Lactation

Question 1

Why lactation can be names exterior gestation?

Answer 1

• it provides a continuity in terms of security and nourishment between the mother and infant.

Question 2

What should be done 1 hour after parturition?

Answer 2

• It is recommended that infants are placed in contact with the mother’s breast as soon as possible (e.g. the magic hour).
• It is also recommended that the infant be placed on the mother’s bare chest, as the warmth and smell are comforting to the baby (e.g. skin-to-skin contact).

Question 3

how hormones change after labour

Answer 3

estrogen and progesterone decrease significabtly to allow breastfeeding, prolactin and oxytocin increase

Question 4

How support should be given to a lactating mother?

Answer 4

• A support system is crucial for successful long-term breastfeeding (i.e. the husband and close family must be supportive of the mother’s decision to nurse), as psychological inhibitions may decrease the flow of milk.
  
  • Breastfeeding must be learnt, which may be done through lactation experts.

Question 5

What conditions can cause in lower milk production?

Answer 5

PCOS

Question 6

How breastfeeding can induce the bond between the baby and the mother

Answer 6

• Oxytocin increases maternal-child bonding and may be referred to as a satisfaction or pleasure hormone.

Question 7

what happens to reproductive sysem of mother after labour and then on

Answer 7

• Breastfeeding suppresses ovulation by the decreased levels of estrogen and progesterone, and the increased levels of prolactin.
  
  • The rate of breastfeeding must be maintained to prevent ovulation.
  • Commonly, when the baby starts to sleep through the night, they have reached a developmental stage where the mother should think of other methods of contraception.

Breastfeeding stimulates the contraction of the uterus, resulting in involution of the uterus through oxytocin release, which renders the uterus to its original size

Question 8

Advantages of breastfeeding

Answer 8

• Breastfeeding may aid in proper jaw and tooth development.
• It is bacteriologically safe and always fresh and contains a variety of anti-infectious agents and immune cells.
• Breast milk is nutritionally superior.
• It is associated with a lower risk of food allergies.
• Recent studies have demonstrated that breastfeeding during infancy decreased the rates of respiratory illnesses up till the age of seven years old.
  
  • The early introduction of foods (i.e. below 15 weeks) increased the likelihood of wheezing during childhood.

Question 9

milk constituents

Answer 9

• Milk is a complex fluid containing over 200 known constituents. The increasing sophistication of analytical techniques increases the number of milk components discovered.
• Compartments of milk include micelles, membrane-bound globules, live cells, protein and non-protein nitrogen compounds, carbohydrates, lipids, vitamins, minerals, and trace elements.

Question 10

3 sources of milk components ( where they are produced)

Answer 10

• Milk components may be (1) transferred from the maternal plasma, (2) synthesized from maternal secretory (alveolar) cells from maternal plasma precursors, and (3) synthesized from other mammary cells in situ (i.e. in the original site).

Question 11

3 phases of milk production

Answer 11

1. Colustrum (5 to 7 days)
2. Transitional milk (7 d to 3-4 weeks)
3. Mature milk

Question 12

Describe colustrum ( how does it differ from mature milk, color, quantity, what vitamin is especially high

Answer 12

• In comparison to mature milk, colustrum is (1) high in protein and mineral (sodium, potassium, chloride) content, and (2) lower energy, fat, and lactose content.
• The quantity of colustrum is very small (2-10 mL feeding per day), and is an intense transparent yellow fluid, containing 10 times the carotenoid content of mature milk.

Question 13

How transitional milk differ from colustrum

Answer 13

The quantity of protein decreases to a consistent level, while there is an increase in lactose and fat in transitional milk

Question 14

What is mature milk composition and how and when it can differ and what advice is given to women in regards to mature milk ejection

Answer 14

• Mature milk changes according to the changing infant’s needs (i.e. the time of day, or depending on the age of the child).
• For example, early morning milk may contain more water and lactose due to increased hydration needs of the child (foremilk). Conversely, hindmilk is higher in fat and calories
  
  • Women are advised to empty one breast before moving on to the next one to provide the infant with a greater quantity of hindmilk, and, thus, a greater quantity of fat to aid in brain development.

Question 15

immunological properties of human breast milk and what stage of milk has the highest

Answer 15

• Breast milk may have a direct action against pathogens, modulate the immune response, and promote the growth and maturation of the GI tract.
  
