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Life cycle in Nutrition > Exam 1 Material > Flashcards

Exam 1 Material Flashcards

1
Q

Identify the group that sets the Dietary Reference Intakes

A

-Set by a group of scientists (US and Canada)

  • National Academy of Sciences
  • Institute of Medicine
  • Food and Nutrition Board
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2
Q

Name the two goals of the DRI

A

Dietary adequate and optimal nutrition

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3
Q

State the target populations for the DRIs

A

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:

  1. 9-13 years
  2. 14-18 years
  3. 19-30 years
  4. 31-50 years
  5. 51-70 years
  6. > 70 years
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4
Q

Define Daily Value

A

Not a DRI: reference point for Nutrition facts

Based on a general 2000 kcal diet

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5
Q

Identify appropriate use of nutrient content claims

A 
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
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6
Q

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
A

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)

  1. Develop a question
  2. Search, screen, select studies
  3. Drop studies that do not apply
  4. Extract data and assess risk of bias
    - –bias: prevents unprejudiced consideration of a question
  5. Describe and synthesize evidence
  6. Develop conclusion statements and grade evidence
  7. Identify research recommendations
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7
Q

Name the 2 overarching concepts of the DGA

A
  1. Maintain calorie balance over time to achieve and sustain a healthy weight
  2. Focus on consuming nutrient dense foods and beverages
    - –Nutrient density: measurement of nutrients provided by a food versus calories
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8
Q

Energy density vs Nutrient density and calculate nutrient density

A

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

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9
Q

List the three components of energy expenditure

A
  1. Basal metabolic rate (60-70%)
  2. Thermic effect of food (5-10%)
  3. Physical activity (20-40%)
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10
Q

List the 6 “foods to reduce” per the DGA

A
  1. Sodium
  2. Saturated and Trans Fatty Acids
  3. Cholesterol
  4. Added Sugars
  5. Refined Grains
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11
Q

Remember the 4 “nutrients of concern” for Americans per the DGA

A
  1. Potassium
    - works against sodium
  2. Dietary fiber
  3. Calcium
    - inadequate intake causes low bone mass

4 .Vitamin D

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12
Q

3 nutrients of concern for specific states of the life cycle

A
  1. Iron in young women
    2 .Folate in pregnancy
    3 . Vitamin B12 in older Americans
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13
Q

3 nutrients of concern for specific states of the life cycle

A
  1. Iron in young women
    2 .Folate in pregnancy
    3 . Vitamin B12 in older Americans
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14
Q

Identify 4 USDA food patterns

A
  1. Dietary Approach to Stop Hypertension (DASH)
    - high fruit/veg intake, low fat
    - good evidence for reduction in HTN, CVD
  2. Mediterranean Diet
    - Similar to DASH, higher fat (esp. olive oil)
  3. Lacto-ovo vegetarian
    - eat eggs and dairy but not meat
  4. Vegan
    - will need fortified foods, supplements
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15
Q

Define all three trimesters

A

First: 1-12 weeks
Second: 13-27 weeks
Third: 28-42 weeks

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16
Q

Define 4 term birth categories

A

Term birth: after 37 weeks

Early: 37-38 weeks
Full: 39-40 weeks
Late: 41 weeks
Postterm: 42+ weeks

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17
Q

Interpret the GPA method

A

Gravidity=number of pregnancies

Parity= number of deliveries

Abortus=number of induced abortions or miscarriages

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18
Q

Interpret the TPAL method

A

T=term births

P=preterm births

A=induced abortions OR miscarriages

L=living children

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19
Q

Name three goals of preconception nutrition counseling

A
  1. 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)
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20
Q

Identify EPA guidelines for pregnant of soon-to-be pregnant women should follow regarding mercury consumption

A
  • –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
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21
Q

Describe how the fetus obtains nutrients via the placenta

A

1.Villi project from placenta

  1. 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

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22
Q

List hormonal changes during pregnancy

A

Estrogen, progesterone production skyrockets

-causes emotional changes, sleepiness (esp. first trimester), taste/smell changes

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23
Q

List hematological changes during pregnancy

A
  • Blood volume (esp. plasma) expands
  • allows for flow to fetus
  • hemoglobin, hematocrit, albumin will appear low
  • higher glomerular filtration rate by kidneys
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24
Q

List cardiac changes during pregnancy

A
  • Increased cardiac output

- increased heart size

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25
Q

List respiratory changes during pregnancy

A
  • Increased oxygen requirement = more efficient gas exchange

- feeling short of breath

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26
Q

Define the three levels of pregnancy-induced hypertension

A
  1. Gestational: BP> 140/90
  2. Pre-eclamptic toxemia: BP> 140/90 + proteinuria
  3. Eclampsia: PIH causing seizures
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27
Q

