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WHO global anaemia estimates, edition external icon. Accessed June 3, Stevens GA, Finucane MM, De-Regil LM, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for a systematic analysis of population-representative data external icon.
Lancet Glob Health. Guideline: vitamin A supplementation in infants and children months of age; external icon. National Institutes of Health Office of Dietary Supplements.
What is vitamin D and what does it do? external icon Accessed June 18, Roth DE, Abrams SA, Aloia J, et al. Global prevalence and disease burden of vitamin d deficiency: a roadmap for action in low- and middle-income countries external icon. Ann N Y Acad Sci. Andersson M, Karumbunathan V, Zimmermann MB.
Global iodine status in and trends over the past decade. external icon J Nutr. Iodine Global Network. What is being done internationally about iodine deficiency? Iodization of salt for the prevention and control of iodine deficiency disorders external icon. Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities.
Folic acid helps prevent some birth defects. Blencowe H, Cousens S, Modell B, Lawn J. Folic acid to reduce neonatal mortality from neural tube disorders external icon.
Int J Epidemiol. Ackland ML, Michalczyk AA. Zinc and infant nutrition external icon. Arch Biochem Biophys. Lassi ZS, Moin A, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months.
external icon Cochrane Database of Systematic Reviews , Issue Liu E, Pimpin L, Shulkin M, et al. Effect of zinc supplementation on growth outcomes in children under 5 years of age. external icon Nutrients. Wessells KR, Brown KH. Estimating the global prevalence of zinc deficiency: results based on zinc availability in national food supplies and the prevalence of stunting external icon.
PLoS One. Fink G, Heitner J. Evaluating the cost-effectiveness of preventive zinc supplementation external icon.
BMC Public Health. Brown KH, Hess SY, Vosti SA, Baker SK. Comparison of the estimated cost-effectiveness of preventive and therapeutic zinc supplementation strategies for reducing child morbidity and mortality in sub-Saharan Africa.
external icon Food Nutr Bull. Vitamin D is a fat-soluble vitamin that is essential for maintaining normal calcium metabolism and is thus necessary for bone health. Severe vitamin D deficiency in infants and children results in the failure of bone to mineralize, leading to a condition known as rickets.
Rapidly growing bones are most severely affected by rickets. The growth plates of bones continue to enlarge, but in the absence of adequate mineralization, weight-bearing limbs arms and legs become bowed.
In severe cases of vitamin D deficiency, low serum calcium levels hypocalcemia may induce seizures. Although fortification of foods has led to complacency regarding vitamin D deficiency, nutritional rickets is still being reported in the United States and other nations In the US, fortified foods are a major contributor to dietary vitamin D intake, especially in children, because only a few foods naturally contain vitamin D see the article on Vitamin D.
In the US, milk is voluntarily fortified with IU 10 μg of vitamin D per quart mL 34 , and other foods may be fortified with varying concentrations of vitamin D. Although not required by the US FDA to be listed on the Nutrition Facts food label, some packaged foods, particularly cereals, include the amount of vitamin D in one serving as the percentage of the Daily Value DV.
In Canada, vitamin D fortification of milk and margarine is mandatory, with milk containing IU per mL IU per quart and margarine containing IU per grams 34 , but vitamin D fortification of foods is less common in European nations In addition to diet, vitamin D can be endogenously synthesized in the skin upon exposure to ultraviolet-B radiation from sunlight; however, sunscreens effectively block synthesis of vitamin D in skin see the article on Vitamin D.
When setting the RDA for vitamin D, the FNB assumed minimal sun exposure, even though sun exposure could provide most people with their entire vitamin D requirement.
Analysis of data from the National Health and Nutrition Examination Survey NHANES found that average total vitamin D intakes from diet and supplements combined in US children of ages 4 to 8 were 9.
Total daily vitamin D intakes were even lower for chilren aged 9 to 13 years boys, 7. Sun exposure can substantially affect body vitamin D levels, and measuring hydroxyvitamin D — the major circulating form of vitamin D — is a useful indicator of vitamin D status.
