Preventive aspects of child nutrition

A significant problem of modern dietetics is the preventive aspects of nutrition. Elements of preventive nutrition can be represented by enriching water, flour or table salt with such nutrients as iodine, fluorine or selenium in geochemical zones depleted of these substances.

Preventive measures in regions with the "softest" drinking water require supplementing the diet with magnesium and calcium salts. Monitoring the dietary supply of iron, copper, folic and ascorbic acid is necessary to prevent anemia. The broad preventive value has been confirmed for the combination of food antioxidants, dietary fiber, probiotics and prebiotics. However, prevention of chronic cardiovascular diseases - hypertension and atherosclerosis - is especially important in childhood for children from families where parents or other close relatives had cases of cardiovascular "catastrophes" (strokes or heart attacks) at a relatively young age.

Inclusion in cardiovascular disease prevention programs requires changing the attitude toward the fat component of the diet. An example is the recommendations for such a limitation of the American Academy of Pediatrics.

Fats in the diet of children over two years old

• The proportion of fat before 3 years is 35%, after - 30%.
• The ratio of fatty acids is polyunsaturated: monounsaturated: saturated = 1:1:1.
• The total amount of cholesterol per day is up to 200 mg.
• Energy from protein - 12-15%.
• Energy from carbohydrates - 55-58%.

With such a regime of fat provision, constant and careful monitoring of children's growth is necessary, since for many the given scheme can create difficulties in energy provision. Along with fat restrictions, such children need to increase the proportion of polyunsaturated fatty acids of the 33 group, form a provision of calcium, magnesium, folic acid and pyridoxine.

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Principles of approaching a balanced diet for children over one year old

Providing a multi-component balanced diet after one year is no less important than in the nutrition of children in the first year of life or the nutrition of pregnant women. At the same time, specific difficulties arise, inherent in the growing independence of behavior and decision-making of a child or teenager. At the same time, the possibilities for expanding the range of products of animal and plant origin are gradually increasing, allowing for some approximation to a multi-balanced diet. In everyday life, frequent use of complex forms of registration and computer analysis of the diet is unrealistic, therefore, various pediatric schools are developing simple rules for grouping food products in connection with their role - carriers of a certain group of nutrients. As an example, several options for such grouping can be given.

Principles of forming a universal children's diet ("reasonable" nutrition)

• Milk - 600-800 ml.
• Meat, fish, poultry - 1 serving per day (5-6 per week).
• Liver - 1 serving per week.
• Egg - 1-4 times a week.
• Raw vegetables - 1 serving per day.
• Vegetables, colored - 1 serving per day.
• Fresh fruits (juices) - 2-3 servings per day.
• Bread and cereals. By appetite and fatness.

Within the framework of this approach, it is legitimate to use our recommendations. According to them, the total daily energy content of the "average normal" diet is 1000 + 100n (kcal), the volumetric mass of daily table products is about 1200 + 100n (g or ml, not counting tea and drinks; n is the number of years of the child). The volumes of daily consumption products for children over 2 years old can be calculated.

Protein group:

• lean meat, poultry, offal (liver, kidneys) from 3 years - 1-2 times a week, eggs, legumes in combinations and alternation. Total amount 100+ 10n.

Fish and fish-derived fats:

• trout, mackerel, lake salmon, sardines, lightly salted herring 20-70 g depending on age, 3-4 times a week and/or (on the advice of a pediatrician) fish oil from 2 g (after one year) to 5-7 g at school age.

Vegetable fats:

• sunflower, olive, linseed, rapeseed oil, etc., preferably in salads and in combinations. In total up to 1-2 g per year of life.

Dairy products:

• milk, kefir, yogurt 600-700 ml/day at any age, of which 50-200 ml of product with probiotics + cottage cheese 50-100 g + cheese 15-25 g.

Various vegetables and fruits (except potatoes) 4-5 different colors:

• some vegetables and fruits in unprocessed form, some in unsweetened natural juices. Total amount of vegetables, fruits and juices up to 40p.

