Midterm Flashcards
1
Q
Calorie
A
measure of the amount of energy transferred from food to body
2
Q
Nutrients
A
chemical substances in food that are used by the body
3
Q
Carbohydrates
A
organic compounds consisting of carbon, hydrogen, oxygen
4
Q
Protein
A
organic compounds consisting of AA
5
Q
Fat (lipids)
A
organic compounds that consists of a glycerol and 3 FAs
6
Q
Vitamins
A
group of organic compounds essential for proper nutrient and growth (required in limited amounts)
7
Q
Minerals
A
group of inorganic compounds essential for proper nutrition and growth (limited amounts)
8
Q
Water
A
essential component of our diet; transport nutrients to cells; aids in some reactions (hydrolysis); regulates body temp., rids body of waste
9
Q
Essential Nutrients
A
Obtain from diet
- carbs, certain AA, EFAs, vitamins/minerals, water
10
Q
Cholesterol
A
precursors for steroid hormones and vitamin D; synthesized in liver
11
Q
Glucose
A
major source of cellular energy; can be synthesized in liver
12
Q
Malnutrition
A
under- or over-nutrition
13
Q
RDA
A
Recommended Dietary Allowance
- levels of essential nutrients
- adequate for most healthy people
- decrease risk of certain chronic diseases
14
Q
AI
A
Adequate Intake
- tentative RDAs
15
Q
EARs
A
Estimated Average Requirements
- estimated values to meet requirement of half of the healthy individuals in population
16
Q
Tolerable Upper Limit
A
UL
- upper limits of nutrients compatible with health
- these should not be exceeded
17
Q
Factors that influence nutrient needs
A
age, body size, gender, genetic traits, growth, illness, lifestyle habits, medications, pregnancy/lactation
18
Q
WHO: Health?
A
state of complete physical, mental and social well being and not merely the absence of disease
19
Q
Fundamental conditions and resources for health are
A
peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice and equity
20
Q
Primary
A
health promotion activities aimed at preventing a specific illness/disease
- preceded disease
- immunizations
21
Q
Secondary
A
Activities focused on early identification of health problems
- identify and treat individuals who have asymptomatic/preclinical disease
- screening/breast exam
22
Q
Tertiary
A
Educating an individual with the disease with the goal of returning individual back to optimum levels of functioning
- educating a person with type 2 diabetes on how to identify and prevent complications
23
Q
Public Health Agency of Canada
A
health promotion, prevention and control of disease, disease surveillance, public health emergencies
24
Q
Health Canada
A
health care, education, food guide, development of food regulations
25
Canadian Food Inspection Agency
enforcement of food regulations set by health Canada, inspection of facilities
26
Sodium Reduction Task Force
Interim goal = population mean intake of Na to 2300 mg/day
Long term goal = reduce Na intake to a population mean where 95% of the population have daily intake less than UL (2300 mg/day)
Individual goal = 1500 mg/day
27
Average Na intake among Canadians
3400 mg/day
28
Healthy Eating and Active Living (HEAL) Action Plan
Ontario's effort to meet Pan- Canada's Healthy Living Strategy Targets
- access to healthy food for children
- help Ontarians access dieticians
29
Healthy Change Ontario's Action Plan
improving clinical care, child obesity, doesn't replace HEAL
- keep Ontario healthy
- faster access to stronger family health care
- right care, right time, right place
30
What do dieticians do?
preparation of kits, educational material, policy implementation and guidelines, public level screening, public level education, nutrition counselling
31
Biological impacts of social determinants of health
physical environment 10%
biology and genetics 15%
health care system 25%
social and economic development 50%
32
Social determinants of health
values, assumptions, beliefs
33
Core determinants of health
```
income and social status
social support networks
education
employment and working conditions
social environments
physical environments
biology and genetic environments
culture
health services
personal health practices and coping skills
healthy child development
gender
```
34
Socio-ecological model
Individual - personal level factors (age, food preference)
Interpersonal - factors relating to influence of families, peers, partners, culture
Organizational/Institutional - practice and physical environment of an organization (school, workplace)
Community - cultural values or norms unique to urban, rural and remote settings (access to food)
Public Policy - broader guidelines at various levels of government (Canada's food guide)
35
Food Security
all people, at all times, have physical and economic access to sufficient, safe and nutrition food
36
Food Insecurity
inability to acquire nutritionally adequate foods in culturally acceptable ways
37
Traditional Foods
plants and animals harvested from local environment - contribute toward nutritional health and well being
38
Determinants of traditional food choice
no time to prepare, lack of knowledge, unhealthy (rural)
| no land access, expensive, no availability (rural)
39
Food Sovereignty
People's right to healthy and culturally appropriate food produced through ecologically sound and sustainable methods and their right to define their own food and agriculture system
40
4 main factors that need to be fulfilled in order to achieve food sustainability?
