Midterm 3 Flashcards
low birth weight is defined as
- low birth weight is defined as less than 2500 grams ( 5 1/2 lbs)
nutrients required for cell/tissue development must be available during ——- and what is this period called
- specific time intervals, if missing leads to developing tissue has fewer cells, forms abnormally or functions poorly ( e.g cleft palate from too much vitamin A)
- it called the critical period
Developmental origin hypothesis - Dutch hunger winter (1944-1945)
- 4.5 million people affected
- if women were exposed to famine during pregnancy it led to
1. Lower birth weight
2. Offspring had an increased risk of diabetes and obesity as adults
Developmental origin hypothesis is that increased susceptibility to ———— is —— by energy or nutrient ———- during pregnancy causing fetal tissues in critical phases to make ——— to cope with ——- —- ——-
Adaptations produce changes in —- and —— of tissues (permanent or ———)
- increased susceptibility to chronic disease is “programmed” by energy or nutrient imbalances during pregnancy
- fetal tissue in critical phase make adaptation to cope with poor nutrient supply
- adaptations produce changed in structure and function of tissues ( permanent or long lasting effect)
Weight gain in pregnancy
- weight gain typically depends on a woman’s weight entering pregnancy
- underweight; 28- 40 pounds
- normal and weight 24- 35 pounds
- overweight; 15- 25 pounds
- obesity: 15-20 pounds
Women carrying twins typically gain
37-54 pounds
Weight gain in pregnancy should be
Gradual and consistent, form a high quality diet
Nutrition during pregnancy
- calories
1st trimester= no additional calories
2nd trimester= 340 calories
3rd trimester= 450 calories
Other nutrients - choose nutrient dense foods
- especially folate, iron, calcium
Folate deficiency
- associated with fetal growth failure and malformations and neural tube defects
- adequate folate early in pregnancy reduces neural tube defects
- 600 mg folate is need daily before (neural tube forms before 30 days after conception) and during pregnancy
Neural tube defects
- encephalocele
- spina bifida
- anecephaly
What are the neonatal risks associated with iron deficiency during pregnancy
- Low birth weight
- small for gestational age
- fetal distress
- preterm birth
What are the offspring risks associated with iron deficiency
- memory/ processing disorders
- intellectual disability
- iron deficiency
What are the maternal risks associated with iron deficiency
- preterm labour
- placental abruption
- severe postpartum hemorrhage
- preeclampsia
- hysterectomy
- maternal shock
- increased ICU admission
- maternal death
Calcium is needed for —— and supplied by ——-
- needed for mineralization of bones in the fetus
- supplied by mothers diet and calcium in long bones of mothers body
True or false calcium is supplied by the mothers diet and the calcium in long bones of mothers body
True
Low calcium intake means
- greater calcium losses from maternal bones during pregnancy
Is calcium regained after delivery
Yes
The babies born before 37 weeks of pregnancy
Pre term
the lowest mortality rates occur among infants weighing
weighing 3000 to 3500g ( 6.6 to 7.7 lbs)
Infant mortality rate in 2023 is
3.9 deaths/ 1000 live births
Critical period
Time when cells of a tissue or organ are genetically programmed to multiply and any damage can cause irreversible damage
During the critical period if something goes wrong such as a deficiency in cells the body cannot correct and fully compensate for this later on (true or false)
True
Nutrients requires for cell/ tissue development must be available during ——- and if missing ——-
Specific time intervals
The developing tissue has fewer cells and forms abnormally or functions poorly
How is cleft palate formed
When developing tissue has fewer cells, forms abnormally or functions poorly, from too much vitamin A
Which tissues have their critical periods of development within the first 4 weeks?
The central nervous system, heart, ears, eyes, and legs and arms
During which period does the central nervous system develop critically?
The central nervous system is in its critical period during the first 4 to 6 weeks of gestation.
What tissue develops critically at the latest stage of pregnancy?
The external genitalia has a critical period extending to about 12 weeks.
Why is early development particularly sensitive to external factors?
Early development is sensitive because tissues and organs are rapidly forming, making them more vulnerable to nutritional deficiencies, toxins, or other disruptions.
Which tissues continue to develop until term?
The central nervous system, ears, eyes, teeth, palate, and external genitalia continue developing until term.
What is the most common deficiency in pregnant women and what is the DRI per day during pregnancy
- iron
- 27 mg
What can be concluded about maternal antibiotic use?
Maternal antibiotic use during pregnancy and lactation leads to increased weight gain in offspring compared to controls and prebiotic-treated groups.
