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NUTR 2050 > Midterm > Flashcards

Midterm Flashcards

1
Q

Study of Nutrition

A

Study of food, nutrients and other factors that interact to impact how our bodies process food and utilize nutrients

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2
Q

Benefits of food

A

Provides energy (in form of calories), nutrients, and other substances needed for growth and health

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3
Q

Calorie

A

Measure of the amount of energy transferred from food to energy

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4
Q

Nutrients

A

Chemical substances in food that are used by the body

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5
Q

Diet

A

Consumption of foods and thoughts that go in to what we consume on a daily basis
- tells us about one’s culture and traditions

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6
Q

Carbohydrates

A

Organic compounds consisting of C, H and O

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7
Q

Proteins

A

Organic compounds consisting of amino acids

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8
Q

Fats (lipids)

A

Organic compounds that consist of a glycerol molecule bound to three fatty acids

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9
Q

Vitamins

A

A group of organic compounds essential for proper nutrition and growth and required in limited amount in diet

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10
Q

Minerals

A

A group of inorganic compounds essential for proper nutrition and growth, and required in limited amounts in diet

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11
Q

Water

A

Essential component of our diet

  • helps transport nutrients to cells
  • lubricates us
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12
Q

Essential Nutrients

A

Nutrients we cannot make on our own but only obtain from our diet

  • carbohydrates
  • certain amino acids (9 essential)
  • essential fatty acids
  • vitamins and minerals
  • water (can’t manufacture enough on our own)
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13
Q

Nonessential Nutrients

A

Present in foods and used by the body but not required in the diet since we can also synthesize them ourselves

  • cholesterol
  • glucose
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14
Q

Malnutriton

A

Lack of nutrition over extended period of time

  • undernutrition
  • over-nutrition
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15
Q

Deficiency

A

Inadequate nutrient intake - depletion of tissue reserves - decreased blood nutrient level - insufficient nutrient available to cells - impaired cellular functions - physical signs/symptoms of deficiency - long term impairment of health

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16
Q

Toxicity

A

Excessive nutrient intake - saturation of tissue reserves - increased blood nutrient level - excessive nutrient available to cells - impaired cellular function - physical signs/symptoms of toxicity - long term impairment of health

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17
Q

Dietary reference intakes

A

Nutrient intake standards for healthy members of population

  • established jointly by scientists
  • continually updated
  • different categories exist for certain nutrients
  • Specific to life stage/ages
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18
Q

RDA

A

Recommended dietary allowance

- Levels of essential nutrients adequate for ~98% of population

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19
Q

AI

A

Adequate intakes

- Tentative RDA’s used when scientific information is less conclusive

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20
Q

EAR

A

Estimated average requirements

- Estimated values to met requirements of half of healthy individuals in a population group

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21
Q

UL

A

Tolerable upper intake levels

- Upper limits of nutrients compatible with health (should not be exceeded)

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22
Q

Daily Values

A

Standards for daily intakes of nutrients

  • based on needs for 2000 cal/day diet or eating pattern
  • typically used on nutrition labels of foods
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23
Q

Factors that impact nutrient needs

A
  • age
  • body size
  • gender
  • genetic traits
  • growth
  • illness
  • lifestyle habits
  • medication
  • pregnant (lactating)
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24
Q

Life cycle approach to nutrition and health

A

For certain population groups and life stages different people are more susceptible to deficiencies and diseases

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25
Q

WHO definition of health and extended definition

A

“Health is a state of complete physical, social and mental well being and not merely the absence of disease or infirmity.”

“…the extent to which an individual or group are able to realize aspirations and satisfy needs, and to change or cope with environment.”

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26
Q

Health promotion

A

Process of enabling people to increase control over determinants of health

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27
Q

Fundamental conditions and resources for health are:

A
  • peace
  • shelter
  • education
  • food
  • income
  • a stable eco-system
  • sustainable resources
  • social justice
  • equity
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28
Q

Population/Public Health Approach

A

Our health and health behaviours are the result of numerous determinants from various sectors
- to improve health, action must be taken of the full range of health determinants and involve numerous sectors

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29
Q

Q: Define the term essential nutrients. Identify two essential nutrients and representative examples of foods that contain them

A

Nutrients that our body can’t make so you have to get them from food

  • Carbohydrates (e.g. bread)
  • Calcium (e.g. milk)
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30
Q

3 levels of prevention

A
  1. Primary (ALL)
    - reduce new cases of problem behaviour
  2. Secondary (SOME)
    - improve health of people that already have problematic behaviour
  3. Tertiary (FEW)
    - help people with chronic or infections conditions manage their symptoms
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31
Q

Primary prevention

A

Health promotion activities aimed at a specific illness or disease
- precedes disease and is applied to generally healthy individuals
EX: immunizations, breast cancer screening, session on healthy eating to prevent cancer

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32
Q

Secondary prevention

A

Activities focused on early identification of health problems (identify and treat people who have asymptomatic/preclinical disease)
- people who pose risk factors for certain diseases
EX: breast self exam, screenings for genetic cancers, screening for specific illness

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33
Q

Tertiary prevention

A

Educating of an individual with a disease with the goal of returning them to optimum level of functioning
- targeting people that already have a certain condition
EX: referring a person who has stroke to rehab centre, educating person with type 2 diabetes how to identify and prevent complications

