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nutrition thru life > Intro to lactation > Flashcards

Intro to lactation Flashcards

1
Q

Breastfeeding has been described as “___ ____”

A

external gestation

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2
Q

What is important to help the mother with successful breastfeeding?

A

support system (encouraging environment)

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3
Q

In lactation, what hormones are decreased, and which ones increase?

A

decrease in progesterone and estrogen

increase in prolactin, oxytocin

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4
Q

____ and ____ immediately after birth is important to start milk production

A

holding, sucking stimulus

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5
Q

What are the roles of the 2 main hormones involved in lactation?

A

prolactin: stimulate PRODUCTION of milk from mammary alveolar cells
oxytocin: stimulate contraction of MYEPITHELIAL cells -> milk release

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6
Q

What is also known as the “pleasure hormone?” What roles does it play after birth? (4)

A
  • mothering response
  • milk let-down
  • suppress ovulation (decrease estrogen/progesterone, increase prolactin)
  • help uterus shrink back to normal
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7
Q

Where do oxytocin and prolactin come from?

A

oxytocin: from posterior pituitary
prolactin: from anterior pituitary

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8
Q

Describe the hormonal cascade for milk production and release

A

sucking stimulus -> stimulate hypothalamus -> anterior pituitary -> produce PROLACTIN -> alveolar cells produce milk

posterior pituitary -> OXYTOCIN -> milk let-down

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9
Q

What are some difficulties people may face with breastfeeding? (6)

A
  • lack of knowledge
  • need patience
  • lack of support
  • psychological inhibitions
  • PCOS - less milk production
  • impaired or LBW baby - cannot latch properly
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10
Q

If a mother is not producing enough milk, what can be done? (2)

A

supplement with formula

medication to increase production

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11
Q

True/False: breastfeeding can act as a form of birth control

A

True: as long as infant is ONLY breastfeeding, oxytocin will inhibit ovulation

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12
Q

True/False: breastmilk has over 200 components, and more are being discovered.

A

True

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13
Q

What anti-infectious agents are found in breast milk? What was this found to help prevent in infants and young children?

A

WBC, antibacterial/antiviral molecules

prevent respiratory infections

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14
Q

Advantages of breastfeeding: (5)

A
  • nutritionally superior
  • always fresh, bacteriologically safe
  • help proper jaw/tooth development
  • anti-infectious agents and immune cells
  • reduce risk of allergies
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15
Q

3 phases of milk production (types):

A

COLOSTRUM
TRANSITION
MATURE

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16
Q

What are the different “compartments” or compound types in breast milk? (4)

A
  • macronutrients (protein/carbs/lipids)
  • Cells
  • globules/micelles
  • vitamins/minerals trace elements
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17
Q

Where do the milk components come from? (3)

A
  • transferred from maternal plasma
  • synthesized by alveolar cells from plasma precursors
  • synthesized from other mammary cells in situ
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18
Q

How does time of feeding affect the composition of mature milk (name the types)? How should breastfeeding habits account for this?

A

FORE MILK: early in the day especially, more lactose and water to rehydrate
HIND MILK: towards end of feeding period, more fat and calories

should empty one breast before switch to other one, to make sure infant gets hind milk (fat is important for brain)

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19
Q

Transitional milk describes the shift from ____ to ____. What increases, and what decreases?

A

colostrum; mature milk (up to 3-4 wks)
protein decrease
lactose and fat increase

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20
Q

Why is it important to stimulate maturation of the GI tract in the infant?

A

prevent leaky mucosal barrier and GI lining - don’t want compounds or pathogens to sneak through

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21
Q

compare colostrum to mature milk (4). When is it produced?

A
  • honey like, transparent orange (more carotenoids)
  • more protein and minerals
  • less energy, fat, lactose
  • has more of some immunological factors
    Only in first 5-7 days; small amounts produced (baby doesn’t eat much)
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22
Q

The immunological properties of breast milk: (3)

A

direct action against pathogens
modulate immune response in infant
promote growth/mature GI tract

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23
Q

True/False: immunological factors are only produced in early colostrum

A

False: some are higher in colostrum, but factors are produced throughout lactation

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24
Q

What proteins are not degraded in the stomach and can reach the intestine intact? Describe their structure

A

Whey proteins

Globular, with disulfide bonds

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25
Q

Are immunological factors found in alternatives to breast milk?