food availability, food supply, food access, cultural acceptability
41
Use of models in Public Health
organize our thinking, guide the design of intervention, evaluate the effects of interventions
42
Determinants of malnutrition
agriculture, government, community, school, habits, beliefs, ethnic identities, physiology, nutrition, sanitation, stress, age
43
What percentage of people in US are obese
70%
44
Causes of death in children under 5
neonatal 37%
acute respiratory infections 17%
diarrhea 16%
45
Greatest benefits to improve child mortality
breast feeding counselling, vitamin A supplementation, zinc fortification
46
Deficiency in vitamin A leads to
blindness
47
food rich in Vit A
sweet potato
48
Who is most commonly deficient in iron
pre-school aged children and women
49
foods rich in iron
red meat and spinach
50
What protects many countries against iodine deficiency?
ionized salt
51
Symptoms of iodine deficiency
swelling of the neck
52
foods rich in iodine
cranberries and seaweed
53
What is zinc useful for
management of chronic diarrhea
54
foods rich in zinc
soy beans
55
Periods with greatest benefit from nutrition interventions
prenatal, first 2 years of life, pre-conception, adolescence
56
Emerging Adulthood
phase of lifespan between adolescence and adulthood ~18-25 years
57
Markers of transition to adulthood
completed education, left parents home, full time work, life partner, start family
58
characteristics of emerging adulthood
don't see themselves as adults, time of identity exploration, high level of transition
59
Largest brain structure
frontal lobe
60
What area is within the prefrontal cortex that is associated with set functions
Executive Suite
61
What is the executive suite responsible for?
calibration of risk and reward, problem solving, prioritizing, long term planning, self evaluation, regulation of emotion (Overall maturity)
62
Myelination
more extensive myelination of nerves - more efficient signal transmission
63
Synaptic Pruning
nerve connections are pruned back - more efficient signal transmission among retaining nerves
64
What do myelination and synaptic pruning lead to
sophisticated learning and emotion regulation
65
Changes by end of emerging adulthood
more complex thinking, appreciation of diverse views, emotional regulation, risk taking and decision making
66
"window of opportunity"
emerging adulthood
67
When is fast food intake at its highest
emerging adults
68
common barriers to food prep
too busy, insufficient money, inadequate cooking skills
69
Who is the main target for fast food industry
young men
70
meal between dinner and breakfast
fourth meal
71
large increase in prevalence of obesity among?
18-29 year olds
72
transition to university weight gain
first 3-4 months --> 2-7 pound increase
73
Body Mass Index
weight relative to height, not a direct measure of body fat, estimate of body fatness and risk associated with body fat
74
pounds to kg
divide by 2.2
75
inches to cm
multiply by 2.54
76
Underweight BMI
77
Normal BMI
18.5-24.9
78
Overweight BMI
25-29.9
79
Obese Class I BMI
30-34.9
80
Obese Class II BMI
35-39.9
81
Obese Class III BMI
> 40
82
BMI Limitations
does not take into account bone density, not to be used with pregnant/lactating women, does not capture risk with weight change
83
BMI results less accurate for
emerging/young adults, muscular/lean individuals, certain population groups, older adults >65, dehydrated individuals
84
Puberty
period in which humans become biologically capable of reproduction
85
Ova
female reproductive cells that are produced and stored within ovaries
86
Follicle
cellular structure in ovary where ovum matures
87
Sperm
male reproductive cells
88
How long does puberty occur
3-5 years
89
menstrual cycle length
~4 week cycle
90
GnRH in menstrual cycle
released by hypothalamus
| - stimulates pituitary gland to release FSH and LH
91
FSH in menstrual cycle
stimulates maturation of ovum (and sperm in men) and stimulates production of estrogen
92
LH in menstrual cycle
stimulates secretion of progesterone and surge in LH causes release of ovum
93
Estrogen in menstrual cycle
stimulates further growth and maturation of follicle, stimulates vascularity and storage of glycogen/other nutrients within uterus, decrease in estrogen at end of menstrual --> release of GnRH
94
Progesterone in menstrual cycle
prepares uterus for fertilized ovum, increases vascularity of endometrium and stimulates cell division of fertilized ova
95
Two phases of menstrual cycle
Follicular and luteal phase
96
Follicular Phase
first half of menstrual
- follicle growth and maturation
- main hormones = GnRH, FSH, LH, estrogen, progesterone
97
Luteal Phase
last half of menstrual
- after ovulation, development of egg
- if ovum is not fertilized, decreases in estrogen and progesterone stimulate menstrual flow
- decrease in estrogen stimulates the release of GnRH and it starts again
98
Different between men and women cycles
men - ongoing
| women - cyclic
99
Which signal releases LH and FSH in men
GnRH
100
What stimulates the production of testosterone in men?