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34
Q

Health promotion (in CA) at federal level

A
  • Public Health Agency of Canada
  • Health Canada
  • Canadian Food Inspection Agency
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35
Q

Health promotion (in ON) at provincial level

A
  • Ministry of Health and Long Term Care

- Public Health Units

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36
Q

Health Canada

A
  • Health care
  • Education, food guide
  • Development of food regulations (food labeling, the Food and Drugs Act, health claims)
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37
Q

Public Health Agency of Canada

A
  • Health promotion
  • Prevention and control of disease
  • Disease Surveillance
  • Public health emergencies (food borne illness outbreaks)
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38
Q

Canadian Food Inspection Agency

A
  • Enforcement of food regulations set by Health Canada
  • Inspection of facilities
  • Identification and oversight of food recalls
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39
Q

Federal Minister of Health

A

Jane Philpott

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40
Q

PHAC Healthy Living Strategy targets

A
  1. Healthy eating, physical activity, and theirrelationsaip to health weights
  2. Tobacco, diabetes, chronic disease prevention, etc.
  3. Mental Health
  4. Injury prevention
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41
Q

Sodium reduction strategy for Canada

A 
Particular strategy initiated in 2007:
Reduction task force
- researchers, industry, medical community, professional organizations, government
Risks
- elevated blood pressure
- CVD
- stroke
- kidney disease
Avg. intake among CA (3400 mg/day)
Recommended intake (1500 mg/day)
UL (2300 mg/day)
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42
Q

Who has highest intake of sodium?

A

Male teenagers

  • sports drinks
  • processed foods
  • fast food availability
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43
Q

High sodium in common processed foods

A
  • Kraft dinner
  • Frozen pizza
  • Pizza pockets
  • Soy sauce
  • Ketchup
  • Pickles
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44
Q

Provincial Minister of Health

A

Dr. Eric Hoskins

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45
Q

Ministry of Health and Long Term Care

A

Healthy Eating and Active Living Action Plan
- access to healthy food for children
- help Ontarians access dieticians
- Active 2010
Healthy Change Ontario’s Action Plan
- provides action plan for Health Care
- keeping ontario healthy, faster access to stronger family health care, right care, right time, right place

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46
Q

What do Dietitians do in Public Health?

A
  • Preparation of kits, educational material
  • Liaise with policy makers to work on nutrition policy implementation and guidelines
  • Public level screening
  • Public level education
  • Nutrition counselling (in person, telephone)
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47
Q

Define social determinant of health

A

Economic and social circumstances within which people live
- processes/mechanisms by which members of different socio-economic groups come to experience varying degrees of health and illness

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48
Q

12 Core Determinants of Health

A
  • health services
  • education
  • physical environments
  • social support networks
  • health child development
  • gender
  • social environments
  • personal health practices and coping skills
  • culture
  • biology and genetic endowment
  • employment and working conditions
  • income and social status
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49
Q

Socio-ecological Model

A

Individual - Interpersonal - Organizational - Community - Public Policy

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50
Q

SeM - INDIVIDUAL

A

Personal level factors

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51
Q

SeM - INTERPERSONAL

A

Factors relating to the influence of families, peers and partners, culture

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52
Q

SeM - ORGANIZATIONAL (institutional)

A

Practices and physical environment of an organization

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53
Q

SeM - COMMUNITY

A

Cultural values or norms unique to urban, rural and remote settings

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54
Q

SeM - PUBLIC POLICY

A

Broader guidelines at various levels of government

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55
Q

Where do food and nutrition fit into the SeM?

A

Individual: lactose intolerance impacting calcium status in individuals
Interpersonal: meal-time practices in the home – eating meals together
Organizational/institutional: time and space available to eat lunch at your workplace
Community: living in a food desert – few locations nearby to purchase healthy fresh foods
Public Policy: The former Conservative government replacing the federal Food Mail program which subsidized foods being shipped to the North, with Nutrition North, another federal program which subsidizes food retailers – none have been successful in establishing food security in remote northern regions of Canada!

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56
Q

Food security

A

All people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life

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57
Q

Food insecurity

A

The inability to acquire nutritionally adequate foods in culturally acceptable ways

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58
Q

Food availability

A

Daily energy, macronutrient, and micronutrient needs must be met

  • food can be available for individuals or families living in a city or rural area
  • sources of food locally such as farmer’s markets, grocery stores etc.
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59
Q

Food access

A

Individuals or households may not have access to available foods due to circumstances such as insufficient income or lack of transportation

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60
Q

Food supply and systems

A

Environmental impacts can lead to droughts, floods, sharp price increases

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61
Q

Traditional foods

A

Plants and animals harvested from the local environment

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62
Q

Tradition food systems

A

Include preferences at individual level

- physical, social and cultural environments

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63
Q

Determinants of traditional food choice

A
  • no time to prepare
  • lack of knowledge
  • unhealthy
  • no land access
  • expensive
  • no availability
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64
Q

Food as a social determinant of health

A

To achieve sustainable food systems, community members of all ages must identify a shared vision of food security and translate it into a locally controlled food system in order to ensure a vibrant healthy community

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65
Q

Emerging adult

A

Phase of the life span between adolescence and adulthood

  • a period of time to explore possibilities and define one’s self
  • not necessarily settled on career, house, partner
  • theory coined by Jeffrey Arnett
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66
Q

Transitional period leading to adulthood

A
  • moving from home
  • paying bills
  • own place to live
  • buying/cooking food
  • responsible for yourself (making appointments)
  • completing education
  • life partner
  • starting family
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67
Q

How has this stage evolved?

