Haemophilia Causes

• Haemophilia A is a recessive X-linked genetic disorder involving a lack of functional clotting Factor VIII and represents 80% of haemophilia cases.
• Haemophilia B is a recessive X-linked genetic disorder involving a lack of functional clotting Factor IX. It comprises approximately 20% of haemophilia cases.
• Haemophilia C is an autosomal genetic disorder (i.e. not X-linked) involving a lack of functional clotting Factor XI. Haemophilia C is not completely recessive, as heterozygous individuals also show increased bleeding.

Genetics

X-linked recessive inheritance

Females possess two X-chromosomes, males have one X and one Y-chromosome. Since the mutations causing the disease are X-linked, a woman carrying the defect on one of her X-chromosomes may not be affected by it, as the equivalent allele on her other chromosome should express itself to produce the necessary clotting factors, due to X inactivation. However, the Y-chromosome in men has no gene for factors VIII or IX. If the genes responsible for production of factor VIII or factor IX present on a male's X-chromosome are deficient there is no equivalent on the Y-chromosome to cancel it out, so the deficient gene is not masked and he will develop the illness.

Since a male receives his single X-chromosome from his mother, the son of a healthy female silently carrying the deficient gene will have a 50% chance of inheriting that gene from her and with it the disease; and if his mother is affected with haemophilia, he will have a 100% chance of being a haemophiliac. In contrast, for a female to inherit the disease, she must receive two deficient X-chromosomes, one from her mother and the other from her father (who must therefore be a haemophiliac himself). Hence haemophilia is far more common among males than females. However, it is possible for female carriers to become mild haemophiliacs due to lyonisation (inactivation) of the X-chromosomes. Haemophiliac daughters are more common than they once were, as improved treatments for the disease have allowed more haemophiliac males to survive to adulthood and become parents. Adult females may experience menorrhagia (heavy periods) due to the bleeding tendency. The pattern of inheritance is criss-cross type. This type of pattern is also seen in colour blindness.

A mother who is a carrier has a 50% chance of passing the faulty X-chromosome to her daughter, while an affected father will always pass on the affected gene to his daughters. A son cannot inherit the defective gene from his father. This is a recessive trait and can be passed on if cases are more severe with carrier.
Genetic testing and genetic counselling is recommended for families with haemophilia. Prenatal testing, such as amniocentesis, is available to pregnant women who may be carriers of the condition.
As with all genetic disorders, it is of course also possible for a human to acquire it spontaneously through mutation, rather than inheriting it, because of a new mutation in one of their parents' gametes. Spontaneous mutations account for about 33% of all cases of haemophilia A. About 30% of cases of haemophilia B are the result of a spontaneous gene mutation.
If a female gives birth to a haemophiliac child, either the female is a carrier for the blood disorder or the haemophilia was the result of a spontaneous mutation. Until modern direct DNA testing, however, it was impossible to determine if a female with only healthy children was a carrier or not. Generally, the more healthy sons she bore, the higher the probability that she was not a carrier.
If a male is afflicted with the disease and has children with a female who is not even a carrier, his daughters will be carriers of haemophilia. His sons, however, will not be affected with the disease. The disease is X-linked and the father cannot pass haemophilia through the Y-chromosome. Males with the disorder are then no more likely to pass on the gene to their children than carrier females, though all daughters they sire will be carriers and all sons they father will not have haemophilia (unless the mother is a carrier).

Severity

There are numerous different mutations which cause each type of haemophilia. Due to differences in changes to the genes involved, people with haemophilia often have some level of active clotting factor. Individuals with less than 1% active factor are classified as having severe haemophilia, those with 1-5% active factor have moderate haemophilia, and those with mild haemophilia have between 5-40% of normal levels of active clotting factor.

Diagnosis

Haemophilia A can be mimicked by von Willebrand disease.

• could significantly affect as many as 1 in 10,000 people.
• type 2A, where decreased levels of von Willebrand Factor can lead to premature proteolysis of Factor VIII. In contrast to haemophilia, vWD type 2A is inherited in an autosomal dominant fashion.
• proteolysis of Factor VIII. In contrast to haemophilia, vWD type 3 is inherited in an autosomal recessive fashion.

Additionally, severe cases of vitamin K deficiency can present similar symptoms to haemophilia. This is because vitamin K is necessary for the human body to produce several protein clotting factors. This vitamin deficiency is rare in adults and older children but is common in newborns. Infants are born with naturally low levels of vitamin K and do not yet have the symbiotic gut flora to properly synthesise their own vitamin K. Bleeding issues due to vitamin K deficiency in infants is known as "haemorrhagic disease of the newborn", to avoid this complication newborns are routinely injected with vitamin K supplements.

