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lactation nutritional requirements Flashcards

1
Q

Why would different stages of lactation have different nutrient requirements?

A

Composition and amount of milk will change

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2
Q

Does basal metabolic rate change in lactating women?

A

No

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3
Q

How can a woman make up for the energy cost of lactation without any increase in intake? Why is this not the case for most women?

A

Lower physical activity

Most women are less active immediately after birth (rest and heal), but in following months it is highly variable

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4
Q

the energy output needed for lactation is computed from __________ and __________.

A

amount of milk production

energy density of the milk

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5
Q

How is the energy requirement for milk calculated?

A

(g of milk/day) x (0.67kcal/g)

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6
Q

How is the EER for lactation period calculated?

A

normal EER of age group + energy output for milk - weight loss

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7
Q

As the age of the infant increases beyond 6 months, the energy required for lactation will:

A

decrease (lower volume produced)

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8
Q

How does the lactating mother’s body change in the 6 months post partum? Why does this occur?

A
  • gradual weight loss (0.8kg/month)
  • fat loss from subcutaneous region
    energy mobilization from fat stores
    *does not occur in ALL women
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9
Q

When is the mother’s weight assumed to stabilize, and calorie reduction for weight loss no longer applied in the lactation EER?

A

after 6 months (weight loss calorie reduction = 0)

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10
Q

The extra energy for lactation will come primarily from _____, not from ____.

A 
maternal stores (fat)
not from diet
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11
Q

Does protein intake affect milk protein concentration? The minimal amount needed is ____, in order to ______.

A

No

1g/day, to maintain SKELETAL MUSCLE, and produce adequate milk volume!

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12
Q

The ____ approach is used for estimating protein requirements in lactation. What 2 assumptions are made?

A

factorial
assume:
1. amount of MAINTENENCE protein for mother does not change
2. amount of protein/AA needed for milk will increase as milk production increases

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13
Q

True/False: There is a higher energy requirement for milk production in 0-6 months, so the EER for the mother will be greater than the EER after 6 months.

A

False: milk energy output is greater, but EER is reduced to allow for weight loss

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14
Q

Is energy output considered when calculating lactation period EER?

A

Yes.

Includes normal EER, which accounts for estimated activity levels

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15
Q

What non protein nitrogen compound in milk is notably important, and how is it produced (3)?

A

UREA

  • Diversion from urine (given to milk instead of peed out)
  • colonic fermentation of milk
  • produced from protein/AA
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16
Q

The total increase in needed protein is the sum of:

Can we use this number directly as the increase in EAR?

A

milk protein + milk NPN (conversion factor
No, need to account for protein conversion efficiency - only 0.47 efficient at turning diet protein into body protein
(need to divide by 0.47)

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17
Q

How does the NPN content in milk affect protein requirements?

A

some protein is required to provide N for NPNs

use conversion factor of 6.25 to estimate amount needed

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18
Q

The EAR of protein for lactating women (<6 months) is:

the RDA is:

A

1.05g/kg/day
multiply by 1.24 (CV = 12%)
RDA = 1.1g/kg/day (rounded)

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19
Q

Protein is important to provide the protein and AA content in milk, but it will also provide ______, which accounts for 25% of the total milk ____.

A

convert to NPN (non protein nitrogen)

N

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20
Q

Can higher omega 6 intake be beneficial for preventing deficiency in the infant through breastmilk? How is this reflected by the nutrient recommendations?

A

no evidence that increased intake by mother will have benefit

AI is given, since insufficient data
higher than nonpregnant AI, set as the MEDIAN intake in areas of no deficiency

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21
Q

What nutrient is definitely needed in greater amounts during lactation, and why (2)?

A

Carbohydrates
mammary gland preferentially uses glucose
require high level of precursors (glucose) to make constant concentration of lactose in milk

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22
Q

Small amounts of __ and ___ can help reverse omega 3 deficiency in infants, and can be counted as part of the ___ . Why?

A

DHA; EPA
AI
Less conversion of omega 3 required (spared)

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23
Q

Why are the AI recommendations for omega 3 and 6 higher for lactating women, even though no evidence suggests increased requirements?

A

Based on MEDIAN intake in populations with no deficiency, happens to be higher

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24
Q

Overall, for all age groups it is recommended to increase protein intake by ____ during lactation.

A

25g

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25
Q

Lactating women will often have lower levels of ____ (LCFA) in RBCs and plasma. What could this indicate, and what has been found to increase concentrations in both mother and infant?

A

DHA

could indicate inadequate intake; milk production is depleting maternal supply
or could be normal physiological change/adaptation (hormones, nutrient transfer, fat metabolism)

fish oil supplement

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26
Q

In pregnant women, the ____ will increase, signifying an increase in ____ utilization.

A

RQ

carbohydrate

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27
Q

omega 3s in breast milk are sourced from (2):

A

diet

maternal stores

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28
Q

Are fibre requirements changed during lactation?