A

Generally speaking…

  • leaving home at older ages
  • leaving school at older ages
  • age of marriage is increasing
  • age of parenthood increasing
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68
Q

Average age of first marriage in 1972 vs. today for men and women

A

Men: 25 vs. 31
Women: 22 vs. 29

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69
Q

Characteristics of emerging adult

A
  • Don’t see themselves as adults
  • Time of identity exploration
    (work, love, worldview, lifestyle)
  • Experimentation
  • High level of transition
    (residential status, school attendance)
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70
Q

Human brain does not reach full maturity until?

A

Mid 20’s

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71
Q

Brain development in emerging adulthood

A

Frontal lobe

  • largest of brain’s structures
  • “prefrontal cortex” changes
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72
Q

Prefrontal cortex

A

Termed “Executive Suite” - Involves processing of tasks such as:

  • calibration of risk and reward
  • problem solving
  • prioritizing
  • long term planning
  • self evaluation (awareness being less critical)
  • regulation of emotion (not being so dramatic)
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73
Q

Changes to prefrontal cortex during emerging adult stage

A

“Melting of teenage brain”
Myelination
- more extensive myelination of nerves in this area of rain
Synaptic pruning
- nerve connections are pruned back = more efficient signal transmission among remaining nerves

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74
Q

Result of changes to prefrontal cortex

A
  • More sophisticated learning and emotion regulation

- Executive suite functions are more efficient

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75
Q

Changes by the end of emerging adulthood

A
  • More complex thinking (consider both present and future)
  • Appreciation of diverse views
  • Emotional regulation (weigh immediate rewards with future consequences)
  • Risk taking and decision making (increased ability to modulate risk taking and make decisions about future)
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76
Q

Overall health and well-being of emerging adult

A
  • self reported health is good to excellent
  • rates of disease and stability are low
  • peak in substance use, STI
  • psychiatric disorders also peak (anxiety increases but depression decreases)
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77
Q

Window of opportunity for public health

A

Time of identity exploration during emerging adult stage

  • incorporating health related behaviours is part of self-identity
  • important indicator of lasting health-related behaviours
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78
Q

Nutrition in emerging adulthood

A
  • Support active lifestyle
  • Maintain physical status (healthy body weight, prevent type 2 diabetes)
  • Special requirements for reproduction
  • Otherwise nutrient requirements for adulthood
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79
Q

Trends in general dietary intake emerging adult

A
  • Fast food intake is highest
  • High consumption of sugar-sweetened and caffeinated beverages
  • High salty snack foods
  • Low intake of fruit and vegetables (only 13% of uni/college students have 5 or more servings per day)
  • Low milk intake
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80
Q

Lifestyle influences emerging adult diet

A

Eating on the run is common

  • sugar sweetened beverage
  • fast food
  • total fat and saturated fat
  • fruits and veggies
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81
Q

True or false - students who live on campus have better diets than those who live off campus?

A

True - Compared to students living on campus those that lived with parents or in rented houses/apartments had:

  • increased fast food intake
  • decreased fruit, vegetable, and whole grain intake
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82
Q

Obesity and weight gain in emerging adults

A
  • Large increase in prevalence of obesity among 18-29 year olds
  • Transition to university (freshman 15)
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83
Q

BMI

A

Measure of obesity - weight relative to height (not a direct measure of body fat)
BMI = kg/m2
NOT ACCURATE FOR EVERYONE

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84
Q

BMI underweight

A

less than 18.5

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85
Q

BMI normal

A

18.5-24.9

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86
Q

BMI overweight

A

25.0 - 29.9

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87
Q

BMI obese I

A

30-34.9

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88
Q

BMI obese II

A

35.0 - 39.9

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89
Q

BMI obese III

A

greater than 40.0

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90
Q

Key considerations for using BMI

A
  • 18+
  • based on population level data
  • only part of an individual’s risk assessment
  • does not take into account bone density
  • not to be used with pregnant/lactating women
  • does not capture risk with weight change
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91
Q

Results of BMI less accurate for who?

A
  • emerging or young adults
  • muscular/lean individuals
  • certain population groups
  • adults older than 65
  • dehydrated individuals
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92
Q

Q: BMI measure don’t accurately represent healthy weights for:

A. athletes with larger percentage of muscle
B. individuals with little muscle mass
C. individuals with large, dense bones
D. dehydrated individuals
E. all of the above
A

ALL OF THE ABOVE

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93
Q

Fertility

A

Ability to bear children

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94
Q

Infertility

A

Inability to bear children

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95
Q

(In)Fecundity

A

Biologic ability (inability) to bear children (uterus, ovaries - basically having proper parts)

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96
Q

Subfertility

A

Reduced level of fertility or early pregnancy losses

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97
Q

Infertility rates

A
  • About 18% of couples are sub fertile (44% able to conceive with no intervention in 3 years)
  • Healthy couples have a 20-25% chance of diagnosed pregnancy within a single menstrual cycle
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98
Q

Puberty

A

Period in which human become biologically capable of reproduction

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99
Q

Ova

A

Female reproductive cells that are produced and stored in ovaries

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100
Q

Follicle

A

Cellular structure in ovary where ova matures

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101
Q

Sperm

A

Male reproductive cells

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102
Q

Reproductive system develops…

A

within first months after conception and continue to grow and develop through puberty (course of 3-5 years)

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103
Q

Women born with how many ova?