However, higher serum hydroxyvitamin D serum levels may benefit health; thus, the Linus Pauling Institute recommends that children ages 4 to 13 years should have a daily intake of to 1, IU 15 to 25 μg of vitamin D, consistent with the recommendations of the Endocrine Society Given the average vitamin D content of the diets of children, supplementation may be necessary to meet these recommendations.
The American Academy of Pediatrics currently suggests that all children receive IU of supplemental vitamin D daily 26 — an amount that is typically found in multivitamin supplements. The RDA for vitamin E in children, expressed as an amount of the α-tocopherol form of the vitamin , was based on extrapolations from intake recommendations for adults, accounting for differences in lean body mass and increased needs of growth during childhood.
A US national survey, NHANES , found that children ages 4 to 8 years had an average intake of 5. These intakes are below the current RDA.
Surveys in The Republic of Korea and Germany have also reported low intakes of vitamin E in children 42, However, true vitamin E deficiency is rare and has been observed only in cases of severe malnutrition, genetic defects affecting the α-tocopherol protein, and fat malabsorption syndromes ; see the article on Vitamin E.
Adequate intake of calcium throughout childhood and adolescence is important for proper mineralization of growing bones, attainment of peak bone mass, and reduction of risk for osteoporosis in adulthood Thus, dietary intake recommendations for calcium in children are established based on the calcium intake needed to support bone accretion and overall calcium retention i.
Calcium intake recommendations are higher in children ages 9 to 13 to account for increased needs of the mineral during puberty Many American children have dietary calcium intakes below current recommendations, with girls having lower intakes than boys.
A recent study reported daily calcium intake in children using data from NHANES , a US national survey Milk contains mg of calcium per cup; therefore, children ages 4 to 8 and children ages 9 to 13 could meet the RDA for calcium by drinking 3.
Certain vegetables and grains also provide calcium, but their bioavailability is lower compared with dairy. For more information on dietary sources of calcium and calcium bioavailability, see the article on Calcium. If children do not meet the RDA through diet alone, LPI recommends supplemental calcium.
The Nutrition Facts label of packaged foods lists calcium content in one serving as a percent of the Daily Value DV , with the DV being 1, mg. However, because the RDA for children ages 9 to 13 years is higher, the percentage of the DV listed would be an overestimation of the percentage of the RDA.
The mineral fluoride is important for the prevention of dental caries tooth decay. Specific cariogenic cavity-causing bacteria found in dental plaque are capable of metabolizing certain carbohydrates sugars and converting them to organic acids that can dissolve tooth enamel.
If unchecked, the bacteria may penetrate deeper layers of the tooth and progress into the soft pulp tissue at the center. Untreated caries can lead to severe pain, local infection, tooth loss or extraction, nutritional problems, and serious systemic infections in susceptible individuals Increased fluoride exposure, most commonly through water fluoridation, has been found to decrease dental caries Fluoride consumed in water appears to have a systemic effect in children before teeth erupt, as well as a topical surface effect in children and adults after teeth have erupted.
The FNB set an adequate intake AI recommendation based on estimated intakes 0. For information about sources of fluoride, see the article on Fluoride. Additionally, fluoridated toothpastes are very effective in preventing dental caries but add considerably to fluoride intake of children, especially young children who are more likely to swallow toothpaste.
Researchers estimate that children under 6 years of age ingest an average of 0. Children who ingest more than two or three times the recommended fluoride intake are at increased risk of dental fluorosis.
To prevent dental fluorosis while providing optimum protection from tooth decay, it is recommended that parents supervise children under 6 years of age while brushing with fluoridated toothpaste.
In addition to discouraging the swallowing of toothpaste, children should be encouraged to use no more than a pea-size application of toothpaste and to rinse their mouths with water after brushing 47, For more information about dental fluorosis, see the article on Fluoride.
Iodine is required for the synthesis of the thyroid hormones , triiodothyronine T 3 and thyroxine T 4. To meet the body's demand for thyroid hormones, the thyroid gland traps iodine from the blood and incorporates it into thyroid hormones that are stored and released into the circulation when needed.
In target tissues, such as the liver and the brain, T 3 , the physiologically active thyroid hormone, can bind to thyroid receptors in the nuclei of cells and regulate gene expression.
