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BreastEd > BE 01 > Flashcards

BE 01 Flashcards

0
Q

Why is human BM low in protein?

A

Baby born immature w/ kidneys and liver not yet able to process high protein feeds

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1
Q

Four feeding choices for infants (in order) - WHO, UNICEF

A
  1. BM from mom’s breast
  2. Expressed BM from mom
  3. Donor BM
  4. Appropriate BM substitute
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2
Q

Why is human BM high in lactose

A

Brain will triple in weight in next two years

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3
Q

More than 98% of fat in BM is in the form of….

A

Triglycerides

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4
Q

The medium- and long-chain fatty acids that make up the triglycerides in BM come from….
(2)

A

Maternal Circulation

Manufactured locally

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5
Q

The 2 most abundant fatty acids in BM triglycerides are…

Also high in… (2/2)

A

Oleic acid & Palmitic acid
Also high in…
-Essential fatty acids (linoleic acid & linolenic acid)
-Long-chain polyunsaturated fatty acids (eg arachidonic acid & docosahexanoic acid)

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6
Q

Why are long-chain fatty acids important for infant?

A

They are constituents of brain and neural tissue

Needed early in life for mental and visual development

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7
Q

75% of nitrogen-containing compounds in BM come from….

A

Protein

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8
Q

Two types of proteins in BM & their ratio

A

Micellar caseins & aqueous whey proteins

40:60

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9
Q

Predominant casein of human milk & function

A

b-casein

Forms micelles and produces soft, flocculent curd in infant’s stomach

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10
Q

4 major whey proteins in BM are

A

a-lactalbumin
lactoferrin
secretory IgA
serum albumin

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11
Q

Principal carbohydrate of human milk is….

Where is it manufactured?

A

Lactose

In the mammary epithelial cell

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12
Q

Ex. of antimicrobial factors in BM (12)

A 
secretory IgA, IgM, IgG
lactoferrin
lysozyme
complement C3
leucocytes
bifidus factor
lipids & fatty acids
antiviral mucins, GAGs
oligosaccharides
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13
Q

Ex. of growth factors in BM (6)

A 
epidermal (EGF)
nerve (NGF)
insulin-like (IGF)
transforming (TGF)
taurine
polyamines
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14
Q

Ex. of cytokines and anti-inflammatory factors in BM (7)

A 
tumor necrosis factor
interleukins
interferon-g
prostaglandins
a1-antichymotrypsin
a1-antitrypsin
platelet-activating factor: acetyl hydrolase
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15
Q

Ex. of digestive enzymes in BM (4)

A

amylase
bile acid-stimulating esterase
bile acid-stimulating lipases
lipoprotein lipase

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16
Q

Ex. of hormones in BM (10)

A 
feedback inhibitor of lactation (FIL)
insulin
prolactin
thyroid hormones
corticosteroids, ACTH
oxytocin
calcitonin
parathyroid hormone
erythropoietin
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17
Q

Ex. of transporters in BM (6)

A 
lactoferrin (Fe)
folate binder
cobalamin binder
IgF binder
thyroxine binder
corticosteroid binder
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18
Q

Ex. of potentially harmful substances in BM (10)

A 
viruses (eg HIV)
aflatoxins
trans-fatty acids
nicotine, caffeine
food allergens
PCBs, DDT, dioxins
radioisotopes
drugs
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19
Q

Ex. of other things in BM (5)

A

casomorphins
d-sleep peptides
nucleotides
DNA, RNA

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20
Q

Variation in BM concentration influenced by (6)

A

Varies on lactation period, geographic location, BF routine, parity, age, other mat charact, maternal diet, season

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21
Q

4 Stages of Lactation

A

Colostral
Transitional
Mature
Involutional

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22
Q

Colostrum time period

A

Birth - first 3 to 5 days after delivery

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23
Q

Transitional milk time period

A

After colostrum - end of second week

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24
Q

Mature milk time period

A

During full lactation

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25
Q

Involutional milk time period

A

End of lactation

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26
Q

Colostrum is higher in (4)…. and lower in (3)…. than mature BM

A

Higher: secretory IgA, lactoferrin, vitamin A, sodium
Lower: fat, lactose, vitamin B1

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27
Q

Involutional milk is high in(3)…. and low in(1)….

A

High: protein, fat, sodium
Low: lactose

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28
Q

Study chart on BE01: 1. Food_and_nutrition_bulletin….

A

Pgs. 4-8

Human vs cow milk

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29
Q

Study table 4 in BE01: 1. food_and_nutrition_bulletin….

A

Pg. 9

Typical daily intakes (g) of selected BM constituents

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30
Q

Nitrogen in human milk derived from two sources….

A

Protein and non-protein components

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31
Q

Protein content of human milk (appx)

A

9g/L, decreasing as lactation progresses

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32
Q

Function of proteins in BM (7)

A

Provide essential amino acids for growth (all present in BM)
Provides protective factors (eg immunoglobulins)
Carriers for hormones (eg thyroxine)
Carriers for vitamins (eg folate-binding proteins)
Provide enzymatic activity (eg amylase)
Provide other biological activities (eg IGF)
Minimal contributor to total energy provided by BM (1g provides 4 calories)

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33
Q

Casein is what 5 of total protein in BM

A

40%

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34
Q

Function of Casein

A

Mainly nutritive, providing minerals and essential amino acids to infant
Also provides peptides with multiple functions, including antimicrobial, opioid, GI functions

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35
Q

Whey proteins include (5)

A 
a-lactalbumin
serum albumin
lactoferrin
immunoglobulins
lysozyme
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36
Q

a-lactalbumin

  • is X% total protein in human milk
  • is higher/lower than cow’s milk
A
  • is 10-20% of total protein in BM

- is much higher than cow’s milk

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37
Q

a-lactalbumin does…..

  • in mammary gland
  • in infant
A
  • mammary gland: participates in lactose synthesis, creating osmotic “drag” to facilitate milk production and secretion
  • in infant: binds Ca and Zn, may facilitate absorption of essential minerals; during digestion peptides formed have antibacterial and immunostimulatory properties & cause apoptosis of tumor cells
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38
Q

Factors that promote GI maturation in infant

A

Growth factors, incl EGF, IGF, TGF

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39
Q

Non-protein Nitrogen (NPN)…

  • % of total nitrogen
  • roles
A
  • 20-25% total nitrogen

- still studying roles, current known include essential vitamins, stimulation of beneficial bacteria….

