Exam 1 Material Flashcards
Identify the group that sets the Dietary Reference Intakes
-Set by a group of scientists (US and Canada)
- National Academy of Sciences
- Institute of Medicine
- Food and Nutrition Board
Name the two goals of the DRI
Dietary adequate and optimal nutrition
State the target populations for the DRIs
Set for healthy people
-amounts intended to be provided by foods: varied diet will likely provide other nutrients for which DRIs not set
Infants: 0-6 months, 7-12 months
Children: 1-3 years, 4-8 years
Males and Females:
- 9-13 years
- 14-18 years
- 19-30 years
- 31-50 years
- 51-70 years
- > 70 years
Define Daily Value
Not a DRI: reference point for Nutrition facts
Based on a general 2000 kcal diet
Identify appropriate use of nutrient content claims
Free= none or trivial amount Low= less than a set amount Reduced= 25% less than reference food High= 20% or more DV Good source= 10-19% DV More= 10% more than reference food
Describe the process by which the dietary guidelines for Americans (DGA) are developed:
- Who is on the committee?
- How often are they released?
- 7 steps to develop the guidelines
Who is on the committee?
-Joint effort by USDA and USDHHS
How often are they released?
-Released every 5 years
7 steps to develop the guidelines (systematic review process)
- Develop a question
- Search, screen, select studies
- Drop studies that do not apply
- Extract data and assess risk of bias
- –bias: prevents unprejudiced consideration of a question - Describe and synthesize evidence
- Develop conclusion statements and grade evidence
- Identify research recommendations
Name the 2 overarching concepts of the DGA
- Maintain calorie balance over time to achieve and sustain a healthy weight
- Focus on consuming nutrient dense foods and beverages
- –Nutrient density: measurement of nutrients provided by a food versus calories
Energy density vs Nutrient density and calculate nutrient density
Energy dense: high amount of calories for low amount of nutrients
Nutrient dense: high amount of nutrients for low amount of calories
Nutrient density calculation
(% DRI of nutrient in food serving)/ (% daily calories in food serving)
*want ND>1
List the three components of energy expenditure
- Basal metabolic rate (60-70%)
- Thermic effect of food (5-10%)
- Physical activity (20-40%)
List the 6 “foods to reduce” per the DGA
- Sodium
- Saturated and Trans Fatty Acids
- Cholesterol
- Added Sugars
- Refined Grains
Remember the 4 “nutrients of concern” for Americans per the DGA
- Potassium
- works against sodium - Dietary fiber
- Calcium
- inadequate intake causes low bone mass
4 .Vitamin D
3 nutrients of concern for specific states of the life cycle
- Iron in young women
2 .Folate in pregnancy
3 . Vitamin B12 in older Americans
3 nutrients of concern for specific states of the life cycle
- Iron in young women
2 .Folate in pregnancy
3 . Vitamin B12 in older Americans
Identify 4 USDA food patterns
- Dietary Approach to Stop Hypertension (DASH)
- high fruit/veg intake, low fat
- good evidence for reduction in HTN, CVD - Mediterranean Diet
- Similar to DASH, higher fat (esp. olive oil) - Lacto-ovo vegetarian
- eat eggs and dairy but not meat - Vegan
- will need fortified foods, supplements
Define all three trimesters
First: 1-12 weeks
Second: 13-27 weeks
Third: 28-42 weeks
Define 4 term birth categories
Term birth: after 37 weeks
Early: 37-38 weeks
Full: 39-40 weeks
Late: 41 weeks
Postterm: 42+ weeks
Interpret the GPA method
Gravidity=number of pregnancies
Parity= number of deliveries
Abortus=number of induced abortions or miscarriages
Interpret the TPAL method
T=term births
P=preterm births
A=induced abortions OR miscarriages
L=living children
Name three goals of preconception nutrition counseling
- Maximize nutrition
- prenatal supplement before attempting pregnancy
2 .Maintain a healthy weight
- Obesity in men
- –hypogonadism, gynecomastia, reduced testosterone, higher estrogen
- Obesity in women
- -menstrual irregularities, polycystic ovarian syndrome (chronic failure to ovulate)
- Obesity related to adverse birth outcomes (eclampsia, congenital malformations)
3. Minimize toxin exposure (both parents)
Identify EPA guidelines for pregnant of soon-to-be pregnant women should follow regarding mercury consumption