A

Lifetime supply of approximately 7 million

- during fertile years about 400-500 ova will mature and be released

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104
Q

Menstrual cycle

A

4 week interval in which hormones direct buildup of blood and nutrient stores within uterus
- ova matures and is released

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105
Q

Follicular phase

A

First 14 days of cycle

- helping egg mature to eventually be released through ovulation

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106
Q

Luteal phase

A

Last 14 days of cycle

  • lining of uterus build up (blood and nutrients)
  • egg released
  • ovulation occurs
  • menstruation and fertilization takes place
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107
Q

Gonadotropin-releasing hormone

A

Released by hypothalamus

- stimulates the anterior pituitary gland to release FSH and LH

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108
Q

Follicle-stimulating hormone

A
  • stimulates maturation of ovum (&sperm in men)

- stimulates production of estrogen

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109
Q

Lutenizing hormone

A
  • stimulates secretion of progesterone

- surge in LH causes release of ovum

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110
Q

Estrogen

A
  • stimulates further growth and maturation of follicle
  • stimulates vascularity and storage of glycogen and other nutrients within uterus
  • decrease in estrogen at the end of menstrual cycle stimulates release of GnRH
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111
Q

Progesterone

A
  • prepares uterus for fertilized ovum

- increases vascularity of endometrium

112
Q

Sperm production

A

Men are born with sperm-producing capability

- sperm production begins during puberty and decreases somewhat after age 30 with production continuing to old age

113
Q

Ongoing vs. cyclic

A
  • Men continually produce sperm

- Menstruation is cyclic

114
Q

Sperm production hormones

A
  • GnRH signal release of FSH and LH
  • FSH and LH stimulate production of testosterone by testes
  • Testosterone stimulate maturation of sperm (takes 70-80 days)
  • Sperm are stored in epididymis and released in semen
115
Q

Main fertility disruptions

A
  • contraceptive use
  • severe stress
  • infection
  • tubal damage
  • chromosomal damage
116
Q

Nutrition and lifestyle factors affecting fertility

A
  • energy status and nutrient adequacy
  • obesity
  • weight loss
  • undernutrition
  • high intensity training
  • low intake of specific foods and food components
117
Q

Estrogen and leptin levels increase with…

A

high body fat

118
Q

Obese women tend to have higher/lower levels of estrogen, androgens and leptin?

A

HIGHER

- fertility compromised in women with BMI greater than 30 (disruption of hormones)

119
Q

Hormonal differences result in?

A

Irregularity of menstrual cycle, ovulatory failure and amenorrhea

120
Q

Obesity and hormonal affect on men

A
  • lower levels of testosterone

- increased estrogen and leptin levels

121
Q

Reducing fertility problems

A

Weight loss

  • 7 to 22 pounds in overweight women
  • 100 pounds in very obese men
  • reduces insulin resistance and can ameliorate hormonal imbalances
122
Q

Weight reduction strategy should:

A
  • focus on lifestyle changes
  • improve overall diet quality
  • decrease caloric intake
  • increase physical activity
123
Q

Weight loss in non-overweight women

A
  • loss of over 10-15% of usual weight decreases estrogen, LH, and FSH
  • results in amenorrhea, anovulatory cycles
  • athletes
  • eating disorders that result in very low weight and fat stores
  • fertility compromised in women with BMI less than 20
124
Q

Weight loss in non-overweight men

A
  • loss of 10-15% normal weight leads to decreased sperm viability and motility
  • loss of over 25% normal weight stops sperm production
125
Q

Acute undernutrition

A

Associated with dramatic decline in food energy and nutrients that recovers with normal food intake or eating behaviour (definite problems in terms of fertility)

126
Q

Chronic undernutrition

A

Primary effect = birth of small/underweight infants with high likelihood of death in first year of life

  • reduced fertility
  • huge problems in terms of birth outcomes
127
Q

Adverse effects of intense physical activity over long term

A

As a result of hormonal and metabolic changes

  • delayed age at puberty
  • lack of regular menstrual cycles
  • reduced levels of estrogen
  • low levels of body fat
  • decreased bone mass (stress fractures)
128
Q

Female Athletic Triad consists of:

A
  • amenorrhea
  • eating disorder (restricting)
  • osteoporosis
129
Q

Female athletic triad triggered when

A

energy intake is substantially below requirement

130
Q

Female athletic triad results in:

A
  • decreased LH and FSH levels
  • lack of estrogen
  • no menstruation
131
Q

Plant based diet (or low fat, high fiber) linked to?

A

Reduced estrogen and irregular periods

- less than 20% total calories from fat seems to negatively influence fertility

132
Q

Isoflavones (from soy)

A
  • may influence levels of gonadotropins, estrogen and progesterone
  • also associated with reduced sperm count in men
133
Q

Soy consumption

A

In increased amounts soy can mimic hormones in body and tends to disrupt hormone and menstrual cycles

134
Q

Low iron linked to:

A
  • premature delivery

- low iron status of baby

135
Q

Iron and fertility

A

About 50% of women enter pregnancy with inadequate iron stores and supplements usually recommended

136
Q

Caffeine and fertility

A

No evidence for linkage

- in some studies chance of conception decreased

137
Q

Alcohol and fertility

A
  • may decrease estrogen and testosterone levels
138
Q

Folate and fertility

A

Folate intake related to increased fertility in women and healthy development of embryo following conception

139
Q

Periconceptional period

A

After conception but before pregnancy is diagnosed

140
Q

Which nutrient is very important in the periconceptional period?