Too little vitamin A results in
Poor fetal growth
Too much vitamin A results in and what intake of retinol daily is too much
- fetal malformations (in facial features and heart defects)
- intake of 10 000- 15 000 IU of retinol daily is too much
What should you limit your vitamin A intake to when pregnant
5000 IU/ day and take no vitamin A containing medications
Is beta carotene, a precursor to vitamin A and is it harmful? Is it from plant foods?
Yes,
no it is not harmful
Yes
What does a lack of vitamin D do to pregnant women and what kind of women are at a greater risk of a vitamin D deficiency
Compromises fetal growth and development
Vegan women since Vit D is found naturally in animal products
What is the vitamin D recommendation for pregnant women and what should it not exceed
- 600 IU is the official recommended
- should not exceed 4000 IU
What are the only supplements recommended for all pregnant women? And how about multivitamin mineral pills?
- iron and folate
- Multivitamin Mineral Pills are recommended for women who do not consume an adequate diet and for high risk categories such as twins, heavy cigarette smokers and those with alcohol or drug abuse
What percent of pregnant women take multiple vitamins and mineral supplements
83%
Is Fetal Alcohol Syndrome a permanent condition
Yes
What amount of alcohol is absolutely safe during pregnancy
None
To prevent impairments in fetal growth and development women should not ——
Drink alcohol during pregnancy or when trying to get pregnant
What to do when someone is experiencing morning sickness/ nausea during pregnancy
- get up slowly in morning
- eat dry toast or crackers
- chew gum or suck hard candies
- eat small, frequent meals
- avoid foods with offensive odours
- when nauseated do not drink citrus juice, water, milk, coffee or tea
What to do when experiencing constipation and hemorrhoids
- fiber, exercise and liquids
What to do when experiencing heartburn during pregnancy
- relax and eat slowly
- eat small and frequent meals
- drink liquids between meals
- avoid spicy or greasy foods
- elevate head while sleepy
- wait an hour after eating before lying down
What are the nutrition related concerns associated with pregnancy
A) nausea/ morning sickness
B) constipation and hemorrhoids
C) Heartburn
High risk pregnancy factors
- Maternal weight before pregnancy (over or under-weight)
- Maternal weight gain during pregnancy
- Maternal nutrition
- Socioeconomic status
- Lifestyle habits (smoking, alcohol, drugs)
- Age - geriatric pregnancy?
- Previous pregnancies (number, interval, outcomes, twins)
- Maternal health (high BP, diabetes, etc.)
How much does an infant’s birthweight change in the first year?
Infants triple their birthweight by 1 year.
By how much does an infant’s length increase in the first year?
Length increases by 50% in the first year.
How does growth rate change after infancy?
Growth rate declines after infancy.
What is the average heart rate for infants compared to adults?
• Infants: 120-140 beats/min
• Adults: 70-80 beats/min
What is the respiration rate for infants compared to adults?
• Infants: 20-40 breaths/min
• Adults: 15-20 breaths/min
What are the energy needs of infants compared to adults?
• Infants: 100 kcal/kg
• Adults: <40 kcal/kg
Breast milk composition compared to recommend adult diet
Breast milk
Protein- 6%
Fat- 55%
Carbohydrates- 39%
Recommended adult diets
Protein- 12%
Fat- 30%
Carbohydrates- 58%
When should you introduce cows milk and what happens when you introduce it before 6 months
- 9-12 months of age
- before 6 months associated with intestinal bleeding and iron deficiency
When should you introduce solid foods to babies and how
- typically at 6 months
- iron fortified cereal first
- pureed vegetables and fruits next
- new recommendations don’t dictate an order
- progress to family foods by 12 mths
Foods to avoid in the first year (what food may cause allergic reactions)
- cows milk
- egg whites
- fish
- nuts
- soy
- wheat
Foods to avoid in the first year ( foods that may cause other problems)
- corn (hard to digest).
- honey (unpasteurized)
- coffee
- prune juice and other fruit drinks
Foods to avoid in the first year of life (what is the last category of food to avoid)
Food that may lead to choking
Vitamins are chemicals in food required for —- and —-
Normal growth and health
Adequate intakes do what
Protect people against deficiency diseases and prevent chronic diseases
Every vitamin has a range of intake where it functions best (true or false)
True
What is a good way to get enough vitamins in your diet
Eating 5 or more servings of fruits and vegetables each day is a good way to get enough vitamins in your diet.
What are 3 examples outlining the history of vitamin deficiencies
- Vitamin D deficiency known as rickets
- Thiamin Deficiency known as beri beri
- Niacin Deficiency known as Pellagra
When was Vitamin D deficiency most relevant and how did it occur and what was discovered in 1921
1880-1920, 90% of children in parts of Europe and in Boston had rickets (industrialization era)
- smoke from coal-burning fires absorbed much of UV portion of sunlight which was needed to produce vitamin D in the skin
- UV B rays absorb the rays needed to make vitamin D
- In 1921 it was discovered that if you exposed children to UV light, symptoms of rickets disappeared.