A

same calculation; slight increase due to increase in energy intake
(14g/1000kcal)

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29
Q

How is EAR and RDA determined for carbohydrates during lactation?

A

add amount of carbs needed to replace those given to milk to normal EAR (add 60g per day)

multiply by 1.3 (CV of 15%)

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30
Q

Is there an increased need for thiamine during lactation? Why or why not?

A

Yes

some is transferred to milk, some is used in the energy cost of milk production

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31
Q

What is needed as a precursor for lactose? Where can this come from? (3)

A

Glucose

carbohydrates from diet
AA from diet (or proteolysis)
glycerol from fat oxidation (very limited!)

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32
Q

Daily milk production is about ____ L.

A

7.8 L

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33
Q

Most nutrient requirements will ____ once the baby surpasses 6 months. why?

A

decrease

less feeding, introduce solids

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34
Q

Is the requirement for riboflavin increased during lactation, and why or why not?

A

Yes; increase in EAR to account for 0.3mg put into milk each day
(assume 0.7 efficiency, so increase amount by 0.4mg)
calculate RDA as 1.2x = 1.6mg/day

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35
Q

Can the body synthesize niacin?

A

Yes, to some extent, from Tryptophan

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36
Q

a woman nursing multiple children would:

A

have higher milk production, have higher nutrient needs

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37
Q

How are lactation and pantothenic acid status related (2)?

A

higher pantothenic acid intake -> more in milk

decreased pantothenic acid concentration in maternal blood in months following pregnancy (vs nonpregnant)

38
Q

Are there any differences in biotin requirements?

A

Yes, slight increase in AI to account for amount deposit in milk

39
Q

How do niacin requirements during pregnancy compare to riboflavin requirements?

A

Similar effects: increase in EAR to account for amount deposited in milk, and energy needs

but: higher CV due to variability in converting Trp -> niacin

40
Q

True/False: Biotin requirements during lactation are not affected by age or lactation stage.

A

True

41
Q

Low intake of maternal B___ will lead to compromised status in the infant, especially since the secretion of this vitamin into milk is much less than the diet amount

A

B6

42
Q

Is the AI for pantothenic acid increased during lactation? Why or why not?

A

Yes, to account for amount deposit in milk and prevent decreasing concentration in mother
*however, no evidence to suggest that normal AI would be inadequate

43
Q

for vitamin ____, the amount in the diet must be increased by much more than what is actually deposited in the milk.

A

B6

diet increase is 5x more than amount that goes into milk

44
Q

Which B vitamins have an AI, and which ones have an RDA?

A

RDA: riboflavin, niacin, B6, folate, B12
AI: biotin, pantothenic acid

45
Q

what is the folate bioavailability factor for food folate?

A

2

assume only 50% bioavailable, so need to eat 2x as much to get the DFE

46
Q

The secretion of vitamin B___ into milk will decrease after 6 months. Is this taken into account by the recommendations?

A

B12

No; just calculated using higher amount

47
Q

Low B12 concentrations in breast milk are common in what 2 situations?

A

vegetarian mothers

poor populations with low meat consumption

48
Q

How are increased folate needs calculated? What is the RDA?

A

(amount deposit in milk per L) x (milk volume) x bioavailability factor (2)

add that addition amount to the normal EAR

assume CV = 10% -> RDA = 500 microgram/day

49
Q

The amount of vitamin ___ concentration in milk will decrease after 6 months, but recommendations will stay the same.

A

C and B12

50
Q

True/False: vitamin C requirement is higher in pregnant women than lactating women

A

False: lactating women have higher requirement

51
Q

The need for choline is (increased/not affected) by lactation. Why? (2)

A

increased (AI increased also)

  1. substantial secretion into milk
  2. no known mechanisms for increased conservation/absorption/synthesis in mother
52
Q

The increase in choline AI during lactation accounts for _____. An absorption efficiency of ____% is assumed.

A

amount deposited in milk

100%

53
Q

vitamin A needs (increase/stay the same) during lactation

A

increase substantially

54
Q

Vitamin D needs (increase/stay the same) during lactation. Why? (2)

A

stay the same

  1. small amounts secreted into milk
  2. unclear what is minimal amount needed to maintain normal active vit D concentration in mother (no sign that requirements are increased)
55
Q

Vit D needs are higher if:

A

sunlight exposure is inadequate

56
Q

How is vitamin A requirement during lactation calculated? Why?

A

average amount received by infant per day (400 micrograms)
add to normal EAR (EAR + 400RAE)

To ensure adequate body stores of vit A in infant

57
Q

vitamin D needs are the same for all age groups except:

A

infants (less)

elderly (more)

58
Q

Can diet affect vitamin K status of breast milk?

A

From diet: no (no significant secretion into milk)

From drug supplements: yes, increase in phylloquinone

59
Q

The AI of vitamin K is (increased/not changed) during lactation. why?