  • An immature GI tract (i.e. mucosal barrier) may permit the passage of unwanted compounds.
• Immunological factors are produced throughout lactation, and certain factors are highest in colustrum.

Question 16

why cow’s milk is not recommended for the first 9 moth of life

Answer 16

Most immune factors are not found in infant formula, and lower concentrations are found in cow’s milk

Question 17

what enzyme protect protein structure in milk

Answer 17

• Whey proteins are structurally different than caseins, and are resistant against proteolysis and acid denaturation, as they contain anti-proteases (e.g. sulfhydryl oxidases).
  
  • Anti-proteases may protect bioactive proteins, enzymes, and immunoglobulins by preserving their disulfide bonds.

Whey proteins contain multiple disulfide bonds, providing a rigid structure that is difficult to digest by proteases, allowing them to bypass the stomach without being completely digested

Question 18

what antibodies are present in milk, against what

Answer 18

• Antibodies are abundant in milk, and are directed against bacteria, bacterial toxins, viruses, fungi, and food proteins that may cause allergies.
  
  • Antibodies passed to the infant through human breast milk provides passive immunity.
  • IgA, IgM, IgE, and IgI are contained within the mammary gland, while IgG is contained in the maternal plasma.
  • Antibodies provide bacterial and viral neutralizing capacities, which inhibit colonization of the gut.

Question 19

what antobodies are the most abundant and where they come from

Answer 19

• IgA forms 90% of the secretory antibodies and arise from the B-cells of the maternal small intestine and respiratory tract, travelling through the maternal blood to form mature milk in the mammary gland.
  
  • IgA is protective against many pathogens, as the B-cells originate from maternal sites where there is high exposure to pathogens.

IgA within the GI tract is resistant to proteolysis, acting on the mucosal surfaces of the GI tract

Question 20

what is bifidus factor

Answer 20

• The bifidus factor is a nitrogen-containing carbohydrate, which promotes the growth of lactobacilli, an important probiotic bacterium that may antagonize the survival of enterobacteria, decreasing the risk of diarrheal diseases in childhood (e.g. salmonella, E. coli).

Studies have demonstrated that breastfed babies have a lower risk of developing diarrhea during childhood, due to the promotion of lactobacilli by the bifidus factor

Question 21

role of lactobacilli in infants

Answer 21

• Lactobacilli is the dominant bacteria in the lower GI of breastfed infants, where they secrete organic acids that inhibit the growth of pathogenic bacteria.

Question 22

what is necrotizing enterocolotis

Answer 22

• Necrotizing enterocolitis is an infection that destroys intestinal tissue, causing acute inflammation of intestinal mucosa. It is the most common intestinal disease in premature babies.
• Necrotizing enterocolitis may also occur in full-term babies born with a health issue, such as a heart defect, or if there was a disruption of oxygen or blood flow to the intestine, causing necrosis of the intestinal tissue.
• In rare cases, necrotizing enterocolitis may lead to perforation, in which case waste products and bacteria within the intestine enter the bloodstream or the abdominal cavity.
• Necrotizing enterocolitis may be due to bacterial growth that erodes the intestinal wall, or a decreased quantity of oxygen or blood flow.
• Breastfeeding may reduce the risk of developing necrotizing enterocolitis.

Question 23

how else breastmilk protect the baby ( which is not found in cow’s milk)

Answer 23

• Breast milk contains anti-staphylococcus factor, and lysozymes, which breakdown bacteria by destroying proteoglycans embedded in the cell wall of the bacteria.
  
  • Lysozymes are not found in cow’s milk.

Question 24

what is found in breast milk that protects against bacteria that need Fe for survival

Answer 24

• Lactoferrin, a whey protein, is produced by milk lymphocytes and inhibits siderophilic bacteria, which are bacteria that require iron for survival.
  
  • Apo-lactoferrin (unconjugated) competes for iron and forms 80% of the lactoferrin found breast milk. Holo-lactoferrin are conjugated with iron.

Question 25

use of lactoperoxidases, lipases and interferins in breast milk

Answer 25

• Lactoperoxidases kill Streptococci and enteric bacteria.
• Lipases enhance fat breakdown in the gut, and their products (free fatty acids and monoacylglycerols) have anti-viral properties.