A

FOLATE - healthy development of embryo

- many women not following recommendation to take folate supplements

141
Q

Where is folate found?

A

Many dark leafy greens

142
Q

Who is most vulnerable to be lacking in folate consumption?

A
  • single women
  • unplanned pregnancy
  • low education
143
Q

Folate after fertilization

A

Insufficient amounts affect embryonic development especially neural tube defects

144
Q

Neural tube defects

A
  • occur in first 2-3 weeks after conception before mother knows she is pregnant
  • anywhere in spine (most commonly lower)
  • paralysis, exposed meninges, hydrocephalus
145
Q

Folate recommendation

A

400 micrograms/day recommended in supplemental form to all women who are sexually active and at risk of becoming pregnant

146
Q

Naturally occurring folate

A
  • green leafy veggies (asparagus, broccoli, brussels sprouts)
  • avocado
  • corn, beets
  • fruits
  • whole grains
  • dried beans, lentils and peas
  • beef liver
  • yeast preparations
147
Q

Bioavailability of nutrients

A

Efficiency of absorption, utilization and or retention of nutrients present in food

148
Q

Bioavailability affected by:

A
  • nutrient content of food
  • food processing
  • physical state of person
  • ability to digest and absorb nutrients is compromised
  • interactions among components of diet
149
Q

Bioavailability can be improved by?

A
  • Fortification

- Enrichment

150
Q

Fortification

A

Addition of nutrients not originally present in particular food

  • almond milk
  • rice milk
151
Q

Enrichment

A

Addition of nutrients that were lost during food processing

- addition of vitamins to processed white flour

152
Q

Folic acid

A

Synthetic form of natural folate

  • highly bioavailable
  • found in supplements and supplemented food
153
Q

Folic acid fortified foods in CA

A
  • flour, white, enriched
  • enriched pasta
  • enriched corn meal
  • infant formula
  • formulated liquid diets
  • meal replacements
  • stimulated meat/poultry products and extenders
  • simulated egg
154
Q

Voluntarily fortified foods

A
  • breakfast cereals
  • pre cooked rice
  • fruit flavoured drinks
  • evaporated goat’s milk
  • beverages from legumes, nuts
155
Q

Q: Which is high folate breakfast?

  1. 2 slices of 7-grain toast, 1tbsp jam, cup skim milk, medium banana, coffee with cream
  2. 1.5 cups of cooked oatmeal, 1tbsp brown sugar, 1 cup rice milk, 1c apple juice
A

BREAKFAST 2

156
Q

Diabetes Mellitus

A

Intolerance to carbohydrate with fasting glucose greater than 126 mg/dL

157
Q

Type 1 diabetes

A

Results from destruction of insulin-producing cells (10% of cases)

158
Q

Type 2 diabetes

A

Body unable to use insulin normally or to produce enough insulin or both (90% of cases)

159
Q

Gestational diabetes

A

Onset during pregnancy (3-7%)

  • often times type 2 and younger women
  • poorly controlled blood glucose levels increases risk of fetal and maternal health problems
  • increased risk of miscarriage
  • fetal size diminished
  • macro semantic birth
  • increased risk of mother and infant
  • developing type 2 diabetes late in life
160
Q

Diabetes prior to pregnancy

A

High blood glucose levels during first 2 months of pregnancy are associated with 2-3 fold increase in congenital abnormalities in newborn and higher rates of miscarriage

161
Q

Prevention of GDM

A
  • weight loss
  • exercise
  • healthful dietary pattern
  • increased fiber intake
  • intake of low GI carbohydrate sources
  • increased vegetable and fruit consumption
162
Q

Q: Three components of female athlete triad are?

A

Amenorrhea, disordered eating, and osteoporosis

163
Q

Gestational age

A

Assessed from date of conception

164
Q

Gestational age for average pregnancy

165
Q

Menstrual age

A

Assessed from onset of last menstrual period

166
Q

Menstrual age for average pregnancy

167
Q

Embryo

A

First trimester

168
Q

Fetus

A

Second trimester

169
Q

Before 20 weeks

A

Miscarriage or spontaneous abortion

170
Q

After 20 weeks

A

Fetal death/still birth

171
Q

Preterm

A

Born less than 37 week

172
Q

Post term

A

Born after 42 weeks

173
Q

Real critical period?

A

Between second and third trimester

174
Q

Baby born anytime before 26 weeks

A
  • not likely to survive on their own

- lungs not properly developed

175
Q

Maternal anabolic phase

A

Weeks 1-20

  • focus is building mother’s capacity
  • approximately 10% of fetal growth occurs
176
Q

Maternal catabolic phase

A

Weeks 20-40

  • stored energy and nutrients to fetus
  • approximately 90% of fetal growth occurs
177
Q

Maternal physiology

A

Changes in maternal body composition and functions occur in specific sequence

178
Q

Specific sequence of maternal physiology

A
  1. maternal plasma volume expands
  2. maternal nutrient stores increase
  3. placental weight increases
  4. uterine blood flow increases
  5. fetal weight finally really starts to increase
179
Q

Body water changes during pregnancy

A

Women’s body water increases between 7 and 10L

  • results from increased plasma and extracellular volume and amniotic fluid
  • begins first few weeks after conception
  • necessary in relation to nutrients that need to be delivered (expand overall blood volume to increase capacity to deliver nutrients_
180
Q

Preferred fuel for fetus?