Laboratory findings in various platelet and coagulation disorders (V - T)

Condition	Prothrombin time	Partial thromboplastin time	Bleeding time	Platelet count
Vitamin K deficiency or warfarin	Prolonged	Normal or mildly prolonged	Unaffected	Unaffected
Disseminated intravascular coagulation	Prolonged	Prolonged	Prolonged	Decreased
Von Willebrand disease	Unaffected	Prolonged or unaffected	Prolonged	Unaffected
Hemophilia	Unaffected	Prolonged	Unaffected	Unaffected
Aspirin	Unaffected	Unaffected	Prolonged	Unaffected
Thrombocytopenia	Unaffected	Unaffected	Prolonged	Decreased
Liver failure, early	Prolonged	Unaffected	Unaffected	Unaffected
Liver failure, end-stage	Prolonged	Prolonged	Prolonged	Decreased
Uremia	Unaffected	Unaffected	Prolonged	Unaffected
Congenital afibrinogenemia	Prolonged	Prolonged	Prolonged	Unaffected
Factor V deficiency	Prolonged	Prolonged	Unaffected	Unaffected
Factor X deficiency as seen in amyloid purpura	Prolonged	Prolonged	Unaffected	Unaffected
Glanzmann's thrombasthenia	Unaffected	Unaffected	Prolonged	Unaffected
Bernard-Soulier syndrome	Unaffected	Unaffected	Prolonged	Decreased or unaffected
Factor XII deficiency	Unaffected	Prolonged	Unaffected	Unaffected
C1INH deficiency	Unaffected	Shortened	Unaffected	Unaffected

Management

Commercially produced factor concentrates such as "Advate", a recombinant Factor VIII, come as a white powder in a vial which must be mixed with sterile water prior to intravenous injection.

Though there is no cure for haemophilia, it can be controlled with regular infusions of the deficient clotting factor, i.e. factor VIII in haemophilia A or factor IX in haemophilia B. Factor replacement can be either isolated from human blood serum, recombinant, or a combination of the two. Some haemophiliacs develop antibodies (inhibitors) against the replacement factors given to them, so the amount of the factor has to be increased or non-human replacement products must be given, such as porcine factor VIII.
If a person becomes refractory to replacement coagulation factor as a result of circulating inhibitors, this may be partially overcome with recombinant human factor VII (NovoSeven), which is registered for this indication in many countries.
In early 2008, the US Food and Drug Administration (FDA) approved Xyntha (Wyeth) anti-haemophilic factor, genetically engineered from the genes of Chinese hamster ovary cells. Since 1993 (Dr. Mary Nugent) recombinant factor products (which are typically cultured in Chinese hamster ovary (CHO) tissue culture cells and involve little, if any human plasma products) have been available and have been widely used in wealthier western countries. While recombinant clotting factor products offer higher purity and safety, they are, like concentrate, extremely expensive, and not generally available in the developing world. In many cases, factor products of any sort are difficult to obtain in developing countries.
In Western countries, common standards of care fall into one of two categories: prophylaxis or on-demand. Prophylaxis involves the infusion of clotting factor on a regular schedule in order to keep clotting levels sufficiently high to prevent spontaneous bleeding episodes. On-demand treatment involves treating bleeding episodes once they arise. In 2007, a clinical trial was published in the New England Journal of Medicine comparing on-demand treatment of boys (< 30 months) with haemophilia A with prophylactic treatment (infusions of 25 IU/kg body weight of Factor VIII every other day) in respect to its effect on the prevention of joint-diseases. When the boys reached 6 years of age, 93% of those in the prophylaxis group and 55% of those in the episodic-therapy group had a normal index joint-structure on MRI^. Prophylactic treatment, however, resulted in average costs of $300,000 per year. The author of an editorial published in the same issue of the NEJM supports the idea that prophylactic treatment not only is more effective than on demand treatment but also suggests that starting after the first serious joint-related haemorrhage may be more cost effective than waiting until the fixed age to begin. This study resulted in the first (October 2008) FDA approval to label any Factor VIII product to be used prophylactically. As a result, the factor product used in the study (Bayer's Kogenate) is now labelled for use to prevent bleeds, making it more likely that insurance carriers in the US will reimburse consumers who are prescribed and use this product prophylactically. Despite Kogenate only recently being "approved" for this use in the US, it and other factor products have been well studied and are often prescribed to treat Haemophilia prophylactically to prevent bleeds, especially joint bleeds.

Gene therapy

On 10 December 2011, a team of British and American investigators reported the successful treatment of haemophilia B using gene therapy. The investigators inserted the F9 gene into an adeno-associated virus-8 vector, which has a propensity for the liver, where factor 9 is produced, and remains outside the chromosomes so as not to disrupt other genes. The transduced virus was infused intravenously. To prevent rejection, the people were primed with steroids to suppress their immune response. In October 2013, the Royal Free London NHS Foundation Trust in London reported that after treating six people with haemophilia in early 2011 with the genetically modified adeno-associated virus, over two years later all were still producing blood plasma clotting factor.