FSH and LH
101
Maturation of sperm
70-80 days
102
where is sperm stored
epididymis
103
Decreased fertility associated with
number, motility, morphology
104
Main fertility disruptions
adverse effects, contraceptive use, severe stress, infection, tubal damage/structural damage, chromosomal damage
105
Nutrition/Lifestyle factors affecting fertility
energy status and nutrient adequacy, obesity, weigh loss, under-nutrition, high intensity training, low intake of specific foods/food components
106
What hormones do fat cells produce
estrogen, testosterone, leptin
107
changes in levels of estrogen, testosterone and leptin affect?
follicular development, ovulation, sperm production, sperm maturation
108
Hormonal differences can result in
irregularity of the menstrual cycle, ovulatory failure and amenorrhea (ovulatory failure)
109
lower levels of testosterone lead to
lower sperm production
110
first line of defence in improving fertility
weight loss
111
Weight reduction strategy should:
focus on lifestyle changes, improve overall diet quality, decrease caloric intake, increase physical activity
112
Acute under-nutrition
associated with dramatic decline in food energy and nutrients that recovers with normal food intake or eating behaviour
113
Primary effect of chronic under nutrition
birth of small/underweight infants (likelihood of death in first year)
reduced fertility
114
Adverse effects of intense physical activity
delayed age at puberty, lack of regular menstrual cycle, reduced levels of estrogen, low levels of body fat, decreased bone mass
115
Female Athletic triad
amenorrhea, eating disorder, osteoporosis
- when energy intake is substantially less than requirement
- decreased LH/FSH levels and lack of estrogen
116
Oxidative Stress
when the production of free radicals exceeds the body's own antioxidant defenses
117
Oxidative stress in men
decrease sperm mobility and reduces ability of sperm to reach egg
118
oxidative stress in women
harm egg and follicle development, interferes with implantation of egg
119
Key antioxidants
vitamin C, E, beta-carotene, selenium
120
Zinc - prevents oxidative stress in men only
prevents oxidative damage, involved in sperm maturation involved in testosterone synthesis
121
low zinc status in men associated with
low sperm count, low sperm quality, abnormal morphology
122
High Plant based diets effect son fertility
high finer --> reduce estrogen and irregular periods
| isoflavones (soy) --> influence levels of gonadotropins, estrogen and progesterone, reduced sperm count
123
Low iron intake linked to
premature delivery and low iron status of infant
124
caffeines affect on fertility
chance of conception decreased
125
alcohols affect on fertility
may decrease estrogen and testosterone levels
126
Heavy metals affect on fertility
decreased sperm production and abnormal motility and mobility
E.g. mercury/lead
127
when is folate very important
peri-conceptual period (after conception but before pregnancy is diagnosed)
128
insufficient amounts of folate lead to
embryonic development (neural tube defects = spina bifida)
129
folate recommendation
40 ug/day
130
pregnancies most vulnerable to folate deficiency
single women, unplanned pregnancies, low education
131
Bioavailability
the efficiency of absorption, utilization and/or retention of the nutrients present in food
132
Bioavailability can be affected by
nutrient content, food processing, physical state of the person, ability to digest and absorb nutrients, interactions among components, presence of anti-nutritional factors
133
Improving Bioavailability
Fortification and enrichment
134
Fortification
addition of nutrients not originally present in the particular food
135
Enrichment
addition of nutrients that were lost during food processing
136
Folate
natural form, 50% bioavailability, prone to damage, leafy greens/beets
137
Folic acid
synthetic form, highly bioavailable, supp.