EAR

A

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
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28
Q

RDA

A

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
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29
Q

AI

A

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
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30
Q

UL

A

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
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31
Q

AMDR

A

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%
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32
Q

EER

A

EER- Estimated Energy Requirement

–Average energy intake predicted to maintain energy balance in a healthy individual

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33
Q

Sodium

A
  • Higher sodium intake=Higher BP (HTN)
  • -causes CVD, CHF, CKD
  • AI=1500 mg
  • UL=2300 mg
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34
Q

Saturated fat

A
  • 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
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35
Q

Trans fat

A
  • -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
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36
Q

Cholesterol

A
  1. Cholesterol
    - Present only in animal foods
    - Rec: <200 mg if at CVD risk
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37
Q

Added Sugars

A
  1. Added Sugars

- low nutrient density

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38
Q

Refined grains

A
  1. Refined Grains
    - Endosperm flour enriched with lost vitamin/minerals
    - -not enriched with lost fiber
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39
Q

Changes in Calorie needs during each trimester of pregnancy

A

First-0
Second-340-360
Third-452-472

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40
Q

Protein requirements during pregnancy

A

1-20 weeks: 0.8/g/kg/day
21-42 weeks: 1.1g/kg/day
+25 g/day for additional baby

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41
Q

Carbohydrate requirements during pregnancy

A

175g/day

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42
Q

Lipid requirements during pregnancy

A

No overall goal

DHA support fetal brain development: 300 mg/day

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43
Q

Known safe amount of alcohol consumption during pregnancy

A

No set safety level

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44
Q

Major consequences of fetal alcohol syndrome

A
  • 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
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45
Q

Difference between folic acid and folate

A

Folic acid= fortification (more stable)

Folate= naturally occuring

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46
Q

Food sources of folate and the major issue with consuming enough folate

A

Meats, fruits, vegetables (asparagus), dry beans, peas, nuts, whole grains

-Unstable to UV light, heat, oxygen, acid, and metals-food sources may be insufficient

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47
Q

2 serious consequences of folate deficiency

A

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

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48
Q

2 types of neural tube defects

A

Spina bifida
–spinal cord does not close without folic acid and fluid-filled pouch of nerves can grow through opening

Ancephalus
–only brainstem develops

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49
Q

Recommended amounts for folate intake for:
nonpregnant women
pregnant women
women who have had a child with neural tube defects

A

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

50
Q

7 iron-containing foods and categorize them as heme or non-heme

A

Heme: meat, esp. red meat

Non-heme: 
legumes/tofu
raisins
prunes
molasses
fortified cereals
cooking cast iron skillets
51
Q

4 ways Iron absorption is decreased and 2 ways it is increased

A 
decreased:
soy protein
tannins (tea)
some types of fibers (phytates)
minerals

increased:
Vitamin C (aids conversion to ferrous state)
high-protein foods

52
Q

Define Ferritin, Transferrin, and Mean corpuscular volume

A

Ferritin: storage form
Transferrin: transport form (inversely related to iron supply)
Mean corpuscular volume: average RBC size

53
Q

Appropriate dose for an Iron supplement to correct deficiency

A

325 mg ferrous sulfate daily or twice per day for 2-3 months

54
Q

Based on lab values, diagnose Iron deficiency

A

Classic presentation

  • low hemoglobin and hematocrit
  • low mean corpuscular volume
  • high transferrin
  • low ferritin
55
Q

Effects of caffeine and artificial sweeteners on pregnancy outcomes

A

caffiene
-unknown but recommended to avoid or consume equivalent of 1 serving per day of caffeine

artificial sweeteners
-no known relationship to negative outcomes

56
Q

4 foods that may contain Listeria that should be avoided by pregnant women

A

avoid raw milk, deli meats, smoked seafood, and soft cheeses

57
Q

Breast structures related to lactation

A

Lobules: where milk is produced

flows down ducts and out the nipple

58
Q

Define colostrum
when it is produced
it benefits

A

Colostrum

  • yellowish fluid
  • high in protein, micronutrients, immunoglobulins
  • start producing colostrum in late pregnancy
59
Q

Function of prolactin and oxytocin

A

Prolactin: stimulates milk production
Oxytocin: stimulates let-down (walls of mammary gland contract, pushing milk down ducts)

60
Q

Benefits of breastfeeding for mother

A

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

61
Q

Benefits of breastfeeding for baby

A
  • decreased incidence and severity of infectious disease
  • decreased rates of asthma, allergies, leukemia/lymphoma, high cholesterol, obesity, diabetes, sudden infant death syndrome
62
Q