What was the first medical link to Thiamin deficiency (beri beri) and what was the symptoms of Thiamin deficiency
- 1st medical link to this dietary deficiency was made by a Japanese doctor who observed the symptoms in Japanese navy crew who ate only polished white rice but not in crew who got meat, beans and barley
- Polished rice with husk, bran and germ
removed = strips nutrients - Fatigue, together with complications affecting the cardiovascular, nervous, muscular, and Gl systems
What are the “3 D’s” associated with niacin deficiency aka pellagra and when was it the most relevant, and where? What was the staple food that caused this?
- three ‘D’s: dermatitis, diarrhea, dementia
- 1907-1940 in USA (3 million cases, 100,000 deaths) early 1900’s in the southeastern USA, cotton economy failed, and people ate corn as a staple
- niacin in corn is tightly bound and not very available for absorption
Vitamin A Deficiency is the leading cause of.. and increases… and what is one of the first signs of the deficiency
- Leading cause of preventable childhood blindness and increases the risk of death from common childhood illnesses such as diarrhea
-Night blindness is one of the first signs of vitamin A deficiency (Inability to see in dim light to full on blindness)
What foods beta-carotene found in and is there a upper tolerable limit if not what does high intake cause
Deep orange fruits and vegetables
• Dark green vegetables
• No upper tolerable limit but high intakes may turn skin yellow-orange
Retinol (pre-formed Vitamin A) Found in? And what should be taken note of?
Found in: Animal products with fat (meat, fish, eggs, dairy)
Note: Some acne medications contain vitamin A derivatives (retinoids). These can be harmful during pregnancy. Avoid getting pregnant for 4 weeks after use.
Iodine is an element needed for… and what happens if it’s deficient and what is the percentage of the worlds population remain at risk for iodine deficiency
- lodine is an element that is needed for production of thyroid hormone
- If deficient, leads to hypothyroidism = weight gain, inability to tolerate
cold, fatigue - Can lead to intellectual disabilities in children if mother was deficient during pregnancy
- Approximately 30% of the world’s population remains at risk for iodine deficiency
What are the water soluble vitamins, due to water solubility what happens to these vitamins and are they safe in high doses? Which vitamins can be toxic in high doses? Megadoses? Water soluble vitamins are also ——- during food storage and preparation
• The B vitamins and vitamin C
• Due to water solubility, they “wash out” of the body in one to several days
- Except for B12 as it can be stored up to one year in the liver
- This does not make them safe in high doses…
• Vitamin B6, niacin and C can be toxic in high doses
• “Megadoses” stress the kidney
• Water soluble vitamins are easily destroyed during food storage and preparation
How to minimize nutrient losses
- Refrigerate fruits & vegetables
- To minimize oxidation, reduce contact with air
- Wash fruits & vegetables before cutting
- To minimize cooking losses, steam or stir-fry vegetables. Avoid high temperature for long time.
Is folate the natural form and the folic acid synthetic form
Yes
What is folate found in and what is the most common food source is enriched or fortified food products is synthetic folic acid more ———-
- leafy green vegetable
- legumes
- lentils
- fortified grain products
- most common food source is enriched or fortified food products
- synthetic folic acid is more bio available than naturally occurring food folate
What does folate deficiency affect
- Lack of folate reduces DNA stability
- Heart health
- Fetal health
Folate deficiency —- and —— carcinogenesis
How?
Induces and accelerates
- structure of cells genetic material become disrupted and accumulate resulting in cancer
Lack of folate causes —— to accumulate
- lack of folate causes homocysteine to accumulate in blood
- high homocysteine results in heart attacks and strokes
There is almost a complete absence of spinal cord and brain deformities in babies born to mothers consuming ———- ——- what are the two most common neural tube defects and what are the recommended intakes for folate
- Almost complete absence of spinal cord and brain deformities (neural tube defects) in babies born to mothers consuming adequate folate.
- The two most common neural tube defects are spina bifida (treatable) and anencephaly (fatal - portion of brain and skull missing).