138
The leading cause of female infertility
Polycystic Ovary Syndrome
139
Clinical signs of PCOS
high levels intra-abdominal fat, obesity, menstrual irregularities, acne, high testosterone, insulin resistance
140
PCOS affect on infertility
~70%
- absence of ovulation
- irregular menstruation
- risk of spontaneous abortions/gestational diabetes
141
Nutritional management of PCOS
primary goal = increase insulin sensitivity
- weight loss and exercise
insulin sensitizing drugs
long term health problems - need team-centred approach, tailor plan to individual
suggested diet
- veg/fruit, lean protein, whole grain, fibre, non-fat dairy, regular meals
-low glycemic index
- healthier fat sources
--> can't cure but can manage long term complications and alleviate symptoms
- symptoms tend to improve substantially from 5-10% weight loss
142
Glycemic Index
measure of the extent to which 50 grams of carbohydrate containing food raises 2-hour post meal blood glucose compared to a similar amount of glucose or white bread
143
High glycemic index
glucose, potatoes, pretzels, rice krispies, gatorade
144
Medium glycemic index
sweet potatoes, brown rice, raisins
145
Low glycemic index
oatmeal, banana, honey, pasta
146
Diabetes Mellitus
intolerance to carbohydrates with fasting glucose >126 mg/dL
147
Type 1 diabetes
results from destruction of insulin producing cells (10%)
148
Type 2 diabetes
body unable to use insulin normally, to produce enough insulin or both (90%)
149
Gestational diabetes
onset during pregnancy (usually type 2)
- poorly controlled blood glucose levels
- miscarriage/ risk of mother or infant developing type 2 later in life
150
Affect of high blood glucose levels during first two months of pregnancy
teratogenic
| - associated with 2-3 fold increase in congenital abnormalities
151
Prevention of GDM
weight loss, exercise, healthy dietary pattern, increase fiber, intake of low GI foods, increase veggie/fruit consumption
152
Gestational Age
Assessed from date of conception (avg. pregnancy = 38 weeks)
153
Menstrual Age
assessed from onset of last menstrual period (LMP) (avg. pregnancy is 40 weeks)
154
Peri-conceptual
4 weeks before and after conception
155
Very pre-term
before 34 weeks
156
Pre-term
before 37 weeks
157
At term
40 weeks
158
Post-term
greater than 42 weeks
159
embryo
conception to 8 weeks
160
fetus
8 weeks to 40 weeks
161
neonatal/newborn
40 weeks to 1 week past term
162
post-neonatal
1 week post term to 12 weeks post term
163
Miscarriage/spontaneous abortion
conception to 20 weeks
164
Fetal death/still birth
20 to 40 weeks
165
perinatal
20 weeks to term
166
Two phases of pregnancy
Anabolic and catabolic
167
Maternal Anabolic
week 1-20
building mother's capacity
10% fetal growth
- blood volume expansion, increased cardiac output, buildup of fat, nutrients and liver glycogen stored, growth of some maternal organs, increased appetite, food intake, decreased exercise tolerance, increased levels of anabolic hormones
168
Maternal Catabolic
week 20-40
stored energy and nutrients to fetus
90% fetal growth
- mobilization of fat and nutrient stores, increased production and blood levels of glucose, triglycerides and FAs, decreased glycogen stores, accelerated fasting metabolism, increased appetite and food intake decline somewhat near term, increased levels of catabolic hormones
169
How much does body water increase during pregnancy
7-10L
- results from increased plasma and extracellular volume and amniotic fluid