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40
Q

A diet deficient in free amino acid taurine results in…

A

impaired fat absorption, bile acid secretion, retinal function and hepatic function

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41
Q

Where does most protein synthesis occur?

Add’l milk proteins (eg albumin, immunoglobulins) derived from….

A

Lactocyte of mammary gland

add’l proteins derived from mother’s extracellular fluid

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42
Q

Carbohydrates in BM:

  • primary
  • 1.2% of milk made up of….
  • these 4 present in sm quantities
A
  • lactose (disaccharide)
  • over 130 different oligosaccharides (short chains of monosaccharides) (varies w/ many factors)
  • glucose, frutose, glycoconjugates glycoprotein and glycolipid in sm Q’s
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43
Q

Lactose….

  • stable?
  • [Avg]
  • % energy requirements provided (and measure)
A
  • most table component of mature BM
  • [avg] = 68g/L
  • provides up to 40% of energy req’s (each gram of carbs provides 4 calories)
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44
Q

Where is lactose synthesized?

A

in breast by lactocytes

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45
Q

What are the lactocytes?

A

Single layer of secretory cells that comprise the spherical alveolus

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46
Q

Lactose is a disaccharide. Prior to absorption what happens?

A

Prior to infant absorption broken down by enzyme lactase, to glucose and galactose

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47
Q

Where is lactase prodiced and when is it secreted in infant?

A

Lactase enzyme produced in brush border of small intestine.

Secreted in fetus from about 24 weeks gestational age

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48
Q

Functions of lactose (4)

A
  1. rapid increase of lactose at SA (Lact II) causes osmotic drawing of water into breast secretion - result: copious BM production
  2. enhances absorption of Ca and Fe
  3. Glucose and galactose provide energy to body, esp rapidly growing infant brain.
  4. Galactose essential for develop of CNS
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49
Q

Likelihood of seeing primary lactose intolerance

A

HIGHLY unlikely. If happens is usually after weaning!

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50
Q

Most variable constituent of human milk is

A

FAT

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51
Q

Milk fat is inversely related to

A

Degree of breast fullness

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52
Q

98-99% of milk fats are….

A

triglycerides (triacylglycerols)

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53
Q

Each gram of fat provides X calories

Fats provide what % energy in BM

A

Each g of fat provides 9 calories

Fats provide about half of energy in BM

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54
Q

Function of fats in BM (3)

A

Essential for synthesis and develop of retinal and neural tissue and support develop of human immune system

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55
Q

Human milk contains these fatty acids….

A

Medium chain
Long chain
-inclu long chain polyunstaurated fatty acids (LCUPFA)

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56
Q

BM is rick source of these 2 essential fatty acids and their derivatives

A

linoleic acid –> arachidonic acid (AA)

alpha-linolenic acid –> docosahexaenoic acid (DHA)

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57
Q

LCPUFA status of brain of AF infant provides possible explanation of…

A

decreases in neurological function and later cognitive ability found in AF infants
(AF has significantly lower LCPUFAs)

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58
Q

Remaining 1-2% fat not composed of triglycerides include (6)…

A 
Di- and monoglycerides
Nonesterified fatty acids
Phospholipids
Cholesterol
Cholesterol esters
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59
Q

Chemical form of triglycerides

A

Three fatty acids bound to glycerol molecule

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60
Q

Where are triglycerides synthesized?

A

In lactocytes from free fatty acids and glycerol

Fatty acids may be manufactured in lactocyte or originate from bloodstream

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61
Q

Maternal diet and protein….

  • Total amount?
  • Types of fats?
A

Mat diet does NOT affect total amount of fat in human milk.

Types of fat in mon’s diet influence composition of fatty acids in her BM.

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62
Q

When mothers ingest typical western diet, what % of fatty acids synthesized in mammary gland?
What does that mean about those not produced in mammary gland?

A

20% from mammary gland, rest from bloodstream.

Therefore, composition of the 80% reflects composition of dietary intake or adipose deposited fatty acids

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63
Q

Fats synthesized in mammary gland are XX fatty acids, while those synthesized in adipose tissue are XX.

A

Mammary: medium-chain fatty acids

Adipose tissues: long-chain fatty acids

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64
Q

When mothers eat high-carb, low fat diet, as much as XX% of fatty acids may be synthesized in mammary gland.

A

40%

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65
Q

BF women should aim to return to pre-preg weight by…

A

6 mos PP

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66
Q

Level of cholesterol in BM? Consistent?

A

Remains constant at 100-200 mg/L despire dietary change

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67
Q

Function of cholesterol in BM

A

Necessary for formation of stale cell membrane structure.

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68
Q

Role of phospholipids

A

Vital role in myelinization of CNS and develop of retina

Most important growth during critical period is occurring in the brain which will double in size during first year.

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69
Q

Mean concentration of fat in BM

A

4%, but subject to large sampling errors.

Remember, lots of variability in fat content by breast fullness (1-18%)

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70
Q

What breaks triglycerides down in to free fatty acdis and glycerol

A

LIPASES

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71
Q

Which lipases break down triglycerides into free fatty acids and glycerol in BM, and how (4)?

A
  1. Bile salt-stimulated lipase (in BM, aiding baby’s digestive enzymes)
  2. Lingual lipase (initiates digestion process in infant’s mouth)
  3. Gastric lipase (continues digestion in infant’s stomach)
  4. Pancreatic lipase (completes digestion in the small intestine)
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72
Q

Which 2 lipases markedly aid digestion of lipids in BF infant?

A

Gastric and bile-salt stimulated lipase

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73
Q

Why might expressed & stored BM have a soapy smell/taste, potentially refused by infant?
How to fix if baby refuses?

