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NTLk > 8) Fat, Carbohydrate, Water, Mineral, Electrolyte, and Vitamin Requirements in Lactation > Flashcards

8) Fat, Carbohydrate, Water, Mineral, Electrolyte, and Vitamin Requirements in Lactation Flashcards

1
Q

How does the recommendation for energy vary during lactation?

A

The EER increases

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2
Q

How does the recommendation for protein vary during lactation?

A

The RDA increases

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3
Q

How do the recommendations for omega-3 and omega-6 fatty acids vary during lactation?

A

The AIs increase

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4
Q

How does the recommendation for carbohydrates vary during lactation?

A

The RDA increases

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5
Q

How does the recommendation for fiber vary during lactation?

A

The AI does not change

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6
Q

How does the recommendation for water vary during lactation?

A

The AI increases

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7
Q

How does the recommendation for calcium vary during lactation?

A

The RDA does not change

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8
Q

How does the recommendation for phosphorus vary during lactation?

A

The RDA does not change

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9
Q

How does the recommendation for magnesium vary during lactation?

A

The RDA does not change

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10
Q

How does the recommendation for iron vary during lactation?

A

The RDA decreases

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11
Q

How does the recommendation for zinc vary during lactation?

A

The RDA increases

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12
Q

How does the recommendation for iodine vary during lactation?

A

The RDA increases

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13
Q

How does the recommendation for selenium vary during lactation?

A

The RDA increases

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14
Q

How does the recommendation for copper vary during lactation?

A

The RDA increases

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15
Q

How does the recommendation for manganese vary during lactation?

A

The AI increases

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16
Q

How does the recommendation for fluoride vary during lactation?

A

The AI does not change

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17
Q

How does the recommendation for chromium vary during lactation?

A

The AI increases

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18
Q

How does the recommendation for molybdenum vary during lactation?

A

The RDA increases

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19
Q

How does the recommendation for potassium vary during lactation?

A

The AI increases

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20
Q

How does the recommendation for sodium vary during lactation?

A

The AI does not change

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21
Q

How does the recommendation for chloride vary during lactation?

A

The AI does not change

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22
Q

How does the recommendation for thiamine vary during lactation?

A

The RDA increases

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23
Q

How does the recommendation for riboflavin vary during lactation?

A

The RDA increases

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24
Q

How does the recommendation for niacin vary during lactation?

A

The RDA increases

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25
Q

How does the recommendation for pyridoxine vary during lactation?

A

The RDA increases

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26
Q

How does the recommendation for folate vary during lactation?

A

The RDA increases

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27
Q

How does the recommendation for vitamin B12 vary during lactation?

A

The RDA increases

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28
Q

How does the recommendation for biotin vary during lactation?

A

The AI does not change

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29
Q

How does the recommendation for choline vary during lactation?

A

The AI increases

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30
Q

How does the recommendation for pantothenic acid vary during lactation?

A

The AI increases

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31
Q

How does the recommendation for vitamin C vary during lactation?

A

The RDA increases

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32
Q

How does the recommendation for vitamin A vary during lactation?

A

The RDA increases

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33
Q

How does the recommendation for vitamin D vary during lactation?

A

The RDA does not change

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34
Q

How does the recommendation for vitamin E vary during lactation?

A

The RDA increases

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35
Q

How does the recommendation for vitamin K vary during lactation?

A

The AI does not change

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36
Q

How is the milk energy output calculated? (2)

A

1) Milk production on a daily basis by a lactating mother

2) The energy density of human milk

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37
Q

What occurs to milk production rates prior to six months of lactation? What occurs afterwards?

A
  • Milk production rates increase during the first 6 months of lactation
  • After, milk production rates are variable due to differences in the weaning period (generally decrease)
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38
Q

Theoretically, the energy cost of lactation could be met how? (2)

A

1) Decreasing the time spent in physical activity

2) Increasing the efficiency of performing routine tasks

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39
Q

In general, how does weight fluctuate during the first 6 months post-partum?

A

Most women experience a mild and gradual weight loss

40
Q

How is the EER for lactating women calculated (0 to 6 months post-partum)?

A

EER + Milk Energy Output - Weight Loss

41
Q

How is the EER for lactating women calculated (7 to 12 months post-partum)?

A

EER + Milk Energy Output

42
Q

How does diet and body composition affect the concentration of protein in human milk?

A

Human milk is NOT affected by either

43
Q

Does the lactation process alter the maintenance of protein requirement?