A

Formula: NO

Cow milk: lower amounts

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26
Q

____ proteins are resistant against acid and proteolysis. Why?

A

Whey proteins

contain ANTI-PROTEASES (sulfhydryl oxidase) - preserves disulfide bonds

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27
Q

How can processing of breast milk affect the immunological factors?

A

Freezing - damage WBC in breast milk, but other factors remain
Fridge - up to 3 days is still good
Microwave - destroys WBC (Also can create hot spots)

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28
Q

What is the purpose of antibodies in breast milk, and why are they important for the infant?

A

provide PASSIVE IMMUNITY (defense against pathogens)

infant immune system is not fully developed

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29
Q

The main antibodies in breast milk: (4)

A

IgG
IgA
IgM
IgE

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30
Q

Describe the process of antibody synthesis for breastmilk:

A

B cells travel to mammary glands -> form plasma cells -> create antibodies

31
Q

The antibodies are produced ____, except Ig___ which comes from where?

A

in the mammary gland;

IgG is exception, comes directly from maternal plasma

32
Q

The B cells used for synthesizing antibodies in breastmilk typically come from where? Why?

A

Respiratory and intestinal tract

areas of HIGH EXPOSURE to pathogens (good “database” in B cells)

33
Q

The antibody ____ is protective against many pathogens, and is ___% of the secretory antibodies

A

IgA

90%

34
Q

What are the anti-infectious agents in breast milk? (proteins) (8)

A
  • lysozymes
  • lactoferrin
  • lactoperoxidases
  • lipases
  • interferons
  • B12 binding protein
  • fibronectin
  • complement proteins
35
Q

An important N containing carbohydrate in breast milk was once known as the ___ ____, but now called _____.

A

bifidus factor

human milk oligosaccharides

36
Q

What are the immune cells found in breast milk? (3)

A
  • macrophages
  • neutrophils
  • lymphocytes
37
Q

How might antibodies be beneficial for the baby’s gut?

A

Neutralize harmful bacteria so that gut can be colonized by “good” bacteria

38
Q

How does HMO benefit immunity?

A

promote growth of LACTOBACILLUS in lower GI tract -> produces acids that prevent pathogen growth

prevent enterobacteria -> diarrhea diseases
prevent necrotizing enterocolitis (dying GI tissue)

39
Q

What are 2 anti-infectious factors found in breast-milk? (other)

A

HMO/bifidus factor

anti-staph factor

40
Q

What is the role of lysozymes?

A

Break down bacteria cell wall (proteoglycans)

41
Q

What is the role of lactoferrin? Why is it so efficient?

A

Bind to iron very efficiently (limits amount for siderophilic bacteria)
80% is in the “free” form (ample amounts) - able to bind very well to any iron present

42
Q

list the causes of necrotizing enterocolitis: (4)

A

premature
poor blood flow to gut
health defect
bacterial infection

43
Q

Which of the breast milk anti-infectious proteins can give some antiviral benefits?

A

lipases

interferons

44
Q

What is the role of lipases? How does this contribute to immunity?

A

break down fat

produces monoacylglycerols and free FA -> antiviral properties

45
Q

Interferons will inhibit:

A

intracellular viral replication

46
Q

What is the role of lactoperoxidases?

A

Kill strep and enteric bacteria

47
Q

Which of the cells in breast milk are responsible for synthesis (2)? What do they produce?

A

Lymphocytes: IgAs and others
Macrophages: complement proteins, lysozymes, lactoferrin

48
Q

How do fibronectin and complement proteins aid in fighting bacteria?

A

Fibronectin: increase phagocytosis
complement: create pores in bacteria -> destroyed

49
Q

Which WBCs in breast milk are responsible for phagocytosis?

A

macrophages

neutrophils

50
Q

Which anti-infectious agents act by reducing the nutrients available for bacteria?