- Intakes should be: 400 unigrams all females
600 unigrams pregnant
4 mg previous neural tube defect
Vitamin C is a ——- and it ———- tissues from oxidative stress, what is oxidative stress caused by and over time lead to increased risk of
- antioxidant
- protects tissues from oxidative stress
- oxidative stress is caused by free radicals that are produced in response to normal metabolism using oxygen; UV radiation; air pollution; tobacco smoke
- over time lead to increased risk of cancer, heart disease and arthritis
Vitamin C along with vitamin E and other phytochemical found in fruits and vegetables…
neutralize free radicals
What are free radicals
- free radicals are like robbers which are deficient in energy
- free radicals attack and snatch an electron from other cells to satisfy themselves which damages cells membrane
What is vitamin Cs roles
- Antioxidant
- Cofactor in collagen formation
- In stress
- Role in the common cold
What does vitamin C being a cofactor in collagen formation mean and with vitamin C deficiency what is a major symptom
- help form collagen ( fibrous structural protein of connective tissue)
- assist in preventing bruising with vitamin C deficiency, tissue hemorrhage or bleeding is a major symptom
Vitamin C role in stress; what gland contains more vitamin C than any other organ and when is vitamin C released. what are examples of stresses what is the recommended intakes of vitamin C
- adrenal glands contain more vitamin C than any other organ, released with stress hormones during stress reaction
- stresses: infections, burns, toxic heavy metals, chronic aspirin, barbiturates (sedatives), oral contraceptives (also B6, B12, folate ) cigarette smoking *There is a higher recommendation
Males = 90 mg/d
Females = 75 mg/d
Smoker = +35 mg/d
1 g/day of vitamin C led to.. vitamin c reduces ….. what is vitamin c the body needs to prevent scurvy and what does excess vitamin c do
- 1 day shorter cold and reduced severity of symptoms by 23%
- vitamin c reduces blood histamine but at a dose of 2 g daily for 2 weeks
- body needs 10 mg prevent scurvy
- excess; nausea, diarrhea, abdominal cramps, excessive gas
What is vitamin D different roles
- Bone growth
- Cancer
- Multiple sclerosis; rheumatoid arthritis
What does vitamin D do for bone growth
raises blood concentrations of Ca & phosphorus
1) increase absorption from intestine
2) increase reabsorption from kidneys
3) mobilization from bones into blood
What is the link of vitamin D and cancer
- recent research: breast, prostate, colon decreases with increased vitamin D intake
Multiple sclerosis; rheumatoid arthritis and latitude what level supplement decreases the risk of MS and what is the percentage
- living higher than 37° latitude increases MS risk >100%
- 400 U supplement decreases risk by 40%
What amount of sunlight is needed to produce sufficient vitamin D
- 9 min of daily sunlight in the summer,
with forearms and lower legs exposed
light from produces sufficient vitamin D
the sun
(25 min suggested for dark pigment)
What is the food sources of vitamin D and what is the most reliable source
Food Sources:
• Fortified dairy foods
• Fortified margarine
• Fish oils
• Egg yolk
* fluid milk is most reliable source
Vitamin D Production
-
Vitamin D production depends on:
- Sun angle
- Latitude
- Season
-
Limited production:
- Northern latitudes (above 50° N): 6 months
- Middle latitudes (40° N - 50° N): 4 months
Note: Consider supplementation if needed. With latitude
Reduced production of vitamin D results in and what amounts of sun is required for a day
1) 70 years and older - vitamin D production falls to
30% of younger adults
2) institutionalized individuals at high risk
3) sunscreen - reduce or block vit. D synthesis, but not completely
* 15 min exposure early morning or late afternoon without sunscreen produces all that is required for a day
DRI for vitamin D
- 600 IU for those >70 years it is 800 IU
- tough to get from food, fish best source supplement is recommended
What are phytochemicals and what do they protect against
• Biologically active compounds of plants (protect them from bacteria, animals, etc. and give pigmentation and flavor) believed to reduce risk of chronic disease in humans
What phytochemical are essential what properties must they have to make them useful to our tissues are some phytochemical toxic to us
- None of the phytochemicals are essential
- Many have protective and antioxidant properties that make them useful to our tissues
- Others are toxic to us - Too much is not better!
What diseases can phytochemicals protect us from?
- Cancer
- Heart disease
- High blood pressure
- Other chronic diseases
The correct balance of phytochemicals is unknown, but to get adequate levels, we need to:
- Follow the advice in Canada’s Food Guide and
- Eat a variety: don’t eat the exact same foods every day
Free radicals and sources of free radicals, antioxidants help neutralize…
- Free radicals are highly reactive molecules that can damage DNA, leading to cellular dysfunction and aging.
-
Sources of free radicals:
- UV light
- Air pollution
- Smoking
- Ionizing radiation
- Normal metabolism
- DNA damage can contribute to the development of chronic diseases and cancer.
- Antioxidants help neutralize free radicals and protect cells from damage.
What do antioxidant do
• protect cells against oxidative damage and reduce the risk of developing certain types of cancer. Phytochemicals with antioxidant activity: allyl sulfides (garlic, onions), carotenoids (carrots, tomatoes), flavonoids (berries), polyphenols (grapes, tea).