In target tissues, T 4 , the most abundant circulating thyroid hormone, can be converted to T 3 by selenium -containing enzymes known as deiodinases.
In this manner, thyroid hormones regulate a number of physiologic processes, including growth, development, metabolism , and reproductive function 49, Iodine deficiency is now accepted as the most common cause of preventable brain damage in the world.
The spectrum of iodine deficiency disorders IDD includes mental retardation, hypothyroidism , goiter , and varying degrees of other growth and developmental abnormalities 49, Iodine deficiency is associated with goiter; the incidence of goiter is higher in girls than boys.
Children in iodine-deficient areas show poorer school performance, lower IQs, and a higher incidence of learning disabilities than matched groups from iodine-sufficient areas.
A meta-analysis of 18 studies concluded that iodine deficiency alone lowered mean IQ scores in children by Global estimates indicate that Major international efforts have produced dramatic improvements in the correction of iodine deficiency in the s, mainly through the use of iodized salt in iodine-deficient countries For more information on the international effort to eradicate iodine deficiency, visit the websites of the International Council for the Control of Iodine Deficiency Disorders ICCIDD or the World Health Organization.
The intake recommendation for children in this younger age group was based on results of a balance study in eight-year-old children who did not have goiters The amount of iodine in iodized salt and the contribution of iodized salt to total iodine intake vary by nation.
Salt used in processed foods and the fast food industry is generally not iodized However, the US is currently considered to be iodine-sufficient Seafood is rich in iodine because marine animals can concentrate the iodine from seawater, and certain types of seaweed e.
Dairy products are also relatively good sources of iodine. However, iodine content of plant foods depends on the iodine content of the soil Iron is an essential component of hundreds of proteins and enzymes involved in various aspects of metabolism , including oxygen transport and storage, electron transport and energy metabolism, antioxidant and beneficial pro-oxidant functions, oxygen sensing, and DNA synthesis 9 , ; see the article on Iron.
Iron is stored in the body as ferritin, and serum level of ferritin is a good clinical indicator of iron status in children Iron deficiency, which is the most common nutritional deficiency in the world, is a major public health problem, especially in developing nations, but it is also prevalent in industrialized nations.
Iron-deficiency anemia results when there is inadequate iron to support normal red blood cell formation. The anemia of iron deficiency is characterized as microcytic and hypochromic, meaning red blood cells are measurably smaller than normal and their hemoglobin content is decreased.
Low red cell count, low hematocrit , and low hemoglobin concentrations are all used in the clinical diagnosis of iron-deficiency anemia For details regarding the clinical diagnosis of iron-deficiency anemia, see Chapter 4 in the book, Nutritional Anemia, which is available through the Sight and Life website.
Most observational studies have found relationships between iron-deficiency anemia in children and poor cognitive development, poor school achievement, and behavior problems. However, it is difficult to separate the effects of iron-deficiency anemia from other types of deprivation in such studies, and confounding factors may contribute to the association between iron deficiency and cognitive deficits Yet, several possible mechanisms link iron-deficiency anemia to altered cognition.
For example, any cognitive benefit associated with iron supplementation could be possibly due to changes in nerve myelination , which have been observed in iron-deficient animals Iron has an important role in the development of the cells that produce myelin 74 ; as noted above, the myelin sheath is the insulating layer of tissue comprised of lipids and proteins that surrounds nerve fibers.
This sheath acts as a conduit in an electrical system, allowing for rapid and efficient transmission of nerve impulses Iron is also important for enzymes involved in the synthesis of certain neurotransmitters and for DNA synthesis Children between the ages of 4 and 13 years are at lower risk of iron deficiency compared to younger or older children because infants, toddlers, and adolescents generally have higher growth rates 9.
Girls in this latter age group who start to menstruate need an additional 2. These intake recommendations were based on a factorial modeling approach that accounts for the amount of iron needed to replace basal losses losses in urine, feces, and sweat and the iron requirements associated with growth increases in hemoglobin, the oxygen-carrying pigment in red blood cells mass; increases in iron content of tissues; and for the younger age group, increases in iron storage.