A

No

44
Q

What is the most important quantitative non-protein nitrogen component in breast milk?

A

Urea

45
Q

How is urea in breast milk produced?

A
  • Diversion of urea loss from urine

- Colonic fermentation to milk

46
Q

What two factors are the basis of the additional protein requirements during lactation?

A
  • Output of total protein in milk

- Output of non-protein nitrogen in milk

47
Q

What factor is the basis of the additional omega-6 fatty acid requirement during lactation?

A
  • It is based on the AI
  • There is no evidence that an increase in requirement has any effect on infant growth and development
  • The AI is based on the median intake of the healthy population
48
Q

How is the demand for the secretion of omega-3 fatty acids in breast milk met? (2)

A

1) Omega-3 fatty acids from maternal tissues

2) Dietary intake

49
Q

Lactating women display (lower/higher) plasma and RBC levels of DHA in comparison to non-lactating women.

A

lower

50
Q

What may the lower plasma level of DHA in lactating women reflect?

A

1) Declining DHA status due to inadequate omega-3 fatty acid intake
2) Normal physiological response to changes in endocrine status, lipid metabolism, and nutrient transfer

51
Q

How may DHA be increased in the mother and infant?

A

Supplementation of fish oil during pregnancy

52
Q

What factor is the basis of the additional omega-3 fatty acid requirement during lactation?

A
  • It is based on the AI
  • There is no evidence that an increase in requirement has any effect on infant growth and development
  • The AI is based on the median intake of the healthy population
53
Q

How does the respiratory quotient and the carbohydrate utilization rate vary during lactation?

A
  • Higher respiratory quotient

- Higher carbohydrate utilization rate

54
Q

Which fuel source does the mammary gland preferentially use?

A

Glucose

55
Q

What must be present in sufficient quantities allow for proper milk production, in terms of carbohydrate metabolism? (3)

A

1) Increase in precursors for lactose synthesis
2) Increase in glucose from ingested carbohydrates
3) Increase in amino acids from ingested foods to prevent utilization of endogenous proteins

56
Q

What factor is the basis of the additional carbohydrate requirement during lactation?

A

The amount of carbohydrates necessary to replace the carbohydrates secreted in human milk

57
Q

What factor is the basis of the additional water requirement during lactation?

A
  • It is based on the AI
  • There is no evidence that renal function and hydration status are different during lactation
  • The AI is based on the median intake of the healthy population
58
Q

How may water requirement during lactation be calculated? (2)

A
  • AI (median intake of the healthy population)
  • The sum of the non-pregnant water requirement alongside the water content of milk
  • These two values are similar
59
Q

What is the primary source of calcium for the secretion in human milk? Is it dependent or independent of calcium intake?

A
  • Increase in maternal bone resorption

- Independent of calcium intake

60
Q

How is the bone loss that occurs during lactation regained?

A
  • Upon the return of ovarian function

- The changes in bone mass are related to the lack of estrogen

61
Q

What are the four sources of calcium that are used for milk production? (4)

A

1) Dietary intake
2) Fractional intestinal absorption
3) Decrease in renal excretion
4) Stimulation of bone resorption

62
Q

How do blood calcitriol levels differ between lactating and non-lactating women?

A

They do not differ

63
Q

How may bone loss be minimized by dietary calcium intakes during lactation?

A
  • Dietary calcium intake does NOT minimize bone loss during lactation
  • There is no evidence that calcium intake in lactating women should be increased
64
Q

How does the concentration of phosphorus vary as lactation progresses?

A

Concentration of phosphorus decreases

65
Q

The blood phosphorus levels of lactating women are (low/high).

A

high

66
Q

What are the three reasons that explain for a high blood phosphorus level during lactation? (3)

A

1) Increase in bone resorption
2) Decrease in blood PTH, increasing serum inorganic phosphate concentration
3) Decrease in urinary excretion

67
Q

Which nutrient requirements may be increased in lactating adolescents and in mothers nursing multiple infants?

A
  • Calcium
  • Phosphorus
  • Magnesium
68
Q

What provides the necessary magnesium for lactating women? (2)

A

1) Decreased urinary excretion

2) Increased bone resorption

69
Q

How do blood concentrations of magnesium differ between lactating and non-lactating women?

A

They are the same

70
Q

Until menstruation resumes, what are iron requirements based on for lactating women?

