NUTRITION AND A CHILD WITH DS- PART 3

FAT

One declaration, the pie charts & the pictures are taken from different sources of Internet but they all are confirmed with my text books of pediatrics & my journals of pediatric. The composition of different fats are explained excellently in my books but the charts are either shaded or are in black & white so clarity was a problem.

Fat is an important source of energy besides providing satiety & palatability. In a balanced diet around 25-30% of calorie comes from fat. (9 calorie per gram of Fat)

If we look at the molecular composition of  human body Fat comprises  10%.

Why we need Fat?

Functions of Fat:

1.  A concentrated source of energy.
2.  Helps in absorption of fat soluble vitamins i.e Vitamin A, D, E & K
3. Serves as a media for transportation of fat soluble vitamins.
4. Contains fat soluble vitamins.
5. Provides padding for the protection of internal organs.
6. Essential parts of all cell membranes are fats.
7. Fats are important precursors of  hormones.
8. Brain is 60% fat.
9. Effective & healthy functioning of nerve is due to fat(This  explains why flaxseed oil & diet rich in DHA is advised).
10. Provides feeling of satiety.
11. Responsible for flavors of food. 

A fat molecule is made up of two components.

1. A Glycerol which is the 'backbone' of the molecule
2. Fatty acids attached to the backbone

Each glycerol is attached with three fatty acids and form Triglycerides. 

Triglycerides are the main constituents of natural fats and oils. 

 Let us understand common terminologies.

Lipid is a general term used for all that is hydrophobic, insoluble in water & soluble in organic solvents. This include fats, oils, waxes & steroids.

Though fats & oils are mixture of unsaturated & saturated fatty acids,

Oil is referred to an unsaturated fatty acid that is liquid at room temperature.

Fat is referred to a saturated fatty acid that is solid at room temperature.

For nutrition purpose the terms fatty acid & triglyceride will serve the same meaning.(No need to go in details of the molecular structure as that is not going to help in selection of food) 

In this article we will use the term FAT in general as one of the macronutrients. 

There are several types of fatty acids, and fats are usually made up of a mixture of different types.

Fats are classified as SATURATED & UNSATURATED.

 

 

 Trans fats are a type of unsaturated fat typically created in an industrial process called partial hydrogenation. Below is an example.

Before going into the details of good fat & bad fat we will first understand what should be a healthy fat profile of an individual.

As we have already seen FAT is needed for vital functions and vital organs of human body. Fat is needed even to digest food. If we consume diet low in all types of fat we are at increased risk of hormone abnormalities, cardiovascular disease and decreased brain & immune functions.

What happen to fats we take in our food?

As shown digested & absorbed fats(Cholesterol) remain in blood as Lipoproteins. Body Cholesterol can be classified into Low density lipoproteins(LDL), Very low density lipoproteins(VLDL) & High density lipoproteins(HDL). 

When there are excess fats in our diet, HDL help get rid of excess cholesterol by transporting them from the blood vessels to the liver for excretion while  LDL & VLDL increases the blood levels of cholesterol by transporting them from liver to blood vessels & get deposited.

By now, I hope it is clear that we need to select more fat that becomes HDL after digestion.

Let us see the effects of Saturated, Trans, Monounsaturated & Polyunsaturated fats on LDL,VLDL & HDL.

So it is clear that Fats that lowers LDL/VLDL & raise HDL are GOOD & Fats that raise LDL/VLDL & lowers HDL are BAD. Saturated & Trans fats are BAD FATS & Monounsaturated fatty acids (MUFA) & Polyunsaturated fatty acids(PUFA) are GOOD FATS.
This does not mean that one should abundant BAD FAT totally.  

Minimizing consumption of saturated fats is ideal but minimizing consumption of all fats is not good.

Diet must contain the right proportion of fats. 8% of calories from saturated, 10% from polyunsaturated & 12% from monounsaturated. 

  

Trans fats should be avoided as much as possible but as a fast for one/two days is not going to help you in reducing weight & one or two portions of  healthy food won't improve your health, having pastries/cookies or doughnuts occasionally is not going to have bad effects on health. Only thing is they should not be a part of our routine menu. Whenever it happens that child consumes trans fats for say 2-3 days consecutively try  to balance it by giving only healthy fats  for few days.