Preventive exercises

It is recommended that people affected with haemophilia do specific exercises to strengthen the joints, particularly the elbows, knees, and ankles. Exercises include elements which increase flexibility, tone, and strength of muscles, increasing their ability to protect joints from damaging bleeds. These exercises are recommended after an internal bleed occurs and on a daily basis to strengthen the muscles and joints to prevent new bleeding problems. Many recommended exercises include standard sports warm-up and training exercises such as stretching of the calves, ankle circles, elbow flexions, and quadriceps sets.

Alternative medicine

While not a replacement for traditional treatments, preliminary scientific studies indicate that hypnosis and self-hypnosis may be effective at reducing bleeds and the severity of bleeds and thus the frequency of factor treatment. Herbs which strengthen blood vessels and act as astringents may benefit people with haemophilia, however there are no peer reviewed scientific studies to support these claims.

Contraindications

Anticoagulants such as heparin and warfarin are contraindicated for people with haemophilia as these can aggravate clotting difficulties. Also contraindicated are those drugs which have "blood thinning" side effects. For instance, medicines which contain aspirin, ibuprofen, or naproxen sodium should not be taken because they are well known to have the side effect of prolonged bleeding.
Also contraindicated are activities with a high likelihood of trauma, such as motorcycling and skateboarding. Popular sports with very high rates of physical contact and injuries such as American football, hockey, boxing, wrestling, and rugby should be avoided by people with haemophilia. Other active sports like soccer, baseball, and basketball also have a high rate of injuries, but have overall less contact and should be undertaken cautiously and only in consultation with a doctor.^[

haemophilia Complications

Severe complications are much more common in severe and moderate haemophiliacs. Complications may be both directly from the disease or from its treatment:

• Deep internal bleeding, e.g. deep-muscle bleeding, leading to swelling, numbness or pain of a limb.
• Joint damage from haemarthrosis (haemophilic arthropathy), potentially with severe pain, disfigurement, and even destruction of the joint and development of debilitating arthritis.
• Transfusion transmitted infection from blood transfusions that are given as treatment.
• Adverse reactions to clotting factor treatment, including the development of an immune inhibitor which renders factor replacement less effective.
• Intracranial haemorrhage is a serious medical emergency caused by the buildup of pressure inside the skull. It can cause disorientation, nausea, loss of consciousness, brain damage, and death.

Haemophilic arthropathy is characterized by chronic proliferative synovitis and cartilage destruction. If an intra-articular bleed is not drained early, it may cause apoptosis of chondrocytes and affect the synthesis of proteoglycans. The hypertrophied and fragile synovial lining while attempting to eliminate excessive blood may be more likely to easily rebleed, leading to a vicious cycle of hemarthrosis-synovitis-hemarthrosis. In addition, iron deposition in the synovium may induce an inflammatory response activating the immune system and stimulating angiogenesis, resulting in cartilage and bone destruction.

Life expectancy

Like most aspects of the disorder, life expectancy varies with severity and adequate treatment. People with severe haemophilia who don't receive adequate, modern treatment have greatly shortened lifespans and often do not reach maturity. Prior to the 1960s when effective treatment became available, average life expectancy was only 11 years. By the 1980s the life span of the average haemophiliac receiving appropriate treatment was 50–60 years. Today with appropriate treatment, males with haemophilia typically have a near normal quality of life with an average lifespan approximately 10 years shorter than an unaffected male.



Since the 1980s the primary leading cause of death of people with severe haemophilia has shifted from haemorrhage to HIV/AIDS acquired through treatment with contaminated blood products.



The second leading cause of death related to severe haemophilia complications is intracranial haemorrhage which today accounts for one third of all deaths of people with haemophilia. Two other major causes of death include hepatitis infections causing cirrhosis and obstruction of air or blood flow due to soft tissue haemorrhage.