A

not changed; no significant secretion into milk

60
Q

The median intake of vitamin E is much (higher/lower) than the estimated average requirement for lactation. Does this signify a problem?

A

lower
NO: deficiency in vitamin E is very rare in breastfed infants
vitamin E intake is usually UNDERREPORTED by mothers (actually consuming more); so real AI is likely higher

61
Q

Are renal function and hydration status affected by lactation? How is the AI set for water?

A

No

median intakes during lactation (increased to 3.8L per day of total water)

62
Q

Are vitamin E supplements necessary for lactation?

A

No; deficiencies are very rare in breastfed infants.

63
Q

The lactation EAR for vitamin E is calculated by:

A

adding amount secrete into milk to normal EAR

64
Q

True/False: lactation will result in some bone loss in the mother

A

True; but will be regained when ovaries become active again

65
Q

For sodium, a ___ amount is secreted into milk, and the AI is (increased/not changed). What mineral is equimolar in requirements?

A

small amount
not changed (no diff in req)
Cl (equimolar)

66
Q

Where does the calcium for breastmilk come from?

A

mostly bone resorption (mother’s stores)

independent of intake

67
Q

True/False: the same number of grams of Na and Cl are needed per day

A

False: same number of MOLES, but weight is different (different molecular weights)

68
Q

Conversion of dietary K to milk K is very ____. How does this affect any changes in AI?

A 
very efficient (100%)
AI is increased by amount found in milk
69
Q

Does the RDA for Ca change for lactation? What are the physiological changes?

A

No

  1. bone resorption -> Ca stores mobilized
  2. Ca excretion decreased (renal conservation)
70
Q

What evidence shows that Ca absorption is not increased during lactation?

A
  • levels of calcitriol do not increase in mother
71
Q

Can adding extra Ca in the diet help prevent maternal bone loss?

A

No; independent of diet; more due to lack of estrogen

72
Q

P is deposited into milk from where? What other mineral is similar to this?

A

from bone resorption, decreased urinary excretion

similar to Ca

73
Q

What mineral content will decrease in milk as lactation progresses?

A

Phosphorus

74
Q

During lactation, blood levels of P will (increase/decrease). Why? (2)

A

Increase!

  1. increased bone resorption -> release into blood
  2. decreased PTH -> more free Pi
75
Q

The minerals ___, ___ and ___ do not need increases in diet during lactation, and the increased needs are provided for by bone _____ and renal _____.

A

Ca, P, Mg

resorption; conservation

76
Q

Is more Mg recommended for lactating mothers?

A

No; same RDA.

Similar reasons as P and Ca

77
Q

estimation of Fe requirement for lactation is based on the ____ approach. What is considered? (2) And what needs to be done to convert this into a recommendation for diet?

A

factorial
basal losses
amount in milk

account for absorption: divide by 0.18 (18% absorption efficiency)

78
Q

True/False: The concentration of Mg will decrease as lactation progresses

A

False; stays constant

79
Q

What factor for Fe requirement is not considered until after 6 months of lactation have passed?
What additional factor is considered for adolescent mothers?

A

menstruation

adolescent: growth - will need additional iron for tissues and Hb

80
Q

average absorption % of zinc in adult women is:

How does this change during lactation?

A

27%

increases to 38%

81
Q

what 2 factors after birth will contribute some extra Zn? is this reflected by the RDA?

A
  • involution of uterus
  • decrease in blood volume

release about 1 mg/day for a month for reutilization
Not reflected in RDA, but can calculate yourself: subtract the extra Zn for FIRST 4 WEEKS

82
Q

How is the EAR for lactation Se requirements calculated?

A

Normal Se requirement + amount secreted into milk

83
Q

The secretion of what mineral is especially high in milk, compared to the normal intake of the mother?

A

Iodine; secretion amount losses is actually HIGHER than what normal intake would be!

84
Q

Most Se in milk is present in what form? Does it require a conversion factor for absorption?

A

Selenomethionine

No; absorption >90% efficiency

85
Q

Cu requirement during lactation is (increased/not increased). What is the assumed absorption efficiency?

A

increased (deposit in milk)

assume 65-70% efficiency

86
Q

The recommended intake requirements of ___ during lactation are more than double the normal requirements

A

Iodine

87
Q

Fluoride levels in milk are very _____. Is it affected by levels in drinking water, and is supplementation necessary?

A

low
No
No; does not affect intake in infant or requirements of mother (no AI change)

88
Q

The mineral ____ has extremely low absorption of 1%. How does this affect needs during lactation?

A

Cr

only 0.2microgram deposit in milk per day, but due to poor absorption should add 20 micrograms to previous requirement

89
Q

Does Mn requirement change during lactation? Is the AI affected, and are deficiencies common?

A

No (but 3mg deposit in milk per day)
AI is higher (median intake happens to be higher)
deficiency not common in North America

90
Q

The lactation RDA for Mo accounts for:

A

non lactating requirements + amount deposit in milk

nutrition thru life (15 decks)

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