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INTRODUCTION

The importance of nutrition in medicine transcends the basic need for energy and for preventing deficiencies. Nutrition from preconception and throughout infancy, childhood, and adolescence is not only essential for growth and neurodevelopment, but it also plays a pivotal role in overall wellness, susceptibility to chronic diseases, and adult long-term health. Nutrition is a common foundational requirement across cultures and all ages. The pediatric medical provider is in a unique position to be able to assess nutrition issues acutely and longitudinally, guide families in addressing nutrition needs and concerns, and promote evidence-based nutrition recommendations.

NUTRITIONAL REQUIREMENTS

NUTRITION & GROWTH

The nutrient requirements of children are influenced by growth rates that vary with age and are especially important during early postnatal life (Table 11–1). The period between conception and 2 years of age is referred to as “the critical 1000-day window.” Nutrient intake during this time is considered a modifiable factor that can profoundly affect cognitive development, lifelong mental health, as well as impact health risks for obesity, hypertension, and diabetes. Optimizing nutrient provision and healthy intake in infancy/childhood helps provide an early foundation for future growth and development throughout the lifecycle.

Table 11–1.Growth rates in infancy.

DIETARY REFERENCE INTAKE

The dietary reference intakes (DRIs) include four reference values for nutrients and are used to assess and plan the diets of healthy individuals based on their age and gender.

  1. Recommended Dietary Allowance (RDA): The average daily level of a nutrient intake sufficient to meet the requirements of nearly all (97%–98%) healthy individuals in a specific age and gender group.

  2. Estimated Average Requirement (EAR): The average daily level of a nutrient intake estimated to satisfy the needs of 50% of healthy individuals in a specific age and gender group.

  3. Adequate Intake (AI): Established using observational data when evidence is insufficient to develop an RDA

  4. Tolerable Upper Intake Level (UL): The maximum daily nutrient intake level unlikely to cause adverse health outcomes.

The Acceptable Macronutrient Distribution Range (AMDR) is the calculated range of energy from protein, carbohydrates, and lipids recommended for a healthy diet.

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Otten  JJ, Hellwig  JP, Meyers  LD: DRI, Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: National Academies Press; 2006:xiii, 543.

ENERGY

There is no DRI for energy. Estimated energy requirements (EER) are used instead. The significant determinants of energy expenditure are (1) basal metabolism (reflected in resting energy expenditure (REE), (2) physical activity, (3) growth (1 g of ...

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