- preparation for women's body to facilitate transfer of nutrients
- by 2nd/3rd trimester body learns to compensate
- edema
170
What is the preferred fuel for fetus
Glucose
171
Anabolic hormones
promote increased insulin production
172
Catabolic hormones
promote increased insulin resistance
173
3 sources of energy for fetus
maternal dietary glucose (carb)
glycogen stores (storage form)
new glucose created through gluconeogenesis
174
Diabetogenic
effect of pregnancy results from maternal insulin resistance
175
How much protein is accumulated for new maternal/fetal tissue
925g (2lbs)
| - less used for energy, more used for protein synthesis
176
Affect of fat stores
anabolic - accumulation
| catabolic - fat mobilization
177
What does mother use fat for
energy
178
What does fetus use fat for
steroid hormone synthesis (estrogen and progesterone)
179
What does placenta use fat for
nerve and cell membrane production (cholesterol helps to keep membranes fluid)
180
Placenta functions
hormone and enzyme production
nutrient and gas exchange
removal of waste from fetus
181
Factors that affect transfer of nutrients
size/charge
| - small molecules with little charge pass most easily
182
What passes through most easily
lipids - hydrophobic
183
Priority of nutrients
mother > placenta > fetus
184
Tissue growth in first 2 weeks following conception
organs, spine, brain stem
185
Tissue growth following week 5
rudimentary kidney, liver, circulatory, eyes, ears, moth, hands, arms, GI
186
Hypertrophy
cells grow in size
187
Hyperplasia
cells multiply
188
What is the most critical time for development in fetus
during first 2 months post conception
189
Perinatal mortality
combined mortality of stillbirths and live births with death occurring up to 6 days of age as a proportion of all births
190
low birth weight
191
Large for gestational age
> 4500 g (10lbs)
- rapid weight gain of mother, untreated gestational diabetes
- complications for mother
- taller later in life
- later life risks dependent on maternal gestational diabetes
192
Disproportionately small for gestational age
asymmetrical
- shorter term malnutrition (3rd trimester)
- post birth complications (hypoglycemia, hyperthermia)
- small organs, normal cell #
- can catch up
- poorer academic performance, risk of heart disease, high blood pressure, type 2 diabetes later on
193
Proportionately small for gestational age
symmetrical
- chronic malnutrition
- fewer birth related complications to dSGA
- small organs and small # cells
- minimal catch up, breast feeding helps
- risk of obesity, high blood pressure, type 2 diabetes later on
194
what percent does preterm birth account for in perinatal mortality
75-85%
195
Risk factors for preterm birth
Known
- poor uterine blood flow, incompetent cervix, pre-eclampsia, cigarette smoking, under nutrition, low weight gain during pregnancy, short interval between pregnancies, multi-fetal pregnancies
Potential
- stress, anxiety, depression
196
Reasons for infant mortality
access to health care, access to healthy/affordable foods, resources present
197
Desirable birth weight
3500-4500 g (7lb 12 oz to 10lb)
| - less risk of heart/lung disease, diabetes, hypertension
198
Recommended weight gain for BMI
28-40 lbs
199
Recommended weight gain for BMI 18.5 - 24.9
25-35
200
Recommended weight gain for BMI 25-29.9
15-25
201
Recommended weight gain for BMI >30
11-20
202
Where does the weight come from?
