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Nutrition 325 > Midterm1 > Flashcards

Midterm1 Flashcards

1
Q

fecundity

A

biological ability to bear children

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2
Q

fertility

A

actual production of children

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3
Q

infecundity

A

biological inability to bear children after 1 year of unprotected intercourse

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4
Q

infertility

A

absence of production of children

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5
Q

approx. what % of couples are infertile/infecund ?

A

~15%

44% diagnosed as infertile will conceive within 3 years without technology

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6
Q

chance of diagnosed conception within a given menstrual cycle

A

20 -25% for healthy couples

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7
Q

women born with how many immature ova?

A

~ 7 million primordial follicles

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8
Q

how many ova will mature and be released during fertile years?

A

~400-500

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9
Q

women over age ___ more likely to have disorders related to chromosomal defects than younger women

A

35, sperm production also decreases after 35

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10
Q

purpose of menstrual cycle

A

prepare ovum for fertilization and uterus for implantation

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11
Q

hormones involved in menstrual cycle

A 
Estrogen 
gonadotropin-releasing hormone (GnRH)
follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
progesterone
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12
Q

2 phases of menstrual cycle

A

follicular phase - first half, 1-14

luteal phase - 14-28

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13
Q

___ signals menstruation

A

drop in progesterone

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14
Q

___ causes release of egg from follicle

A

LH

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15
Q

if pregnancy occurs…

A

Progesterone and estrogen stay high to inhibit GnRH

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16
Q

menstruation

A

decreased estrogen and progesterone and increased prostaglandins result in uterine wall contraction and release of outer wall as menstrual flow

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17
Q

E2 stimulates …

A

hypothalamus to secrete GnRH

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18
Q

GnRH stimulates ..

A

pituitary to release FSH and LH

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19
Q

FSH…

A

promotes growth of follicles, stimulates secretion of E2 by follicle, stimulate maturation of ovum

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20
Q

LH…

A

surge stimulates release of ovum from follicle, stimulates secretion of E2 and progesterone by follicle…stimulate endometrium to expand and store nutrients in prep for implantation

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21
Q

corpus luteum

A

formed in luteal phase
secretes progesterone and E2 –> inhibit GnRH and stimulate development of endometrium
if implantation - continues to secrete E2 and P to maintain endometrium
no implantation - E2 and P decrease, removing inhibitory effect on GnRH

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22
Q

FSH stimulated testes to..

A

release sperm/ production of sperm

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23
Q

prostaglandins cause..

A

cramps in women and vaginal contractions to push sperm up

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24
Q

in males LH stimulates…

A

production of androgens (testosterone) by testes

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25
Q

testosterone/androgens stimulate…

A

maturation of sperm

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26
Q

chronic under nutrition –>

A

birth of small/frail infants with high likelihood of death in first year

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27
Q

acute under nutrition –>

A

dramatic decline in fertility that recovers with food intake (more dramatic impact than chronic)

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28
Q

weight loss greater than ____ (and bad effects)

A

> 10-15% decreased estrogen, LH, and FSH

amenorrhea, anovulatory cycles, short or absent luteal phases

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29
Q

___% of infertility cases related to weight loss

A

30%

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30
Q

sperm viability and motility decreases when weight drops to _____ below normal and ceases if wt loss exceed ___

A

10-15%

25% of normal

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31
Q

how obesity decreases fertility

A

dip in estrogen needed to continue menstrual cycle

fat cells produce estrogen and mask dips

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32
Q

fertility lower with BMI…

A

lower then 20 or greater than 30

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33
Q

iron and fertility

A

rate of infertility lower in women who use iron supplements

pre-pregnancy iron deficiency linked to preterm delivery and low iron status of infant

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34
Q

in ___ PMS…

A

1987, moved from psychogenic to physiological category

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35
Q

PMS diagnosis

A

dependent on standard questionnaire

1-5 symptoms intense enough to disrupt work or social life for at least 2 consecutive luteal phases