Interferons produced by milk lymphocytes inhibit intracellular viral replication

Question 26

Use of vitamin B12-binding protein , neutrophils, complement proteins and fibronectin in human milk

Answer 26

• Neutrophils (90% of white blood cells in milk) are responsible for phagocytosis and intracellular killing of microbes, and macrophages (10% of white blood cells in milk) synthesize complement proteins, lactoferrin, lysozymes and carry-out phagocytosis.
• Complement proteins are responsible for the attack of the plasma membrane of pathogens, aid in inflammatory processes, and promote opsonisation (molecular mechanism whereby molecules, microbes, or apoptotic cells are chemically modified to have a stronger attraction to the cell surface receptors on phagocytes and NK cells)
• Fibronectin increases phagocytosis.

Question 27

growth factors in human breast milk

Answer 27

Cortisol, thyroxine, insulin, prostaglandins, polyamines, insulin-like growth factor

Question 28

Role of cortisol, thyroxine and insulin

Answer 28

• stimulate the synthesis of intestinal enzymes and the maturation of the gut mucosa.

Question 29

Role of prostaglandins

Answer 29

• Prostaglandins stimulate mucus secretion and cell division, which is important as the mucosal barrier of the infant is extremely immature, and it must grow as it is the first line of defense within the GI tract.

Question 30

Polyamines, what are they and what they are needed for

Answer 30

• Polyamines (e.g. spermine and spermidine), containing two or more primary amino groups, are growth factors that increase cell replication.

Question 31

Need of insulin-like growth factor and vitamin E

Answer 31

• Insulin-like growth factor increases the rate of gut maturation.
• Vitamin E stimulates the immune system.

Question 32

whata milk proteins are found in human milk and what is their quantity to the other animals

Answer 32

• The protein content of the milk is directly proportional to the growth rate of the animal.
  
  • Humans possess an extremely low-growth rate, and their milk contains a low-protein content in comparison to other animals.
• Caseins are complexes of caseinates found in micelles, in combination with calcium, magnesium, and phosphates.
  
  • Caseins are phosphoproteins that occur solely in milk.
  • The micelle structure allows casein to carry an ample quantity of calcium, magnesium, and phosphorus.
• Whey is the thin liquid remaining after the removal of the acid precipitate of the curd, and the removal of the cream.

Question 33

Advantages of human milk in comparison to bovine milk

Answer 33

• The whey-to-casein ratio is 60:40 in human milk, and 40:60 in cow’s milk.
• A greater quantity of whey forms a soft curd in the stomach, increasing their absorption within the underdevelopment infant GI tract.
  
  • Whey also contains a higher proportion of nucleotides, a better balance of essential amino acids, and a decreased risk of allergic reactions.

Question 34

where lactalbumin and lactoferrin are synthesized

Answer 34

• Lactalbumin, a component of lactose synthetase, and lactoferrin, an iron-binding protein, are synthesized in the mammary gland.

Question 35

What is the major supply of minerals ( fe, Ca, Zn, Se,

Answer 35

• Lactalbumin is a metalloenzyme that binds calcium and zinc.
• Xanthine oxidase supplies iron and molybdenum.
• Glutathione peroxidase, which is an antioxidant enzyme, contains selenium.
• Alkaline phosphatase supplies zinc and magnesium.
• Lactoferrin provides iron, although 20% of lactoferrin is in the holo-enzyme form.
  
  • The iron present in the environment of the GI tract are taken up by apo-lactoferrin to protect bacterial growth.
  • Holo-lactoferrin, containing iron, provides iron to the infant.

Question 36

major proteins in human milk, compared to cow’s (allergies)

Answer 36

• serum albumin and IgA, while the major proteins in cow’s milk are B-lactoglobulin and serum albumin.
  
  • b-lactoglobulin is responsible for most of the antigenicity of cow’s milk, associated with the allergenic properties of cow’s milk. b-lactoglobulin is not present in human milk.

Question 37

how cow’s milk can lead to T1DM

Answer 37

• Serum albumin is different in cow’s milk than in human milk.

