Carbohydrate balance in children. Lipid balance in children.

 

Carbohydrate balance in children. Lipid balance in children.

 

Carbohydrates are the main source of a quick release of energy in children They are very important for heart activity, thermoregulation and have influence on metabolism of proteins, fats and -water. If there is lack of carbohydrates in the organism, fats and proteins are used as the source of energy, but this process is not economical.

Metabolism of carbohydrates after their amvil in the digestive system includes their decomposition to monosaccharides, synthesis and decomposition of glycogen in tissues, anaerobic and aerobic decomposition of glucose and glyconeogenesis.

Carbo hydrates can be present in the organism as monosaccharides (glucose, fructose, galactose), disaccharides (lactose, saccharose, maltose, isomaltose) and polysaccharides (starch, dextrine, cellulose, glycogen),

The main functions of carbohydrates in the organism are described below.

Glucose is the main energy source for the development of a foetus. Though after the birth such a function is carried out by lipids, however, carbohydrates in this respcct also play an important part, At combustion of 1 g of carbohydrates 4 kcal will be derived. Sugar is the unique supplier of energy for neurons of the brain and erythrocytes. Recollect a phrase from biochcmislry- ‘fats bum down in the furnace of carbohydrates’ – and you will understand that a poor amount of sugar hinders the metabolism of lipids, and it can eventually induce acetonaemic syndrome.

The plastic function: they are formed from structural components of cells and are components of the main biological substances i enzymes, hormones, immune bodies) and connectivc tissue.

Regulation of digesiiort- Carbohydrates of nutrition, by classification of the WHO (1980), are divided into 2 groups: adoptive by an organism of the person and non-adoptive. “I he latter are not hydro!yzed by the gastrointestinal tract enzymes, are not absorbed into the intestine, and if absorbed, they are not metabolized. Ton-adoptive carbohydrates oligosaccharides and polysaccharides are referred (recollect the coprologic examination – this is cellulose), they fulfil the indicated function of Carbohydrates, t.e they normalize digestion.

The features of carbohydrate metabolism in children are as follows.

The metabolism of carbohydrates in a foetus substantially depends on the diet of the pregnant woman; as the concentration of glucose in blood of the full)re mother varies within the day, it goes through the placenta to the foetus not in the constant amount, A considerable change in the level of insulin/glucose in the foetus at incomplete nutrition of the pregnant Woman can result in long-term violations of the metabolism of the carbohydrates in children,

A high activity of combustion of carbohydrates is typical for the newborn period-it is 30-35 % higher versus an adult person. RigM after birth the amount of glucose decreases, achieving its minimum level in 4-6 hours and this is maintained about 4 days. The amount of ulucose in blood reaches the age norm in a mature child by the 10 – 14th day of life, in a premature one only within 1-2 months of life.

In breast milk, lactose is ihc main carbohydrate, and an increase of the amount of sugar in mature breast milk takes place at the expense of it <7 g/dL) in comparison with colostrum (4-5 gML); in cow’s milk the amount of lactose averages 4.7 g/dL Digestion of carbohydrates:

a} it starts in the oral cavity, where the enzyme amylase is secreted from the salivary glands; by ihe birth, the salivary glands are found morphologically; however, their secretory function is reduccd

till 2-3 months.    a reinforced salivation and derivation of diastase are analysed

in the 4-5 months oflife;

digestion of carbohydrates tit the stomach by enzymes ol saliva continues;    

mainly carbohydrates are digested in the proximal department of the small intestine under the influence of A amylase of the pancreas, where they are degraded up to monosaccharides and tlisaccharides. Enzymes of the mucous membrane of the intestine (glucoamylase and disacchandase) take part in the digestion. Dssaceharidase converts disaceharides into monosaccharides, whicti are the only form capable to be absorbed in the small intestines tuta blood (the speed of ihe absorption of carbohydrates can be various: the fastest is that of glucose, fructose being slower).