Sources of Trans Fats

 Saturated Fats are needed, the functions are as follows; 

Saturated fats are needed for energy, hormone production, cellular membranes and for organ padding. Certain saturated fatty acids are also needed for important signaling and stabilization processes in the body & for better functioning of the immune system of the body. Saturated fatty acids that play important roles in these processes are mainly palmitic acid, lauric acid & myristic acid. (no need to remember the names of any of these, information provided is just to enhance the confidence which is a byproduct of knowledge) 

The source of palmitic acid is mainly palm oil. Palm oil comes from the palm fruit, while palm kernel oil is extracted from the palm seed. The one that comes from fruit is a better source of not only saturated fats but a great source of MUFA & to some extent PUFA.

The source of lauric acid is mainly virgin coconut oil

 & the source of myristic acid is again virgin coconut oil & dairy fat(Ghee/butter). 

Amul butter (Nutritional Information*)

Amount per 100 g
Energy, cal	722
Energy from Fat, cal	720
Total Fat, g	80
Saturated fat, g	51
Cholesterol, mg	180
Sodium, mg	836
Total Carbohydrate, g	0
Sugar, g	0
Protein, g	0.5
Vitamin A, mcg	650
Not a significant source of Dietary fiber, Sugars, Vitamin C, Calcium and Iron.

There are no tight compartments, all oils are mixer of Saturated, MUFA & PUFA.

 Now let us have a look at the good fats, MUFA & PUFA. Their functions are same as mentioned in the beginning. Additionally they protects heart by lowering LDL & raising HDL.

MUFA: Monounsaturated fat is considered to be the healthiest type of dietary fat.

Monounsaturated fats come mostly from plant sources. Foods that contain monounsaturated fats(Omega-9) include:

• peanuts
• avocados
• olives
• cold pressed extra virgin olive oil
• canola, almond, hazelnut and peanut oils

 

 PUFA: Polyunsaturated fatty acids,which are found in high amounts in oils from grains & seeds, such as flaxseed oil, are liquid at room temperature & remain liquid even when cooled. PUFA consists of Omega-3 & Omega-6 fatty acids. Ideal ratio of Omega-3 to Omega-6 fatty acid is not known but it is estimated to be around 1:2. Sources of Omega-6 fatty acids are abundant in our routine diet, it is important to decrease it by decreasing the consumption of meat, dairy & refined products while increasing the consumption of Omega-3 rich food like salmon fish, flaxseed oil, walnuts & green leafy vegetables.

Proper balance of Omega-3 & Omega-6 is important for healthy cell membrane. Omega-6 is pro-inflammatory while Omega-3 is anti-inflammatory. Thus consumption of Omega-6 in large quantity may lead to atherosclerosis(thickening of wall of blood vessels), arthritis, inflammatory bowel disease and asthma.

To balance the ratio, use more than two or three types of oils. Flaxseed, fish and mustard have high levels of Omega-3 fatty acids followed by  pulses, green vegetables, wheat & bajra.

Sources

You don't need to remember any of the pie chart, chemical or molecular composition of anything. Just look at food as food only but...but the purpose of providing the information is to make you understand why we need to avoid Trans fats, why intake of Saturated fat need to be restricted, though good why Omega-6 should not be over consumed, why Omega-3 & Omega-9 sources need to be more in our diet. You just need to remember the healthy sources....that's all....!!!  
The chart below will help you to combine oils for your routine use.

Few more I would like to mention as I didn't get the chart.
The colours shown are same as above chart. Red for saturated, blue for PUFA & yellow with highlight for MUFA.
 Beef Fat:               52%   4%    44%
Chicken Fat:         31%    22%    47%
Grapeseed Oil:     10%   73%   17%
Wheat germ Oil:  20%   64%    16%
Walnut Oil:            9%    67%   24%
Sesame Oil:            15%  44%  41%
Almond Oil:             8%   19%  73%
Hazelnut Oil:            7%   11% 82%
Rice bran Oil:         25%  34%   38%
Mustard Oil:           12%  21%  60%

Now mix any two or more according to availability. Choose one that is good source of healthy saturated(coconut/palm) with one or two rich in MUFA & PUFA.

What is optimum Nutrition?