181
Q

Carbohydrate metabolism during anabolic phase

A

Hormones promote increased insulin production

182
Q

Carbohydrate metabolism during catabolic phase

A
  • Increased insulin resistance in mother
  • Hormones inhibit energy storing
  • Women’s body can’t use glucose as energy source and rely on fat stores instead
183
Q

Fetus has glucose from what 3 main sources?

A
  • Maternal dietary sources
  • Maternal storage form of glucose
  • Glucose manufactured from gluconeogenesis from fat stores in earlier stage of pregnancy
184
Q

Diabetogenic effect of pregnancy

A

Results from maternal insulin resistance

- huge spikes in glucose during pregnancy

185
Q

Protein metabolism during pregnancy

A
  • About 925g of protein accumulated for new maternal and fetal tissue (growing hair/skin/nails, enzyme manufacturing)
  • no extra protein is stored
  • primarily met by mother’s intake
186
Q

Fat metabolism during pregnancy

A

Fat stores accumulate in first half of pregnancy and enhanced fat mobilization in last half of pregnancy

187
Q

Blood lipid levels during pregnancy

A

Increase from non pregnant women to third trimester

188
Q

What is fat used for during pregnancy?

A 
Mother
- reliance on fat stores for energy
Placenta
- steroid hormone synthesis
Fetus
- nerve and cell membrane production
- energy
189
Q

Mineral metabolism during pregnancy

A

Calcium
- increased bone turnover so more calcium absorbed from food
Sodium
- increased requirement due to elevated body water and tissue enlargement

190
Q

Placenta (flat cake)

A

Disk shaped organ of nutrient and gas exchange between mom and fetus (temporary organ)

191
Q

Functions of placenta

A
  • hormone and enzyme production
  • nutrient and gas exchange
  • removal of waste from fetus
192
Q

Factors that affect nutrient transfer between placenta

A
  • size and charge of molecules
  • small molecules with little charge pass through most easily (i.e. water)
  • lipid solubility of particles (lipids pass through more easily)
  • concentration of nutrients in maternal and fetal blood
193
Q

Critical periods

A

Preprogrammed time periods during embryonic and fetal development when specific cells, organs and tissues are formed and integrated or functional levels established

194
Q

Fetal development

A
  • one way street

- most critical development during first 2 months post conception

195
Q

Very preterm birth

A

Gestational age less than 32 completed weeks

196
Q

Perinatal mortality

A

Combined mortality of stillbirths and live births with death occurring up to 6 days of age as a proportion of all births

197
Q

Low birth weight

A

Birth weight less than 2500 g (5.5 lbs)

198
Q

Disproportionately Small for Gestational Age

A

dSGA (asymmetrical)

  • short term malnutrition during 3rd trimester
  • post birth complications
  • small organs, normal cell #
  • can catch up
  • poorer academic performance, risk of heart disease, high bp, type 2 diabetes later on
199
Q

Proportionately Small for Gestational Age

A

pSGA (symmetrical)

  • chronic malnutrition
  • fewer birth related complications
  • small organs and # of cells
  • minimal catch up, breastfeeding helps
  • risk of obesity, high bp, type 2 diabetes later on
200
Q

Large for Gestational Age

A

Greater than 90th percentile for sex and GA and birthweight greater than 4500 g (10 lbs)

  • rapid weight gain of mother, untreated GDM
  • complications for mother
  • taller later in life
  • later life risks (chronic disease)
201
Q

Preterm birth rates in CA

A
  • rates are going down as we are learning more about healthy pregnancy and nutriton
202
Q

Infant mortality

A

Reflects general health and socioeconomic status of a population because it identifies vulnerable members of population

203
Q

How much weight should you gain during pregnancy?

A

DEPENDS ON PRE-PREGNANCY WEIGHT (don’t gain much during 1st trimester)

  • underweight (28-40 lbs)
  • normal weight (25-35 lbs)
  • overweight (15-25 lbs)
  • obese (11-20 lbs)
204
Q

Where does pregnancy weight go?

A 
Baby: 7-8 lbs
Maternal fat and nutrient stores: 7 lbs
Maternal blood: 4 lbs
Fluids in maternal tissue: 4 lbs
Placenta: 1-2 lbs
Amniotic fluid: 2 lbs
Uterus: 2 lbs
Maternal breast tissue: 2 lbs
205
Q

Risks with too little weight gain

A
  • preterm birth
  • poor fetal growth
  • small for gestational age
206
Q

Risks with too much weight gain

A
  • preterm birth
  • large for gestational age
  • caesarean birth
  • weight retention mom (future risk of obesity)
  • WEIGHT loss not recommended during pregnancy
207
Q

Q: How much do energy needs increase in the first trimester?