Describe the American Academy of Pediatrics’ recommendations on breastfeeding duration

A
  • Exclusive breastfeeding until 4-6 months when food introduction begins
  • include supplemental breastfeeding until 1 year
63
Q

American Academy of Pediatrics’ recommendations on vitamin D supplementation

A

all breastfed infants need supplement 200 IU vitamin D starting at age 2 months

64
Q

4 ways that breast milk can change over time with mother’s diet

A
  1. Taste changes depending on mother’s diet
  2. fore milk-less fat, hind milk-higher fat
  3. Whey: casein ratio (90:10, 80:20, 60:40)
  4. Cholesterol-beneficial effect on serum cholesterol later in life
65
Q

Calories per ounce in breastmilk

A

20 kcal/oz

66
Q

3 infant reflexes related to breastfeeding

A
  1. Suckling
  2. Oral search reflex
  3. Rooting reflex
67
Q

Breastfeeding hunger signs

A
  1. Sucking on fists
  2. Rooting reflex
  3. Crying is late sign; try to identify early
68
Q

Ways to hold baby during breastfeeding

A
  1. Football hold
  2. Cradle hold
  3. Cross-cuddle hold
  4. May lie down, use pillows, cushions
69
Q

Ways to help a baby latch on

A
  1. Touch baby’s bottom lip with nipple

2. Bring baby to breast with nipple centered in mouth

70
Q

Feeding/frequency of breastfeeding

A
  • allow baby to drink as much as possible from one breast and burp
  • newborns: 10-12 feedings per day
71
Q 
Way to solve common issues during breastfeeding, including:
sore nipples
letdown failure
engorgement
plugged ducts
mastitis
A

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
72
Q

2 contraindications to breastfeeding

A

HIV and alcohol

73
Q

Current recommendations for alcohol use while breastfeeding

A

Not before 3 months old, have 1 drink, wait 4 hours before breastfeeding

74
Q

Identify the 10 steps of the baby-friendly hospital initiative

A
  1. Written policy
  2. Trained staff
  3. Inform all pregnant women about benefits and how to manage
  4. Help initiate feeding within 30 mins of birth
  5. Show mothers how to breastfeed and maintain lactation when separated
  6. Give newborns no other food/drink
  7. Rooming in (keep baby in mother’s room)
  8. Encourage breast feeding on demand
  9. No pacifiers
  10. Post-hospital support (family + work+ medical)
75
Q 
Goal weight gains for:
single (underweight)
single (normal)
single (overweight)
single (obese)
twins
triplets
A

-single (underweight): 28-40 #
-single (normal): 25-35 #
single (overweight): 15-25 #
single (obese): none
twins: 40-45 #
triplets: 50-60 #

76
Q 
Birth weight classifications for infants:
Normal birth weight
Low birth weight (LBW)
very low birth weight (VLBW)
extremely low birth weight (ELBW)
A
  • 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#)
77
Q

Size for gestational age: classifications for infants

small for gestational age (SGA)
appropriate for gestational age (AGA)
large for gestational age

A

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

78
Q

Describe patterns for antenatal growth

A

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

79
Q

Measure head circumference, weight, and length of an infant

A

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

80
Q

How are fat and carbohydrate digestion and renal function in infants different from older children and adults?

A

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.

81
Q

Calculate amount of formula needed to support growth

A

Breast milk and formula both provide approximately 20 kcal/oz

-Can be estimated with EER

82
Q

Name causes and symptoms of dehydration and water intoxication in infants

A

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

83
Q

List steps in infant formula preparation

A
  • 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
84
Q

5 developmental milestones that dictate when/which foods should be introduced

A
  • able to hold up head
  • sit with little support
  • move tongue independently of head
  • generally 4-6 months old
85
Q

Describe appropriate introduction of foods

  • what should be introduced first
  • what order foods should be introduced
  • how often to introduce new foods
A
  • 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
86
Q

Steps in feeding an infant

A
  • 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
87
Q

3 signs of hunger and 3 signs of satiety in an infant

A

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

88
Q

Foods that should not be offered to an infant

A
  • 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
89
Q

List steps in tooth formation, including the role of calcium, phosphorus, and fluoride.

A
  • 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.
90
Q

Define dental caries, and name the 4 factors that must be present for them to form.

A

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
91
Q

Define fermentable carbohydrates and describe their role in formation of dental caries.

A

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.

92
Q

Identify fermentable foods.