A

This is caused by BM lipase beginning the digestion process
Fine for baby to drink, if he will take it.
If refuses, scald BM (see other card on how)

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74
Q

How to scald BM

A
  1. In heavy-based pan over low heat, bring milk to just below boiling point.
  2. As soon as she sees some steam rising and bubbles forming around inside edges of pan, remove fr heat. Stir occasionally while heating to prevent a skin from forming on top.
  3. Cool and store as usual.
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75
Q

Only difference between foremilk and hindmilk

A

Fat content is much higher in hindmilk AT A GIVEN BF

but changes at different rates between BFs

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76
Q

What is lactoengineering? What is it currently used for?

A

Altering milk composition for a particular purpose. Currently used to provide high-fat BM to VLBW preemies.

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77
Q

Vitamin A:

  • fat or water soluble?
  • Two categories
A

-FAT SOLUBLE
-Two categories:
-Retinol from animal sources (liver, whole milk, eggs)
-Carotenoid, a provitamin fr yellow and green vegetables and fruit
which is converted to retinol in body

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78
Q

Function of Vit A
Deficiency causes
Deficiency caused by

A

Necessary for vision, immune system, maint of epithelial structures.
Deficiency causes blindness and death.
Deficiency caused by early weaning, insufficient intake of foods rich in vit A, low-fat diets, chronic exposure to cigarette smoke.

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79
Q

Vit A in BM

  • good source?
  • which type?
  • effect of supplementation?
A
  • BM excellent source of vit A
  • BM vit A mainly retinol, influenced by maternal serum levels of retinol
  • Suppl including vit A and beta-carotene significantly increase [BM]
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80
Q

When are vitA levels highest?

A

Early lactation, gradually decline

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81
Q

Vit D

  • fat or water soluble?
  • functions
A

-FAT SOLUBLE
-Functions:
-Bone health: Ca and phosphorous homeostasis (prevents rickets
and osteoporosis)
-Cell proliferation
-Role in prevent hypertension, autoimmune disorders, cancer

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82
Q

Sources of Vit D

A

Main source: sunlight reacting on skin - produces lg amounts, eg 10,000-20,000 IU in 10-12 mins for person in swimsuit in Boston

Found naturally in very few foods, incl: fatty fish, egg yolks, some wild mushrooms, fortified foods

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83
Q

BM levels of vit D & depletion

A 
Low usually (20-<100IU/L)
Stores of Vit D laid down during preg in normal moms may be depleted in 2 mos in absence of exposure to sunlight.
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84
Q

Adequate level of Vit D?

A

No consensus
Current recommend is 400 IU/day, beginning soon after birth.
Admin as medicine to prevent rickets.

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85
Q

Supplement mom’s Vit D?

A

Yes, usually they are low. Mat vit D3 suppl of 6400 IU/day meets needs of lactating woman, raising level to upper normal range, also maintaining normal [vit D] in EBF infant

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86
Q

Vit E

  • fat or water soluble
  • function
  • what is it?
A
  • FAT SOLUBLE
  • Function: antioxidant that protects cell membranes from oxidation
  • Vit E describes collection of tocopherols of which alpha-tocopherol is most significant
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87
Q

Vit E:

  • Good source (colostrum, mature milk)?
  • Supplement?
  • Fx of smoking and infant formula
A
  • Colostrum rich source of Vit E, as with mature milk. Since fat-soluble, higher levels found in hind-milk.
  • Suppl not recommend for healthy babies and moms
  • Smoking causes oxidative stress, reduces vit E in BM. Smoking & formula cause deleterious pro-oxidant fx in infants
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88
Q

Vit K

  • fat or water soluble?
  • where produced
  • good sources
A
  • FAT SOLUBLE
  • produced by bacteria in human intestines (menaquinone, vit K2)
  • sources include leafy greens, avocado, kiwi: phylloquinone and vit K1 are the plant sources
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89
Q

Which components of blood are vit K-dependent?

A

Prothrombin, coagulation factors VII and IX, some plasma proteins.
^all = blood clotting factors

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90
Q

Maternal intake of X mg/day provides [BM] that meet infant’s daily requirement.

A

5 mg/day

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91
Q

Adequacy of maternal diet for meeting infant vitamin K needs?

A

Inadequate. Vit K xfer across placenta is poor and [BM] varies considerably by maternal diet.

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92
Q

Supplement recommend Vit K

A

Single IM injection of Vit K1 recommended for all healthy term infants at birth, with no further supplementation recommended.

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93
Q

Early onset Vitamin K deficiency bleeding (VKDB)…
-presents when, how

Late onset VKDB
-presents when, how

A

EARLY: presents between 1-7 days of age, usually as hemorrhage at umbilical cord site, GI tract or circumcision site

LATE: between 2-12 weeks with intracranial, GI, cutaneous bleeding.
-Late onset results in serious morbidity or mortality and occurs almost exclusively in BF infants who did not receive parenteral (IMI) prophylactic vit K soon after birth

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94
Q

Vit C

  • fat or water soluble?
  • sources
  • deficiency causes
A
  • WATER SOLUBLE
  • humans dependent on vit C from external sources (body cannot make own) - found in fruits and veggies
  • deficiency causes scurvy
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95
Q

Supplement vit C?

A

NO. Intake of vit C in mat diet, but not as suppl, determines [vit c] in BM. Supplementation does not raise BM levels above normal in well-nourished women.

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96
Q

B-complex vitamins

  • name all 4 listed here (there are 8 total)
  • function
  • sources
A
  • Thiamin (B1), riboflavin (B2), B6 (pyridoxine), B12 (cobalamin)
  • play role in cell metabolism
  • found in potatoes, bananas, lentils, tempeh, turkey, liver, tuna, brewer’s yeast
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97
Q

Thiamin (vit B1)

  • suppl?
  • [BM] influenced by…
A
  • [thiamin] of BM in well-nourished moms meets infants needs, not signif affected by suppl.
  • influenced by maternal thiamin intake. Suppl during preg and lat only for women w low serum thiamin
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98
Q

Riboflavin (vit B2)

  • suppl?
  • [BM] influenced by
A
  • No need to supplement in well nourished moms

- influenced by mat intake of riboflavin

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99
Q

Vitamin B6 (pyridoxine)

  • suppl?
  • RDA
  • [BM] ifluenced by
  • compl foods
A
  • not needed if well nourished
  • RDA: 2 mg/day for infant
  • influenced by mat intake, mat supplementation in deficiency beneficial to mom & baby
  • compl foods at 6 mos should be rich in vit B6 to meet increasing needs for vitamin at this age
100
Q

