GI Nutrition

Question 1

In what illnesses are there evidence for probiotics?

Answer 1

prevention of antibiotic-associated diarrhea

shorten the duration of acute infectious viral diarrhea

prevent NEC in preterm infants

decrease the symptoms of colic

decrease some symptoms of IBS

Question 2

Benefits of breastfeeding

Answer 2

Decreased infectious diseases
- Bacterial meningitis, diarrhea, bacteremia, respiratory infections, AOM, UTI

Reduced hospital admissions

Reduces SIDS

Enhanced neurocognitive development

Reduced breast and ovarian cancer in mom

Greater postpartum weight loss for mom

Question 3

What are benefits of human milk for prems?

Answer 3

Reduced incidence of NEC

Fewer severe infections

Reduced colonization by pathogenic organisms

Improved neurodevelopmental outcome

Question 4

Human milk banking - benefits

Answer 4

Reduced incidence of NEC, Fewer severe infections, Reduced colonization by pathogenic organisms,
Improved neurodevelopmental outcome

Question 5

Pasteurization of donor breast milk - what does it remove?

Answer 5

Inactivated bacterial and viral contaminants
Nutritional components mostly unaltered
Immunological factors: IgA remains active, IgG reduced to 70%, IgM completely removed

Question 6

when to use height instead of length

Answer 6

2-3 years

Question 7

Birth - 2years: Risk/Overwt/Obese

Answer 7

Risk of overweight
= Weight for length >85th

Overweight
= Weight for length >97th

Obesity
= Weight for length >99.9th

Question 8

2-5 years

Risk/Overwt/Obese

Answer 8

Risk of overweight
= BMI >85th

Overweight
= BMI >97th

Obesity
= >99.9th

Question 9

5-19 years

Overwt/Obese/Severe

Answer 9

Overweight
= BMI >85th

Obesity
= BMI >97th

Severe Obesity
= >99.9th

Question 10

When to add lumpy textures to food

Answer 10

by 9 months

Question 11

How much cow’s milk can infant have

Answer 11

max 750ml/d <1yo

max 500ml/d >1yo

Question 12

Formula feeding - for how long and when to switch to cows milk

Answer 12

No longer than 9-12 months

Homo milk at 9-12 months

Question 13

What is the best guide to assess overall health & nutrition status

Answer 13

Serial weight & height

Question 14

What percentiles does the WHO charts use

Answer 14

WHO uses 0.1, 3, 15, 50, 85, 97, 99.9 percentiles

Question 15

MPH

Answer 15

= (fathers ht + mothers ht)/2 +/- 6.5 (range +/-8.5)

Question 16

Causes of growth failure

Answer 16

Nutritional intake inadequate:

• Eating poorly
• Anorexia with chronic disease
• Oral skills lacking

Increased energy losses

• Emesis
• Malabsorption
• -Pancreatic disease (CF, –Schwachman-Diamond)
• -Cholestatic Liver disease
• -Intestinal (celiac, Cohn’s)

Increased energy needs
- Chronic condition
- Recurrent infections
Endocrine problem
- Hypothyroidism
- GH deficiency

Other

• Diencephalic tumour
• RTA

Question 17

Basic w/u for poor growth

Answer 17

Step 1
CBC
ESR, CRP
Lytes, blood gas, glucose
BUN, Creatinine
Protein and Albumin
Iron, TIBC, Transferrin saturation, Ferritin
Calcium, Phos, Alk-P
Liver enzymes (AST, ALT, GGT)
Serum IgG, IgM, IgA
TTG + IgA
TSH
Urinalysis

Step 2
Sweat Chloride
Vitamin levels
Fecal Elastase
Bone Age

Step 3
Referral to specialist

Question 18

Normal growth in the first few years

When does growth taper off

Answer 18

First year of life: gain ~7kg + 21cm
Second year of life: ~2.3kg + 12cm
2-5 years: growth slows: 1-2 kg/year + 6-8 cm/year

Slows 2-5 years

Question 19

Infantile Colic - age + 3 criteria

Answer 19

<4mo with all of:

• paroxysms of irritability, fussiness or crying that start and stop without obvious cause
• episodes lasting 3 h or more per day and occurring at least three days per week for at least one week
• no failure to thrive.

Question 20

Options for severe colic

Answer 20

Concern for CMPA: can try empiric time-limited (2 weeks) ther trial of a hypoallergenic diet

BF w/o concern of CMPA: can consider eliminating cow’s milk from the maternal diet

Bottle-fed w/o concern CMPA: time- limited empiric trial of an extensively hydrolyzed formula

Question 21

What is a concerning component of soy formula

Answer 21

phytoestrogens

Question 22

How should CMPA be treated

Answer 22

extensively hydrolyzed formulas

NOT SOY

Question 23

What are the indications for using soy based formula

Answer 23

Galactosemia

Cultural or religious reasons

Question 24

What are the known harms of soy formula

Answer 24

premature (↑ rate of adverse rxns to soy pn)

Congenital hypothyroidism (phytoestrogens can alter TPO = abn thyroid fn (only in congen hypothy, not healthy thryoids)

Question 25

What infants should receive iron supplementation

Answer 25

LBW infants who are mainly breastfed: should give iron supplement
BW 2.0-2.5 kg: 1-2 mg/kg/day for the first 6 months of age.
BW < 2.0 kg: 2-3 mg/kg/day for the first year of age.

Question 26

Iron absorption from human milk?

Answer 26

Iron absorption from human milk: 20% to 50% (10% to 20% from infant formulas)

Question 27

Risk factors for iron deficiency <2yo

Answer 27

preterm delivery or birth weight <2500 g
low socio-economic status
infants born to mothers with anemia or obesity
early umbilical cord clamping
male sex
exclusive breastfeeding for longer than 6 months
high cow’s milk intake
prolonged bottle use
chronic infection
lead exposure
low dietary intake of iron-rich complementary foods.

Question 28

Measures to prevent iron deficiency

Answer 28

• Delayed cord clamping
• If formula feeding, providing iron-fortified formula
• Feeding iron-rich complementary foods from age 6 months
• Not using cow’s milk as the main milk source until infants are a year old, and limiting cow’s milk intake to 500 mL/day thereafter.

Question 29

treatment of iron deficiency anemia

• how to improve absorption
• length of treatment

Answer 29

oral iron supplements 2 - 6 mg/kg/day of elemental iron in divided doses

Absorption improves when iron is ingested with a source of vitamin C.

Supplements should be continued for a minimum of 3 months, followed by a reassessment of iron status including CBC and serum ferritin.