A
  1. Grains
  2. Fruits
  3. Dairy (especially sweetened; alkaline + calcium may be protective, cheese prevents bacteria from recognizing fermentable CHO)
93
Q

Describe 4 factors that affect the cariogenicity of foods.

A
  1. Form/consistency
  2. Exposure
  3. Nutrient Composition
  4. Sequence/frequency of eating
94
Q

Define baby-bottle tooth decay and list ways to prevent it.

A

Tooth decay caused by giving milk or juice (or other sugary drink) to baby before going to bed

Prevention:

  1. Bottle is for milk/formula or water only
  2. No putting baby to bed with bottle
  3. Teeth/gums cleaned with washcloth or gauze pad after feedings
  4. Avoid sugar
  5. Teach older children to brush after consuming sugar
95
Q

Name 4 benefits of fluoride and 2 ways it is provided.

A

Benefits

  1. Incorporated unto hydroxyapatite if consumed
  2. Repairs early decay
  3. Hardens enamel (more impervious to decay)
  4. Interferes with bacterial function

Provided

  1. Topical (toothpaste)
  2. Drinking water
96
Q

Describe the utility of fluoride in drinking water.

A
  • 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
97
Q

Name the effect of chronic fluoride over-consumption and situations in which it occurs.

A

Effect: fluorosis (mottling of teeth)

Occurs where fluoride levels in water are naturally high and not reduced due to EPA guidelines

98
Q

Describe methods to reduce risk of acute fluoride toxicity

A
  • No fluoride toothpaste/mouthwash before age 2

- Pea sized for brushing will not hurt older children

99
Q

Differentiate between the 3 types of adverse reactions to food

A

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

100
Q

Describe two means of diagnosing a food allergy

A

Skin-prick test

Double-blind, placebo-controlled oral food challenge is gold standard

101
Q

Identify signs of an allergic reaction to food

A 
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)

102
Q

Name the way to prevent an allergic reaction

A

avoidance of food

-consider potential cross-contamination

103
Q

Name the primary method of treating a reaction once it occurs

A

Anaphylaxis treatment-epinephrine

104
Q

Name the top 8 allergens and state which are the most common in children vs. adults

A 
Milk (children)
Eggs (children)
Peanuts (adults)
Tree nuts (adults)
Soy
Wheat
Fish
Shellfish
105
Q

Define exclusion diet

A

-Use when suspecting food intolerance and specific food not known

106
Q

Describe labeling requirement for food allergens

A

-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
107
Q

3 routes of feeding a low birth weight infant and indications for each

A
  1. 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
  2. Enteral-used when baby not able to suck (<32 weeks)
  3. Oral (PO)
    - nipple-feeding or breast-feeding
    - if infant is able to suck ~32weeks gestation
    - hard work for babyy-moniter if getting fatigued
108
Q

Define disorganized feeding

A

-disorganized feeding–occurs when infant has unpleasant reaction to attempts to feed and doesn’t want anything near mouth

109
Q

Describe ways to provide breastmilk for infants

A

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
110
Q

Differentiate preterm infant formulas from term infant formulas

A
  • formulated to promote growth at intrauterine rates
  • more “pre-digested” then regular infant formula
  • available in 20, 24, and 30 kcal
111
Q

Describe calorie, protein, lipid, carbohydrate, and micronutrient needs for preterm infants, and state how each can be met

A

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
112
Q

Calculate adjusted gestational age and use calculation appropriately

A

Calculation:
–40 weeks (term)-birth gestational age=number of weeks premature (AKA correction factor)

–Chronological age-correction factor=adjusted age

113
Q

Name the specialized growth curve used for LBW infants

A

Ehrenkranz

114
Q

Troubleshoot failure to thrive with 7 appropriate interventions

A
  1. asses growth more frequently or more detailed (pea pod)
  2. Monitor all intake (food diary): is infant getting enough?
  3. Is infant supported well during feeding?
  4. Change frequency of feeding or volume of feeding
  5. Change nutrient composition: make feedings more concentrated to expend less energy to consume
  6. Observe feeding: is it a low-stress environment? (may require parent education)
  7. Adjust feedings away from guidelines if not working
115
Q

Describe how inborn errors of metabolism occur

A

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
116
Q

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

A

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!

117
Q

Name the cause of down syndrome

A

Caused by extra chromosome 21

118
Q

Identify health concerns related to downs syndrome and how they may affect infant nutrition

A
  • 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)
119
Q

Describe macronutrient needs in infants

-when should these nutrients be supplemented?

A

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
120
Q

Describe micronutrient needs in infants (iron, fluoride, vitamin B12, vitamin K, vitamin D)
-when should these nturients be supplemented?

A

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

Life cycle in Nutrition (4 decks)

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