The intake recommendations also account for average bioavailability the fraction of iron retained and used by the body of dietary iron in these age groups The amount of bioavailable iron in food or supplements is influenced by the iron nutritional status of the individual and also by the form of iron heme or nonheme.
Individuals who are anemic or iron deficient absorb a larger percentage of the iron they consume especially nonheme iron than individuals who are not anemic and have sufficient iron stores 77, In addition, heme iron, found in meat, poultry, and fish, is more readily absorbed and its absorption is less affected by other dietary factors than nonheme iron — the form found in plants, dairy products, fortified foods, and supplements.
The absorption of nonheme iron is strongly influenced by enhancers and inhibitors present in the same meal 77, Organic acids, such as citric, malic, tartaric, and lactic acids, also enhance nonheme iron absorption. Further, consumption of meat, poultry, and fish enhance nonheme iron absorption, but the mechanism for this increase in absorption is not clear 76, Inhibitors of nonheme iron absorption include phytic acid, which is present in legumes , grains, and rice.
Additionally, polyphenols found in some fruit, vegetables, coffee, tea, wines, and spices can markedly inhibit the absorption of nonheme iron, but this effect is reduced by the presence of vitamin C 64 , Soy protein, such as that found in tofu, has an inhibitory effect on iron absorption that is independent of its phytic acid content The mineral magnesium is involved in more than essential metabolic reactions that are generally involved in energy production and the synthesis of nucleic acids DNA and RNA , proteins , carbohydrates , and lipids Magnesium also plays structural roles in bone, cell membranes , and chromosomes and is also required for various cellular processes, including ion transport across cell membranes, cell signaling , and cell migration This recommendation was based on data from magnesium balance studies in children of this age 81, Good dietary sources of magnesium include nuts and green leafy vegetables because magnesium is part of chlorophyll — the green pigment in plants.
Meats and milk have an intermediate magnesium content, with milk providing mg per cup 79 , Refined foods generally have the lowest magnesium content. Analysis of data from the NHANES study found that US children ages 2 to 12 years who consumed three or more daily servings of whole grains had significantly increased magnesium intakes In , the FNB set the AI for children by extrapolating from the adult AI using relative energy intakes.
The mineral zinc is essential for growth and development, immune function , neurological function, and reproduction. Zinc plays a number of catalytic, structural, and regulatory roles in cellular metabolism see the article on Zinc. Zinc deficiency is a major public health concern and has been estimated to affect more than 2 billion people in less developed nations Children are at increased risk for zinc deficiency, which can lead to delayed physical growth, impaired immunity, and possibly to delayed mental development.
Mild forms of this mineral deficiency, which are common in both developing and developed nations, appear to have negative effects on growth and development 23 , However, the lack of a sensitive indicator of mild zinc deficiency hinders the scientific study of its health implications.
Mild zinc deficiency contributes to impaired physical growth in children 88, Significant delays in linear growth and weight gain, known as growth retardation or failure to thrive, are common features of mild zinc deficiency in children. In the s and s, several randomized , placebo -controlled studies of zinc supplementation in young children with significant growth delays were conducted in Denver, Colorado.
Modest zinc supplementation 5. More recently, a number of larger studies in developing countries observed similar results with modest zinc supplementation.
A meta-analysis of growth data from zinc intervention trials recently confirmed the widespread occurrence of growth-limiting zinc deficiency in young children, especially in developing countries Although the exact mechanism for the growth-limiting effects of zinc deficiency are not known, recent research indicates that zinc availability affects cell-signaling systems that coordinate the response to the growth-regulating hormone , insulin-like growth factor-1 IGF-1 91, Adequate zinc intake in children is essential in maintaining the integrity of the immune system 23 , 93 , and zinc deficiency is associated with increased susceptibility to a variety of infectious agents The adverse effects of zinc deficiency on immune system function are likely to increase the susceptibility of children to infectious diarrhea, and persistent diarrhea contributes to zinc deficiency and malnutrition.