Vit b12 (cobalamin)

  • use
  • sources
  • suppl?
  • if deficient, and sx in baby
  • who is deficient, how to treat?
A
  • necessary for synthesis of red bood cells and maint of CNS
  • sources: animal foods, eg fish, meat, poultry, egg and dairy products
  • no need to suppl mother who has sufficient amounts of b12
  • if mom is deficient, BM will not meet baby’s needs: baby may have failure to thrive, lethargy, hypotonia, develop delay or regression, megaloblastic anemia –> if untreated, cerebral atrophy and death
  • Vegans and women who recently had bariatric surgery may be deficient and should eat vit B12 fortified foods or eat supplements
101
Q

Some research found that mothers taking mega-doses of B6 may suppress secretion of this hormone

A

Prolactin

102
Q

Minerals in human milk

  • concentration
  • bioavailability
  • relationship with other nutrients fx…
A
  • low concentration but
  • high bioavailability
  • absorption, metabolism, excretion
103
Q

The [BM] of these three minerals doe snot correspond with maternal serum values

A

Calcium
Phosphorous
Magnesium

104
Q

Calcium in BF infants

  • function
  • variation
  • correlation btwn BM volume and [Ca]?
A
  • bone growth and regulating muscle and heart function
  • wide variations in [BM Ca] between regions, even may be 2-fold variation in same community
  • BM volume and [Ca] are NOT correlated.
105
Q

Infant Ca requirement for first year of life

A

200 mg/day avg

106
Q

BM Ca output averages….

A

200 mg/day (infant needs) but varies considerably and decreases in later lactation

107
Q

Relationship between Ca intake and infant length velocity or bone mineral content in first month of life?

A

NO

108
Q

Supplement Ca?

  • lactating women
  • pregnant women
A
  • NO for lactating - no change in [BM]

- suppl during preg may influence BM levels PP

109
Q

What primarily influences sodium levels?

A

Degree of closure of tight junctions between lactocytes of alveoli
*lactocytes are milk producing cells

110
Q

When are tight junctions open?

3

A
  • Early lactation, close by 4 days PP
  • sodium levels 1/2 to 1/3 less in mature milk than colostrum
  • Mastittis
  • Na, Cl levels increase, giving milk salty taste
  • Poor establishment of lactation causes tight junctions to fail to close
  • can cause hypernatremic dehydration d/t poor lactation management
111
Q

These minerals not influenced by maternal intake (3)
The levels of these minerals in infancy strongly influenced by fetal liver stores accumulated during last trimester of preg

A

Copper, Iron, Zinc

112
Q

Iron

  • bioavail - high or low?, vs bovine milk
  • does heat tx alter?
  • presence of these components aid absorption
  • suppl?
A
  • very high bioavail: 5x more efficient absorption human vs bovine milk
  • heat tx does not alter rate of Fe absorption by infant
  • high lactose and Vit C aid absorption
  • unnecessary to suppl in first 6 mos if EBF
113
Q

Zinc

  • active or passive transport to BM?
  • function
  • fx of Zn deficiency
A
  • active transport
  • necessary for enzyme activity, immune function, protein synthesis, wound healing, DNA synthesis, cell division, supports normal growth & developo during preg, childhood, adolescence
  • deficiency: growth retardation, loss of appetite, impaired immune function
114
Q

Selenium

  • high/low at initiation of lactation initiation
  • mean values stable across pop?
  • mat [selenium] influences [BM]? Infant plasma content?
A
  • HIGH at initiation
  • mean values vary by pop and follow geog distrib
  • mat selenium status closely related to milk selenium values, which is positively related to infant plasma content
115
Q

Iodine

  • richest sources
  • function
  • fx of deficiency
A
  • from ocean, eg seaweed, fish, and from iodized salt
  • required for synthesis of thyroid hormones necessary for brain develop during fetal and early postnatal life
  • deficiency is leading cause of brain damage in adults
116
Q

Iodine

  • suppl?
  • BM level vary widely on (2 things)
  • dietary intake influence [BM]?
A
  • YES, if needed!
  • varies on geographic region and mat intake
  • iodine in BM responds quickly to dietary iodine intake, either supplemented or consumed in natural foods
117
Q

Recommend if women living in iodine deficient region?

A

Recommend all pregnant and lactating women consume up to 5g of iodized salt per day.

118
Q

Fluoride

  • BM levels related to mat nutrition?
  • suppl (pre- and post-6 mos)
  • reports of fluorosis when…
A
  • BM levels independent of mat nutrition
  • no suppl fluoride during first 6 mos; from 6 mos - 3 yrs, decision to supplement should be made on basis of [fluoride] of water supply and in other food, fluid sources, toothpaste.
  • suppl not usually needed unless [drinking water] is <0.3 ppm)
  • fluorosis in infants receiving formula reconstituted with fluoridated water
119
Q

Define Secretory Differentiation (Lactogenesis I)

A

Colostrum begins to be synthesized in breast from about mid-pregnancy. Risk in serum prolactin most closely assoc w this functional develop. Progression to full lactation held in check by high levels of serum progesterone.

120
Q

Much change in [milk components] until birth of infant?

A

NO

121
Q

Define Secretory Activation (Lactogenesis II)

A

Following birth, presence of high serum prolactin and rapid withdrawal or progesterone. SA results in ransition from colostrum to mature milk over period of 72-96 hours.

122
Q

Milk components relatively stable by Day X in lactating mother

A

Day 4

123
Q

The majority of mature milk is made of…. (%)

The effect of this is…

A

Water (87.5%)
Water drawn into lactocyte to maintain osmotic equilibrium in response to synthesis of lactose. As lactose expelled into milk secretion, water moves with it. Lactose, therefore, exerts major control over milk yield.

124
Q

Milk Yield at:
First 24 hours PP
Day 3
Day 14

A

First 24: 37.1 g (7-122.5)
Day 3: 408 g (98.3-775)
Day 14: 1156 g

125
Q

24 hour milk volume remains stable for indiv mom and baby from X age until X age while EBF.