Haemophilia Signs and symptoms

Characteristic symptoms vary with severity. In general symptoms are internal or external bleeding episodes, which are called "bleeds"^. People with more severe haemophilia suffer more severe and more frequent bleeds, while people with mild haemophilia usually suffer more minor symptoms except after surgery or serious trauma. Moderate haemophiliacs have variable symptoms which manifest along a spectrum between severe and mild forms.
In both haemophilia A and B, there is spontaneous bleeding but a normal bleeding time, normal prothrombin time, normal thrombin time, but prolonged partial thromboplastin time. Internal bleeding is common in people with severe haemophilia and some individuals with moderate haemophilia. The most characteristic type of internal bleed is a joint bleed where blood enters into the joint spaces. This is most common with severe haemophiliacs and can occur spontaneously (without evident trauma). If not treated promptly, joint bleeds can lead to permanent joint damage and disfigurement. Bleeding into soft tissues such as muscles and subcutaneous tissues is less severe but can lead to damage and requires treatment.
Children with mild to moderate haemophilia may not have any signs or symptoms at birth especially if they do not undergo circumcision. Their first symptoms are often frequent and large bruises and haematomas from frequent bumps and falls as they learn to walk. Swelling and bruising from bleeding in the joints, soft tissue, and muscles may also occur. Children with mild haemophilia may not have noticeable symptoms for many years. Often, the first sign in very mild haemophiliacs is heavy bleeding from a dental procedure, an accident, or surgery. Females who are carriers usually have enough clotting factors from their one normal gene to prevent serious bleeding problems, though some may present as mild haemophiliacs.

Haemophilia

Haemophilia (/hiːməˈfɪliə/; also spelled hemophilia in North America, from the Greek haima αἷμα 'blood' and philia φιλία 'love'[1]) is a group of hereditary genetic disorders that impair the body's ability to control blood clotting, which is used to stop bleeding when a blood vessel is broken. Haemophilia A (clotting factor VIII deficiency also in factor IX and VII) is the most common form of the disorder, present in about 1 in 5,000–10,000 male births. Haemophilia B (factor IX deficiency) occurs in around 1 in about 20,000–34,000 male births.



Like other recessive sex-linked, X chromosome disorders, haemophilia is more likely to occur in males than females. This is because females have two X chromosomes while males have only one, so the defective gene is guaranteed to manifest in any male who carries it. Because females have two X chromosomes and haemophilia is rare, the chance of a female having two defective copies of the gene is very remote, so females are almost exclusively asymptomatic carriers of the disorder. Female carriers can inherit the defective gene from either their mother or father, or it may be a new mutation. Although it is not impossible for a female to have hemophilia, it is unusual: daughters which are the product of both a male with haemophilia A or B and a female carrier will have hemophilia, while the non-sex-linked haemophilia C due to coagulant factor XI deficiency, which can affect either sex, is more common in Jews of Ashkenazi (east European) descent but rare in other population groups.

People with hemophilia have lower clotting factor level of blood plasma or impaired activity of the coagulation factors needed for a normal clotting process. Thus when a blood vessel is injured, a temporary scab does form, but the missing coagulation factors prevent fibrin formation, which is necessary to maintain the blood clot. A hemophiliac does not bleed more intensely than a person without it, but can bleed for a much longer time. In severe hemophiliacs even a minor injury can result in blood loss lasting days or weeks, or even never healing completely. In areas such as the brain or inside joints, this can be fatal or permanently debilitating.

In India Hemophilia is patient is not well aware of this physical disabilities, in Kerala  the government is giving free treatment for this special disabilities.

In Aluva Govt Hospital giving alll the facilities for hemophilia patient at free of cost the Kerala Government in India is providing all Factor medicine at free of cost thought Karunya Pharmacy.

Better Child care and healthy eating

All children in child care need regular healthy meals, snacks and fluids (drinks). Promoting children’s health is an important aspect of good quality child care. It’s important that children in care are offered nutritious meals and enjoy positive mealtime experiences. Research has shown that some children in care may not get enough of some important dietary nutrients.

Regardless of whether food is provided, all childcare services have a responsibility to promote good nutrition for children in their care. Childcare centres and all staff should be familiar with hygiene standards, nutrition principles for children, and food safety laws.

Types of child care

There are many types of childcare options available for children including:

• Long day childcare centres (LDCCC)
• Occasional care and preschool
• Family day care
• Extended family care (especially grandparents)
• Out of school hours care.

More than 50,000 children in Victoria attend long day care on a part-time or full-time basis. Long day care is defined as spending at least eight hours a day in child care.

Guidelines for nutrition and health standards

The National Childcare Accreditation Council (NCAC) provides national guidelines for child care, which cover all areas of care. These guidelines contain information on all aspects of quality child care including standards of discipline, hygiene, programming, communication, food and nutrition.

Some of the issues covered include:

• Respect – show respect for all children
• Environment – provide a pleasant, culturally appropriate atmosphere for children at mealtimes that encourages social interaction and learning
• Culture – provide culturally appropriate meals, food and drink for children
• Nutrition – promote healthy eating and good food habits
• Hygiene – have staff trained in correct food handling and hygiene.

Nutrition

Food provided in child care has an important role to play in the growth and development of children and in the development of future eating habits. In long day childcare centres, menus should aim to meet a significant amount of a child’s daily nutrition requirements. A variety of foods such as vegetables, fruits, cereals, lean meat, fish, chicken, milks, yoghurts and cheeses should be provided to children in care, including a range of textures and tastes, appropriate to the developmental stages of different age groups.