- –no shark, swordfish, king mackerel, or tile fish
- –limit consumption of canned white tuna or tuna steak to 6 oz per week
- –Eat up to 12 oz per week of a variety of fish that are lower in mercury
- —–canned light tuna, shrimp, salmon, catfish, pollock
- –Check local advisories regarding the safety of fish caught by friends or family in local lakes, rivers, and coastal areas
Describe how the fetus obtains nutrients via the placenta
1.Villi project from placenta
- Blood vessels from embryo project into this space
- -nutrients, oxygen, waste exchanged across intervillous space in placenta
*placental damage caused by pre-existing cardiovascular or renal disease, preeclampsia
**placental exchange
-from fetus to mom: CO2, urea, uric acid, bilirubin
from mom to fetus: O2, H2O, CHO, AA, lipid, vitamins, minerals, drugs, viruses, alcohol, nicotine
List hormonal changes during pregnancy
Estrogen, progesterone production skyrockets
-causes emotional changes, sleepiness (esp. first trimester), taste/smell changes
List hematological changes during pregnancy
- Blood volume (esp. plasma) expands
- allows for flow to fetus
- hemoglobin, hematocrit, albumin will appear low
- higher glomerular filtration rate by kidneys
List cardiac changes during pregnancy
- Increased cardiac output
- increased heart size
List respiratory changes during pregnancy
- Increased oxygen requirement = more efficient gas exchange
- feeling short of breath
Define the three levels of pregnancy-induced hypertension
- Gestational: BP> 140/90
- Pre-eclamptic toxemia: BP> 140/90 + proteinuria
- Eclampsia: PIH causing seizures
EAR
EAR- Estimated average requirement
- -Intake of nutrient that meets the needs of 50% the healthy individuals given a gender and stage of the life cycle
- -Use EAR when assessing dietary habits of groups
RDA
RDA- Recommended Dietary Allowance
- -Intake of a nutrient sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals based on gender and stage of the life cycle
- -Expressed as an average daily amount of the nutrient
- -Based on an EAR plus an increase to account for variation
- -Use for individual planning
- -RDA set for Calcium, Carbohydrate, copper, folate, iodine, iron, magnesium, molybdenum, niacin, phosphorus, protein, riboflavin, selenium, thiamin, Vitamin A, Vitamin B6, Vitamin B12, Vitamin C, Vitamin D, Vitamin E, zinc
AI
AI- Adequate Intake
- -Recommended average daily intake established when there is insufficient evidence (or agreement) to set an RDA
- -Observe healthy people and their intake of a nutrient
- -AI set for: alpha-linolenic acid, biotin, chloride, choline, chromium, fat (infants 0-12 months), fluoride, linoleic acid, manganese, pantothenic acid, potassium, sodium, total fiber, vitamin K, water
UL
UL-Tolerable Upper Intake Level
- -Highest average daily intake level that is unlikely to have adverse health effects for almost all individuals in the general population
- -Intakes above the UL may have adverse effects
- -Not a recommended intake
- -No established benefit for consumption of nutrients at levels above RDA or AI
- -For most nutrients, refers to total intake from food, fortified food, and nutrient supplements
- -UL set for: boron, calcium, chloride, copper, folate, fluoride, iodine, iron, magnesium, manganese, molybdenum, niacin, nickel, phosphorus, selenium, sodium, vitamin A, vitamin B6, vitamin C, vitamin D, vitamin E, vanadium, zinc
AMDR
AMDR- Acceptable Macronutrient Distribution Ranges
- -Range of intakes (% total Kcals) for an energy source associated with the reduced risk of chronic disease while providing adequate intake of essential nutrients
- –CHO: 45-65%
- –PRO: 10-35%
- –FAT: 20-35%
EER
EER- Estimated Energy Requirement
–Average energy intake predicted to maintain energy balance in a healthy individual
Sodium
- Higher sodium intake=Higher BP (HTN)
- -causes CVD, CHF, CKD
- AI=1500 mg
- UL=2300 mg
Saturated fat
- High saturated fat diet associated with increased risk CVD
- -Raises total cholesterol
- -Raises LDL cholesterol
- -Most in animal fats
- -Replace SFA with MUFAs and PUFAs
Trans fat
- -Present in partially hydrogenated oils
- -Intake from natural foods fairly low; can be avoided by avoiding SFA
- -Increases CVD risk
- –Raises total cholesterol
- –Raises LDL cholesterol