Bovine serum albumin has been implicated in the development of type I diabetes. A homologic similarity between an antigenic site on BSA and the antigenic site on the pancreas, which may lead to type I diabetes

Question 38

how cow’s milk can induce children to cry

Answer 38

• IgG is closely associated with infant colic, which is described as inconsolable crying, and abdominal distress and distension. The baby cries for at least half an hour consecutively for at least three times a week and is inconsolable.

Question 39

How increased number of non-protein N is advantageous

Answer 39

• Non-protein nitrogen is contained in higher quantities in human milk, in comparison to cow’s milk.
  
  • A higher proportion of non-protein nitrogen in human milk may be advantageous in terms of digestibility.

Polyamines, nucleotides (e.g. orotic acid) may play a role as growth factors in the human gut.

Question 40

Why there is high taurine in human milk

Answer 40

• Required for bile acid conjugation
• Putative neurotransmitter

Conditionally essential amino acid in the newborn

Question 41

Why there is low quantity of Met, and high cysteine

Answer 41

• Cystathione is late to develop
• An excess of blood methionine may adversely affect the CNS
• High cysteine:methionine -> cystine utilized without need for methionine metabolism which is impaired due to developmental delay in cystathionase
• A high cysteine to methionine ratio allows the utilization of cysteine without the metabolism of methionine, which is important as the metabolism of methionine in the newborn is impaired, as it is not fully mature.
  
  • Thus, the high cysteine to methionine ratio in human milk prevents methionine build-up within the infant, which is beneficial as methionine is the most toxic amino acid at high levels.
  • There is a developmental delay in cystathionase, which is responsible for the breakdown of homocysteine to cysteine, increasing the risk of an accumulation of methionine.
  • Methionine is added to soy formulas, as they contain extremely low contents of methionine.

Question 42

Why there is low Phe and Tyr in human milk

Answer 42

• Tyrosine aminotransferase and para-hydroxyphenyl pyruvate oxidase are late to develop.

An excess of blood phenylalanine and tyrosine may adversely affect the CNS, as they are neurotoxic.

Question 43

clinical signs to cow’s milk allergy

Answer 43

• GI tract – vomiting, nausea
• Respiratory – sneezing, wheezing, chronic cough
• Skin – dermatitis
• Neurological – headaches

Question 44

how Cow’s milk can cause allergy in infants

Answer 44

• IgE binds to food proteins, forming a complex that binds to receptors on mast cells and basophils, causing the release of cytokines, interleukins, and platelet-activating factor to provoke an inflammatory response via histamine release.
  
  • The release of histamine may cause bronchial hyperactivity, asthma, dermatitis (rashes), vomiting, and diarrhea.

Question 45

what should be given to an infant that shos cow’s milk allergy

Answer 45

• The management of a cow’s milk allergy in an infant is by utilizing formula containing casein or whey protein hydrolysates, which is preferable over soy protein formulas, as there is a cross-reactivity between milk protein and soy protein.
  
  • If an infant may develop a reaction to cow’s milk protein, then they may develop a reaction to soy milk protein.

Soy protein is associated with a lower bioavailability of minerals, including zinc, calcium and iron, as phytic acid complexes with these minerals, which prevents their absorption

Question 46

what happens to children that are fed with soy formulas

Answer 46

Infants provided with soy formulas had decreased calcium and phosphorus retention, as well as decreased bone density. Soy formula contains higher amounts of calcium and phosphorus than cow’s milk, but the bioavailability is much lower, providing a decreased incorporation into bone

Question 47

how breastfeeding protects against milk allergy (IgA)

Answer 47

• IgA aids in the blockage of whole food proteins from absorption by binding to them.
  
  • The IgA and food protein complex promote mucus release from goblet cells and proteolysis at the mucosal surface.
  • Blood IgA binds to food proteins via the reticuloendothelial system, also known as the mononuclear-phagocyte system, which is a network of cells found throughout the body that clear-out food proteins that are bound to IgAs, which is a way in which breastfeeding may protect against milk allergies.

Question 48

how colostrum helps with antogens protection

Answer 48

• Infants have leaky tight junctions within their GI tract, which allows antigens to pass through.

Colostrum hastens the closure of leaky junctions

Question 49

What is heiner’s syndrome

Answer 49

• Heiner’s syndrome is a rare hypersensitivity to unheated cow’s milk protein, which is presented primarily as a pulmonary and infectious disease.
• Heiner’s syndrome is not an allergic reaction, but it is an immunologically-mediated response, referred to as a hypersensitivity, and is associated with GI blood loss, iron deficiency anemia, and failure to thrive.