Children are also encouraged to drink water and milk throughout the day. Other sweet drinks such as juices and cordials are not necessary.
Sweet foods such as cakes, biscuits, lollies, and chocolates should not be served on a regular basis in child care. Individual centres may have a policy on the availability of sweet foods and other treats.

Breastfeeding

Childcare services have a responsibility to offer opportunities and support to families to continue to provide breast milk for children in their care. Childcare services can provide support by developing and implementing clear policies and procedures for storage and provision of expressed breast milk for children in their care. Policies for safe storage and provision of infant formulas are also required.

Meals and snacks

Mealtime arrangements can vary. Some centres provide all meals and snacks, while other centres ask families to provide meals for their own children. Long day child care centres must provide a minimum of one meal and two snacks each day. Often this will be morning tea, lunch and afternoon tea. Some centres also serve breakfast. Even when they don’t provide meals, childcare staff can encourage and support families to provide healthy meals for their children whilst in care.

Mealtimes should be relaxed and supervised

The mealtime atmosphere and the attitude and behaviour of childcare workers is important to the development of healthy eating practices. Children should be relaxed and happy when they are eating. Meals are often shared with carers and other children. Childcare workers should develop and encourage healthy eating patterns and positive attitudes to food and also supervise children’s eating. Children learn from others about food preferences and how to eat.
Safety at mealtimes is important.

Other important points:

• Food should be an appropriate size and texture for the age and ability of the child so they can easily chew and swallow their food.
• Nuts and other hard foods that are difficult for young children to chew should be avoided.
• Children should not be force-fed.
• Children should be seated quietly at mealtimes.

Food hygiene is essential

Careful preparation of food and correct food handling techniques are important. Childcare centres must observe the following principles:

• Regular training for all cooks and staff in safe food storage, preparation and handling of food
• Safe food handling by children and staff, including sharing of food for example when fruit platters are shared
• Adequate hand washing by staff and children
• Safe use of microwave ovens for heating food and drinks.

Food regulations and preschools

Local council health departments can provide help and advice regarding food safety in childcare centres. In Victoria, the requirements of the Food Act 1984 do not apply to preschools where parents or carers bring food to the preschool.

When your child takes fruit or vegetables for morning tea or takes their own lunch, the preschool is not subject to the Food Act requirements, even if the preschool staff or parents cut up the fruit and vegetables and place them on a platter to be shared. However, everyone should follow the basic hygiene rules of hand washing.

Menus should be on display

A childcare centre nutrition policy should provide guidelines for all aspects of meal preparation and service to cooks, staff and parents. In centres that offer meals, menus are on display to give parents the opportunity to provide feedback.

Special diets

Some children have other special dietary requirements due to food allergies, cultural background or medical conditions. Childcare services work together with families to ensure the specific needs of individual children are met.

Food allergies

On rare occasions, for example, a life-threatening situation for a child with a severe food allergy can occur within a childcare setting. Many centres have a food allergy policy in order to limit the risk associated with severe food allergy reactions. Childcare staff should be made aware of your child’s food allergies and food intolerance.

Dental health

Children who consume high-sugar foods and drinks risk tooth decay. Around 50 per cent of all primary school children seen by the School Dental Service in Victoria have signs of dental decay. Nutrition policies in childcare centres should include dental health guidelines. Supervised teeth brushing programs in childcare have been shown to reduce tooth decay.

Key principles should include:

• Baby feeding bottles should not contain sweet drinks.
• Baby feeding bottles should not be used to settle children at rest times.
• Sugary snacks should be limited.
• Children should not get sweet foods as a reward for good behaviour.
• Teeth brushing should be encouraged after meals.

Where to get help

• Your doctor
• Your local council
• Your maternal and child health nurse

Things to remember

• Children may eat a large proportion of their daily food consumption in child care.
• Childcare centres should adhere to hygiene regulations and nutrition standards.
• Childcare centres should be aware of your child’s food allergies and intolerances.

Healthy eating tips

A healthy diet should include a good variety of nutritious foods. These include a range of breads, pastas, lean meats, fruits and vegetables. Eating breakfast is also an important part of a healthy diet. Keep fat and salt intake low. A good balance between exercise and food intake is important to maintain a healthy body weight.

A healthy diet should include a wide variety of nutritious foods for sufficient intake of all nutrients, including vitamins and minerals. Foods to include are breads, pastas, lean meats, fish, fruits and vegetables. A healthy diet can help you maintain a healthy body weight and decrease your risk of many diet-related chronic diseases, such as cardiovascular disease, type 2 diabetes and some cancers.