~ 30 lbs (upper limit)
- baby = 7-8
- maternal fat/nutrient stores = 6
- maternal blood = 4
- fluid in maternal tissue = 4
- placenta = 1-2
- amniotic fluid = 2
- uterus = 2
- maternal breast tissue = 2
203
Risk with too little weight gain
preterm birth and poor fetal growth
204
Risk with too much weight gain
preterm birth, LGA, caesarian section birth and weight retention in mom
205
Energy Needs in 1st trimester
no increase
206
Energy needs in 2nd trimester
increase by 340 kcal
207
Energy needs in 3rd trimester
increase by 452 kcal (2-3 servings from EWCFG)
208
Average consumption of fluid during pregnancy
~9 cups/day
209
carbohydrate intake
50-65%
210
protein intake
increase 25 g/day ~71g/day
| - average woman consumed ~78g
211
Folate roles
needed for organ/tissue growth, gene expression
212
Inadequate folate leads to
birth defects, low birth weight, preterm delivery
213
Folate recommendations
600 ug (400ug folic acid supp)
214
Vitamin A role
cell differentiation
215
Vitamin A deficiency
affect fetal lungs, urinary tract, heart
216
Vitamin A toxicity
> 10,000 IU/day
- facial malformations, brain and heart dysfunctions
- only with pre-formed vitamin A (retinol)
217
Vitamin A recommendation
770 ug/day (same as non-pregnant women)
218
Vitamin C recommendation
85 mg/day (75 mg in non-pregnant)
219
Vitamin D deficiency
poor fetal bone and tooth enamel formation, smaller than average
220
Vitamin D recommendation
660 IU (same in non-pregnant)
221
Risk factors for vitamin D inadequacy
vegan, lack of sun exposure, dark skin, obesity
222
Iron recommendation
27 mg/day (18 mg for non-pregnant)
223
additional iron required for
fetus and placenta
increased RBC
blood loss at delivery
224
What is used to measure iron status
ferritin
225
Two forms of iron
heme and non-heme
226
Heme iron
meat, poultry, fish
| - more readily absorbed
227
Non-heme iron
eggs, plant based foods, whole grain
228
main inhibitors of iron absorption
1. polyphenols - tea/coffee
2. phytate - legumes/veggies
3. calcium at levels above 300 mg
229
Optimizing iron absorption
Vitmain C, drink tea/coffee 1-2 hours after meals, avoid Ca supp. with meals
230
Calcium requirement
1000 mg/day (same as non-pregnant)
| - increase in 3rd trimester by 300 mg/day
231
Caffeine allowance
300mg/day
- 1-3 x 200ml cups coffee
- 12x 200 ml cups weak tea
- 12 oz dark chocolate
232
Two primary omega 3's
DHA and EPA
233
Why is EPA important in mothers diet?
keeps blood viscous, decreases inflammation, dilates blood vessels
234
Why is DHA important for fetus?
structural component for cell membranes in NS --> higher intelligence, better vision
235
Omega 3 recommendation
AI = 300mg, UL = 2g
236
Best source of omega 3s
fish (5oz/week)
237
Fish to avoid (mercury poisoning)
shark, tuna, swordfish
238
Fish to eat
salmon, canned light tuna, haddock
239
Vegetarian possible supplementation
folate, vitamin D, rion, vit B12, DHA, calcium
240
Benefits of physical activity during pregnancy
decrease risk of gestational diabetes
better placenta function and birth outcomes
helps prepare for birth (shorter labor)
prevents weight retention post-partum
241
Why is gestational diabetes mellitus a problem
extra glucose to fetus --> increase in insulin in fetus --> stored as triglycerides --> increase in fat mass --> metabolic adaptions that carry through life
- increased risk of still birth
242
Gestational Diabetes risk to mother
c-section delivery, pre-eclampsia, risk of type 2 diabetes, high blood pressure, obesity later on
243
Gestational Diabete risk to fetus
stillbirth, miscarriage, congenital abnormalities, large baby, insulin resistance, type 2 diabetes, high blood pressure, obesity later
244
Risk factors for GDM
obesity, weight gain between pregnancies, underweight, over 35, family history, chronic hypertension
245
GDM Management
- 3 meals/snacks - even carbs throughout day
- no energy restriction
- limit concentrated sugar
- appropriate weight gain
- regular exercise
- diet plan (40-50% CHO, 30-40% fat, 20% protein)
- low GI diet (increased fruits/veggies, increased fiber)
- if nutrition therapy doesn't work - insulin
246
Goals of Canadian Prenatal Nutrition Program
| CPNP
- improve maternal/infant health
- reduce incidence of preterm birth
- promote and support breast feeding
- build partnership with communities
- strengthen community support for pregnant women
247
What does CPNP do?
- funds community programs to provide services, resources to vulnerable pregnant women
- target women living in poverty, teens isolated, drug/alcohol abuse, immigrant
- enhances access to services (food/vit. supp., nutrition counselling, support, education, referral)
248
Fetal Alcohol Spectrum Disorder (FASD)
Describes range of disabilities that result from exposure to alcohol during pregnancy
249
The Government of Canada's FASD Initiative
Prevent and improve lives of those affected - led by PHAC and health canada
250
Ontario Programs
```
Best Start
- resources for service providers
- community hubs
Healthy Babies Healthy Children
- 0-6 years of age
- provide visiting nurse, family home visitors, referral services
```
251
What hormones prepare mammary glands for lactation
estrogen and progesteron
252
Functional unit of mammary glands
alveoli
253
Each alveolus is composed of ? with a duct in the center
secretory cells
254
What contract during letdown causing milk ejection?