Question 50

how much is milk fat in milk

Answer 50

Milk fat= 2.9-5.5% by weight

Question 51

composition of guman milk lipids

Answer 51

• 98% of milk fat in breast milk is composed of triacylglycerols.

2% is composed of diacylglycerols, monoacylglycerols, cholesterol, cholesterol esters, free fatty acids, and phospholipids

Question 52

how breast milk lipids are arranged

Answer 52

• Breast milk lipids are enclosed within membrane-enclosed milk fat globules.
  
  • The core is composed of triacylglycerols, while the membrane contains phospholipids, cholesterol, and proteins.

Question 53

why lipids are important in breast milk

Answer 53

Triacylglycerols are the main source of energy in milk, providing 55 to 60% of energy, which is important as it is a more efficient way of delivering energy to the infant given their small stomach size

• Fat has a low-metabolic cost, as there is solely 1% of energy invested for the synthesis of adipose tissue storage, as opposed to carbohydrates for which there is 25% of energy invested.

Question 54

where milk lipids are synthesized

Answer 54

• Fatty acids with a backbone of fewer than 16 carbons are synthesized in alveolar cells within the mammary gland from glucose.
• Fatty acids with a backbone of greater than 18 carbons are synthesized from maternal adipose tissue stores and the diet.

Question 55

how lipid synthesize for milk is promoted

Answer 55

• An increase in prolactin during lactation (1) increases lipoprotein lipase (LPL) activity within the mammary gland, and (2) increases free-fatty acid uptake into the mammary gland.
  
  • LPL hydrolyzes lipoproteins to produce free fatty acids, promoting the cellular uptake of free fatty acids and chylomicron remnants.
  • The activity of lipoprotein lipase within the maternal adipose tissue decreases, which means that the adipose tissue takes up less fatty acids, aiding in the transport of fatty acids from the adipose tissue to the mammary tissue (maternal stores to breast milk).

Question 56

how human milk composition is superior to bovine’s ( palmitic acid, Ca)

Answer 56

• Human milk contains a higher proportion of palmitate at the second carbon position of triacylglycerols.
  
  • Within the GI tract, triacylglycerols are catabolized to monoacylglycerols and 2 free fatty acids.
    
    • Lipases may cleave fatty acids easily from the first and third position, but the hydrolysis at the second position is generally slow and is often resistant to lipase activity.
  • Palmitic acid is the primary saturated fatty acid in cow and human milk fat.
  • Monoacylglycerols containing palmitic acid are better absorbed than free palmitic acid.
    
    • Monoacylglycerols form better micelles.
    • Free palmitic acid is found in cow’s milk, while monoacylglycerols containing palmitic acid at the second position is found in human milk.
      
      • Saturated free fatty acids within the GI tract combine with calcium, and create non-soluble calcium soaps, lowering the bioavailability of calcium and preventing its proper absorption.
      • Monoacylglycerols containing a saturated fatty acid does NOT form these non-soluble calcium soaps.

Question 57

how breast milk can help digestion

Answer 57

• Gastric lipase begins the digestion of fats, which is generally well-developed in newborns.
• Then, pancreatic lipase is secreted in the gut to metabolize the lipids. In a newborn, there is a certain immaturity in terms of the exocrine function of the pancreas, resulting in a decreased secretion of pancreatic lipase.
• Bile salt stimulated lipase is present in breast milk and is activated within the GI tract to aid in the lipolysis.

Question 58

what is the advantage of human’s milk over bovine apart from palmitic acid

Answer 58

•↑ Oleic acid & ↓ SFA

Oleic acid is better absorbed than saturated fat

• 5 X greater EFA than cow’s milk
• Linolenic acid:

Breast milk 0.7 – 1.3%

Formulas 1 – 5%

Question 59

describe how high oleic acid and saturated fat can be adventageous

Answer 59

• Oleic acid is better absorbed than saturated fat.
• Saturated fat, including palmitic acids, form complexes called non-soluble calcium soaps, decreasing the absorption of fat, calcium, and magnesium.