Healthy diets contain a variety of foods

In general, we should include a range of nutritious foods and eat:

• plenty of breads and cereals (particularly wholegrain), fruit, vegetables and legumes (such as chickpeas, lentils and red kidney beans)
• low-salt foods, and use salt sparingly
• small amounts of foods that contain added sugars
• reduced-fat milk and other dairy products.

It is also important to drink an adequate amount of water.

Physical activity and healthy eating

A good balance between exercise and food intake is important, as this helps to maintain muscle strength and a healthy body weight. At least 30 minutes of moderate intensity physical activity, such as walking, is recommended every day.

Keep fat to a minimum

Adult diets should be low in fat, especially saturated fat. Saturated fat, which is the main fat in animal products, fried foods, chocolate, cakes and biscuits, is more easily deposited as fat tissue than unsaturated fat. Saturated fat can also be converted into cholesterol and cause blood cholesterol levels to rise.

Dietary fat helps with the absorption of fat-soluble vitamins (A, D, E and K). Small amounts of polyunsaturated and monounsaturated fats may have some health benefits when they are part of a healthy diet. Monounsaturated fats are found in nuts, olive oil and avocados, and may help to lower the bad type of cholesterol (low-density lipoprotein or LDL).

Polyunsaturated fats are generally thought to lower blood cholesterol levels. Polyunsaturated omega-3 fatty acids, which are found in fish, nuts and seeds, are thought to have an anti-clotting effect on blood, to reduce the risk of heart disease and to possibly lower blood pressure.

Eat and drink less high-kilojoule foods

The total amount of energy-dense (high-kilojoule) foods you eat may be as important as the total amount of fat in your diet. To reduce the energy density of your diet, you need to increase the amount of plant foods, such as wholegrain breads and cereals, fruit and vegetables that you eat.

This will provide essential nutrients, help to make you feel ‘full’ and also reduce the amount of fat in your diet. High energy drinks such as sports drinks, cordials, soft drinks, fruit juice, energy drinks should also be limited.

Eat foods rich in calcium and iron

It is important for all Australians to eat foods which contain iron and calcium. In particular:

• Calcium – is important for bone health especially for infants, women and girls.
• Iron – carries oxygen around the body and is especially important for women, girls, vegetarians and athletes to reduce the risk of anaemia.

Drink alcohol in moderation

Alcohol is high in energy (kilojoules) and should be consumed in moderation. Men should drink less than two standard drinks per day and women less than one standard drink per day. One standard drink is 375 ml mid-strength beer, 100 ml wine or 30 ml spirits. Alcohol should not be given to children and is not recommended for pregnant or breastfeeding women.

Healthy diets for babies and children

There are guidelines to follow that help encourage a healthy diet for your infant or child, including:

• Infants – it is encouraged for babies to be breastfed for the first year of life. In most cases, breastfeeding should be the only source of food in the first six months. If you use formula, be careful not to overfeed or underfeed your baby.
• Sugar – children should eat only a small amount of foods that contain sugar and avoid food with added sugar, such as lollies, fruit drinks and soft drinks.
• Low-fat diets – are not appropriate for infants and young children under two years of age. A diet low in fat, especially saturated fat, may be considered for older children.
• Drinks – infants and children should be encouraged to choose water as their preferred drink.

Don’t skip breakfast

Children who skip breakfast generally have poorer nutrition. Their diets contain less:

• calcium
• iron
• dietary fibre
• vitamins such as riboflavin and niacin.

Skipping breakfast becomes more common as children get older. Some schools have introduced breakfast programs because they were concerned about children who skip breakfast. Children generally perform better at school when they have breakfast. They are also more likely to maintain a healthy weight when they consume a healthy breakfast.

Adults who eat a healthy breakfast are more likely be a healthy weight and more productive at work.

Tips for healthy breakfasts

Some easy-to-prepare, healthy breakfast ideas include:

• fresh fruit with wholegrain breakfast cereal and reduced fat milk. Toast with a thin spread of margarine (polyunsaturated or monounsaturated)
• toast with cheese and tomato. Hot or cold reduced fat milk
• rolled oats made with quick oats. Add sultanas and reduced fat milk. Toast with a thin spread of margarine (polyunsaturated or monounsaturated). Orange juice
• baked beans on toast. Orange juice
• fruit or plain yoghurt with fruit.

Things to remember

• A wide variety of foods is important for good health.
• Calcium and iron are important nutrients in our diets.
• Infants and young children should not be placed on low-fat diets.
• Encourage infants and children to choose water as their preferred drink.
• Children will have better nutrition and do better at school if they eat breakfast.
• Be physically active.

