Food as a means to realising children s growth potential. Lebo Matshego-Roda Nutritionist (NWU) PhD Student, (UNISA)

Transcription

1 Food as a means to realising children s growth potential Lebo Matshego-Roda Nutritionist (NWU) PhD Student, (UNISA)

2 Content Reaching development potential : assessment tools, what nutrients do children need, when and why? How are South African Children Scoring on their nutrient intakes? What has been the consequence of inadequate nutrition? How can we improve the outlook for children?

3 The end in mind! Its not new news our nutritional status is poor Parents want the best for their children The best is relative to a child s potential Nutrition, is as essential, as the stimulation, right books, uniforms and education to reaching one s potential Nutrition is not complicated or expensive but the issue of the transition is complicated!

4 Tools to measure Physical Height & Weight: most appropriate to measure nutrition status and child growth Skinfold circumferences : considered good indicators for assessing obesity Very small and very large circumferences are both indicative of health or developmental risk (WHO,2007) Hip and waist circumferences fat distribution Cognition Griffiths Scales of Mental Development Holistic view of child s development Engages children through play Covers 5 areas across child's development: 1. Foundations of learning 2. Language and communication 3. Eye and hand co-ordination 4. Personal, social, emotional 5. Gross Motor On time identification of child s growth & developmental gaps are critical

5 Growth milestones Cognition Phyical Growth Pre-school School Aged Adolescents Grow 7-10 cm per year Physically active 2 X the height X times the weight they were at birth Significant Increase in vocabulary Brain weighs 3x more Clear imaginations illogical, ego-centric, magical thinking Poor understanding of time Slow steady growth 6-8 yrs Grow 6cm per year Motor & perceptual motor skill better integrated Use physical activities - develop gross and fine motor skills Use language as communication tool Perspective taking & more effective coping skills Concrete operation Significant growth spurt Puberty weight gain Body changes Think hypothetically Formal operations Think logically & abstractly

6 Reaching development potential Psychosocial and biological factors and by genetic inheritance. The brain develops neurogenesis, axonal and dendritic growth Synaptogenesis and synaptic pruning Myelination Different times build on each other, such that small perturbations in these processes can have long-term effects on the brain's structural and functional capacity. McGregor, S Lancet 2007; 369: 60 70

7 Factors that impact development Early undernutrition Iron deficiency Environmental factors Poor stimulation and social interaction Socioeconomic drivers are much more important than biological ones in determining child development and cognitive ability Cognitive ability and achievement at the end of grade 1 predicted later school progress

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9 Nutrients missing in the diet? 1999 NFCS 2003 SADHS 2012 SANHANES Energy intake, calcium, iron, zinc, selenium, Vitamin A, C, D & E, niacin, B6, folate below two thirds of RDA = < 67% of the RDA < 40 % of children (6 months to 5yrs) receive vit A supplementation < 5 yrs. : 10 % have anaemia 4 in 10 Vitamin A and zinc deficient Vitamin A- still a major public health problem decrease from 63.6% to 43.6% 19% don t eat breakfast (10-14yrs)

10 Changing micronutrient needs > 15% increase in nutrient needs > 50% increase in nutrient needs > 15% increase in nutrient needs 1-3 y 4-8 y 9-13 y >18 y Increase from toddlerhood to children Increase from children to adolescence Increase from adolescence to adults Vitamin A (µg/d) Vitamin C (mg/d) Vitamin D (µg/d) Vitamin E (mg/d) Vitamin B1 (mg/d) Vitamin B2 (mg/d) Vitamin B3 (mg/d) Vitamin B6 (mg/d) Vitamin B9 (µg/d) Vitamin B12(µg/d) Calcium (mg/d) Zinc (mg/d) Iron (mg/d) Moving from toddlerhood to young children is marked by a 33% + increase in the needs of Vitamin A, C, B3, B9, B12, Calcium, Zinc and Iron

11 Reaching their potential, means feeding them the right nutrients at the right time R 429, EFSA maintenance of good vision Vitamin A changes food into energy + normal psychological function + reduction of tiredness and fatigue B Vitamins cell protection from free radical damage Vitamin C normal bone structure Vitamin D healthy heart Vitamin E reduction of tiredness + healthy blood formation Iron normal immune function + contributes to normal cognitive (brain processing) function Zinc maintain healthy bones and teeth Calcium