Question 60

Breast milk vs bovine’s : EFAs

Answer 60

• Long-chain polyunsaturated fatty acids are contained in higher quantities (5 times more) in human breast milk, as opposed to infant formulas.
• Essential fatty acid precursors within the breast milk are unlikely to be sufficient for the newborn, as they are developmentally immature of elongase and desaturase enzymes, required to form EFAs. This effect is intensified in premature infants.
• DHA is the predominant lipid within retinal phospholipids and are contained in high amounts of brain cell membranes. DHA is required for proper vision and learning

Question 61

what is the case of P to Ca ratio in human’s milk vs cow’s

Answer 61

• The calcium to phosphorus ratio is 2:1 in breast milk and 1.5:1 in cow’s milk.
  
  • A greater quantity of phosphorus causes an increase in calcium excretion within the gut, decreasing the absorption of calcium, but this was only shown to be the result in adults with calcium deficient individuals.
    
    • At an adequate calcium intake, high intake of phosphorus is not likely to affect bone metabolism or calcium absorption.
    • However, in neonates, the greater calcium to phosphorus ratio in breast milk may be beneficial.

Question 62

why lower content of Mg, Na, K,citrate in milk is beneficial for the baby

Answer 62

• There is a lower solute load (e.g. magnesium, sodium, potassium, and citrate) in human breast milk, decreasing the strain on the infant’s kidney.
  
  • Breast milk has a lower protein content and a lower solute load, which results in a lower stress of the kidneys.
  • An increased stress on the infant’s kidneys is exacerbated when there is excretion of the excess of available water to allow for the excretion of excess solutes, which causes the kidneys to concentration urine, disrupting their water balance, and potentially causing dehydration.

Question 63

what is the second primary component in human milk apart form water

Answer 63

Lactose

Question 64

why osmolarity kept by lactose is important

Answer 64

• The maintenance of osmolarity maintains the energy cost of lactation low.

Question 65

how lactose is valuable in human’s milk

Answer 65

• Lactose also aids in mineral absorption by forming soluble chelates, preventing these minerals (e.g. calcium and phosphorus) from precipitating within the duodenum due to its alkaline pH, increasing their absorption.
• Lactose also stimulates the growth of beneficial microorganisms, such as lactobacilli.

Question 66

how gestational age of the baby affects human’s milk and is preterm milk is optimal

Answer 66

• Gestational age may affect breast milk composition, depending on whether infants are born at term or pre-term.
  
  • Pre-term milk is higher in energy, protein, sodium, and chloride; and lower in lactose.
    
    • The nutrient composition indicates the nutrient needs of the pre-term infant.
• Pre-term milk is not optimal because there are insufficient amount of calcium, phosphorus, magnesium, and vitamin D. In these situations, pumping the milk followed by fortification is recommended.

Question 67

what happens with milk’s composition with increased length of lactation

Answer 67

(1) a decrease in total protein, immunoglobulins, and fat-soluble vitamins, and (2) an increase in lactose, fat, energy, and water-soluble vitamins.

• As lactation continues, there is a higher proportion of medium-chain fatty acids (e.g. C8:0 to C14:0), and palmitoleic acid (C16:0) due to the changing needs of the infant.
• With time, the rate of nerve cell division decreases (lower quantity of DHA required), but there is an increase in myelination of nerve cell, requiring medium-chain fatty acids to synthesize the myelin sheath.

Question 68

how foremilk differs frim hindmilk in fat content

Answer 68

• Foremilk has a low-fat content, but hindmilk has three times higher the fat content.

Question 69

how mother’s malnutrition influence milk

Answer 69

• Malnutrition does not possess an effect of immune factors in mature milk, but there is a decrease in immune factors in colostrum.
• There may be a severe effect if there is a severe protein-energy malnutrition, in which case there will be a drop in the protein and immune factor components in breast milk.
• In the case of severe energy restriction, there may be a decrease in milk volume.

Question 70

how maternal body fat content can influence breast milk

Answer 70

An increase in maternal body fat content increases the concentration of fat within breast milk.

Question 71

does the diet will influence cholesterol and phospholipids in milk

Answer 71

• Changes in diet do not pose an effect on cholesterol and phospholipid content of milk.
• Their secretion rate corresponds to the total quantity of milk fat secretion within milk, which is not affected by the diet.

While the quantity of fat consumed in the diet does not affect the composition of milk, the type of maternal fat consumed may affect the fatty acid composition of milk fat.