Food variety and a healthy diet for healthy living

Food variety means eating a wide variety of foods (a balanced diet) from within and across each of the five food groups, in the amounts recommended. Eating many different foods helps maintain a healthy, well-balanced and interesting diet that provides adequate nutrition. Eating a variety of foods can help prevent diseases such as diabetes, cancer and cardiovascular disease.

Food variety means eating a wide variety of foods from each of the five food groups, in the amounts recommended. Eating many different foods helps maintain a healthy and interesting diet which provides a range of different nutrients to the body. Eating a variety of foods promotes good health and can help reduce the risk of disease.

Five major food groups

The five food groups are:

• vegetables and legumes/beans
• fruit
• lean meats and poultry, fish, eggs, tofu, nuts and seeds, legumes/beans
• grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties
• milk, yoghurt, cheese and/or alternatives, mostly reduced fat.

Foods are grouped together because they provide similar amounts of key nutrients. For example, key nutrients of the milk, yoghurt, cheese and alternatives group include calcium and protein, while the fruit group is a good source of vitamins, especially vitamin C.

These food groups make up the Australian Guide to Healthy Eating.

Choose a variety of foods

Eating a varied, well-balanced diet means eating a variety of foods from each food groups daily, in the recommended amounts. It is also important to choose a variety of foods from within each food group because different foods provide different types and amounts of key nutrients.

Choosing a variety of foods will help to make your meals interesting, so that you don’t get bored with your diet.

Occasional foods

Some foods do not fit into the five food groups because they are not necessary for a healthy diet. These foods are called ‘discretionary choices’ and they should only be eaten occasionally. They tend to be too high in either energy (kilojoules), saturated fat, added sugars, added salt or alcohol, and have low levels of important nutrients like fibre.

Examples of ‘discretionary choices’ or occasional foods are:

• sweet biscuits, cakes, desserts and pastries
• processed meats and fattier/salty sausages, savoury pastries and pies, commercial burgers with a high fat and/or salt content
• sweetened condensed milk
• ice cream and other ice confections
• confectionery and chocolate
• commercially fried foods
• potato chips, crisps and other fatty and/or salty snack foods including some savoury biscuits
• cream, butter and spreads which are high in saturated fats
• sugar-sweetened soft drinks and cordials, sports and energy drinks and alcoholic drinks.

Small allowance for healthy fats

Unsaturated fats are an important part of a healthy diet. The two main types of unsaturated fats are monounsaturated fats (found in olive and canola oil, avocados, cashews and almonds) and polyunsaturated fats like omega-3 fats (found in oily fish) and omega-6 fats (found in safflower and soybean oil and Brazil nuts). These fats can help reduce the risk of heart disease and lower cholesterol levels when they replace saturated fats in the diet.

The Australian Dietary Guidelines include a small allowance for healthy fats each day (around 1–2 tablespoons for adults and less for children). The best way to include healthy fats in your diet is to replace saturated fat that you may currently be eating (such as butter and cream) with a healthier, unsaturated fat option (such as polyunsaturated margarine or olive oil).

Include the five food groups in your diet

It’s not hard to include foods from the five food groups into snacks and meals. Some suggestions include:

• Vegetables and legumes – raw or cooked vegetables can be used as a snack food or as a part of lunch and dinner. Salad vegetables can be used as a sandwich filling. Vegetable soup can make a healthy lunch. Stir-fries, vegetable patties and vegetable curries make nutritious evening meals. Try raw vegetables like carrot and celery sticks for a snack ‘on the run’.
• Fruit – this is easy to carry as a snack and can be included in most meals. For example, try a banana with your breakfast cereal, an apple for morning tea and add some berries in your yoghurt for an afternoon snack. Fresh whole fruit is recommended over fruit juice and dried fruit. Fruit juice contains less fibre than fresh fruit and both fruit juice and dried fruit, and are more concentrated sources of sugar and energy. Dried fruit can also stick to teeth, which can increase the risk of dental caries.
• Bread, cereals, rice, pasta and noodles – add rice, pasta or noodles to serves of protein and vegetables for an all-round meal. There are many varieties of these to try. Where possible, try to use wholegrains in breads and cereals.
• Lean meat, fish, poultry, eggs, nuts, legumes and tofu – these can all provide protein. It’s easy to include a mixture of protein into snacks and meals. Try adding lean meat to your sandwich or have a handful of nuts as a snack. You can also add legumes to soups or stews for an evening meal.
• Milk, yoghurt and cheese – try adding yogurt to breakfast cereal with milk, or using cottage cheese as a sandwich filling. Shavings of parmesan or cheddar can be used to top steamed vegetables or a salad. Use mostly reduced fat products.

Serving sizes of vegetables and legumes/beans

One standard serving of vegetables is about 75 g or:

• ½ cup cooked vegetables
• ½ cup cooked dried or canned beans, peas or lentils
• 1 cup salad vegetables
• ½ cup sweet corn
• ½ medium potato or other starchy vegetables (such as sweet potato)
• 1 medium tomato.