It has been estimated that diarrheal diseases result in the deaths of about 3 million children each year Zinc supplementation in combination with oral rehydration therapy has been shown to significantly reduce the duration and severity of acute and persistent childhood diarrhea and to increase survival in a number of randomized controlled trials 96, Recently, a meta-analysis of randomized controlled trials concluded that zinc supplementation reduces the frequency, severity, and duration of diarrheal episodes in children under five years of age The World Health Organization and the United Nations Children's Fund currently recommend zinc supplementation as part of the treatment for diarrheal diseases in young children Zinc supplementation may also reduce the incidence of lower respiratory infections, such as pneumonia.
A pooled analysis of a number of studies in developing countries demonstrated a substantial reduction in the prevalence of pneumonia in children supplemented with zinc A recent meta-analysis found that zinc supplementation reduced the incidence but not duration of pneumonia or respiratory tract illnesses in children under five years of age Due to conflicting reports , it is not yet clear whether zinc supplementation has utility in treating childhood malaria.
Because a sensitive indicator of zinc nutritional status is not readily available, the RDA for zinc was based on a number of different indicators of zinc nutritional status and represents the daily intake likely to prevent deficiency in nearly all individuals in a specific age and gender group.
Shellfish, beef, and other red meats are rich sources of zinc. Nuts and legumes are relatively good plant sources of zinc. Zinc bioavailability the fraction of zinc retained and used by the body is relatively high in meat, eggs, and seafood because of the relative absence of compounds that inhibit zinc absorption and the presence of certain amino acids cysteine and methionine that enhance zinc absorption.
The zinc in whole-grain products and plant proteins is less bioavailable due to their relatively high content of phytic acid, a compound that inhibits zinc absorption The enzymatic action of yeast reduces the level of phytic acid in foods.
Therefore, leavened whole-grain breads have more bioavailable zinc than unleavened whole-grain breads Choline can be synthesized by the body in small amounts, but dietary intake is needed to maintain health Choline and its metabolites have a number of essential biological functions.
Choline is used in the synthesis of specific phospholipids i. Choline is needed for myelination of nerves and is a precursor for acetylcholine, a neurotransmitter involved in muscle action, memory, and other functions For more information about the role of choline in the body, see the article on Choline.
Due to the lack of data in children, intake recommendations for choline in children were extrapolated from adult recommendations using metabolic body weight, accounting for growth. A number of foods contain choline, but eggs, meats, and milk are the primary sources in the American diet α-Linolenic acid ALA , an omega-3 fatty acid , and linoleic acid LA , an omega-6 fatty acid, are considered essential fatty acids because they cannot be synthesized by humans.
The long-chain omega-6 fatty acid, arachidonic acid AA , can be synthesized from LA, and two long-chain omega-3 fatty acids, eicosapentaenoic acid EPA and docosahexaenoic acid DHA , can be synthesized from ALA These polyunsaturated fatty acids have a number of biological activities that are generally important for the structure and function of cell membranes , vision, eicosanoid synthesis, regulation of gene expression , and nervous system function see the article on Essential Fatty Acids.
Dietary intake recommendations for ALA and LA in children were based on median intakes of American children, a population where omega-3 and omega-6 fatty acid deficiencies are not observed.
The AI of ALA for children ages 4 to 8 years is 0. The long-chain omega-3 fatty acids, EPA and DHA, can contribute to these intake recommendations. Flaxseeds, walnuts, and their oils are among the richest dietary sources of ALA, but canola oil is also an excellent source of ALA.
Oily fish, such as salmon, tuna, trout, and sardines, are the major dietary source of EPA and DHA Sources of LA include vegetable oils, such as soybean, safflower, and corn oil, nuts, seeds, and some vegetables see the article on Essential Fatty Acids.
The FNB sets a tolerable upper intake level UL for most micronutrients. The UL is the highest level of daily nutrient intake likely to pose no risk of adverse health effects in almost all individuals of a specified age group.
This level applies to total daily intake from food, water, and supplements. Due to the potential for adverse effects, it is recommended that individuals not exceed the UL.
Thus, individuals should use the UL as a guide to limit daily micronutrient intake, not as a recommended level of intake Table 3 lists the UL for children ages 4 to 8 years, and Table 4 lists the UL for children ages 9 to 13 years.
