Beslenme ve Diyet Dergisi / J. Nutr. and Diet., 14 : 159 - 167, 1985. 159
NUTRİTİON DURING LATE INFANCY : THE FOLLOW - ON CONCEPT
Phar. Ö m er RENKLİGÜMÜŞ*
The feed in g o f the older infant should be a continuation o f the g o o d nutrition provided by breast m ilk o f form u la fe e ding.
A fte r fo u r or five months, m others start including small am ounts o f sem isolid and solid foods into their babies’ diets. Foods added to the diet o f the older infant should be o f the type su p p ortin g his developm ent. This w ay it is possible to introdu- ce a variety o f foods as well as develop the infant’s chew ing and sw allow ın g reflexes. However, the selection o f w ron g foods du- rin g this period, m ay lead to m alnutrition and its consequences. S in ce there is disagreem ent on the nutritions fo r babies during w eaning, the nutritional recom m endations given in RDA are b roa d ly accepted as safe and appropriate amounts. During the w ea n in g period, m ilk and m ilk foods continue to be important.
INTRODUCTION :
The im portance o f a proper w eaning diet : G ood nutrition an d g o o d fe e d in g habits begin with the b a by’s first breast or fo rm u la fe e d in g and are im portant fo r norm al physical growth, op tim a! m ental developm ent, and m aintenance o f good health th rou gh ou t the b a b y ’s early years. A fter fo u r or five months, m oth ers u su ally begin to expand their babies, diets to include sm all am ounts o f sem isolid and solid foods.
A w ell - balanced, -well - tolerated transition diet is essential to assure continuity in m eeting the grow ing nutritional needs o f the older b a b y during weaning. Sound nutrition during the w ea n in g period provides im portant advantages in such areas as :
160 Renkligümüş, Ö.
• w eigh t gain and growth
• resistance to infection
o physical and m ental developm ent
G row th fail — o ff : Recent studies show that, even m ore
than previously expected, im proper feeding during weaning
m ay lead to m alnutrition and its sequelae. The results o f a study (1), conducted am ong infants in an A sian population indicated that grow th fail - o ff (ie, lethargy, susceptibility to infection, deterioration o f m uscle tone, and dim inished rates o f grow th) rose am ong babies during the w eaning period - from six to eighteen m onths o f age. These m alnutrition - related effects resulted from
• inadequate am ounts o f solid foods to m eet nutritional needs • the absence or abrupt w ithdraw al o f m ilk or m ilk food from
the w eaning diet.
THE COMPLETE W E AN IN G DİET s
The com plete w ean in g diet should consist o f solid or semi- solid foods and shou ld include m ilk fo r calorie and protein supp- lem entation. G enerally, as the b a b y grows, neither solid food n or m ilk alone w ill provide the quantity o f nutrients necessary to sustain rapid grow th and increased activity.
M ilk o r m ilk fo o d that supplem ents a w eaning diet is so- m etim es referred to as follow - on fo o d and is useful in providin g added protein, calories, iron, and other nutrients necessary fo r the g row in g baby.
THE NUTRİTİONAL NEEDS OF OLDER BABİES :
R esearchers disagree abou t the appropriate nutritional
standards fo r babies during w eaning. However, the nutritional recom m endation s outlined in R ecom m ended D ietary AlIow ances
(2) (RDA) are broa dly accepted as safe and appropriate nu t ritional allotm ents. T hey reflect current research on the various nutrients an d in corporate a consensus o f opinion am ong experts in the nutrition field.
n u t r i t i o n d u r i n g LATE INFANCY 161
Because RD A figures apply to th© average nutritional needs o f a. norm al population, babies w ith sp ecific health problems, su ch as low birth weight, dietary deficiencies o r illness, w ould obviou sly require special adjustm ent o f the RDA.
Unless othervvise noted, ali nutrient values fo r food s that appear in the follow in g tables are taken from R ecom m ended D ietary A llow ances (2).
Protein : Perhaps the m ost im portant elem ent in the w ea- n in g diet is protein, w h ich supports the synthesis o f tissues d u rin g this period o f rapid growth. Although the protein requir- m ent p er unit o f b od y w eigh t decrease, overall protein intake is increased as the b a by grows. R ecom m ended protein intake is 2 .2 /k g an d 2.0/k g fo r the age o f 4 and 8 months as referen ce
protein-H igh quality protein is o f particular importance to weaning babies becau se it provides fo r
• intake o f ali essential am ino acids
• easy digestion
• ra p id absorption
• m axim al utilization
• optim al grow th
P rotein quality is often expressed b y one o f the follow ing m ethods.