Serving sizes of fruit

One standard serving of fruit is about 150 g or:

• one medium piece (apple, banana, orange, pear)
• two small pieces (apricots, plums, kiwi fruit)
• 1 cup diced, cooked or canned fruit (no added sugar).

Or only occasionally:

• 125 ml (1/2 cup) fruit juice (no added sugar)
• 30 g dried fruit (such as 4 dried apricot halves, 1½ tablespoons sultanas).

Serving sizes of grain (cereal) foods

Choose mostly wholegrain and/or high cereal fibre varieties of grain foods.

One serve equals:

• one slice of bread (40 g)
• ½ medium roll or flatbread (40 g)
• ½ cup cooked rice, pasta, noodles, barley, buckwheat, semolina, polenta, bulgur or quinoa (75-120 g)
• ½ cup cooked porridge (120 g)
• ¼ cup muesli (30 g)
• 2/3 cup breakfast cereal flakes (30 g)
• 3 crispbreads (35 g)
• 1 crumpet (60 g) or small English muffin or scone (35 g)
• ¼ cup flour (30 g)

Serving sizes of lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans

One serve equals:

• 65 g cooked lean red meat (such as beef, lamb. pork, kangaroo), ½ cup lean mince, 2 small chops, 2 slices of roast meat (about 90-100 g raw weight)
• 80 g cooked poultry such as chicken or turkey (about 100 g raw weight)
• 1 cup (150 g) cooked dried or canned beans, lentils, chick peas or split peas
• 100 g cooked fish fillet (about 115 g raw weight) or 1 small can of fish
• two large eggs (120 g)
• 1 cup (150 g) cooked dried or canned legumes or beans, such as lentils, chickpeas or split peas (no added salt)
• 170 g tofu
• 30 g nuts or seeds, or nut/seed pastes(no added salt), such as peanut or almond butter, tahini.

Serving sizes of milk, yoghurt and cheese

When choosing serves of milk, yoghurt and cheese or alternatives, choose mostly reduced fat.

One serve equals:

• 1 cup (250 ml) fresh, long-life or reconstituted powdered milk
• ½ cup (120 ml) evaporated unsweetened milk
• 2 slices (40 g) hard cheese (such as cheddar)
• ½ cup (120 g) ricotta cheese
• ¾ cup or one small carton (200 g) of yoghurt
• 1 cup (250 ml) soy, rice or other cereal drink with at least 100 mg of added calcium per 100 ml.

Serves for children and adolescents daily

Children and adolescents	Grains (cereal),rice, pasta and noodles	Vegetables, legumes	Fruit	Milk, yoghurt, cheese	Meat, fish, poultry, eggs, nuts, legumes
Children 2-3 years	4	2 ½	1	1 ½	1
Children 4-8 years	4	4 ½	1 ½	2 for boys 1.5 for girls	1 ½
Children 9-11 years	5 for boys 4 for girls	5	2	2 ½ for boys 3 for girls	2 ½
Adolescents 12-13 years	5.5 for boys 5 for girls	5 ½ for boys 5 for girls	2	3 ½	2 ½
Adolescents 14-18 years	7 for boys 7 for girls	5 ½ for boys 5 for girls	2	3 ½	2 ½
Pregnant and breastfeeding girls under 18 years	7	5 ½	2	4	2 ½

Sample serves from the Australian Dietary Guidelines

Serves for women daily

Women	Bread, cereals, rice, pasta, noodles	Vegetables, legumes	Fruit	Milk, yoghurt, cheese	Meat, fish, poultry, eggs, nuts, legumes
Women 19-50 years	6	5	2	2 ½	2 ½
Women 51-70 years	4	5	2	4	2
Pregnant	8 ½	5	2	2 ½	3 ½
Breastfeeding	9	7 ½	2	2 ½	2 ½
70+ years	3	5	2	4	2

Sample serves from the Australian Dietary Guidelines

Serves for men daily

Men	Bread, cereals, rice, pasta, noodles	Vegetables, legumes	Fruit	Milk, yoghurt, cheese	Meat, fish, poultry, eggs, nuts, legumes
19-50 years	6	6	2	2 ½	3
51-70	6	5 ½	2	2 ½	2 ½
70+ years	4 ½	5	2	3 ½	2 ½

Sample serves from the Australian Dietary Guidelin

Things to remember

• Eating a wide variety of healthy foods promotes good health and helps to protect against chronic disease.
• Eating a varied, well-balanced diet means eating a variety of foods from each of the five food groups daily, in the recommended amounts.
• It is also important to choose a variety of foods from within each food group.