A

1) Iron secretion in human milk

2) Basal iron losses

71
Q

What are the additional factors that are taken into consideration to calculate iron requirements for adolescent lactating mothers? (2)

A
  • Iron requirements for the expected growth of the mother
    1) Iron deposition in tissues
    2) Hemoglobin mass
72
Q

What events result in a release of zinc during the first month post-partum? (2)

A

1) Post-partum involution of the uterus

2) Decrease in maternal blood volume

73
Q

How does the fractional absorption of zinc of lactating women differ from non-lactating women?

A

Fractional absorption is higher in lactating women

74
Q

What form of selenium is largely present in milk? Is the bioavailability high or low?

A
  • Selenomethionine

- Bioavailability is higher than 90%

75
Q

What factor is the basis of the additional manganese requirements during lactation?

A
  • It is based on the AI
  • There is no evidence of manganese deficiency in North America
  • The AI is based on the median intake of the healthy population
76
Q

The requirements for which minerals are increased to replace their loss in human milk?

A
  • Zinc
  • Iodine
  • Selenium
  • Copper
  • Chromium
  • Molybdenum
77
Q

Is fluoride contained in high or low concentrations in human milk?

A
  • Low fluoride concentrations

- Insensitive to differences in the fluoride concentration of drinking water

78
Q

What is the absorption efficiency of chromium?

A

Very low (1%)

79
Q

What is the efficiency of conversion of dietary potassium to milk?

A

Almost 100%

80
Q

The requirement for which electrolyte is increased to replace its loss in human milk?

A

Potassium

81
Q

The requirements for which vitamins are increased to cover the energy costs of milk production?

A
  • Thiamine
  • Riboflavin
  • Niacin
82
Q

Women that are breastfeeding more than one infant are likely to require greater quantities of which vitamins? Why?

A
  • Thiamine, riboflavin, niacin

- As they are producing greater quantities of breast milk

83
Q

Which vitamin requirement is GREATLY increased to cover the amount secreted in breast milk?

A
  • Pyridoxine

- They must ingest five times the amount secreted in breast milk

84
Q

The requirements for which vitamins are increased to replace their loss in human milk?

A
  • Thiamine
  • Riboflavin
  • Niacin
  • Pyridoxine
  • Folate
  • Vitamin B12
  • Choline
  • Pantothenic acid
  • Vitamin C
  • Vitamin A
  • Vitamin E
85
Q

What is the calculation used to obtain the additional folate requirement during lactation?

A

Milk Volume x [Folate in breast milk] x Bioavailability factor

86
Q

How does the quantity of vitamin B12 secreted during the first six months compare to afterwards?

A
  • 0 to 6 months: 0.33 ug/day

- 7 to 12 months: 0.25 ug/day

87
Q

A low vitamin B12 concentration in human milk occurs commonly in which scenarios? (2)

A

1) Strict vegetarian mothers

2) Developing countries where there is a lower consumption of animal products

88
Q

What two factors are the basis of the additional choline requirements during lactation?

A

1) To cover the substantial amount secreted in human milk

2) The lack of identification of mechanisms acquired for the conservation of maternal choline status

89
Q

Blood pantothenic acid levels are (lower/higher) at 6 weeks and 3 months post-partum in comparison to control women.

A

lower

90
Q

What two factors are the basis of the additional pantothenic acid requirements during lactation?

A

1) The additional secretion in human milk

2) The decrease in maternal blood concentrations when intakes are around 5 to 6 mg/day

91
Q

How does the vitamin C content in human milk decrease once you add solid foods?

A

Decreases, but the EAR does not decrease over length of lactation

92
Q

What is the EAR for vitamin A based on during lactation?

A

To assure adequate body stores of vitamin A

93
Q

What is the minimum vitamin D intake required to sustain serum calcitriol during lactation?

A
  • It is unclear

- There is no evidence that lactation increases the mother’s RDA for vitamin D

94
Q

Is the EAR for vitamin E lower or higher than the actual intake?

A

Reported to be higher than the actual intake

95
Q

If the intake of vitamin E is lower than the RDA, why are vitamin E supplements determined to be unnecessary during lactation?

A
  • The estimates of vitamin E are underreported

- Vitamin E deficiency in breastfed infants are extremely rare

96
Q

How is the phylloquinone content influenced by the administration of pharmacological doses of vitamin K? How is it influenced by the typical diet?

A
  • Increased with pharmacological doses

- The typical diet has little effect on phylloquinone content in maternal milk

NTLk (20 decks)

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