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36
Q

PMS symptoms occur in

A

40% of women of childbearing age

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37
Q

premenstrual dysphoric disorder (PMDD)

A

5+ symptoms of PMS for at least 2 consecutive luteal phases, 1 symptom related to mood

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38
Q

dysmenorrhea occurs in ___ phase

A

follicular

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39
Q

causes of PMS

A

definite cause unknown

related to changes in serotonin activity following ovulation

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40
Q

nutritional treatment of PMS

A

calcium - normalize (1000-1200mg)
vit D - above RDA
Vit B - above RDA

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41
Q

hypothalamic amenorrhea

A

weight related amenorrhea, functional amenorrhea
cessation of menstruation associated with underweight, weight loss…
caused by deficits in energy and nutrients

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42
Q

Leptin

A

messenger to hypothalamus of peripheral energy status
affected by hypothalamic amenorrhea
released by fat cells

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43
Q

female athlete triad

A

amenorrhea, disordered eating, osteoporosis
results in decrease in LH, FSH, estrogen
low estrogen –> reduction in bone mass

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44
Q

eating disorders affect ___% of young women

A

3-5%

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45
Q

obesity rates in US (20-39 yo)

A

33% of men (>30)
32% of women
5% massively obese (>40)

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46
Q

! cause of infertility of women in US

A

polycystic ovary syndrome

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47
Q

Diabetes mellitus

A

intolerance to carbs with fasting glucose >126 mg/dL

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48
Q

type 1 diabetes

A

own body destroys pancreas and cant produce insulin
10% of cases, 1% of population
autoimmune disease
need insulin administration

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49
Q

type 2 diabetes

A

body cant use the insulin it produces or does not produce enough
11% of population
usually obese

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50
Q

gestational diabetes

A

3-7% of pregnancies

usually obese

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51
Q

insulin resistance

A

cells resist action of insulin in facilitating transport of glucose into cells
cells have 1/4 functioning receptors

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52
Q

glycemic index

A

how body receives sugar from blood

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53
Q

glycemic load

A

glycemic index of food multiplied by grams of carbs divided by 100

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54
Q

polycystic ovary syndrome

A

endocrine disorder characterized by hyperandrogenism and insulin resistance
5-10% of women of reproductive age
majority are obese
any 2 out of 3: oligoovulation and/or anovulation
excess androgen
polycystic ovaries

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55
Q

cause of PCOS

A

uncertain
insulin resistance probably factor
genetic
androgen secreting tumors

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56
Q

management of PCOS

A

increase insulin sensitivity

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57
Q

PKU

A

phenylketonuria , hyperphenylalaninemia
elevated blood phenylalaine from lack of hydroxylase
in pregnancy –> impair CNS development
untreated, ~92% mental retardation

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58
Q

celiac disease

A

autoimmune disease
genetic susceptibility to gliadin portion of gluten
causes malabsorption and flattening of intestinal lining
~2 million in US
linked to infertility in some women and men because not proper nutrients

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59
Q

natality statistics

A

summary of pregnancy related and infant related outcomes

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60
Q

periconceptional

A

month before conception to month after conception

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61
Q

typical pregnancy length

A

40 weeks

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62
Q

preterm

A

37 weeks or before

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63
Q

very preterm

A

less than 34 weeks

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64
Q

embryo

A

until 12 weeks

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65
Q

fetus

A

2nd and 3rd trimesters

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66
Q

neonate

A

newborn

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67
Q

post natal period

A

after 1 month

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68
Q

neonatal

A

up to 1 month after birth

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69
Q

miscarriage

A

first 20 weeks of pregnancy

genetic, uterine, or hormonal abnormalities

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70
Q

fetal death/stillbirth

A

if after 20 weeks

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71
Q

sequence of changes in maternal body composition

A 
plasma volume - weeks 20
nutrient stores - 20
placental weight - 31
uterine blood flow - 37
fetal weight - 37
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72
Q