- –Lowers HDL cholesterol
Cholesterol
- Cholesterol
- Present only in animal foods
- Rec: <200 mg if at CVD risk
Added Sugars
- Added Sugars
- low nutrient density
Refined grains
- Refined Grains
- Endosperm flour enriched with lost vitamin/minerals
- -not enriched with lost fiber
Changes in Calorie needs during each trimester of pregnancy
First-0
Second-340-360
Third-452-472
Protein requirements during pregnancy
1-20 weeks: 0.8/g/kg/day
21-42 weeks: 1.1g/kg/day
+25 g/day for additional baby
Carbohydrate requirements during pregnancy
175g/day
Lipid requirements during pregnancy
No overall goal
DHA support fetal brain development: 300 mg/day
Known safe amount of alcohol consumption during pregnancy
No set safety level
Major consequences of fetal alcohol syndrome
- Facial malformations in the eye placement, nose, and mouth development
- Increased incidence of spontaneous abortions, premature delivery of poorly developed fetuses, respiratory distress syndrom
- growth failure, reduced mental capacity
- Hearing or vision loss
Difference between folic acid and folate
Folic acid= fortification (more stable)
Folate= naturally occuring
Food sources of folate and the major issue with consuming enough folate
Meats, fruits, vegetables (asparagus), dry beans, peas, nuts, whole grains
-Unstable to UV light, heat, oxygen, acid, and metals-food sources may be insufficient
2 serious consequences of folate deficiency
Megaloblastic anemia
- -RBC grow large for cell division but DNA synthesis impaired
- -large, misshapen, nonfunctional: unable to bind oxygen properly
- -fatigue/weakness
Neural tube defects
–skull and spinal cord develop in first 2-3 weeks of pregnancy
2 types of neural tube defects
Spina bifida
–spinal cord does not close without folic acid and fluid-filled pouch of nerves can grow through opening
Ancephalus
–only brainstem develops
Recommended amounts for folate intake for:
nonpregnant women
pregnant women
women who have had a child with neural tube defects
non-pregnant women: 400 mcg/day
pregnant women: 600 mcg/day
women who have already had a child with neural tube defects: 1000-4000 mcg/day
7 iron-containing foods and categorize them as heme or non-heme
Heme: meat, esp. red meat
Non-heme: legumes/tofu raisins prunes molasses fortified cereals cooking cast iron skillets
4 ways Iron absorption is decreased and 2 ways it is increased
decreased: soy protein tannins (tea) some types of fibers (phytates) minerals
increased:
Vitamin C (aids conversion to ferrous state)
high-protein foods
Define Ferritin, Transferrin, and Mean corpuscular volume
Ferritin: storage form
Transferrin: transport form (inversely related to iron supply)
Mean corpuscular volume: average RBC size
Appropriate dose for an Iron supplement to correct deficiency
325 mg ferrous sulfate daily or twice per day for 2-3 months
Based on lab values, diagnose Iron deficiency
Classic presentation
- low hemoglobin and hematocrit
- low mean corpuscular volume
- high transferrin
- low ferritin
Effects of caffeine and artificial sweeteners on pregnancy outcomes
caffiene
-unknown but recommended to avoid or consume equivalent of 1 serving per day of caffeine
artificial sweeteners
-no known relationship to negative outcomes
4 foods that may contain Listeria that should be avoided by pregnant women
avoid raw milk, deli meats, smoked seafood, and soft cheeses
Breast structures related to lactation
Lobules: where milk is produced
flows down ducts and out the nipple
Define colostrum
when it is produced
it benefits
Colostrum
- yellowish fluid
- high in protein, micronutrients, immunoglobulins
- start producing colostrum in late pregnancy
Function of prolactin and oxytocin
Prolactin: stimulates milk production
Oxytocin: stimulates let-down (walls of mammary gland contract, pushing milk down ducts)
Benefits of breastfeeding for mother
Mother
-decreases menstrual blood loss and postpartum bleeding
-lower risk breast/ovarian cancer
-more weight loss
-child spacing
-promotes rapid uterine involution
decreased risk of postmenopausal osteoporosis
Benefits of breastfeeding for baby
- decreased incidence and severity of infectious disease
- decreased rates of asthma, allergies, leukemia/lymphoma, high cholesterol, obesity, diabetes, sudden infant death syndrome
