營養(yǎng)障礙疾病醫(yī)療管理分析

12三月2024營養(yǎng)障礙疾病醫(yī)療管理分析ObjectivesandDemandsTheprinciplesofinfantfeedingandintroducingsupplementalfoodsintoababy'sdietThediagnosis,treatmentandprophylaxisofProtein-energymalnutritionThediagnosisandtreatmentofobesityinchildrenTomasterNutritionalRequirementsandInfantFeeding營養(yǎng)基礎(chǔ)及嬰兒喂養(yǎng)IntroductionLownutritionalstoresHighnutritionaldemandsforgrowthRapidneuronaldevelopmentInfantsandchildrenaremorevulnerabletopoornutritionthanareadultsdietaryreferenceintakes（DRIs）平均需要量EAR(estimatedaveragerequirement)推薦攝入量RNI(recommendednutrientintake)適宜攝入量AI(adequateintake)可耐受最高攝入量UL(tolerableupperintakelevel)一個(gè)人群的RNI=EAR+2SDrequirementsofenergyIncluding:basalmetabolism50%forthermiceffectoffood(TEF)7~8%forphysicalactivityforexcreta10%forgrowthrequirementsofnutrimentEnergyMacronutrient:protein、fat、carbohydrateMicronutrient:mineral、vitaminOtherelement:foodfiber、waterChangesinenergyandwaterrequirementswithageAge(year)Energy（kcal/kg）Water（ml/kg）Infant1101501～31001254～7901007～9807510～12707513～156050Adult40～5040～50SourcesofproteinAnimalproteinPlantproteinThequalityofproteindependsonitsaminoacidcompositionEssentialaminoacidAdult:8Infant:histidinePreterminfant:cystine,tyrosine,arginine,taurineSourcesoffatessentialfattyacidInfantfeedingBreastfeedingMixedfeedingArtificialfeedingTransitionsininfantfeedingBreastfeedingandcomplementaryfeedingtermsanddefinitionsEXCLUSIVEBREASTFEEDING:theinfanttakesonlybreastmilkandnoadditionalfood,water,orotherfluidswiththeexceptionofmedicinesandvitaminormineraldrops.MIXEDFEEDING:theinfantisgivensomebreastfeedsandsomeartificialfeeds,eithermilkorcereal,orotherfoodorwater.ARTIFICIALFEEDING:theinfantisgivenbreast-milksubstitutesandnotbreastfeedingatall.Breastfeeding

CowmilkforcowbabieshumanmilkforhumanbabiesBabiesareborntobebreastfed It’stooimportantnotto!AdvantagesofbreastfeedingTheidealandnaturalfoodforinfants:Nutrition，Immunity，BraindevelopmentandgrowthReducediseaseriskEconomicandconvenienceEstablishanintimate,lovingrelationshipMother’shealthWhyisBreastfeedingImportant?Nutritionally–containsthecorrectbalanceofallnutrientswhentheyareneededProteinquality:Moreeasilydigestedcurd(1:4casein:wheyratio)RichinbetalactoseLipidquality:Richinoleinacid.ImproveddigestibilityandfatabsorptionCalcium:phosphorusratioof2:1Lowrenalsoluteload(infantformuladoesnotchangewithbaby’schangingneeds)Immunity-breastmilkcontainsprotectionagainstinfectionsandinflammation,nomatterwhatageorstageofbreastfeeding.(secretoryIgA,bifidusfactor,lysozyme,lactoferrin,oligose,interferon,livingcells)WhyisBreastfeedingImportant?eczema

Breastfeedingdecreasestheriskofallergicdisorders–aprospectivebirthcohortstudyTypeoffeedingAsthmaAtopicdermatitisAllergicrhinitisChildrenexclusivelybreastfed4monthsormore7.7%24%6.5%Childrenbreastfedforashorterperiod12%27%9%AdaptedfromKullI.etal.Breastfeedingandallergicdiseasesininfants-aprospectivebirthcohortstudy.ArchivesofDiseaseinChildhood2002:87:478-481.DIARRHEALILLNESSAMONGBREASTFEDandFORMULAFEDINFANTSAdaptedfrom:Deweyetal(1995):699-700%Daysill%DaysillOTITISMEDIAAMONGBREASTFEDandFORMULAFEDINFANTSDIARRHEALILLNESSAMONGBREASTFEDandFORMULAFEDINFANTSAdaptedfrom:Deweyetal(1995):699-700%Daysill%DaysillOTITISMEDIAAMONGBREASTFEDandFORMULAFEDINFANTSDurationofbreastfeedingassociatedwithhigherIQscoresinyoungadults,DenmarkAdaptedfrom:MortensenEL,MichaelsenKF,SandersSA,ReinischJM.Theassociationbetweendurationofbreastfeedingandadultintelligence.JAMA,2002,287:2365-2371.Economicbenefitsbreastfeedingcostslessthanartificialfeedingnospecialdietformother(digestion+);healthcare$$reducedwhenbabies/momshealthier;nocostofformula($600-$3000/yr)breastfeedingresultsinlowermedicalcarecostsDiabetes,childhoodcancers,earinfections,Crohn’s,morbidityetcAlwaysready!Nowaste!WhyisBreastfeedingImportant?BenefitsofbreastfeedingforthemotherProtectsmother’shealthhelpsreducesriskofuterinebleedingandhelpstheuterustoreturntoitsprevioussizereducesriskofbreastandovariancancerHelpsdelayanewpregnancyHelpsamotherreturntopre-pregnancyweightSummaryofdifferencesbetweenmilksAdaptedfrom:Breastfeedingcounselling:Atrainingcourse.Geneva,WorldHealthOrganization,1993(WHO/CDR/93.6).母乳分期Stagingofbreastmilkperiodvolumecharacteristic初乳within4－5d15-45ml/dyellowmoreprotein,VitA,taurine,mineralcolostrum過渡乳5-14d500ml/dwhite,morefatproteinandmineral↓protein↓transition成熟乳after14d700-1000ml/dAllingredientsquantityandingredients↓maturecompositionofbreastmilkchangesduringonefeedingsessionThefirstpart：fat?，protein?Thesecondpart：fat?，protein?Thethirdpart：fat??Estabilshingandmaintainingthemilksupply

Preparationbeforedelivery:gainweight(12~14kg)AppropriatecarefornipplesThefirstbreast-feedingshouldtalkplaceassoonaspossibleafterbirth.InfantsshouldbefedondemandPromotinglactationAppropriatetechniqueof