Protein e fficie n cy ratio : The protein efficiency ratio (PER) is d eterm in ed in rats and is defined as the weight gain per
gram o f protein fed; it is a formula used to measure the extent
to w h ich a protein is utilized b y the body. The Standard fo r protein in terms o f PER is considered to be casein, having a PER o f 100 % .
A m in o acid con ten t : A second measure o f the quality of p rotein is its essential am ino acid content. The RDA recom - m ends n in e am ino acids as essential fo r grow ing babies (Tab le 1).
162 Renklieümüs, Ö. T ablo 1 : Essential Am ino A cid Requirem,ents(*)
A m ino Acid Requirement (m g/kg body w eight/day) Fraction o f High Quality Protein (m g /g of protein) Histidine 33 17 Isoleucine 83 42 Leucine 135 70 Lysine 99 51 M ethionine + cystine f 49 26 Phenylalanine + tyrosine f 141 73 Threonine 68 35 Tryptophan 21 11 Valine 92 48
(*) About 35 % of a baby’s dietary protein intake must be provided as essential amino acids.
f For infants 4 to m onths old.
f Cystine can raplace part of the requirement for m ethionine : tyrosine can replace part of the requirement for phenylalanine.
Chemical score : Chem ical score determ ination is based on the am ino acid content o f a particular protein in relation to the am ino acid content o f a Standard. Standards used in calcu latin g chem ical score are.
• optimal essential am ino acid pattern (Table 1)
• w hole egg protein
Both o f these standards are assigned a ch em ical score, or nutritive value , o f 100. A lthough this m ethod agrees w ith the b iolog ic value determ ined fo r protein, it does not m easure p r o tein digestibility, as does the PER.
NUTRITION DURING LATE INFANCY 163
C arboh ydra tes/F a ts :
The old er b a b y ’s in creased en e rg y requ irem en ts m ust be su pported b y an increase in ca loric intake. A s the b a b y grows, en erg y requirem en ts decrease p e r unit o f b o d y w eight, but to- tal intake requirem en ts con tin ue to increase. R ecom m en ded intake is 115 k c a l/k g and 105 k c a l/kg fo r the age o f 4 and 8
respeclively.
C arboh ydrates an d fats should be present in a balan ced
C .
ratio in the w ea n in g diet. Utilized as en ergy sources b y the body, calories support p h ysiologic processes vital to ov era ll b ody functioning.
C arboh ydrates p rov id e energy in the form o f starches, m o- n osacch arides, a n d disaccharides. These are an im portant en erg y sou rce fo r brain tissue. Dietary fats fu n ction as carriers o f fa t - solu ble vitam ins. In addition they provide essential fatty acids w hich,
« m aintain the fu n ctio n and integrity o f cellular and subcel- lular m em branes,
® regulate cholesterol m etabolism ,
• fu n ction as precursors fo r h orm one - like com pounds such as prostaglandins.
C urren t research stresses the im portance o f linoleic acid fo r babies. A cco rd in g to one authority, it is recom m en ded that lin oleic a cid p rovide 2 % to 3 % o f total en ergy intake (3). M in erals s
P roper intake o f m inerals in the w eaning diet is necessary to • su pport p h ysiologic processes
ı © rep lace fetal stores
® prevent deficiencies
The R D A takes into accou n t current research fin din gs in determ in in g the m inerals, trace elem ents, and electrolytes n e cessary to the hu m an diet (Table 2).
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43 J3 cö w '3 3 > a es a Q +NUTRITION DURİNG LATE INFANCY 165 Iron : The w ean in g diet o f the older ba,by shou ld include a p roper intake o f iron. By the age !of fo u r to six m onths, fetal stores o f iron have been depleted, m akin g iron intake im pera- tive. A daily supply o f dietary iron is essential to m aintain adequate form a tion o f h em oglobin and prevent iron d eficien cy anem ia.
Zinc : Fetal stores o f zinc declin e du rin g early infancy. D eficien cy o f zinc can result in
• loss o f appetite • fa ilu re to g row
o im paired w ou n d healin g
• skin changes.
C alcium : This nutrient, a lon g w ith phosphorus, is o f par- ticular im portan ce to the w ea n in g b a b y in prom otin g p roper bon e and skeletal form ation . C alcium is also a necessary nut rient fo r
• b lo o d coa gu la tion • m y oca rd ia l fu n ction • m uscle con tractility
• con trollin g the excitability o f nerves. V itam ins
A soun d w ea n in g diet m ust include a bala n ced p rofile of vitam ins. V itam ins are n ecessary fo r
o preven tion o f in fection • support o f tissue grow th
• p reven tion o f d e ficien cy states
The R D A recom m en d s that 13 vitam ins be included in the vveaning diet (Table 2).
V itam ins C and D : T he w ean in g b a b y has a particular need fo r vitam ins C and D, as both are directly in volved in p roper tissue grow th and n eith er appears to be synthesized by the body.