Question 72

when there can be EFA deficiency (milk) and difference in diet and milk composition

Answer 72

• linolenic acid content in breast milk depends on the diet:
  
  • Vegetarians have > 30% linoleic acid
  • Omnivores have 6.9 to 18% linoleic acid
  • Very low-fat intake has < 1% linoleic acid

A quantity of linoleic below 6% of the total fat intake increases the risk of essential fatty acid deficiency

• A low-fat and energy-restricted diet increases the proportion of C16:0 and long-chain saturated fatty acids within breast milk, as there is an insufficient ingestion of essential fatty acid, which increases the quantity of fatty acids mobilized from maternal fat stores.
• Vegan infants receive insufficient amounts of DHA due to insufficient omega-3 fatty acid intakes. However, they receive sufficient quantities of omega-6 fatty acids.

Question 73

how much of milk fat is derived from mother

Answer 73

30% usually, if malnutrition, proportion varies

Question 74

maternal diet and fat soluble vitamins in milk

Answer 74

• Fat-soluble vitamins are not very affected by maternal malnutrition, apart from vitamin D.
• If the mother does not ingest sufficient vitamin D or has insufficient sun exposure, there will be poor vitamin D content within breast milk.
  
  • However, excessive maternal vitamin D supplementation may cause toxicity in the infant. Vitamin D has a relatively low UL.

Safe supplementation of the mother has been demonstrated to increase vitamin D concentrations within the baby’s plasma

Question 75

water soluble vitamins in milk and mother’s diet

Answer 75

• baby’s plasma.
• Water-soluble vitamins are generally affected by malnutrition. A deficient quantity of water-soluble vitamins within breast milk may be increased by supplementation.
  • Infantile vitamin B₁₂ deficiency has been reported in vegetarians.
  • Infantile Beriberi is seen after being nursed by a mother with Beriberi.
  • A low maternal vitamin B₆ intake increases the risk of a vitamin B₆ deficiency within the infant but has also been shown to be associated with decreased attentiveness in the infant.
  • A low maternal vitamin C intake decreases the vitamin C content in breast milk.

Question 76

is Se and I content are influenced by diet? is mineral intake influences milk

Answer 76

• Selenium and iodine milk content is closely associated to maternal dietary intake.
  
  • There is no significant relationship between maternal mineral intake and breast milk content, except for selenium and iodine.

Question 77

how environmental conaminants can be a disadvantage to breastfeeding

Answer 77

• The risk of the environmental contaminants is still unclear.
• There is a greater risk for the fetus than for breastfed infants because the infant (1) has a more sensitive CNS, (2) has a higher dose per kilogram of body weight, and (3) has less fat tissue to store contaminants, increasing their availability to other areas of the body where they may have other deleterious effects.

Question 78

how PCBs and dioxins in milk can influence the baby

Answer 78

• PCBs and dioxins in breast milk may interfere with vitamin K metabolism, which is linked to the late hemorrhagic disease of the newborn.
• PCBs induce the activity of cytochrome P450.
  
  • Gamma-glutamyl carboxylase in cytochrome P450 requires vitamin K as a co-enzyme, metabolizing vitamin K.
• Vitamin K is not recycled in the normal salvage pathway but is instead metabolized and excreted.
• This effect is also observed with anti-convulsants and anti-seizure medications.
• PCBs and dioxins are excreted in higher amounts into the milk in the first week after birth.

Question 79

how vitmamin K deficiency can be disadvantageous to breastfeeding

Answer 79

• Breast milk contains low quantities of vitamin K.
• The newborn has a sterile gut, which means that they do not possess bacteria to synthesize vitamin K.
• The newborn has a developmental immaturity in terms of the synthesis of prothrombin, which may increase the risk of bleeding.

Neonates have poor vitamin K stores at birth, requiring mandatory injections of vitamin K (0.5 to 1 mg) to be given at birth

Question 80

should be drugs (medicine) be exluded during lactation

Answer 80

• The most commonly used drugs are excreted into milk, but only a handful pose a significant health risk.
• Consultation with a doctor or pharmacist is required to identify (1) drugs that are less readily excreted in milk, and (2) drugs with a short half-life.
  
  • The type, half-life, dose and duration of use must be considered.