208
Q

Energy needs trimester 2

A

Increase kcal by 340

209
Q

Energy needs in trimester 3

A

Increase Kcal by 452

- essentially 2-3 more servings from EWCFG

210
Q

MINIMUM carbohydrate intake during pregnancy

A

175 g/day

  • primary source for fetus
  • definitely needs to increase
211
Q

Alcohol ingestion during pregnancy

A

Not necessarily solid evidence but should be avoided

212
Q

Artificial sweeteners during pregnancy

A

No evidence of causing harm but think about nutrient density

- ensure that nutrient dense foods aren’t replaced by artificial sweeteners

213
Q

Protein during pregnancy

A

+25g/day (approximately 71g) particularly in second and third trimester

214
Q

Folate recommendation during pregnancy

A

600 micro grams/day of dietary folate (400 micro grams/day as folic acid supplement)

215
Q

Iron needs in pregnancy

A

27 mg/day

- additional iron needed for fetus and placenta, increased red blood cells, blood loss at delivery

216
Q

Iron status

A

Many women enter pregnancy with subclinical deficiency

- for infants this could lead to low birth weight, preterm birth, and slower cognitive development

217
Q

Iron supplementation during pregnancy

A

16-20 mg iron per multivitamin throughout pregnancy (lower absorption)

218
Q

If iron deficient

A

Provide supplemental form only

- side effects: nausea, cramps, gas, constipation

219
Q

Calcium intake during pregnancy

A

Recommendation same as nonpregnant - 1000 mg/day
- increased need in 3rd trimester of an extra 300 mg/day - can be accounted for by increased absorption from food and release of calcium from maternal bones

220
Q

Foods to avoid during pregnancy

A
  • semi soft cheeses
  • raw and undercooked meats, poultry and fish
  • runny yolks and raw eggs
  • lunch meats
  • uncooked hot dogs
221
Q

Caffeine during pregnancy

A

Recommended less than 300 mg/day

  • 1-3 200 ml cups of coffee
  • 12 200 ml cups of weak tea
  • 12 oz dark chocolate
222
Q

GDM risks for mother

A
  • c section delivery
  • risk of preeclampsia
  • risk of type 2 diabetes, high bp, and obesity later on
223
Q

GDM risks for infant

A
  • still birth
  • miscarriage
  • congenital abnormalities
  • large baby
  • insulin resistance, type 2 diabetes, high bp, obesity later on
224
Q

GDM management

A 
3 meals and snacks
- even out carbohydrate intake across day
No energy restriction
Limit concentrated sugar
Appropriate weight gain
Regular exercise
225
Q

Diet plan prescribed to manage GDM

A

40-50% CHO
30-40% fat
20% protein
* if nutrition therapy does not work within 2 weeks may need insulin

226
Q

Mammary gland development

A

During puberty a system of dunces, lobes and alveoli develops
- estrogen and progesterone levels contribute
System remains inactive until pregnancy
During pregnancy growth proliferates with ductal branching and lobular-alveolar development proceeding at a spectacular, orderly, rate

227
Q

Alveoli

A

Functional units in mammary glands

228
Q

Secretory cells

A

Make up alveolus (just below nipple) and have a duct in the center

229
Q

Myoepithelial cells

A

Line alveoli and contract during letdown causing milk ejection

230
Q

Mammary glands

A

Milk producing cells

231
Q

Two key hormones in lactogenesis

A
  1. Prolactin

2. Oxytocin

232
Q

Prolactin

A

Stimulates production of milk

- suckling, stress, sleep and sex can produce prolactin

233
Q

Oxytocin

A

Stimulates production of milk and let down of milk into ducts (also causes uterus to contract during birth)
- suckling, thinking about child, crying, sex produce oxytocin

234
Q

Lactogenesis I

A
  • begins during last trimester of pregnancy and lasts until 2-5 days after birth
  • milk formation begins, and lactose and protein content in milk increases
  • may be affected by premature delivery (mothers with premature births are usually unable to provide full milk supply)
235
Q

Major CHO in milk?

236
Q

Lactogenesis II

A
  • begins 2-5 days after birth
  • characterized by increased blood flow to breasts (onset of milk secretion)
  • significant changes in milk composition and quantity over first 10 days of life
237
Q

Lactogenesis III

A
  • begins about 10 days after birth
  • milk composition is more stable
  • routine schedule of breast feeding should be established
238
Q

Human milk consumption

A
  • only food needed by majority of healthy infants for up to 6 months
  • allows for transfer of energy, nutrients and antibodies from mother to infant to protect against infections
239
Q

Composition of human milk can change…

A
  • over a single feeding
  • over a day
  • based on infant age
  • presence of infection in breast
  • with menses
  • with maternal nutritional status
240
Q

Colostrum

A

First milk secreted in Lactogenesis II

  • very high in protein compared to milk once established
  • high in secretory IgA and lactoferrin (involved in immune function and high in Vit A)
  • lower in energy, lactose, and fat
241
Q

Water in human milk

A
  • major component in human milk is water
  • same concentration as maternal plasma
  • allows baby to be hydrated
242
Q

Energy in human milk

A

Approximately 0.65 kcal/mL

- less in calories than human milk substitutes

243
Q

Lipids in human milk

A
  • second largest component
  • provides half calories
  • foremilk lower fat compared to hind milk
  • what mother eats does not affect fat content
244
Q

Maternal diet and lipid content in milk

A

Affects fatty acid profile but not total fat content

245
Q

Protein in human milk

A
  • relatively low compared to other mammals
  • mostly dependent on time since delivery
  • both nutritional and non-nutritional effects
246
Q

Casin

A
  • main protein in mature human milk
  • contributes to white appearance
  • facilitates calcium absorption; increases calcium bioavailability by creating a soluble complex
247
Q

Whey

A
  • other water soluble protein in milk
  • some mineral/hormone/vitamin binding proteins
  • ex: lactoferrin (carries iron in a form that is easily absorbed)
248
Q

Lactose

A
  • major CHO in milk
  • enhances calcium absorption
  • stimulates growth of good bacteria and prevents growth of bad bacteria in developing infant gut
249
Q

Oligosaccharides

A
  • medium length CHO containing lactose at one end
  • can be bound to proteins or lipid
  • prevent binding of pathogenic microorganisms to walls of infant gut, preventing infection and diarrhea
250
Q

Q: What fat-soluble vitamin is given to all infants at birth?