In a human organism numerous doubled mechanisms oi support of glucose concentration within physiological limits are formed at starvaiion or great exercise stress. The main hormones regulating the methabolism of carbohvdrales arc: adrenaline, which increases the amount of glucose in blood, and insulin, which reduces its amount After reception of carbohydrates with nutrition, the level oi glucose in blood circulation channels is elevated, but insulin comes into effect immediately and in 1-2 hours its amount is reduced to normal exponents,

Medical terminology:

glycaemia- the amount of sugar in blood;

normoglycaemia – the amount of sugar in blood is wilhm its

normal limits;_ hyperglycemia— the amount of sugar in blood is higher thaormal;

hypoglycaemia – the amount of sugar in a blood is lower thaormal.

Diabetes mellitus, It is a chronic disease, characterized by hyperglycemia and glycosuria. In excess of sugar in an organism hypcrinsufinism occurs, which leads to dystrophic changes in the islands of Langerhans in the pancreas with resultant development of diabetes melhtus (refer negative feedback mechanism). Dystrophic changes cause hupohisulinism, that in turn hinders uptake of glucose by cell? Tlie main laboratory sign consists in hyperglycemia.

In cases of emergency, at home the doctor should differentiate hypcrglycaemia from hypoglycaemia, whose diagnosis can be made on the basis of the clinical signs.

Differential diagnosis of hypergiycacinia ami hypoglycaemia

Lipid metabolism in children

Lipid metabolism includes metabolism of neutral lipids, phosphatides, lipoproteins, glycolipids, cholesterol and steroids.

Lipids and products of their metabolism fulfil different functions:

plastic function – they arc part of integrated cell membrane, including that of the nervous system cells;

protection of the abdominal organs from injury;

lipids are a concentrated source of energy (1 g – 9 kcal);

lipids are transformers ofliposoluble vitamins (A, D, fi, K), They include lipid acids, which have the common formula; R-OO

IOH

Lipid acids are very numerous and differ by the presence or absence of double connections in molecules (due to this feature, lipid acids are called “saturated” or “unsaturated”). The most common lipid acids are;

– saturated: palmitic (Cks), stearic (C ?), isobutyric (C*) these

are in milk lipids;

-unsaturated: palmiloleic (Ci6), oleic (Cm), huoleic (Cia)- these

are essential; arachidonie (Cu>).

A common feature of lipids is their bad solubility m water and Kood solubility in organic solvents. Lipids can produce emulsions with different degrees of dispersion and stability in water solutions. Transportation of lipid acids through celt membrane in the intestinal tract is possible only in conditions of their complex With proteins or salts of bile acids.

There are two chemical and histological categories ot lipids:

A – “essential fat”, which is pan of cells,

B – “nonessential Tai”, which is concentrate in tlie subcutaneous tissue, in the greater omentum, near kidneys, ovaries, in the bone marrow. Its quantity can increase acid decrease according to energy spending and feeding-

Essential fat is kept in the organism even during long starvation. The quantity of essential fat is 2-5 % of the body mass (without fat), the quantity of nonessential fat is 26 % iewborns and 35 % in adults.

Jn the first month of gestation, development of fat cells (adipocytes) occurs slowly and only during the last 3 months their quantity increases 4 times. AT 28-29 weeks of gestation, fat quantity increases intensively in the subcutaneous tissue, a specific type of fat (brown fill) localizes in the occipital region, between the scapulae in the mediastinum and near the kidneys. Brown fat has a lot of mitochondria, they favouring its vacuolization and arrival in blood. Production of heat iewborns results from metabolism of brown fat – chemical thermogenesis.

Poor development of brown fat in premature newborns, especially iewborns with an extremely low birth weight, incurs a risk of hypothermia development.

During th& first days a newborn infant satisfies its energy need mostly by carbohydrates, When the quantity of tniik starts to increase, lipids appear. Lipids are disintegrated due to action of enzymes in the gastrointestinal tract and are resorbed by its mucous membrane. Absorption of fat by cells of villi of intestines occurs by pinoeytosis with creation of chylomicrons, which are the transport form of lipids.