A

Lactoferrin (iron)

B12 binding protein (B12)

51
Q

Where is the main area of the baby’s body that these immune factors play a role?

A

GI tract

52
Q

Give 2 examples of prostaglandins in breast milk:

A

spermine

spermidine

53
Q

the growth factors in breast milk: (3)

What are their roles?

A

cortisol/thyroxine/insulin -> stimulate gut enzymes -> mature GI tract
prostaglandins -> mucus secretion & cell division
polyamines -> growth factor; increase cell replication

54
Q

What vitamin can help stimulate the immune system in infants?

A

vitamin E

55
Q

What are the 2 main milk proteins? Describe them.

A

CASEINS: phosphoproteins in micelles with Ca, P, Mg
WHEY: resistant to acid, leftover after acid precipitation of casein

56
Q

Why does human milk have lower proportion of protein compared to cow or goat?

A

slower growth rate

57
Q

How does human milk differ from bovine milk? (4)

A

more whey, less casein
more nucleotides
better balance of essential AA
lower risk of allergy

58
Q

Which milk protein type is better absorbed by the infant?

A

Whey - forms softer curd -> travel through GI and slow release of peptides
Pepsin not yet mature in stomach, can’t break down casein well

59
Q

What is an important role of whey proteins? Which ones in particular?

A

bind and supply minerals
lactalbumin (Ca and Zn)
Lactoferrin (Fe)

others:
xanthine oxidase (Fe and Mo)
Glutathione PO (Se)
Alkaline phosphatase (Zn and Mg)
60
Q

What are the NPNs? How well are they absorbed?

A

non protein nitrogen: AA, peptides, N-acetyl sugars, urea, nucleotides
Better digestibility

61
Q

What is a major protein in cow milk that is responsible for most allergy reactions? To what extent is it in human milk?

A

B-lactoglobulin

NOT AT ALL in human milk

62
Q

Human milk is rich in ____, which is a conditionally essential non protein amino acid. What else is it needed for? (2)

A

taurine
bile acid conjugation
act as neurotransmitter

63
Q

What protein in cow milk is linked to type 1 diabetes? How could this occur?

A

bovine serum albumin

similar structure to site on pancreas -> antibody made for antigenic site -> body will attack own pancreas

64
Q

How can cow milk formula be processed to prevent allergic reactions?

A

hydrolyze proteins

65
Q

How does the allergic response occur?

A

IgE bind to food proteins -> bind to mast cells -> cytokine/IL/platelet activation -> INFLAMMATION (histamine release)

66
Q

What antibody in cow milk has been linked to an excessive crying condition in infants? What is that condition?

A 
IgG
colic (intestinal distress, gassy)
67
Q

In terms of amino acids, human milk is higher in ___ while lower in ___ , ____and ____. why?

A

rich in cysteine - cystathionase not fully developed, cannot synthesize enough
low in met, phe, tyr
- met: cannot convert to cys efficiently, excess levels bad for CNS
- Phe and Tyr: tyr aminotransferase and PHPP oxidase not fully developed, excess bad for CNS

68
Q

What are the clinical signs of a cow milk allergy?

A

vomit/nausea/diarrhea
sneeze/wheeze/cough
dermatitis
headaches (crying)

69
Q

Should infants who develop a cow milk allergy be given soy as an alternative?

A

No
can also develop allergy
also: phytic acid lowers nutrient absorption
lower Ca, P

70
Q

What antibody in breast milk can help prevent food allergies? How? (2)

A

IgA
bind to food molecules -> prevent from going through leaky gut and causing reaction -> passed out through reticuloendothelial system

promote mucus production to form protective layer in gut

71
Q

What type of milk help to stimulate sealing of the gut leaky junctions?

A

Colostrum (early milk)

72
Q

What is the syndrome that is a hypersensitivity to cow’s milk? What symptoms does it cause, and why is it hard to diagnose?

A

Heiner’s syndrome
GI blood loss -> iron deficiency anemia
failure to thrive

similar symptoms to pulmonary disease; appears like an infection

73
Q

Why should newborns never be given cow milk at all?

A

allergy risk

GI not yet sealed (antigens can leak through)

nutrition thru life (15 decks)

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