Describe the American Academy of Pediatrics’ recommendations on breastfeeding duration
- Exclusive breastfeeding until 4-6 months when food introduction begins
- include supplemental breastfeeding until 1 year
American Academy of Pediatrics’ recommendations on vitamin D supplementation
all breastfed infants need supplement 200 IU vitamin D starting at age 2 months
4 ways that breast milk can change over time with mother’s diet
- Taste changes depending on mother’s diet
- fore milk-less fat, hind milk-higher fat
- Whey: casein ratio (90:10, 80:20, 60:40)
- Cholesterol-beneficial effect on serum cholesterol later in life
Calories per ounce in breastmilk
20 kcal/oz
3 infant reflexes related to breastfeeding
- Suckling
- Oral search reflex
- Rooting reflex
Breastfeeding hunger signs
- Sucking on fists
- Rooting reflex
- Crying is late sign; try to identify early
Ways to hold baby during breastfeeding
- Football hold
- Cradle hold
- Cross-cuddle hold
- May lie down, use pillows, cushions
Ways to help a baby latch on
- Touch baby’s bottom lip with nipple
2. Bring baby to breast with nipple centered in mouth
Feeding/frequency of breastfeeding
- allow baby to drink as much as possible from one breast and burp
- newborns: 10-12 feedings per day
Way to solve common issues during breastfeeding, including: sore nipples letdown failure engorgement plugged ducts mastitis
Sore nipples
- use nipple guards
- pump only when very sore
Letdown failure
- relaxation
- comfort upset baby, take a break, try again
Engorgement
- prevent by nursing frequently
- try pumping until breasts are softer and baby can latch on
Plugged duct
-gentle massage, warm compresses, completely empty breasts
Infection/mastitis
- need antibiotics and pain relief
- keep nursing, if possible
2 contraindications to breastfeeding
HIV and alcohol
Current recommendations for alcohol use while breastfeeding
Not before 3 months old, have 1 drink, wait 4 hours before breastfeeding
Identify the 10 steps of the baby-friendly hospital initiative
- Written policy
- Trained staff
- Inform all pregnant women about benefits and how to manage
- Help initiate feeding within 30 mins of birth
- Show mothers how to breastfeed and maintain lactation when separated
- Give newborns no other food/drink
- Rooming in (keep baby in mother’s room)
- Encourage breast feeding on demand
- No pacifiers
- Post-hospital support (family + work+ medical)
Goal weight gains for: single (underweight) single (normal) single (overweight) single (obese) twins triplets
-single (underweight): 28-40 #
-single (normal): 25-35 #
single (overweight): 15-25 #
single (obese): none
twins: 40-45 #
triplets: 50-60 #
Birth weight classifications for infants: Normal birth weight Low birth weight (LBW) very low birth weight (VLBW) extremely low birth weight (ELBW)
- Normal birth weight: ≥ 2500g (5.5#)
- Low birth weight (LBW): < 2500 g (5.5#)
- Very low birth weight (VLBW): < 1500 g (3.3#)
- Extremely low birth weight (ELBW): < 1000g (2.25#)
Size for gestational age: classifications for infants
small for gestational age (SGA)
appropriate for gestational age (AGA)
large for gestational age
Small for gestational age (SGA) : < 10th percentile standard weight for
gestational age
Appropriate for gestational age (AGA): 10-90th percentile weight for
gestational age
Large for gestational age (LGA) : > 90th percentile weight for gestational age
Describe patterns for antenatal growth
6% weight loss in first few days, should regain in ~1 week
LBW-catch-up growth over first year–higher nutrient needs
LGA-lag-down growth over first year–slower weight gain before settling into curve
-Infants will generally follow growth curve
Measure head circumference, weight, and length of an infant
Length: Use length board with fixed headpiece and movable foot piece. 2 measurers–one holding infants head in place, other holding infant and getting foot stretched on foot piece. Measure to nearest .1cm, take 2 measurements
Weight: remove clothing, dry diaper, place on scale tray. Nearest .01kg
Head Circumference: flexible measuring tape, measure more prominent part of back of head to just above eyebrows. Round to nearest .1cm. Average 2 measurements
How are fat and carbohydrate digestion and renal function in infants different from older children and adults?