12 Some more on calcium Birth To Twenty data Soweto, 1994, longitudinal Body composition and bone mineral density scans Physiological measures (pubertal development, biochemical markers of insulin) Prediction and measurement of risk, early expression of the metabolic syndrome (obesity, hypertension and insulin resistance) Richter, L International Journal of Epidemiology 2007;36:

13 Calcium: Growth and bone health Improved growth in comparison with children born in the 70s White children continue to be taller and heavier 18 analyses examining ethnic differences in bone mass pre-pubertal Black children, despite adverse environmental factors (low calcium intakes <400 mg/day, less physical activity, lower socio-economic status) have greater hip bone mass than White children adjusting for differences in stature, likely due to genetic rather But the role of calcium goes beyond bone health

14 Calcium: Regulation of metabolic disorders

15 Macronutrients, a matter of socio-economic status 50% insufficient energy intake, mostly rural children Protein intake generally higher But Free State & Northern Cape had intake less than two thirds of RDA Maize, milk, white sugar, tea, brown bread commonly consumed More recent data is required NFCS, 1999 REGIONAL DATA Jennifer M MacKeown, Public Health Nutr Jun; 10(6): macro- and micronutrient intake among a true longitudinal group of South African adolescents at two interceptions (2000 and 2003): the Birth-to-Twenty (Bt20) Study

16 Energy recommendation Recommended Dietary Allowances Energy Protein Age Daily Per kg Daily Per kg Ref: NICUS

17 The Healthy Active Kids South Africa (HAKSA) Report Card 2014 Examines the best evidence available for the current health status of South African children and youth, and asks the question: Are we doing enough? The current generation of children may experience a shorter life expectancy than their parents. They deserve a better future. In urban primary schools, approx. 1 in 3, 10 yrs olds did not have physical education during the week. Pre-schoolers spend 86% of their time indoors & nearly ¾ of time inactive yrs spend > 3 hrs/day watchingtv Less than 50% of South Africans are food secure. 84% of overweight children had an overweight mother, while 52% had an obese mother.

18 The Healthy Active Kids South Africa (HAKSA) Report Card 5 in 10 kids eat only one serving of fruit a day. 1 in 2 kids will drink at least one sugary drink a week. At least half of those kids will drink two glasses at a time. 19% skip breakfast 31% not hungry in the morning 51% don t take lunchbox to school High fast food intake - average intake by adolescents Boys who were obese between the ages of 4 and 8 yrs were 20 X times more likely to be obese at 16 to 18 years old Girls of similar age group were 42 X more likely to be obese same age

19 Fast-food consumption among 17-year-olds in the Birth to Twenty cohort 7-day assessment Consumed fast-food items Most popular food = KOTA (white bread, chips, a slice of cheese and any number of delicatessen meats and sauces) = 5970 kj.> 50% energy requirements in 1 meal Mean fast-food intake was 8.1 items and 7.2 items per week for males and females respectively A FeeleySouth African Journal of Clinical NutritionVol 22, No 3 (2009)

20 Who will be their superhero to save them! Fitzgerald et al., 2010; Potvin et al., 2003 research recognises the need to consult and engage children and interventions be designed in partnership with children

21 INSIGHT PERSPECTIVE THEORY EVIDENCE PARTNERSHIP

22 Behavior modification Motivate Inform Girls are 42 X more likely to be obese as they grow older Nudge Enable Menu s with foods that are familiar, tasty and affordable

23 Improve Nutrition, Improve Health Outcomes, Improve Children s Potential Identifying and closing gaps timeously is critical in ensuring the optima growth potential. FOOD INSECURITY Nutrient density of the diet is insufficient to meet their nutrient requirements potential growth will be compromised. The 1000 days of life is a critical window of opportunity to lay a solid foundation. Evaluate the impact of food fortification programmes, and voluntary addition of nutrients to improve the micronutrient status of South African children

24 Ke a leboga! Siyabonga! Thank You! Enkosi!Dankie! Merci!