Myoepithelial cells
255
Two key hormones in lactogenesis
prolactin and oxytocin
256
Prolactin
- stimulates milk production
| - inhibits ovulation
257
Oxytocin
- stimulates milk ejection ("let down")
| - promotes uterine contractions
258
Lactogenesis I
Begins during last trimester and lasts 2-5 days after birth
| - milk formation begins (lactose and protein content increase)
259
Major CHO in milk
lactose
260
Lactogenesis II
Begins 2-5 days following birth
- increase in blood flow to breast
- milk "comes in"/onset of milk secretion
261
Lactogenesis III
Begins about 10 days after birth
| - milk composition is more stable (quantity/nutrients)
262
What is the only requirement for children up to age 6 months
human milk
263
Milk allows for?
transfer of energy, nutrients and antibodies (IgA)
264
Colostrum
Lactogenesis II
- very high in protein
- IgA and lactoferrin
- low in energy, lactose, fat
- yellow colour --> beta carotene
265
Foremilk
produced at beginning of feeding
| - lower in fat/energy
266
Hindmilk
Stored deeper in breast
- more concentrated
- higher in fat/energy
267
Major component of milk
water
| - isotonic with maternal plasma
268
Energy provided by milk
~0.65 kcal/ml
| - less calories in milk vs. milk substitutes
269
Second largest component of milk
Lipid
- provide 1/2 the calories
- maternal diet affects individual FA content but not overall fat content
270
Protein fractions in human milk
Casein and whey
271
Casein
main protein in mature human milk
| - facilitates calcium absorption, increases calcium bioavailability by creating soluble complex
272
Whey
- water soluble
- some mineral-, hormone- and vitamin-binding proteins are part of whey
Ex. lactoferrin
273
Lactose
- enhances Ca absorption
| - stimulates growth of good bacteria and prevents growth of bad in infant gut
274
Oligosaccharides
medium length CHO containing lactose at one end
- can be bound to proteins (glycoproteins) or lipids (glycolipids)
- prevent binding of pathogenic microorganisms to walls of infant gut, preventing infection and diarrhea
275
What vitamin is given to all new borns
vitamin K
276
What are vitamin E levels linked to
milks fat content
277
Vitamin E roles
muscle development, prevention of RBC lysis
278
Vitamin A roles
cell differentiation
| - twice as much in colostrum
279
Vitamin D roles
fetal growth, addition to bone, and tooth/enamel formation
| - maternal sun exposure can increase levels in milk up to 10 fold
280
Low B12 seen in women:
- vegans/undernourished
- gastric bypass surgery
- have hyperthyroidism or pernicious anemia (an ability to absorb B12)
281
Mineral content in milk
decrease after 4 months (except for magnesium)
282
Zinc roles
growth, cognitive development and immune function
- bound to protein for increase availability
- rare defect in mammary gland uptake of zinc may cause deficiency --> diaper rash
283
Trace minerals in human milk
Copper, selenium, chromium, manganese, molydenum, nickel, fluoride
- not altered by mothers diet, except fluoride
284
Fluoride AI
0.01 mg/day for infants
285
Fluoride importance
helps prevent cavities and tooth decay
286
Breast milk benefits to baby
- best form of nutrition
- increased bioavailability
- protection from GI, respiratory and ear infections
- decreased infant mortality (SIDS, sanitation)
- decreased risk of of allergy, asthma, eczema, inflammatory bowel disease
- special benefits for preterm infants
287
Breast feeding benefits to mother
- reduced post partum bleeding
- delayed return of ovulation/start of menstruation
- decreased risk of breast/ovarian cancer and osteoporosis
- return to pre-pregnancy weight
- increased self confidence/bonding with infant
- practical
288
Breastfeeding duration
Exclusive for 6 months
289
Breastfeeding process
- position baby
- position breast
- present breast
- proper infant latch
290
Evidence of successful feeding
wet diapers, diluted urine, smooth bowel movements, feeds frequently, adequate growth
291
Ellyn Satter's Division of Responsibility
Parents responsible for? And infant responsible for?