Infants rely on lingual (tongue) and gastric (stomach) lipase to digest fat compared to adults using pancreatic lipase.
Lactase is main CHO digestive enzyme in infants because lactose is primary CHO in breast milk.
Renal tubules in infants haven’t fully developed yet, not able to get rid of waste products as efficiently as adults, need to avoid sugar and salt in infant diets.
Calculate amount of formula needed to support growth
Breast milk and formula both provide approximately 20 kcal/oz
-Can be estimated with EER
Name causes and symptoms of dehydration and water intoxication in infants
Dehydration: caused by excessive loss: diarrhea, sweating/extreme heat. Kidneys not mature enough to concentrate urine, monitor number of wet diapers
Intoxication: caused by substituting water for milk or diluting milk
List steps in infant formula preparation
- Clean bottles, nipples mixers, formula can
- mix according to package directions
- may be refrigerated for up to 24 hours
- rewarm in hot water bath-no microwave
- shake well
- test on inner wrist before giving to baby
5 developmental milestones that dictate when/which foods should be introduced
- able to hold up head
- sit with little support
- move tongue independently of head
- generally 4-6 months old
Describe appropriate introduction of foods
- what should be introduced first
- what order foods should be introduced
- how often to introduce new foods
- 4-6 mo: rice cereal first (least allergenic) mixed with breast milk or formula
- wheat cereal last
- feed with spoon
- after cereal introduction can introduce pureed foods in any order:6-8mo
- allow child 2-7 days before trying another new food
- 9-12 mo, start phasing out baby food, bring in soft/mashed table food
Steps in feeding an infant
- feed when baby is not too tired/hungry
- use small baby spoon with shallow bowl
- give baby time to open mouth and extend tongue
- place spoon on tongue and press down slightly toward front of mouth
- hold spoon level
- watch for swallow before next bite
- small volume meals: 5-6 bites. no more than 10 minutes
3 signs of hunger and 3 signs of satiety in an infant
Hunger: watching food being prepared, tight fists or reaching for spoon, gets irritated when feeder pauses
Satiety: plays with food or spoon, slows pace of eating, turns head away, stops eating or spits out food
Foods that should not be offered to an infant
- Honey (cannot fight botulism spores)
- cow’s milk (until at least 12 months (could lead to allergies)
- Choke foods:
- hot dog slices,
- grapes,
- raisins,
- peanuts,
- uncut/stringy meats,
- gum and gummy candy,
- hard candy,
- jelly beans
- hard raw fruits or veggies (apple chunks or green beans), –popcorn
- peanut butter
List steps in tooth formation, including the role of calcium, phosphorus, and fluoride.
- Collagen protein matrix forms in first trimester.
- Hydroxyapatite Ca₁₀(PO₄)₆(OH)₂ deposits minerals into the collagen matrix and hardens teeth as it is deposited (includes calcium and phosphorus).
- Fluoride is incorporated into hydroxyapatite and makes teeth more caries-resistant.
Define dental caries, and name the 4 factors that must be present for them to form.
Cavities
4 factors that must be present for caries to form are:
1. Susceptible teeth (weak surface) 2. Microorganisms in mouth 3. Fermentable carbohydrates in diet 4. Time to ferment
Define fermentable carbohydrates and describe their role in formation of dental caries.
Carbohydrates susceptible to the actions of salivary amylase.
Metabolism of fermentable carbs produces acid, this acid + food source for bacteria creates the environment for decay.
Identify fermentable foods.
- Grains
- Fruits
- Dairy (especially sweetened; alkaline + calcium may be protective, cheese prevents bacteria from recognizing fermentable CHO)
Describe 4 factors that affect the cariogenicity of foods.
- Form/consistency
- Exposure
- Nutrient Composition
- Sequence/frequency of eating
Define baby-bottle tooth decay and list ways to prevent it.