Avg volume during this time:

A

From 1-6 mos of age

Avg vol: 780 ml (26 oz) (range: >478 to 1356: >16-45 oz)

126
Q

Do BF babies ever need extra water (under 6 mos)?

A

NO, BM provides all - encourage on demand BF even in hottest weather

127
Q

These 4 factors increase from colostrum to mature milk

A

Energy, Lactose, Glucose, Fat

128
Q

These 5 factors decrease from colostrum to mature milk

A

pH, Sodium, Chloride, Total protein, Secretory IgA

129
Q

In first few days after birth, infant at far greater need for…
Which is why colostrum is higher in…

A

Immunological protection

Higher in sIgA

130
Q

Colostrum acts as a… on the lower bowel, helping to…, reducing infant risk of….due to….

A

Laxative, helping to clear meconium quickly, reducing risk of hyperbilirubinaemia due to reabsorption of unconjugated bilirubin from bowel

131
Q

Define Involution

A

Occurs as result of distention of alveoli by retained milk. Milk composition reverts to be similar to that of colostrum.

132
Q

At birth the baby’s skin and gut are…. but quickly…. of those whom he….

A

sterile, colonized by bacterial flora, comes in contact with.

133
Q

Harmless bacteria that colonize gut are almost exclusively….

A

anaerobic (live without oxygen)

134
Q

Newborn gut initially colonized with…., but then…

*this is an important defense mechanism to protect the infant

A

aerobic bacteria, but then as nutrients and oxygen used it is crowded out by anaerobic bacteria exposed to

135
Q

Main source of bacteria for colonizing newborn gut at and after vaginal birth

A

Maternal intestinal flora

136
Q

Bifidobacteria are natural part of bacteria fora in human body and have symbiotic bacteria-host relationship with humans.
They… (4 things they do)

A
  • promote good digestion
  • boost the immune system
  • control intestinal pH
  • inhibit growth of Candida albicans, E. coli, and other potentially pathogenic bacteria.
137
Q

Bacteria commonly found in artificially fed infant guts

A

bifidobacteria +
predominance of enterococci and enterobacteria.
Development of bifidus flora is unusual.
Clostridia, Enterococci, Klebsiella, E. Coli and Bacteroides are common in gut of artificially fed infants

138
Q

Protective factors in BM (5)

A 
Proteins
Carbohydrates
Fats
Cellular components
Other BM components
139
Q

Protective factors in BM (5)

A 
Proteins
Carbohydrates
Fats
Cellular Components
Other BM constituents
140
Q

Secretory IgA (SIgA)

  • function
  • dose in BM
  • dose in colostrum
A

Fn: main immunoglobulin, provides protection against bacteria colonizing newborn’s gut
Dose BM: 0.5-1 g/L for the duration of lactation
Dose in Colost: up t o12 g/L

141
Q

Study graphic on BE 01 p. 39

A

Mucosal Defense System

142
Q

Role of sIgA (3)

A
  1. sIgA antibodies bind micro-orgs they are specifically directed against, preventing them from attaching to infant’s mucosal membranes
  2. Support develop of infant’s own immune system
  3. Inflamm. reactivity NOT activated by this defense system
143
Q

sIgA content in milk of mothers of preemies

A

is significantly higher in sIgA

144
Q

Lactoferrin

  • what is it?
  • dose in mature BM (colostrum?)
A
  • is a glycoprotein that binds iron

- dose mature: 1-3 g/L (much more concentrated in colostrum)

145
Q

Lactoferrin function (5)

A
  1. bactericidal to many Gram-negative and -positive bacteria, including E. coli
  2. Reacts with the cell membrane of bacteria it comes in contact with
  3. Has antiviral effects
  4. Is antifungal against Candida albicans
  5. Inflammatory reactivity prevented by lactoferrin
146
Q

alpha-Lactalbumin function

A

Forms complex that induces apoptosis (cell death) of all malignant cells, but not normal cells (complex name: HAMLET: human alpha-lactalbumin made lethal to tumor cells)

^may explain why children AF have higher rates of leukemia and lymphomas, and may explain why premenopausal breast cancer risk in women who BF is reduced

147
Q

Lysozyme function

A

enzyme that effectively attacks E. coli in concert with lactoferrin and sIgA

148
Q

Anti-secretory factor function (2)

A
  1. protects mother against acute mastitis

2. protects infant against diarrhea

149
Q

Proteins that protect infant in BM (5)

A 
sIgA
lactoferrin
alpha-Lactalbumin
lysozyme
anti-secretory factor
150
Q

Carbohydrates that protect infant in BM (1)

A

Oligosaccharides

151
Q

Oligosaccharides

  • how they work
  • how they present in BM
A
  • are prebiotics, not digested in small intestine, but enter colon as intact, large carbohydrates that are then fermented by the resident bacteria
  • present in BM by creating increased proliferation of bifidobacteria and lactobacilli (probiotics)
152
Q

Oligosaccharides fact/function (4)

A
  • pass through gut unchanged, also found in urine
  • act as blocking analogues to receptors on epithelial surfaces by resembling binding sites for bacteria, sweeping the bacteria from teh gut with them as they are eliminated.
  • influence microflora composition of BF baby
  • defend infants against pathogens causing otitis media, respiratory tract infections, UTIs, diarrhea
153
Q

Which lipids and fat globules protect BF infant and how

A

fatty acids and monoglycerides PROTECT by ATTACKING/NEUTRALIZING G. lamblia, entamoeba, E. coli, and Shiga-like toxins

154
Q

2 cellular components in BM that most likely protect maternal breasts

A

neutrophils

macrophages

155
Q

lymphocytes in BM - how work, what do

A

Work: absorbed
Do: may confer immunological information to the baby

156
Q

Other protective factors in BM (6)

A 
nucleotides
defensins
cytokines
hormones & growth factors
anti-inflammatory components
soluble CD14 and soluble Toll-like receptor
157
Q

Without defenses from BM, infants will experience (6)

A 
inflammation
tissue damage
clinical symptoms
high energy cost
---> RESULTS IN GROWTH FALTERING
158
Q

Exclusive BF definition (IGAB Consortium)

A

No other liquid or solid from any other source enters the infant’s mouth

159
Q

Almost exclusive BF def (IGAB Consortium)

A

Allows occasional tastes of other liquids, traditional foods, vitamins, medicines, etc.