S pecifically, vitam in C plays a role in the • m etabolism o f am ino acids
• form a tion o f colla g en • absorption o f iron.
V itam in D increases the utilization and retention o f calciu m an d phosphorus, thereby supporting the n orm a l m ineralization o f bone.
166 Renkligümüs, Ö. THE ROLE OF SOLİD FOODS :
A s babies grow and becom e m ore active, solid foods are introduced into the diet to provide larger quantities o f basic nutrients. Presenting the baby with a variety o f foods during vveaning should
• supplement milk in providing the proper balance o f essential
nutrients
• form the basis o f a full adult diet. .Weaning practies :
The schedule by w hich foods are introduced to the b a b y ’s daily diet is influenced by the preference o f the m oth er and doctor, but certain nutritional and practical standards should be m et to ensure proper intake of nutrients and to respond to problem s that m ight arise. Some guidelines fo r proper w eaning
are :
1. Introduce new foods one at a time, one per week. 2. M ake sure the baby is ready fo r nonliquid foods.
3. Serve solid foods in small portions; portion sizes m ay be increased as the baby grows.
4. Serve foods at approximately the same times and intervals each day.
5- Food should not be forced if the baby does not readily ac-cept it. Instead, the food should be served again a week o r two later.
6. Continue to serve m ilk food as the baby is weaned. Gradu- ally decrease the am ount as solid foods increase.
7. If the baby has any unusual reactions to a new food, it should be withdra,wn immediately. A ny unusual sym ptom s should be reported and should receive prom pt m edical at- tention.
Serving appropriate solid foods and m ilk fo o d accordin g to these guidelines helps to ensure
• sound nutritional intake during weaning
• a healthy transition to a full adult diet. THE ROLE OF MİLK FOOD s
M ilk food, or follow - on food, provides a nutritious supple m ent to a regu lar diet o f solid food s during weaning. A p roperly
NUTRITION DURİNG LATE INFANCY 167
b a la n ced m ilk fo o d provides the correct am ounts o f ali nutrients to help ensure a com plete w ean in g diet.
M ilk fo o d is a sound alternative to other types o f m ilk (eg; yogh u rt, con densed milk, evaporated milk, dry milk, and w h ole c o w ’s m ilk ), as these other form s - in the absence of appropriate solid fo o d s - m ay not provide adequate nutrition fo r a w ea n in g baby.
M ilk fo o d is especially im portant in the early stages of w eanin g, w h en a b a by can n ot take in enou gh solid foods to m eet his nutrition al needs.
Ö Z E T
BEBEĞİN İLERİ A Y LA R D A K İ BESLENMESİ : YALNIZ SÜT VERİLMESİNİ İZLEYEN BESLENME DÖNEMİNİN KAVRAM I
Renkligümüş, Ö. B ebeğin ileri aylardak i beslenm esi, anne sütü y a da form ül beslenm esin de kazanılan iyi beslenm enin devam ı olmalıdır. A n
n eler genellikle dördü n cü , beşinci aydan sonra bebeklerinin
beslenm esin e az m iktarlarda y a n - katı ve katı yiyecekler ila ve etm eye başlarlar. İleri aylardaki bebeğin beslenm esine ilave edilen besin ler on u n gelişim ine yardım cı olacak türde olm alı
dır. B öylece hem alm an besinlerin kapsam ı arttınlır, hem de
çiğn em e ve yu tm a refleksi geliştirilir- A n ca k bu dönem de yan lış besinlerin seçim i m alnütrisyon ve sonuçlarına neden olabi lir. Y a ln ız sütle beslenm e dönem inden sonra verilecek besinler k on u su n da görü şler aynı olm adığı için R D A tarafından öneri len m ik ta rla r genellikle gü ven ilir ve uygun m iktarlar olarak k a b u l edilm ektedir.
Bu dönem de de süt ve sütlü besinler önem ini korum aya de vam etm ektedir.
K E F E R E N C E S
1. Field, CE„ Baber, FM. : G rowing up in Hong Kong. Hong K ong Uni-versity Press ,p. 49 - 93, 1973.
2. f~inmmit.t-.pp on D ietary Allowances : Food Nutrition Board : R ecom -m ended Dietary Allowances. ed 9 W ashington. DC. National Acad-em y o f Sciences. 1980.
3. A costa, P.B., Owen, G.M. : Energy and Nutrient Requirem ents o f In fa n ts and Young Children. in Kelley, VC (ed) : Practice of Pediatrics, vol I. Hagerstown, Md. Harper £ Row. p. 5 1978.
4. Burton,. BT. : T he Heinz H andbook of Nutrition. New York. Mc G raw - Hill Book Co, p. 424-445, 1965.