Question 81

what is certain no for drugs, what you need to consider in anticonvulsants,oral contraceptives,antibotics,caffeine, smoking, hot spices, alcohol

Answer 81

• Certain drugs are completely contraindicated for breastfeeding, such as hallucinogenic drugs.
• If a mother is taking anti-convulsants, the infant may require vitamin K supplements.
• A mother taking oral contraceptives (estrogen and progesterone) may cause gynecomastia in young infants and suppress lactation.
  
  • The mini-pill, solely containing progesterone, is prescribed instead.
• Antibiotics may cause allergic reactions, sleepiness, vomiting, diarrhea, and a refusal to eat.
• A caffeine intake above 1 to 2 cups per day may cause restlessness, irritability, and sleeplessness in the infant.
• Sedatives cause lethargy in infants.
• Smoking decreases milk volume.
• Hot spices and garlic may cause distress in the infant.
• Alcohol depresses the infant’s intake of milk, and milk produced is decreased by alcohol.

Question 82

what should be given to infants with PKU

Answer 82

• Infants with phenylketonuria must ingest an infant formula with a low-phenylalanine content to prevent severe mental retardation.
• Infants are screened at birth for PKU, which is an inborn error of metabolism.

Question 83

what is galactosemia, causes, toxicity, and breastfeeding recomemndations

Answer 83

• Galactosemia is a rare autosomal recessive disorder, causing a deficient in 1-P-uridyl transferase, preventing the conversion of galactose to UDP-galactose.
  
  • Galactose + ATP -> Galactose-1-P + ADP + Pi
  • Galactose-1-P -> UDP-Galactose + Glucose-1P
• Galactose-1-P accumulates, producing galactitol, which is highly toxic.
• Galactosemia results in severe mental retardation, cataracts, and liver damage.

Breastfeeding may not be done in infants with galactosemia

Question 84

Can HIV positive mother breastfeed

Answer 84

• In developing countries, there are methods to allow breastfeeding to occur in HIV-positive mothers, minimizing the transfer of the virus through the milk.
• Breastfeeding must be done exclusively throughout six months. Mix-feeding is NOT recommended.

Question 85

why breast milk jaundice occur, what is the treatment

Answer 85

• Breast milk jaundice develops as metabolites of progesterone travel to the infant’s bloodstream, specifically, 5b-pregnane-3a,20b-diol, which inhibits bilirubin conjugation by glucoronyl transferase.
• Jaundice occurs as bilirubin accumulates.
• The treatment is phototherapy, a fluorescent light that is absorbed by the skin of the infant, which converts the bilirubin molecules to water-soluble isomers.
• If the hyperbilirubinemia is extremely severe, then breastfeeding may be withheld for a short period of time. However, it is not recommended for most cases.
• Disease is rare

Question 86

how breastfeeding and eczema are connected

Answer 86

• There are reported cases of infants who have developed eczema while exclusively breastfeeding.
  
  • The onset was associated with the blunting of growth.
  • After breastfeeding was discontinued, symptoms of atopic eczema and rates of growth improved.

Question 87

why breastfeeding should not be exclusive after 6 month

Answer 87

• Prolonged breastfeeding without the introduction of solid foods beyond the age of 6 months results in a reduced growth rate and feeding aversion.
  
  • Babies should be introduced to new foods, flavours, and textures at 4 to 6 months. Moreover, breast milk alone is no longer sufficient to provide for the baby’s nutritional needs.
  • The quantity of breast milk must be decreased while there is an increase in solid foods. At the age of 10 months, they should be consuming half breast milk and half solid foods.

Question 88

Why food should be introduced to infants (iron)

Answer 88

• Iron deficiency may occur after 4 to 6 months, if iron-rich foods are not introduced.
  
  • The issue is not as severe for formula-fed infants, as formulas are fortified with iron.
  • Iron supplementation of breastfed infants is a controversial issue, as iron deficiency is not commonly observed in breastfed infants during the first six months because they possess iron stores that are solely depleted after six months.

Question 89

should mothers take vitamin D when breastfeeding?

Answer 89

• Breastfed infants may be protected from vitamin D deficiency.
  
  • However, vitamin D supplements (10 mg/day) are recommended due to poor exposure to sunlight in Northern climates, and the fact that babies are advised to stay out of the sun during their first year of life.