1. NUTRITION IN CHILDREN AND ADOLESCENTS Dana Hrnčířová Dpt. of Nutrition, 3rd Faculty of Medicine, Charles University

2. LOSS OF FLUIDS Routes of fluid lossLoss /day) Kidney (urine)1200 – 1500 ml GIT (stool)100 – 200 ml Lungs (breathing)400 ml Skin (sweat) Total 500 – 600 ml 2200 – 2700 ml

3. FLUID NEED IN SMALL CHILDREN AGE / weightFluid need 1st day60 ml/kg(50 +10) 2nd day70 ml/kg(50 +20) 3rd day80ml/kg(50 +30) … 10th day150ml/kg(50+100) 10th day - 1st month150ml/kg > 1 month and < 10 kg200ml + 100ml/kg 10 kg - 20 kg500ml +50ml/kg > 20 kg1000ml +20ml/kg

4. INTAKE OF FLUIDS = LOSS OF FLUIDS DGE 2011 Daily intake of water (ml) Groupbeveragesfoodoxid. watertotal 15-18 years15309203502800 19-2414708903402700 25-5014108603302600 51-6412307402802250 ≥ 6513106802602250 Pregnant14708903402700 Breast-feeding171010003903100

5. WHAT TO DRINK? Sugar-sweetened beverages (soft drinks) and juices !!! Sugar (risk of overweight and obesity) Fruit acids (teeth damage) Fructose! (↑ TAG - VLDL, ↑ NEFA) Phosphoric acids (cola) Carbon dioxide (hyperacidity, flatulence, less thirst) Less milk as a consequence?

6. THE ROLE OF CAFFEINE Too much caffeine can cause:  nervousness  upset stomach  headaches  difficulty concentrating or sleeping  increased heart rate and blood pressure  Caffeine is diuretic (risk of dehydratation)

7. OBESITY IN CHILDREN 6. Celostátní antropologický výzkum dětí a mládeže, 2001,Česká republika. Souhrnné výsledky. J. Vignerová et al. Př.F UK v Praze a SZÚ Praha 2006.

8. HBSC study 2005/2006, WHO 2008) PREVALENCE OF OVERWEIGHT AND OBESITY AMONG 13 YEAR-OLDS Girls Boys

9. EATING DISORDERS Unhealthy eating habits that may involve either insufficient or excessive food intake and are conected to individual's physical and mental health Bulimia nervosa anorexia nervosa binge eating disorder Bigorexia (Muscle dysmorphia, person becomes obsessed with the idea that he is not muscular enough) Orthorexia (excessive preoccupation with avoiding foods perceived to be unhealthful) Drunkorexia (self-imposed starvation or binge eating/purging combined with alcohol abuse)

10. FOOD ALLERGIES IN SUCKLINGS Family predisposition to allergies ↓ exclusive breastfeeding for first 6 months / hypoallergenic infant formulas (+ eliminating infant’s allergens from mother’s diet) hypoallergenic infant formulas: partially hydrolyzed extensively hydrolyzed free amino acid-based

11. FOOD ALLERGIES IN CHILDREN 3-4 % of children (decreases with age) Allergy - 1 parent = 40 % risk for a child Allergy - both parents = 70 % risk for a child Allergy - sibbling = 30 % risk for a child „The big eight“ 1.Cow Milk (cross reaction: goat, sheep milk) 2.Egg white 3.Soy 4.Wheat 5.Peanuts 6.Tree nuts 7.Shellfish 8.Fish

12. SYMPTOMS OF FOOD ALLERGIES IN CHILDREN Eczema, hive Digestive problems Wheezing / difficulty breathing Swelling (mouth, lips) Anaphylaxis (rare in infants)

13. FOOD INTOLERANCES doesn't involve the immune system Impaired metabolism (Lactose intolerance, phenylcetonuria,...) Expired food (histamine, tyramine, cadaverin,...) Mental intolerancies

14. LACTOSE INTOLERANCE Lactose intolerance, source: Wikimedia Common

15. COELIAC DISEASE Healthy villi villous atrophy Coeliac disease affects people of all ages, both male and female. Strict gluten free diet!