160
Q

Full BF def (IGAB Consortium)

A

Includes exclusive and almost exclusive

161
Q

Full BM feeding (or fully BM fed) (IGAB Consortium)

A

The infant receives expressed breast milk in addition to BF

162
Q

Partial BF def (IGAB Consortium)

A

mixed feeding, designated at high, medium or low.
Methods for classification suggested include % of calories from BF, % feeds that are BF’s, etc. Any feeding of expressed BM would fall under this category

163
Q

Token BF def (IGAB Consortium)

A

minimal, occasional BFs (for comfort or with less than 10% of the nutrition thereby provided)

164
Q

BF def (WHO)D sDSDS DS swdswd

A

Child has received BM direct from breast or expressed s swxx wwwwwwwwwwwwwwwwwwwwwwd

165
Q

EBF def (WHO)ssssssssssWXssWXWsXWSwwwwwww

A

infant received only BM form mother or wet nurse, or expressed BM, and no other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicinesSS

166
Q

Predominant BF def (WHO)

A

Infant’s predominant source of nourishment has been BM, however can also have received water and water-based drinks, fruit juice, oral rehydration salts solution (ORS), drop and syrup forms of vitamins, minerals and medicines, and ritual fluids (in limited Q’s). With the exception of fruit juice and sugar water, no food-based fluid allowed under this definitionSWwsxwxwSwsssswSssW

167
Q

Full BF def (WHO)

A

EBF and predominant BF together constitute full BF

168
Q

Complementary feeding def (WHO)

A

child has received both BM and solid or semi-solid food

169
Q

Bottle-feeding def (WHO)

A

child has received liquid or semi-solid food from a bottle with a nipple/teat

170
Q

Increased morbidity and mortality in AF infants can be attributed to which 3 things?

A
  1. exposure to pathogens from feeding implements, formula or water used
  2. absence in formula of antibacterial, antifungal, antiparasitic agents found in BM
  3. Slower and weaker develop of infant’s own immune system
171
Q

GI infections cause these 5 things

A 
Diarrhea
Dehydration
Loss of appetite
Resultant weight loss and 
Malnutrition
172
Q

3 most commonly reported causes of infectious diarrhea in infants in first 12 months include (3 + examples)

A

Bacteria (E. coli, Salmonella sp, Campylobater jejuni)
Viruses (esp. rotaviruses)
Parasites (Giardia lambila, Entamoeba histolytica)

173
Q

Relative risk of developing diarrhea throughout life for AF infants as compared to BF infants

  • 0-1 months
  • 1-12 months
A

0-1 mo: 14

1-12 mo: 4-10

174
Q

Necrotizing enterocolitis (NEC)

  • where is this infection commonly seen?
  • risk factors
  • cause
  • mortality rate
A
  • most common GI emergency in NICU
  • risk factors: prematurity, AF, intestinal ischemia, bacterial colonization
  • due to inappropriate inflammatory response of the immature gut to some undefined insult
  • mortality: 15-25%
175
Q

NEC and formula

  • how much was risk of NEC increased in preemies being fed AF?
  • dose-response?
A
  • risk of NEC 28.6

- YES dose-response

176
Q

Powdered infant formula contaminated with Enterobacter sakazakii has been associated with outbreaks of…. (3)

A

NEC
Infant sepsis
Meningitis
[in preterm, neonatal and older infants]

177
Q

What two factors are being administered to preemies at risk for NEC?

A

Epidermal growth factor

Probiotics

178
Q

Relative risk of hospitalization d/t pneumonia in AF infants (vs BF)

A

17

179
Q

Intro. of solids of artificial baby milk before the recommended 6 months of EBF results in X-times increase in pneumonia greater than X episodes of otitis media

A

6x increase in pneumonia

Greater than 3 episodes of otitis media

180
Q

RR for developing respiratory illness throughout life for AF (vs BF) infants @ 1-12 mos

A

3.3-4.3

181
Q

Possible causes of process that increases incidence of otitis media in AF infants (3)

A
  • irritation of middle ear from leakage of cow’s milk into eustachian tube
  • more horizontal feeding position adopted while bottle feeding
  • lack of antibody T- and B- cells found in BM
182
Q

Pneumococci middle ear infections resistant to this BM protective factor, which prevents H. influnzae colonization of the nose and mouth in BF infants

A

sIgA

183
Q

RR for developing otitis media throughout life for AF infants vs BF infants

  • 1-12 mos
  • 1-6 yrs
A
  • 1-12 mos: 8.6

- 1-6 yrs: 3.3-4.3

184
Q

UTI protected by several mechanisms (4)

A
  • Bacteria causing infection comes from bowel, which is similarly colonized between BF mom and baby. Infant protected by mom’s sIgA
  • Bacterial growth in infant’s gut controlled by other antimicrobial factors in BM
  • Lactoferrin from BM absorbed by infant, transported into urine via kidneys, killing bacteria it comes into contact with
  • Milk oligosaccharides also appear in urine, preventing attach of bacteria to urinary epithelium
185
Q

SIDS definition

A

Sudden death of an infant under the age of 1 year that cannot be explained after thorough examination of all factors.
*most SIDS deaths occur between 2-4 mos of age

186
Q

Factors protecting BF babies from SIDS (3)

A
  • During active sleep phase infants signif more rousable that AF infants at 2-3 mos of age
  • Bed-sharing moms/babies have more night feeding, which helps maintain adequate milk supply ensuring longer duration of BF and healthy baby
  • Act of BF promotes optimal develop of oro-facial and jaw development. BF encourages wide palate and thus unobstructed airway. This protection from SIDS may be as much from physical act of BF as from many protective and developmental properties of BM
187
Q

Enterobacter saskazakii def

A

Bacterium belonging to family Enterobacteriaceae

A microorganism implicated in outbreaks causing meningitis or enteritis, esp. in infants

188
Q

Three routes by which Enterobacter sakazakii can enter infant formula

A
  • through raw material used for producing formula
  • through contamination of formula or other dry ingredients after pasteurization
  • through contamination of formula as it is being reconstituted by caregiver just prior to feeding.
189
Q

Increased risk for these 4 diseases assoc with AF and short-term BF

A

type 1 diabetes
celiac disease
some childhood cancers
IBD

190
Q

Type 1 Diabetes Mellitus (DM)

  • def
  • general risk, risk w/ 1st degree relative affected, risk if both parents affected
  • how does BF affect risk?
A
  • Def: autoimmune disease determined by combo of genetic and environ factors
  • Gen pop risk: 0.4%
  • 1st degree rel: up to 6%
  • Both parents: up to 30%
  • BF is protective (if 12+ mos)
191
Q

Hypotheses about what causes trigger which damages islet cells in infants, causing T1DM (3)

A
  • early exposure to cow’s milk protein
  • intro to solid food before 3 mos
  • not having protective benefits of BM
192
Q

Mothers who have T1DM are more/less likely to BF?