Digestion of lipids iewborns has such a peculiarity as participation of a lipase, which is produced by the tongue root glands. The above exogenic lipase arrives in the stomach with mother’s milk. Low acidity of the stomach juicc prevents destruction of milk fat emulsion and favours digestion of lipids Digestion of lipids is more complete if the infant is breast-fed fimulsiflcation of lipids in the intestines is possible due To the action of bile (taurocholie) acid, which creates a complex with lipids, dissolved in water From 25 % to 5U % of lipids are split in the stomach.

The action of pancreatic lipase provides complete splitting of lipids to triglycerides and lipid acids. If the infant has breast feeding,95 % of lipids are absorbed, in premature infants – 85 %, in case oi artificial feeding the absorption of lipids decreases down (o

Disorders of absorption occur due to: large quantities ol satis ot Ca and Mg in food, an inflammatory process in the intestines,

hypovitaminoscs A and B.

Practically alt extracellular lipids are bound with proteins, this phenomenon favouring their solubility and transportation.

The lymphatic system lakes part in the transportation of lipids, which with short chains of lipid acid (C,i) are accumulated in the portal vein system. Lipids with long chains enter the lymphatic system.         .

Tissues can split triglycerides to glycerol and iipid acids, *’hich come to the glycolytic chain in cell mitochondrial and are changed in the Knoon-Linen cycle with a resultant formation of 1 molecule of coenzyme A and a decrease in the lipid acid chain by 2 carbon atoms.

During lipid acid catabohsm, some metabolic products, such as ketone bodies (fl-oxybulyred, acetoacetic and acetone), appear. These products influence the base-acid balance.

Children at the age from 2 to “10 years have a tendency (trend) to ketosis.

Acetonaemie syndrome: This pathological state is based on an increased amount of partial oxidation products of fatty acids in blood, of ketone bodies. These include, aedone, acetoacetic and ff-t.e.hydroxybutyric acid.

The normal amount of ketone bodies in blond is 1-0-2.0 mg% {is determined by the presence of acetone). An increase in ketone bodies is called hyperkdonaemia.

Acetonemic syndrome in paediatrics is not a disease per se, but a complication of another pathological state. The syndrome mostly develops on the basis of an intoxication which can occur in

pneumonia, influenza* acute tonsillitis and infectious diseases. Its

possible causes include ail excessive in lake of fatty foods, diabetes mellitus, liver diseases and a sugar-free diet.Its clinkal signs are as follows: an acidic smell of acetone from the mouth,vomiting; diarrhoea;signs of intoxication;dehydration (in severe conditions).

Laboratory analyses include:

1) detection of hyperketonaemi a (this method is applied rather seldom);

2) the swift (screening) method is estimation of ketone bodies in urine, which increase in acctonaemic syndrome (hypcrketonuria); this can be observed only when there is a rise in the amOUM of kclum; bodies in blood 100 times more than normal.

This is called urinalysis for acetone. The technique is very simple. It can be performed at home by the first aid call, and at night in hospital A drop of the child’s urine is added to sodium nitropmsside (whitish in colour) on a white Petri dish or saucer. Discolouration of the powder is observed within 2 minutes. Normally, the colour of nilroprtissidc should not change In this pathology, the powder colour changes to dark pink (+), dark red (++), brown (+++> or black (+++4). Thus, the greater the number of plusses the higher is the degree ofacetonaemic syndrome.

Nowadays, there are small plastic sticks with specially coloured tips. Dip a stick into a patient’s urine and within 3 minutes you will get the result. Usually on the bottles, in which the sticks are sold, 4 colour variations from lilac to dark purple (results vary from i¥! to /-M++/) are shown.

 

Complex, proved pathogenetic therapy of CF:

·        Hyper caloric diet.
Replacement therapy of exocrine pancreatic insufficiency.
Physical therapy, aimed at improving the drainage function of the lungs.
Antimicrobial therapy of broncho-pulmonary process
Oxygen.
Therapies directed at the elimination of cholestasis
Replacement vitamin fat-soluble vitamins.

