Why Nutrition Matters in

the 21st Century

Learning Objectives

• Describe the importance of nutrition

for children
• Describe the consequences of
inappropriate nutrition
• Describe the role of the multidisciplinary
team
The Importance of
Nutrition For Children

• Essential for growth,

organ maturation and
development
• Prevents nutritional
deficiencies
• Affects the child’s adult
health by preventing or
ameliorating chronic
disease
Global Consequence
of Inappropriate Nutrition

• 50% of pediatric mortality directly or

indirectly associated with malnutrition
• 30% of child mortality could be prevented
with simple nutrition intervention
• 1.3 to 1.45 million infant deaths could be
prevented
• Consequences of early malnutrition on
adult health
Bryce J, et al. Lancet 2005;365:1147-1152.
Global Health Opportunities - 2006 Update on Priorities and US Investments.
http://www.reliefweb.int/rw/lib.nsf/db900SID/DPAS-6MMMFH?OpenDocument.
Black RE, et al. Lancet 2008;371:243-260.
World Deaths in 2000 Attributable
to Selected Leading Risk Factors

Source: WHR; 2002.

Worldwide Prevalence of
Stunting
Maternal and Child
Malnutrition

Black RE, et al. Lancet 2008;371:243-260. Chandra S, et al. Prog Food Nutr Sci 1986;10:1-65.
Grantham-McGregor S.J Nutr 1995;125 (suppl8): S2233-S2238.v
Impact of In-Utero Malnutrition
on Organ Development

• Pancreas: diabetic pattern

• Kidneys: hypertension
• Liver: increased lipids, glucose
• Adipose:
• Expansion, inflammation
• Multiple hormone insensitivity
• Endothelial dysfunction
Petrik J. Endocrinology 1999;140:4861-4873.
Langley-Evans SC, et al. Life Sci 1999;64:965-974.
Gluckman PD. Endocrinology 2001;142:1689-1691.
Obesity

• Having a very high amount of body

fat in relation to lean body mass
BMI (WTkg/HT2cm)
• In pediatrics:
• Overweight:
• BMI >85th percentile
• Obese:
• BMI >95th percentile
• Weight/height >2 SD
• over the median NCHS
The Obesity Epidemic in
Children

Ogden CL, et al. JAMAA 2006;295:1549-55.

The Obesity Pandemic

• Overweight is the most

common pediatric
disease
• 10% of young people
between 5 and 17
years are overweight
(155 million children)

• Over 1.7 billion people

worldwide are
overweight, 310 million
are obese
Complications of Overweight
in Childhood and Adolescence

• Psychological • Respiratory
• Impaired body • Obstructive sleep apnea
perception • Asthma
• Isolation • Hypoventilation
• Aggression • Endocrine
• Drugs and alcohol • Metabolic syndrome
abuse • Type 2 diabetes
• Bulimia • Polycystic ovary syndrome
• Smoking • Menstruation abnormalities
• Cardiovascular • Thyroid gland dysfunction
• Atherosclerosis • Orthopedic
• Hyperlipidemia • Slipped capital femoral
• Endothelial dysfunction epiphysis
• Hypertension • Early degenerative arthritis
• Left Ventricular • Coxa vara
hypertrophy • Blount disease
• Perthes disease
• Back pain
Cali AM, et al. J Clin Endocrinol Metab 2008;92(suppl 1):S31-
S36. Lughetti L, et al. Ann Hum Biol 2008;35:439-448.
Pinhas-Hamiel O, et al. Int J Obes (Lond) 2006;30:267-272.
Childhood Obesity

• A serious problem
• A long-term health problem worldwide
• Has psychosocial as well as physical
consequences
• Treatment methods have questionable efficacy
The Barker Hypothesis

• Fetal adaptations to malnutrition result

in metabolic adjustments that lead to
pathophysiology as adults
• Obesity
• Diabetes mellitus
• Dyslipidemias
• Hypertension
• Cardiovascular disease
Barker DJ. J Intern Med 2007;261:412-417.
Multidisciplinary Task
Conclusions

• Appropriate nutrition is critical

• Inappropriate nutrition during critical periods
can lead to chronic diseases in adulthood
• Appropriate nutrition requires a
multidisciplinary team
• The pediatrician must lead team