Tooth decay caused by giving milk or juice (or other sugary drink) to baby before going to bed
Prevention:
- Bottle is for milk/formula or water only
- No putting baby to bed with bottle
- Teeth/gums cleaned with washcloth or gauze pad after feedings
- Avoid sugar
- Teach older children to brush after consuming sugar
Name 4 benefits of fluoride and 2 ways it is provided.
Benefits
- Incorporated unto hydroxyapatite if consumed
- Repairs early decay
- Hardens enamel (more impervious to decay)
- Interferes with bacterial function
Provided
- Topical (toothpaste)
- Drinking water
Describe the utility of fluoride in drinking water.
- When consumed in drinking water, fluoride is incorporated into saliva and washes teeth with fluoride continuously.
- Fluoride in water associated with reduced caries in 1930s
Name the effect of chronic fluoride over-consumption and situations in which it occurs.
Effect: fluorosis (mottling of teeth)
Occurs where fluoride levels in water are naturally high and not reduced due to EPA guidelines
Describe methods to reduce risk of acute fluoride toxicity
- No fluoride toothpaste/mouthwash before age 2
- Pea sized for brushing will not hurt older children
Differentiate between the 3 types of adverse reactions to food
Food allergy
- involves immune response
- usually to protein in food
Food intolerance
-Adverse reaction but does not involve immune system
Food sensitivity
-not sure if allergy or intolerance
Describe two means of diagnosing a food allergy
Skin-prick test
Double-blind, placebo-controlled oral food challenge is gold standard
Identify signs of an allergic reaction to food
Gastrointestinal -abdominal pain -nausea and vomiting diarrhea -GI bleeding -oral and pharyngeal pruritus (itching)
Cutaneous
- Hives
- Swelling
- Redness/rash
- Itching/flushing
Respiratory -Rhinitis (sneezing, sniffling) -Asthma -Cough Laryngeal edema -Airway tightening
Systemic
-Anaphylaxis
-Hypotension (low blood pressure)
Dysrhythmia (irregular heart beat)
Name the way to prevent an allergic reaction
avoidance of food
-consider potential cross-contamination
Name the primary method of treating a reaction once it occurs
Anaphylaxis treatment-epinephrine
Name the top 8 allergens and state which are the most common in children vs. adults
Milk (children) Eggs (children) Peanuts (adults) Tree nuts (adults) Soy Wheat Fish Shellfish
Define exclusion diet
-Use when suspecting food intolerance and specific food not known
Describe labeling requirement for food allergens
-Top 8 allergens must be clearly listed
Ex: tree nuts, fish, shellfish: must specify type and say “contains”
-if ingredient not clear, put in parentheses after name
Ex: Farina (wheat)
- Does not apply to foods packaged for individual consumer
- Does not list sources of possible contamination
3 routes of feeding a low birth weight infant and indications for each
- Paternal (Intravenous)
- utilizes venous catheter
- used when enteral (via GI tract) not possible. (small stomach, immature GI tract, illness)
- often used immediately after birth for immediate nutrition - Enteral-used when baby not able to suck (<32 weeks)
- Oral (PO)
- nipple-feeding or breast-feeding
- if infant is able to suck ~32weeks gestation
- hard work for babyy-moniter if getting fatigued
Define disorganized feeding
-disorganized feeding–occurs when infant has unpleasant reaction to attempts to feed and doesn’t want anything near mouth
Describe ways to provide breastmilk for infants
Breast milk is preferred method of feeding
- mom produces higher colustrum/milk even after premature deliver
- breast milk fortifiers available to boost micronutrient content for preterm babies (calcium and phosphorus)
- can also put breast milk in feeding tube
- milk banking if mother’s milk not an option
Differentiate preterm infant formulas from term infant formulas
- formulated to promote growth at intrauterine rates
- more “pre-digested” then regular infant formula
- available in 20, 24, and 30 kcal
Describe calorie, protein, lipid, carbohydrate, and micronutrient needs for preterm infants, and state how each can be met
Micronutrients: higher need for calcium, phosphorus, vitamin D, vitamin E, folic acid met by formula or breast milk fortifier.