·        Energy expenditure in patients with cystic fibrosis:

·        Reduced admission energy substrate (poor appetite, nausea, pain due to reflux, behavioral problems – a violation of feeding behavior)

·        Malabsorption (especially fat – substrate with high energy content)

·        Not associated with pancreatic insufficiency due to energy costs of exacerbations of the disease and shortness of breath

·         

Nutrition and cystic fibrosis

·        Chronic malnutrition on a background of chronic intoxication may cause poor growth, and weight loss

·        Infants and adolescents have the highest risk of poor outlived because they highest growth

·        In patients with cystic fibrosis on a background of psychological problems emerging eating disorder

Nutrition and cystic fibrosis

BETTER lifestyle improves lung function

Other genetically determined problems Markers in patients with CF

·        In celiac disease – gluten-free diet

·        When cow’s milk protein intolerance – soy products, dairy-free diet

·        In secondary disaccaride failure – lactose instead of sugar – glucose, limiting fruit with a high content of fructose

·        When impaired glucose tolerance or diabetes mellitus associated with cystic fibrosis – a decrease in the daily diet of carbohydrates, or use sugar substitutes

Requirements for pancreatic enzyme replacement therapy of patients with CF

Only products in small microspheres –
Creon

Requirements for pancreatic enzyme replacement therapy of patients with CF

·        Individually tailored dose adequate degree of pancreatic insufficiency

·        Lifetime

·        Continuous

·        Physiologic the ratio of lipase, amylase, protease

·        adequate to the composition and quantity of food

Effect of evironment factors on the effectiveness of pancreatin replacement therapy in patients with cystic fibrosis

1.     Increased intragastric acidity

2.     The reduced number of bile acids in the lumen of the duodenum 12 against the backdrop of cholestasis syndrome

Compensation beyond pancreatic problems

·        Dysmotility of the stomach (gastroesophageal reflux – GER) – metoclopramide dose in the age

·        When hyperacidic type gastric secretion -? PPIs, H2 blockers

Monitoring of Power

Weight and height – each time you visit a doctor
Indices lay on the growth and weight of the patient’s chart and evaluate their dynamics
Purpose – to detect problems
              time to correction,
              time to influence the course of disease in general

Patient Oscar                                 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patient Vladimir

                                                                                                                                                                                                                                                                                                                                        

                                     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other causes of failure outlived patients with CF

·        Possible lack of salt

·        Insufficient dosage enzyme or wrong mode of application

·        Diabetes caused by cystic fibrosis

·        liver Disease

·        liver Disease

·        gastro esophageal reflux

·        Poor appetite or eating disorders

 

Patient Irina

                                                                                                                                                                                                                                                                      

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nutritional requirements in cystic fibrosis

l     Patients with CF require more calories (120-150% of usual dietary needs for their age)

         For example, a boy aged 7-10 years needs about 1970 kcal / day, but in CF with additional 20-50% of the calorie content may rise to 2360 – 2950 kcal / day

         (Severe lung pathology may make the greater needs)

A diet rich in fat and energy

·        A diet rich in fat and encouraged regular meals and “snacks“

·        Various food – from different groups:
protein: eggs, fish, meat, beans and mole. products
carbohydrates: potatoes, bread, rice, pasta, cereal
Fruits and Vegetables

·        Add more butter, milk, sour cream, cheese and butter to increase the calorie content

·        Fried food is not contraindicated

 

High calorie diet – Ukrainian food

“Soup” – soup, Cabbage, rosolnyk (increase calorie content may lard, vegetable oil, which is added during cooking and sour cream)
Once, sausage, meatballs, burgers, pies will kaloriynishymy if they fry
Dairy products Milk, yogurt, sour cream

 

Recommendations for dosing Creon

l     Babies – 5000 units of lipase to feeding – with fruit puree before each feeding

l     Children 1-3 years – 20 000 of staple food, 10, 000 – with “snack“

l     Preschoolers – 20-30 000 with the main meal 10-20 000 with “snack“

l     Students – 40-60 000 with the main meal 20-30 000 with “snack“

l     Teens – 50-80 000 with the main meal 20-30 000 with “snack”
Creon is applied for 10-15 minutes before meals or just before eating.

l      The dose may vary depending on the nature of the food you eat
Since the age of 3 years, children should be taught to swallow capsules
The capsules should not be chewed
and should not be confused with food

 