Optimum nutrition is one that promotes health. Health refers to achieving full potential in terms of physical growth (body building), activity (energy), intelligence & behavior (brain development), immune competence (protection against infection & immune related diseases), promotion of individual organ functions and prevention of food related diseases such as obesity & its consequences.

There are standard recommended dietary allowances for different age groups. In general infants need 100 calories per kg of body weight per day, thus 10 kg weight child needs 1000 calories per day. Thereafter 50 calories are required per kg weight per day between 10 and 20 kg of body weight and only 20 calories per kg weight per day beyond 20 kg body weight. 

Let me show one example of a child weighing 15 kg.

Child will need 10kg*100= 1000(for first 10 kg) 5kg*50=250(next 5 kg). 

Total calories needed would be 1250/day.

As stated earlier around 60% calories from carbohydrates, 30% from fat & 10% from protein but during periods of fast growth like infancy & adolescence protein requirements should be slightly on a higher side.

Children with Down Syndrome need 10-15% less calories. An active and otherwise playful child with DS will need 10% less calories than a typical child of same weight. A child with DS who has restricted physical activity and not so playful may need 15% less calories compared to a typical child with same weight. The reasons why our children need less calories is the difference in their metabolism. Refer to the article by Mr Ranjan. Below is the link.

http://asianparentsgroup.icyboards.net/showthread.php?tid=956&pid=4846#pid4846 

Let us take an example:

A child with DS weighing 10 kg would need 900 calories per day. Around 60% means 540 calories from carbohydrates. Each gram of carbohydrate gives 4 calories so you need around 135 grams of carbohydrates. As we have discussed earlier choose a good mixer of simple(less) & complex carbs. Next is protein, 10% means 90 calories from protein. Each gram of protein also gives 4 calories. We will need around 25 grams of protein. Lastly fat, 30% means 270 calories from fat. Each gram of fat gives 9 calories. We need around 30 grams of fat. Important note: The sources mentioned(except for oils) are not isolated sources so when you select a protein or a carbohydrate that will have some amount of fat too. Consider this fact while giving oils & prefer to give half the required quantity in a pure form.

You don't need to keep on measuring it daily. Just select the type of food as per its nutritional values and availability & go ahead. I am putting a picture of healthy plate. That will ease you to select the items.

Below is even easier as the plate is divided percentage wise but in picture too much of breads are shown. Consider that as grains, legumes, pulses etc...Oils are not shown separately but sources are shown as seeds, vegetables, fish etc. The portion of trans fat shown should not be a part of routine menu.

Don't get stressed...it's nothing just select as per the taste, requirement & availability. If your child likes ghee/butter, no need to withdraw, that will provide the amount of saturated fat needed. In that case use an oil that is rich in MUFA & PUFA. If you feel that coconut oil suits your child & virgin coconut oil is available, go for it along with good source of MUFA & PUFA & restrict ghee/butter. If you don't want to give milk & you have enough evidences to withdraw milk from your child's diet, now you know the options.

Don't get confused with new researches, the researches will provide us with newer and better sources but the basic NUTRITIONAL  REQUIREMENTS the IMPORTANCE OF EACH COMPONENT and THE METABOLISM remains the same. So whenever you find some new & better substance researched, check its authenticity, cost, taste, availability & your need to use that. If you find everything okay.....go ahead.

How to measure? 

• One tablespoonful of carbs roughly equals to 12 grams. 

• One tablespoonful of oil roughly equals to 13.6-13.8 grams. 

• One tablespoonful of protein(nuts, lentils,pulses...) varies from 8-13 grams. 

I hope you are now clear with the functions, requirements, compositions & importance of the Macronutrients. 

Next & last would be about Water, Micronutrients, Antioxidants & Detox food. 

 

KEEP CALM, READ THIS POST AGAIN.....TAKE YOUR OWN TIME TO UNDERSTAND....GO THROUGH THE POSTS ON CARBOHYDRATES
 & PROTEINS AGAIN...
SELECT FOOD ITEMS....DECIDE FEW ITEMS FOR ROUTINE MENU IN A WAY THAT YOU CAN OFFER VARIETIES OF ITEMS TO YOUR CHILD....
TRY TO KEEP MAJORITY OF THE CALORIE INTAKE DURING THE FIRST HALF OF THE DAY

SEE YOU SOON....