Some even contain micronutrients e. The Food and Nutrition Board of the Institute of Medicine recommends that daily nutrient intake from food and supplements not exceed the UL for each micronutrient.
There is no evidence that consumption of micronutrients at or above the UL results in any health benefits in children, and the UL should not be exceeded except under medical supervision. Children often consume vitamin and mineral-fortified foods like cereal, and their total intake of certain micronutrients like vitamin A, folic acid, copper, and zinc from fortified foods, other dietary intake, and from supplements should be determined to ensure that the UL is not exceeded.
It is also important to note that the daily values DVs listed on supplement labels in the US do not reflect the current intake recommendations RDA or AI.
A healthy diet in children is important to provide nutrients that support optimum physical growth and cognitive development and to also establish healthy eating behaviors that lower risk of chronic diseases in adulthood. Although it is generally advised that micronutrients should be obtained from food, many children do not reach daily intake recommendations for select micronutrients, including vitamins A, C, D, and E, and some minerals, such as calcium and magnesium 37 , Written in August by: Victoria J.
Drake, Ph. Linus Pauling Institute Oregon State University. Reviewed in August by: Dennis M. Bier, M. This article was underwritten, in part, by a grant from Bayer Consumer Care AG , Basel, Switzerland. Lucas BL, Feucht SA. Nutrition in childhood. In: Mahan LK, Escott-Stump S, eds.
Louis: Saunders Elsevier; Wooldridge NH. Child and preadolescent nutrition. In: Brown JE, Issacs JS, Krinke UB, Murtaugh MA, Stang J, Wooldridge NH, eds. Nutrition through the life cycle.
Food and Nutrition Board, Institute of Medicine. Overview and methods. In: Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc.
Washington, D. National Academy Press. Subcommittee on Interpretation and Uses of Dietary Reference Intakes and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes: Applications in Dietary Planning.
The National Academies Press. Subcommittee on Interpretation and Uses of Dietary Reference Intakes. Dietary Reference Intakes: Applications in Dietary Assessment. Using Dietary Reference Intakes in Planning Diets for Individuals.
In: Dietary Reference Intakes: Applications in Dietary Planning. Kleiber M. Body size and metabolic rate. Physiological reviews ;27 4 Underwood BA, Arthur P. National Center on Birth Defects and Developmental Disabilities. Food and Drug Administration. Center for Food Safety and Applied Nutrition.
National Institutes of Health. Office of Dietary Supplements. See the Mineral Deficiency and Toxicity chapter for information on macrominerals and trace minerals. An official website of the United States government.
Here's how you know. dot gov icon Official websites use. https icon Secure. Home Human Nutrition and Food Safety Food Composition Micronutrients Micronutrients. Learn About Micronutrients Micronutrients, or vitamins and minerals, are needed by the body in small amounts.
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People Antibacterial mattress protector both Anthocyanins and inflammation reduction Antibacterial mattress protector micros in their Micronutrient requirements. Micronutirent provide energy and aid in overall health. Microjutrient include Antibacterial mattress protector nutrients, Microjutrient as vitamins and minerals. Macronutrients Micronutrietn micronutrients are types of nutrients in food. Nutrition professionals and government guidelines recommend that people include certain amounts of these nutrients in their diets. This article looks at what they are, the differences between them, how much people need, and different diets that count them. People need macronutrients in their diet in fairly large amounts.
The requitements Antibacterial mattress protector refers to vitamins and minerals, Antibacterial mattress protector can be divided Probiotics for Immune System macrominerals, trace minerals Micronutrien water- and fat-soluble vitamins. An adequate Micronutrient requirements of micronutrients often means aiming Micronutrienh a balanced diet. Micronutrients are one of the major groups of nutrients your body needs. They include vitamins and minerals. Vitamins are necessary for energy production, immune function, blood clotting and other functions. Meanwhile, minerals play an important role in growth, bone health, fluid balance and several other processes. This article provides a detailed overview of micronutrients, their functions and implications of excess consumption or deficiency.
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