292
Parent responsible for:
breast milk & calm environment
293
Infant responsible for:
timing, tempo, amount consumed
294
Breastfeeding recommendations
watch for signs of hunger, feed when awake, calm, hungry, relax and be comfortable, know when baby is full, feeding on demand
295
Maternal diet during lactation
- Increase kcal 330-400 kcal
- drink 16 cups fluids a day
- increase CHO/protein
- increase choline, vitamin C, A, E, potassium, zinc, iodine, selenium, copper, manganese, chromium
- no increase in vitamins D, K, sodium, chloride, calcium, phosphorus, magnesium, fluoride
- double iron intake (18mg)
296
Weight loss during breastfeeding
1 kg/month
297
Alcohol in breast milk
- quickly passes to breast milk (30-60m without food, 60-90 m with food)
- can take 2.5 h per drink to clear from plasma
298
Impact of alcohol on lactation
- disrupts oxytocin and let down
- odor/flavor
- decreases volume consumed
- interferes with infant sleep pattern
299
Nicotine in breast milk
- levels 1.5-3 times higher in breast milk vs. plasma
| - affect amount, colour and flavour
300
Marijuana in breast milk
- transfers to breast milk
- may affect DNA/RNA and proteins needed for growth
- may have affect on brain development
301
Caffeine in breast milk
- 1% of that in plasma
- may accumulate in infants less than 3-4 months
- may interfere with sleep or cause hyperactivity/fussiness
- moderate intake (
302
Environmental contaminants in breast milk
- may accumulate
| - benefits of breast milk out weigh risk of exposure to contaminants
303
Neonatal Jaundice
yellow colour of skin
AKA hyperbilirubinemia
- 60-70% newborns
- most frequent cause for hospital re-admission
- long term elevated bilirubin can cause permanent brain damage
- appears in the eyes first
304
Bilirubin
a pigment produced as heme from RBC breakdown
| - usually processed by liver, but infant liver isn't fully mature
305
End result of very high, untreated levels of bilirubin
Bilirubin Encephalopathy
- may cause brain damage
- mortality rate = 50%
- may cause cerebral palsy, hearing loss, intellectual impairments
- signs: being listless, sick, fevered, high pitched crying, poor latching/feeding, backward arching of neck/body
306
Two type of jaundice in infants
breastfeeding jaundice and breast milk jaundice syndrome
307
Breastfeeding jaundice
```
early onset = 2-5 days of age
Causes:
- not feeding early enough after birth, nursing irregularily/improperly, infant given water
- delayed passage of meconium
Treatment:
- increased/supplemental feedings
```
308
Breast milk jaundice syndrome
```
- more serious
Late onset = 5 days of age
Causes unknown
Treatment
- phototherapy
```
309
Development of food allergies influences by many factors:
genetics, time of introduction of other foods, air pollution
| Prevention - breast feed as long as possible, slow introduction of foods such as nuts if family history
310
Breastfeeding Initiation Rate
proportion of women who report breastfeeding their child, regardless of timing
311
Breastfeeding Duration
total length of time the infant was breastfed
312
Weaning
complete cessation of breastfeeding
313
Women who did not initiate breast feeding
younger, single, less education
314
Women who did initiate breast feeding
married, over 30, higher education
315
Common breastfeeding problems
letdown failure, hyperactive letdown/hyper-lactation, engorgement, plugged ducts/mastitis
316
Factors influencing initiation
embarrassment, time/work constraints, lack of support, lack of milk supply, concerns about diet/health, fear of pain/discomfort
317
Global Breastfeeding - IBFAN
UNICEF, WHO
| "The CODE" = international code of marketing breast-milk consituents
318
Breast feeding committee of Canada
Goal = establish breastfeeding as a cultural norm in Canda by promoting the WHO/UNICEF baby friendly hospital initiative
Does not accept:
- free/low cost breast milk substitutes
- feeding bottles
- implements ten steps to successful breastfeeding
319
INFACT Canada - La LechE League
Nestle Free Week
320
Mother risk - telephone support
provides answer to questions regarding medications, chemical exposures and diseases
- website
321
Breastfeeding
normal and unequalled method of feeding infants
| - nutrition, immunologic protection, growth and development of infants and toddlers
