4050,Sources of protein,Animal protein,Plant protein,The quality of protein depends on its amino acid composition,Essential amino acid,Adult:8,Infant:histidine,Preterm infant:cystine,tyrosine,arginine,taurine,Sources of fat,essential fatty acid,Infant feeding,Breast feeding,Mixed feeding,Artificial feeding,Transitions in infant feeding,Breastfeeding and complementary feeding terms and definitions,EXCLUSIVE BREASTFEEDING:,the infant takes only breast milk and no additional food,water,or other fluids with the exception of medicines and vitamin or mineral drops.,MIXED FEEDING:,the infant is given some breast feeds and some artificial feeds,either milk or cereal,or other food or water.,ARTIFICIAL FEEDING:,the infant is given breast-milk substitutes and not breastfeeding at all.,Breast,feeding,Cow milk for cow babies,human milk for human babies,Babies are born to be breastfed,Its too important not to!,Advantages of breastfeeding,The ideal and natural food for infants:,Nutrition,，,Immunity,，,Brain development and growth,Reduce disease risk,Economic and convenience,Establish an intimate,loving relationship,Mothers health,Why is Breastfeeding Important?,Nutritionally,contains the correct balance of all nutrients when they are needed,Protein quality:More easily digested curd(1:4 casein:whey ratio),Rich in beta lactose,Lipid quality:Rich in olein acid.Improved digestibility and fat absorption,Calcium:phosphorus ratio of 2:1,Low renal solute load,(infant formula does not change with babys changing needs),Immunity,-breastmilk contains protection against infections and inflammation,no matter what age or stage of breastfeeding.(secretory IgA,bifidus factor,lysozyme,lactoferrin,oligose,interferon,living cells),Why is Breastfeeding Important?,eczema,Breastfeeding decreases the risk of allergic disorders a prospective birth cohort study,Type of feeding,Asthma,Atopic dermatitis,Allergic rhinitis,Children exclusively breastfed 4 months or more,7.7%,24%,6.5%,Children breastfed for a shorter period,12%,27%,9%,Adapted from Kull I.et al.Breastfeeding and allergic diseases in infants-a prospective birth cohort study.Archives of Disease in Childhood 2002:87:478-481.,DIARRHEAL ILLNESS,AMONG BREASTFED and FORMULA FED INFANTS,Adapted from:Dewey et al(1995):699-700,%,Days ill,%,Days ill,OTITIS MEDIA,AMONG BREASTFED and FORMULA FED INFANTS,DIARRHEAL ILLNESS,AMONG BREASTFED and FORMULA FED INFANTS,Adapted from:Dewey et al(1995):699-700,%,Days ill,%,Days ill,OTITIS MEDIA,AMONG BREASTFED and FORMULA FED INFANTS,Duration of breastfeeding associated with higher IQ scores in young adults,Denmark,Adapted from:Mortensen EL,Michaelsen KF,Sanders SA,Reinisch JM.The association between duration of breastfeeding and adult intelligence.,JAMA,2002,287:2365-2371.,Economic benefits,breastfeeding costs less than artificial feeding,no special diet,for mother(digestion+),;health care,$,reduced,when babies/moms healthier;,no cost,of formula($600-$3000/yr),breastfeeding results in lower medical care costs,Diabetes,childhood cancers,ear infections,Crohns,morbidity etc,Always ready!,No waste!,Why is Breastfeeding Important?,Benefits of breastfeeding for the mother,Protects mothers health,helps reduces risk of uterine bleeding and helps the uterus to return to its previous size,reduces risk of breast and ovarian cancer,Helps delay a new pregnancy,Helps a mother return to pre-pregnancy weight,Summary of differences between milks,Adapted from:Breastfeeding counselling:A training course.Geneva,World Health Organization,1993(WHO/CDR/93.6).,母乳分期,Staging of breast milk,period volume,characteristic,初乳,within 4,5,d 15-45ml/d,yellow more,protein,VitA,taurine,mineral,colostrum,过渡乳 5-14,d 500ml/d,white,more fat,protein and mineralprotein,transition,成熟乳,after 14 d 700-1000ml/d,All,ingredients quantity,and ingredients,mature,composition of breast milk changes during one feeding session,The first part,：,fat,，,protein,The second part,：,fat,，,protein,The third part,：,fat,Estabilshing and maintaining the milk supply,Preparation before delivery:gain weight(1214kg),Appropriate care for nipples,The first breast-feeding should talk place as soon as possible after birth.Infants should be fed on demand,Promoting lactation,Appropriate technique of breast-feeding,.,No factor is more important for successful breast-feeding than a happy,relaxed state of mind.,The most satisfactory stimulus to the secretion of human milk is regular and complete emptying of the breasts.,Contraindications to breast-feeding,哺乳禁忌,绝对禁忌,HIV、,慢性肾炎、糖尿病、,恶性肿瘤、心功能不全、,精神病、癫痫,相对禁忌,乙肝病毒携带者、无临床症状的结核病,部分母乳喂养,mixed feeding,补授法,Supplemental Feeding,母乳哺喂次数一般不变，先哺母乳，再补充乳品或代乳品,代授法,Breast-bottle-feeding,乳品或代乳品代替一至数次母乳喂养,人工喂养,Bottle-fed,概念,definition,The use of a substitute for breast milk for feeding infants,4个月以内的婴儿，由于各种原因不能进行母乳喂养时，完全采用配方奶或其它兽乳，如牛乳、羊乳、马乳等喂哺婴儿，称为人工喂养。,The principles of infant feeding and introducing supplemental foods,添加辅食的原则,Little to more,由少到多,Thin to thick,由稀到稠,Fine to coarse,由细到粗,Mono to multi,由一种到多种,Introducing gradually when stable,应在婴儿健康、消化功能正常时逐步添加,Transitions in infant feeding,食物转换,月龄,食物性状,种类,餐数,进食技能,主餐,辅餐,46月,泥状食物,菜泥、水果泥、含铁配方米粉、配方奶,6次奶,（断夜间奶）,逐渐加至1次,用勺喂,79月,末状食物,软饭(面)、肉末、菜末、蛋、鱼泥.豆腐.配方米粉、水果,4次奶,1餐饭,1次水果,学用杯,10 12月,碎食物,软饭(面)、碎肉、碎菜、蛋、鱼肉、豆制品、水果,2餐饭,23次奶,1次水果,抓食,断奶瓶,自用勺,Thank You!,