251
Q

Vitamin K

A
  • supplemented to all children at birth
  • about 5% of breastfed infants at risk for K deficiency based on clotting factors
  • infants who did not receive at birth may be deficient
252
Q

Vitamin E

A
  • levels linked to milk’s fat content
  • levels adequate to meed needs for full term infants
  • muscle development; prevention of red blood cell lysis
  • levels are inadequate to meet needs of preterm infants
253
Q

Vitamin A

A
  • important for cell differentiation
  • content in colostrum is about twice that of mature milk
  • yellow colour of colostrum comes from Vitamin A in form of beta-carotene
254
Q

Vitamin D

A
  • key for fetal growth, addition of calcium to bone and tooth enamel formation
  • milk content varies with mother’s diet and sun exposure
  • maternal sun exposure can increase levels in milk up to 10-fold
  • exclusively breastfed infants need supplements
255
Q

Minerals in human milk

A
  • most have high bioavailability (Mg, Ca, Iron, Zinc)

- exclusively breastfed infants have little risk of anemia despite low iron content of human milk

256
Q

Benefits of breastfeeding for baby

A
  • increase bioavailability
  • protection from: GI, respiratory and ear infections
  • decreased infant mortality
  • decreased risk of allergy, asthma, eczema, inflammatory bowel disease, metabolic conditions
  • special benefits for preterm infants
257
Q

Benefits of breastfeeding for mother

A
  • reduced postpartum bleeding
  • delayed return of ovulation
  • uterus decrease in size faster (flat tummy)
  • decreased risk of breast and ovarian cancer and osteoporosis
  • return to pre pregnancy weight
  • increase self confidence and bonding with infant
  • practical
258
Q

3 main types of recommendations

A
  • duration
  • process
  • maternal diet
259
Q

Breastfeeding duration recommendations

A
  • early initiation within one hour of birth
  • exclusive for first 6 months of life
  • appropriate up to 2 years of age
260
Q

Breastfeeding process recommendations

A

Babies mouth needs to cover all of alveolar

  • position baby
  • position breast
  • present breast
  • proper infant latch
261
Q

Maternal diet recommendations during breastfeeding

A
  • energy increase (330-400 kcal)
  • fluid 16 cups per day
  • increased CHO, protein, vitamin C, A, E, potassium, zinc, iodine, selenium, copper, manganese, chromium, choline
  • no increase in vitamin D, K, sodium, chloride, calcium, phosphoric, magnesium, fluoride
262
Q

Q: Milk comes in during which stage of lactogenesis?

A

Lactogenesis II

263
Q

Neonatal jaundice (hyperbilirubinemia)

A

Yellow colour of skin

  • most frequent cause for hospital readmission for newborns
  • 60-70% of newborns
  • if not resolved elevated bilirubin levels can cause permanent damage to brain
264
Q

Bilirubin metabolism

A

In fetal state high levels of hemoglobin are necessary to carry oxygen delivered by placenta

  • at birth infants have very high levels of hemoglobin and hematocrit
  • as infant breathes on their own high hemoglobin is not needed so red blood cells begin to break down and yellow colour results
265
Q

Bilirubin

A

Pigment produced as heme from RBC break down

  • usually processed by liver and excreted in stool
  • newborn liver not fully mature
266
Q

Jaundice appears where?

A
  • first in eyes, face and upper body
  • progresses down toward toes
  • sever cases present in extremities
267
Q

Non-breastfeeding jaundice

A

Most common type

  • early onset: 2-5 days
  • caused by non feeding early enough after birth, nursing irregularly or improperly, infant given water, delayed passage of first stool (meconium)
  • treated by increased/supplemental feedings
268
Q

Breastmilk jaundice Syndrome

A

More extreme

  • late onset: after 5 days
  • only about 20% of babies
  • cause is unknown
  • treatments is phototherapy (light used to help break down bilirubin)
269
Q

Infant allergies

A
  • reduced by exclusive breastfeeding for more than 4 months
270
Q

Are breastfeeding rates in CA going up or down?

A

UP

- wide range between provinces however

271
Q

Who are less likely to initiate BF?

A
  • younger single mothers

- less post secondary education

272
Q

Percent who BF exclusively for 6 months?

A

26% but increasing

273
Q

Who are more likely to BF exclusively?

A
  • married women
  • over age 30
  • higher levels of education
274
Q

What influences decision to breastfeed or not?

A
  • pain
  • physical difficulty
  • practicality
  • diet
275
Q

Common BF problems?

A
  • letdown failure
  • hyperactive letdown
  • engorgement
  • plugged ducts/mastitis
276
Q

Factors influencing intiation?

A
  • embarrassment
  • time and work constraints
  • lack of support from family and friends
  • lack of milk supply
  • concerns about diet and health
  • fear of pain and discomfort
277
Q

La Leche League Canada

A

International organization to support women individually

NUTR 2050 (2 decks)

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