Some products do not require enzymes

l     Only for the exclusive consumption of simple carbohydrates, such as:
Fruit (except avocados)
drinks: fruit juice / lemonade / sweet carbonated water (but milk needs)
boiled sweets
jam, jam, honey
Vegetables (except peas / beans / potatoes)

Salt

·        Higher demand due to sodium loss in sweat

·        Add more salt to food

·        Especially in the hot season, or if the children are too young

·        Check the level of sodium in the urine of children who do not grow well

·        Infant formula and breast milk contain enough salt, so you need to add salt to food babies

Fat-soluble vitamins

·        Fat-soluble Patients with CF are at risk of deficiency of fat-soluble vitamins

·        Vitamins A, D, E and K

·        Even with adequate nutrition children with CF caot get enough of these vitamins. Therefore, you need to add them separately.

·        Can be used together with enzymes

Therapeutic nutrition Cystic fibrosis

In order to increase the daily caloric intake to the basic food added:

         Klinutren Junior, Klinutren, Frezubin (for probe feed or via gastrostomy)

Complete and incomplete Alfaro Frisopep, Frisopep AU

Humana HN mit MST. Therapeutic nutrition with middle branches triglycerides from birth. Impressions

l     For the treatment of diarrhea of various origins in complex forms of bowel disease

l     Lack of pancreatic function

l     Acute and chronic diseases of the hepatobiliary system

l     Celiac disease, cystic fibrosis

l     Laktazna failure

Age recommendation: for all ages (children from birth, older children and adults)

 

Ingredients:

l     Protein is represented mainly casein (90%), 1.9 g/100 ml of

l     Carbohydrates – mostly dextrin

l     50% Fat presented middle branches triglycerides (SLT), which do not require emulgation  bile and are absorbed directly into the portal vein system.

l     Low lactose content (0.5 g/100 ml – 5.6%)

l     Does not contain gluten

l     Banana pectin has a pronounced effect absorbent and reduces signs of diarrhea

l     Dietary fiber banana fiber have a prebiotic effect, stimulating growth natural flora and accelerate the recovery of the intestinal mucosa

l     Energy kkal/100 in 61 ml

study:

“Efficacy of mixtures «Humana HN mit MCT” in patients with CF “
(the duration of the study in 2010 to 2011.)

 

Methods and Materials

•         11 patients, 8 (72.3%) male 3 (27.3%) female

•         the age of 4 months. to? 1 year 5 months.

•         Length using a mixture of 3 to 6 months

•         The mixture used in  7-(63.6%) patients – as the main product

•         in 4 (36.4%) – as foods

•         Indications for assignment:

•         The low number or absence of breast milk in the mother (three patients (27.3%) – breastfeeding, 8 (72.3%) – artificial feeding)

•         Disorders of defecation in the background replacement therapy PF

•         The good tolerability of cow’s milk protein

Methods and Materials

All have:

pancreatic insufficiency, confirmed the level of EF-1

malnutrition and art

All children received basic therapy, including CF Creon drug at a daily dose of 4,500 to 10,000 U / kg lipase

Criteria for evaluating the effectiveness of treatment

•         Organoleptic properties

•         The presence or absence of dyspepsia (regurgitation, vomiting, defecation disorders with steatorrhea)

•         Dynamics available at the time of the appointment of a mixture of dyspepsia

Results

•         All children are willing to eat a mixture of failures posseting, vomiting, blurred nature of feces was observed (100%)

•         four (36.4%) patients refused to use hydrolyzed mixture on a background introduction to their diet «Humana HN mit MST”

Conclusions: Mix «Humana HN mit MST”

•         He has good taste

•         Outstanding tolerated by patients with genetically determined ZSNPZ

•         Has a positive influence on the correct eating behavior, because it is delicious!

•         by:

•         high content of protein (casein)

•         50% medium chain triglyceride content

•         low content of lactose

•         balanced electrolyte composition

•         absence of gluten

•         Recommended for use in patients with CF as primary and secondary food

Hypercaloric application on food

 

 

l     May be useful (but expensive)

l     Used in addition to the usual food

l     They can be useful when a child is ill

l     Most of them also require enzymes

In contrast, the same amount of calories contained in? Glass of milk and a piece of cake