carlo agostoni ii clinica pediatrica irccs ospedale ... · krauses food, nutrition & diet...
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Carlo Agostoni
II Clinica Pediatrica
IRCCS Ospedale Maggiore Cà Granda
Università d i Milano
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PERCHE
1. Per prevenire fasi d i accelerazione della crescita ponderale
2. Perché eccesso ponderale in età pediatrica può associarsi a patologie croniche dell adulto, anche in misura maggiore dell eccesso ponderale in età adulta stessa
3. Per mantenere abitud ini alimentari corrette e stile d i vita adeguato
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METHODS. We studied the relation between overweight and morbid ity and mortality in 508 lean or overweight adolescents 13 to 18 years old who participated in the Harvard Growth
Study of 1922 to 1935. RESULTS. Overweight in adolescent subjects was associated with an increased risk of mortality from all causes
and disease-specific mortality among men, but not among women. Overweight in adolescence was a more powerful pred ictor of these risks than overweight in adulthood. CONCLUSIONS. Overweight in adolescence predicted a broad range of adverse health effects that were independent of adult weight after 55 years of follow-up.
Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935.
Must A et al., N Engl J Med 1992; 327:1350
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PAESI CON INTAKE: NUTRIENTE
MAGGIORE MINORE
Carboidrati (%E) Slavi Mediterranei
Zuccheri (%E) Mediterranei
Lipidi (%E) Mediterranei Scandinavi
SFA (%E) Finlandia Mediterranei e YU
MUFA (%E) Mediterranei Scandinavi
PUFA (%E) Slavi
Proteine, g/kg peso corporeo Spagna Germania, Gran Bretagna
Revisione d i dati raccolti tra il 1984 ed il 2002
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Fruit and vegetable consumption remarkably lowFavourable intervention effect seen only in boys
STRIP BABY PROJECT TURKU - FINLANDIA
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PRINCIPALI ERRORI NUTRIZIONALIETA PRESCOLARE E SCOLARE:
Relativo eccesso calorico vs intake energetico giornaliero (sedentarietà).Colazione non consumata/ inadeguata.Erronea d istribuzione delle calorie nella giornata. Eccesso d i:
proteine e grassi saturi (formaggio, carne);carboidrati ad elevato ind ice glicemico (pane, patate, succhi di frutta).
Scarso intake d i:fibre e proteine vegetali (frutta e verdura, cereali integrali, legumi);pesce
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Cambiamento della spesa energetica con l'età
0
10
20
30
40
50
60
70
80
90
100
110
1 3 6 9 12 15 18
Età (Anni)
Cal
/kg
Totale Basale Attività Crescita Termogenesi Perdite
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Assicurare una corretta crescita, evitando:dieta insufficiente malnutrizionedieta con eccessi obesità, ipercolesterolemia, ipertensione, diabete, malattie cardiovascolare
Consentire lo sviluppo di un corretto rapporto con il cibo per prevenire i disturbi del comportamento alimentare (DCA)
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Insegnanti:conoscenze nutrizionali,
attività fisica
Refezione scolastica
MediciPediatriDietiste
Mass mediaIndustria
Agricoltura di qualità
PoliticiResponsabili di comunità
Abitudini nutrizionali
a casa
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Consigliare d i suddividere l apporto dialimenti in 4-5 pasti al giorno
Raccomandare di evitare i d igiuni
Rilevare periodicamente (almeno 1 voltaall anno) le abitud ini alimentari delbambino
Fornire ai genitori elementi per favorire losviluppo di corrette abitud ini alimentari.
EDUCAZIONE NUTRIZIONALE
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PROTEINEvegetali:animali = 1:1
GRASSI
acidi grassi saturi <10%
CARBOIDRATI
AMIDO a basso ind ice glicemico
10%
30 25 % 60-65 %
RIPARTIZIONE NUTRIENTI
+ tante fibre
+ ferro
+ calcio
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In 4-5 pasti:
colazione + spuntino 20%
pranzo 40%
merenda 10%
cena 30%
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LA PRIMA COLAZIONE4 sono i "plus" della prima colazione
regolarmente consumata:
1. associazione con stili d i vita favorevoli2. associazione con riduzione dell'ind ice di massa
corporea3. miglioramento del comportamento alimentare:
migliore senso di sazietà, minore senso di fame emodulazione della assunzione di cibo al pastosuccessivo (pranzo)
4. associazione con migliore prestazioneneurofunzionale e accademica
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INDICE GLICEMICOINDICE GLICEMICOL IG di un alimento è il rapporto tra l area sottesa alla curva di assorbimento, dopo l ingestione di pane bianco (o glucosio) contenente 50 g di CHO disponibili e quella
ottenuta dall alimento testato
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OGNI GIORNO SALTUARIAMENTE DA LIMITARE
Frutta in genere Banane Biscotti frollini
Latte, yogurt Patatine, pop corn Zucchero
Legumi Riso integrale Brioches, dolci
Pasta al dente Pizza Riso
Muesli Patate Pane bianco
All Bran Cereali pronti
LOW G.I. < 55 55< MEDIUM G.I.< 70 HIGH G.I. > 70
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Overall, there was a dose-response relation between higher intake of white rice and
increasing risk of d iabetes
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IL FUTURO
UNA VISIONE NUTRIECONOMICA?
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DALYDisability-adjusted life years
QALYquality-adjusted life years
MONEY SAVED FOR
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NUTRIENT INTAKES
GROWTHWeight & Length/height
OUTCOME MEASURES Disease preventionNeurodevelopment
Health
LIFESPAN
DALY QALY
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The cost per kilogram of weight-gain prevented over the 2 years of the intervention was NZ$1,708 in 7-year old children (average weight-gain prevented of 0.75 kg) andNZ$664 in 13-year old children (average weight-gain prevented 1.93 kg). 1NZ$=0.63
Moodie ML et al, Obesity 2010;18:1585
2-year controlled community-based obesity prevention initiative
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Krause s Food, Nutrition & Diet Therapy,10th Ed, 2000
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