Iron still needs to be supplemented if using breast milk: 2-4mg/kg/day
- Kcal: 120/kcal/kg
- Protein: 3-4kcal/kg
- Lipid (MCT dominates): 40-50% kcal
- CHO (lactose dominates): 40-50% kcal
Calculate adjusted gestational age and use calculation appropriately
Calculation:
–40 weeks (term)-birth gestational age=number of weeks premature (AKA correction factor)
–Chronological age-correction factor=adjusted age
Name the specialized growth curve used for LBW infants
Ehrenkranz
Troubleshoot failure to thrive with 7 appropriate interventions
- asses growth more frequently or more detailed (pea pod)
- Monitor all intake (food diary): is infant getting enough?
- Is infant supported well during feeding?
- Change frequency of feeding or volume of feeding
- Change nutrient composition: make feedings more concentrated to expend less energy to consume
- Observe feeding: is it a low-stress environment? (may require parent education)
- Adjust feedings away from guidelines if not working
Describe how inborn errors of metabolism occur
Most due to errors in production of a metabolic enzyme.
- autosomal regressive trait affecting enzyme production or function
- genes code for “bad” or nonfictional protein
Discuss the cause and treatment of common inborn errors of metabolism including phenylkentonuria, maple syrup urine disease, galactosemia, glycogen storage disease, fructosemia, and hereditary fructose intolerance
PKU: most common inborn error
- nonfunctional phenyalanine hydroxyls
- unable to convert phenylalanine to tyrosine–causes excess of PHE and deficiency of TYR
- excess phenylalanine causes poor mental development: going off diet even in adulthood causes IQ to lower
- treated by protein restriction and high TYR formula
Maple Syrup Urine Disease
-low activity of branched-chain ketoacid decarboxylase complex, so unable to metabolize valine, leucine, and isoleucine
Galactosemia
- no galactose-1-phosphate uridyltransferase, so unable to metabolize galactose
- treated with complete lactose restriction
Glycogen Storage Disesase
- most common due to no glucose-6-phosphatase, so cannot use glycogen stores to maintain blood glucose
- treated by avoiding fasting
Fructosemia/hereditary fructose intolerance:
deficiency of fructose-1-phosphate aldolase or fructose 1,6-diphosphatase causing inability to metabolize fructose
Most treatment is dietary only!
Name the cause of down syndrome
Caused by extra chromosome 21
Identify health concerns related to downs syndrome and how they may affect infant nutrition
- congenital heart disease
- hypotonia (low muscle tone)
- delayed growth
- developmental delays with poor physical/motor and emotional function
- hearing problems
- dental problems (decreased saliva, more reflux)
- poor vision
- hypothyroidism
- overweight
- seizure disorders
- parents should avoid empty calories
- revised growth charts available
- fiber/fluid to treat constipation
- food introduction may need to be delayed beyond 6 months dependent on infant’s readiness
- may have difficulty sucking due to facial dystonia, difficulty coordinating sucking and breathing (especially if has congenital heart defect)
Describe macronutrient needs in infants
-when should these nutrients be supplemented?
Protein
- Higher protein requirement than adults
- Additional essential AA: histidine
- –Tyrosine, cysteine, taurine in premature infants
a) 0-6 months (AI): 9.1 g/day
b) 6-12 months (RDA): 11 g/day
- –Start supplementing with food to meet protein needs
Carbohydrates
- Lactose is primary form of CHO
- Lactase is fully developed
- Modified formulas available for lactose intolerant infants
Lipids
Human milk contains essential fatty acids (EFA) linoleic acid and α-linolenic acid
–Can make arachidonic acid from EFA
——Used in eicosanoid production
——Also make docosahexaenoic acid (DHA)
——Both important for neural development
- -Eicosapentaenoic acid (EPA) should not be supplemented in infancy
- -Now also supplemented in infant formula
Describe micronutrient needs in infants (iron, fluoride, vitamin B12, vitamin K, vitamin D)
-when should these nturients be supplemented?
Iron
- supplementation of 1 mg/kg/day starting at 4 months
- continue until iron-containing foods introduced (baby cereal)
Fluoride
-use fluoridated water to make cereal, etc., after 6 months old
Vitamin B12
-if mother is a vegan
Vitamin K
-Receive injection at birth (hemorrhagic disease of the newborn)
Vitamin D
- Supplement 400 IU daily for breast-fed infants
- supplement for formula-fed if consuming <1L