A

LESS

193
Q

BF also decreases risk of T2DM.

OR of T2DM develop w/ BF

A

OR 0.61

194
Q

Celiac disease def, prevalence, avg age at dx

A

Def: an autoimmune chronic enteropathy AKA celiac sprue. Intestinal damage and Inflamm response result in maldigestion and malabsorption caused by ingestion of gluten by susceptible individuals
Prevalence: strongly hereditary, prev of 10% w/ presence in 1st degree relative
Avg age: 8.4 years

195
Q

Increase in risk of celiac in non-BF infants

A

2x

196
Q

Current recommendation for preventing celiac:

A

Children to be EBF for 6 mos and BF to continue while, and for several months after, gluten introduced into diet.

197
Q

IBD

  • def
  • 2 types
A

-IBD: idiopathic disease, probably involving immune reaction of body to own intestinal tract
-2 types:
-Ulcerative colitis - chronic inflammatory disorder limited to colon
-Crohn’s disease - can involve any segment of GI tract from mouth
to anus

198
Q

Chance of child of parent with IBD developing IBD is X%

A

5%

199
Q

Possible reasons artificial infant feeding has been linked to GI illnesses (Crohn’s, IBD, etc) (3)

A
  • AF infants have more GI infections
  • AF infants miss out on earlier develop and maturation of GI mucosa that BM stimulates
  • infant formula is trigger for antigen response
200
Q

How does BM help prevent obesity?

A

programs infant’s parameters for normal metabolism and regulation of intake

201
Q

Possible physiological reasons that AF is significantly associated with obesity (4)

A
  • AF babies have half the normal levels of serum leptin. Leptin is hormone that regulates food intake and energy metabolism and is found in BM.
  • BF fx insulin production which can have long-term effects on energy metabolism.
  • Amniotic fluid and BM provide flavor exposure to fetus and infant. These exposures influence taste preference and food choices after weaning. So, maternal healthy food consumption during preg and lact may improve accept of healthy food after weaning.
  • BM programs infant’s parameters for normal metabolism and regulation of intake, reducing weight gain in infancy. This & the relatively low protein level in BM (vs formula) seems to normalize weight later in life. This is called the early protein hypothesis.
202
Q

Possible behavioral reasons that AF is significantly associated with obesity (3)

A
  • Mothers who choose to BF may select healthier foods for their children.
  • Compared with parents who bottle-feed, mothers who BF allow infant to take active role in controlling intake, fostering better self-regulation of energy intake
  • Children with mothers who were obese before pregnancy are at greater risk of becoming overweight. This plus AF combined represent greatest risk for obesity.
203
Q

Possible explanations for reduction in lung function in AF babies include (3)

A
  • Loss of factors in human milk that may favorably modify lung develop and an increase in total lung capacity
  • Increased respiratory muscle strength that reduces residual volume
  • loss of growth factors and cytokines found in BM that influence growth of respiratory alveoli. *Alveoli continue to develop after birth.
204
Q

Multiple Sclerosis

  • define
  • discuss importance of myelin
  • how to prevent (hypothesis)
A
  • MS is idiopathic, inflammatory, demyelinating disease of CNS. Is autoimmune dz where lesions develop along nerve pathways; commonly optic nerve, white matter of cerebellum, brain stem. Neuropsych dysfunction progresses over several years.
  • Myelin: Essential fatty acids necessary for normal myelin develop. Demyelination continues (once it starts) until all abnormally formed myelin is destroyed.
  • D/t ^, follows that prevention of MS should be mainly dietetic measures ensuring sufficient supply of essential fatty acids, minerals and vitamins, during pregnancy and childhood (BF!!!!).
205
Q

Two strongest dietary links to MS:

A
  1. lack of BF and excessive consumption of cow’s milk during infancy.
  2. consumption of animal fats which are deficient in unsaturated fatty acids.
206
Q

Which 4 cancers have been linked to AF include:

A
  • lymphoblastic leukemia
  • Hodgkin’s lymphoma
  • neuroblastoma
  • Wilm’s tumor
207
Q

Possible reasons that AF could be linked to childhood cancers (3)

A
  • Lymphomas common in children with immunodeficiencies, and AF provides none of the immunodefenses BF does
  • Infection has been proposed as risk factor for both leukemia and Hodgkin’s dz. AF infants may be less able to handle carcinogenic insults after infancy w/o BM protection.
  • Alpha-lactalbumin, which can take the HAMLET form, killing tumor cells, not present in AF.
208
Q

Which two hormones found in BM help explain why BF infants better able to maintain normal weight as they grow?

A

Leptin

Insulin

209
Q

Define atopy

A

a form of allergy in which a hypersensitivity reaction eg dermatitis or asthma may occur in a part of the body not in contact with the allergen

210
Q

5 Predictors of childhood allergy

A
  • Hereditary - 43% of children with one parent with hx of atopy - esp maternal
  • Elevated cord blood IgE
  • Maternal cigarette smoking, prenatal and postnatal
  • AF
  • Environmental factors (eg house dust mite, cigarette smoke, etc)
211
Q

Examples of atopic disease manifestation (9)

A
  • asthma
  • eczema
  • cholic
  • failure to thrive
  • anaphylaxis
  • urticaria
  • chronic respiratory disease
  • GI disease
  • rhinitis
212
Q

How does food allergy occur??