Energy group:

• potatoes, various cereals, pasta, bread and baked goods are the main energy “ration”, dosed depending on the child’s physical activity and nutritional status in the range from 150-200 g for young children to 1000-1500 g of ready-made meals for a “sporty” teenager.

"A ration of goodies" or "a reward":

• is used to encourage the child only at the end of the main 3-4 meals and in minimal quantities. It is advisable to minimize the use of sweets and more often involve fresh fruits and juices (5th group of main products), dark (bitter) chocolate, honey (if there is no allergy to them), homemade preserves with a minimum amount of sugar based on berries, especially cranberries, lingonberries, blueberries, black currants. Occasionally - ice cream.

Drinks:

• In addition to milk and juices, children can drink different teas (green and black), prepared with purified tap water or bottled still water approved for baby food.

On the advice of a doctor:

• "insurance" multivitamin or combined multivitamin and multimineral supplements in pills or syrups for children.

When discussing various aspects of milk nutrition for children over one year of age, it is important to keep in mind that, as in the first year of life, in subsequent age periods, the availability of milk and dairy products is especially critical due to the very high need of children and adolescents for assimilable calcium. This issue is discussed in the chapter on the physiology of bone tissue. However, it seems very appropriate to use "cow's milk substitutes" produced by the baby food industry along with whole milk or partially instead of it. This can provide both an additional supply of micronutrients and a limitation of sodium salts. Leading British nutritionist Brian Wharton compares the composition and even the cost of different types of milk. Particularly promising is the replacement of part of whole cow's milk (1-2 glasses) with baby food mixtures such as Follow-up, Enfamil-Unior, etc.

Different forms of milk in baby food. Components in 100 ml of milk (according to B. Wharton, 1990)

Indicators	Mixtures	Follow-up	Whole cow's milk	Cow's milk semi-skimmed	Skim cow's milk
Energy, kcal	67-70	65-67	67	48	34
Protein, g	1.5-1.9	2.0-2.9	3.4	3.4	3.4
Vitamin P, mcg	1.0	1.1-1.2	0.02	0.02	0.02
Iron, mg	0.4-0.7	0.7-1.2	0.05	0.05	0.05 -
Saturated fat, g	1.0-1.9	1,2	2.5	1,1	-
Sodium, mmol	0.6-1.1	1.3-1.5	2,2	2,2	2,2
Price (pence)	7	7	6	6	5
Age at onset of use	From birth	From 6 months	From 1 year	From 2 years old	From 5 years old

The widespread prevalence of nutritional disorders in children in Russia, and mainly qualitative disorders with a deficiency of salts, vitamins and microelements, makes all approaches to improving the balance of the diet extremely important. In all cases where the range and quality of the food products used cannot solve this problem, i.e. for a very large part of children, it is necessary to use artificial products such as the already mentioned nutraceutical milk mixtures or supplements with a wide range of micronutrients. There are real opportunities to combine milk nutrition with separately produced supplements. An example is the enrichment of whole milk with the domestic vitamin complex "Golden Ball" recommended by the Institute of Nutrition. Vitamin and mineral mixtures (premixes) of industrial production ("Valetek", "Elevit", "Viten", "Komivit", etc.) are used to enrich products with micronutrients. Supplements can be tablets, effervescent solutions, etc. A pediatrician deciding on the choice of one or another diet correction agent should act as a dietitian pharmacologist, who understands the tasks and directions of the necessary supplementation and the amount of supplement or nutraceutical needed for a child or group of children. One should be wary of multiple overdoses of any vitamin, mineral or microelement, and not forget about the toxicity of some of them (vitamins A and D, large doses of iron, copper, manganese, iodine, etc.).

Adaptation of a child to regular intake of large doses of some vitamins (ascorbic acid) can lead to the formation of dependence and severe hypovitaminosis when switching to normal provision of this vitamin. Nevertheless, the requirement of modern dietetics for multicomponent balance must be met. This is one of the real ways to improve the health and quality of development of children, and therefore, the ways to a brighter future for them. Confirmation of this came unexpectedly in one of the latest reports of the World Bank (1998). Financiers participating in investments in nutrition programs came to the conclusion that "no other technology provides such opportunities to improve human health for such a low price and in such a short time."