A

It is an immune system response. Occurs when body mistakes ingredient in food, usually a protein, as harmful and initiates antibody response to fight it.

First contact with the food causes body to produce IgE antibodies. Next contact causes body to release histamines and other chemicals into bloodstream, triggering allergic rxn that could be potentially life-threatening.

213
Q

Define leaky gut

A

D/t immaturity of baby’s gut in early months, passage of large unwanted molecules from ingested foods able to pass through the gut wall into bloodstream.

214
Q

Most common single allergen affecting infants

A

Bovine milk proteins (not lactose)

215
Q

The 7 foods that account for 90% of alergic rxns in babies and children are….

A
  • cow’s milk protein
  • eggs
  • peanut
  • soy
  • tree nut
  • fish
  • wheat
216
Q

Incidence of cow milk protein allergy in infants under 12 mos

Often misdiagnosed as…. (2)

A

3%

Misdx: colic, gastroesophageal reflux

217
Q

7 steps in management to control atopic disease

A
  1. ID “at-risk” families - hx, other child with atopic dz
  2. Stop smoking, preferably before preg
  3. From v early in preg, exclude common food allergens, plus any known to have problems in members of that family
  4. Preven post=natal sensitization - continue maternal avoidance diet
  5. EBF for min 4 mos and continue BF after intro of compl foods
  6. Withhold cow’s milk, egg and peanuts and known family allergens for 2-3 years
  7. Contron environ allergens - eg avoid animals, dust mites and molds, smokeHow l
218
Q

How long does it take an infant to double his birthweight

A

6 months

219
Q

How long does it take for infant to double his brain size?

A

1 year

220
Q

Success of adding PUFA’s DHA and ARA to artificial baby formula?

A

NO

221
Q

Benefits of BF in dental health

A

Tongue mvmts of BF help spread palate and thus allow good teeth spacing

222
Q

Bottle feeding and non-nutritive sucking associated with these dental anomalies (2)

A

Altered occlusion: open bite and posterior cross-bite.

223
Q

Do BF or AF children have higher rates of dental caries

A

AF

224
Q

Why does BM sugar not cause dental caries?

A

BM sugar is lactose - split by enzyme lactase into glucose and galactose in infant’s gut, not in the mouth, so not cavity-causing. Sucrose is main sugar implicated in tooth decay.

225
Q

Mean Hb is appx. XX g/L lower in non-lactating women compared with lactating women

A

50 g/L lower

226
Q

Most significant factor in iron deficiency anemia

A

PP blood loss and early recommencement of menses

227
Q

See chart on pg 69/80 of BE01

A

chart of iron and BF vs AF

228
Q

Fertility rate of women EBF, amenorrheic in first 6 months after birth

A

2%

229
Q

How long until fertility returns when lactation is suppressed

A

Within 6 weeks

230
Q

What % of the normal weight gain in pregnancy is attributed to maternal fat stores?

A

25% (7 lb)

231
Q

Estimated avg add’l nutritional burden of EBF until 6 months for RDA energy, vitA, Ca, Fe

A

Small: 0.1-6.0%

*Being amenorrheic for 6 months conserves nutrients such as iron

232
Q

Regulatory processes allowing for successful lactation involve (4)

A
  • mobilizing fat
  • increasing food intake
  • reducing energy expenditure, and
  • changing composition or volume of milk
233
Q

During which trimester(s) does the most bone loss occur?

Amount?

A

Second and third b/c fetal bone growth is at it’s peak.

Amount: 25-30 g calcium (2-3% total body calcium content).

234
Q

Following pregnancy, mom continues to lose further XXX-XXXmg calcium per day in BM

A

300-400mg

235
Q

After BF stops, bone mineral content at most skeletal sites…

A

increases to similar or higher than amount measured shortly after birthing

236
Q

PP decrease in bone mineral content does not occur in women who do not BF?

A

NOT recovered

237
Q

Are either # of pregnancies or length of BF associated with low bone mineral density in post-menopausal women?

A

NEITHER

238
Q

Will calcium supplements during lactation affect process of bone mineral density decrease?

A

No effect, several studies.

239
Q

When a mother with T1DM BF’s, what happens to her total daily insulin requirement? Why?

A

It decreases as a result of increased glucose uptake during lactation

240
Q

Note that there is a dose response relationship with EBF and maternal T2DM risk.

A

That is all.

241
Q

What happens to the T2DM risk for women who have had GDM?

A

Greatly increases later in life.

Women w GDM who suppressed lactation developed early postpartum diabetes at TWICE the rate of those who BF

242
Q

Why do GDM women have higher risk for T2DM?

A

Women who AF had poorer pancreatic beta-cell function vs women who BF for 3 mos in a study

243
Q

How do pregnancy and lactation affect breast cancer risk?

A

Risk of estrogen-receptor positive and progesterone-receptor positive tumors decreases by early age at first pregnancy and multiparity.

Lactation is assoc with reduced risk of both est. and progest. positive AND negative tumors, suggesting different mechanism of protection in lactation.

244
Q

Dose-response relationship exists between EBF duration and breast cancer protection

A

That is all.

245
Q

Discuss endometrial cancer risk and BF

A

Risk of endometrial cxr related to estrogen levels, showing increased risk with increasing endo-or exo-genous estrogen stimulation and reduced risk when opposed by progesterone.

During BF, reduction in endogenous estrogen exposure is larger than that of progesterone, suggesting that BF may possibly reduce risk of endometrial cancer.

246
Q

What are the other 5 names for modified milk for infants?

A 
infant formula
artificial baby milk (ABM)
breastmilk substitutes
artificial formula (AF)
powdered infant formula (PIF)
247
Q

MAKE FLASHCARDS FOR IBCLC PRINCIPLES OF ETHICAL PRACTICE

A

TO DO

248
Q

Elements of informed consent includes a discussion of the following 6 element

A
  1. nature of client’s problem or illness
  2. nature and purpose of proposed procedure or tx
  3. risks and benefits of proposed procedure or tx
  4. alternatives to proposed intervention
  5. risks and benefits of alternative tx or procedure
  6. any risks related to failing to undergo a procedure or tx

BreastEd (3 decks)

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