2 phases of changes during pregnancy

A

maternal anabolic phase, week 1-20

catabolic phase, week 20-delivery

73
Q

anabolic phase

A

build up nutrients, ~10% of fetal growth occurs

74
Q

catabolic phase

A

nutrients delivered to fetus
90% of fetal growth
2nd half and end of pregnancy appetite decreases

75
Q

preferred energy source for fetus

A

glucose

mother become slightly diabetic/insulin resistant

76
Q

key placental hormones

A

human chorionic gonadotropin (hCG) - maintains corpus luteum to maintain uterus for pregnancy
progesterone
estrogen
human chorionic somatotropin (hCS)

77
Q

diabetogenic effect of pregnancy

A

makes women slightly carbohydrate intolerant in 3rd trimester
*to give glucose to fetus
hCS and prolactin inhibit conversion of glucose to glycogen and fat

78
Q

about ___ lb of protein accumulate during pregnancy

A

2 lbs (baby, uterus, breasts, placenta, etc)

79
Q

fat metabolism during pregnancy

A

stores accumulate in first half (anabolic)

store mobilize is last half, blood lipid levels increase dramatically (50% increase in triglycerides)

80
Q

placenta

A

lining of cells separates maternal and fetal blood
hormone and enzyme production
nutrient and gas exchange
removal of waste

81
Q

epigenetics

A

fetal environment effects gene expression and later life

82
Q

critical periods

A

most crucial during 1st 2 months after conception
when specific cells formed and integrated
characterized by hyperplasia
one way street

83
Q

AGA

A

appropriate for gestational age

84
Q

SGA

A

small for gestational age, weight <10th% for gestational age

85
Q

dSGA

A

disproportionately small for gestational age
2/3 of SGA
low weight but normal length and head circumference
very skinny, nutrients or energy deficiency
malnutrition in 3rd trimester
greater risk of heart disease, hypertension, diabetes

86
Q

pSGA

A

proportionately small for gestational age
1/3 of SGA
long term malnutrition in utero
adapted to low nutrient environment, do better
fewer health problems than dSGA

87
Q

LGS

A

large for gestational age
weight >90th% for gestational age
prepregnancy obesity or excessive weight gain
delivery complications

88
Q

___% of embryos are lost <20 weeks

A

30-50%

89
Q

fetal-origins hypothesis of later disease risk

A

exposures to adverse conditions during critical periods of growth and development can permanently affect body structure and functions

90
Q

___ causes increased risk of diabetes later in life

A

not enough glucose - receptors not there, stays in blood longer
too much -

91
Q

greatest maternal weight gain during …

A

24-28 weeks

mother gains weight before fetus

92
Q

normal weight mother should gain

A

25-35 lbs

93
Q

underweight mother should gain

A

28-40 lbs

94
Q

overweigh and obese mothers should gain

A

15-25 lbs

11- 20 lbs

95
Q

need ___ additional Kcal/day

A

~300 additional

total is 80,000 Kcal

96
Q

minimum carb intake for pregnancy

A

175g, to meet fetal brain’s need for glucose
45-65%
no pregnant - 130g

97
Q

protein for pregnancy

A

+25d/day
or 71 for 2nd and 3rd tri
non preg - 46g
average intake ~78g

98
Q

fat for pregnancy

A

energy source for mom, glucose goes to fetus

~33% of total calories

99
Q

omega 3 fatty acids

A

EPA and DHA
300 mg
reduce inflammation, dilate blood vessels,
component of cell membranes
higher intelligence, vision, more mature CNS

100
Q

folate

A

generic for folic acid
enzyme cofactor in DNA synthesis, gene expression and regulation
converts homocysteine to methionine
600 ug DFE

101
Q

inadequate folate between ____ days after conception can cause ___

A

21-27 days after conception

neural tube defects - most common congenital abnormality in infants (anencephaly or spina bifida)

102
Q

vit A toxicity

A

from supplements >10,000 IU and use of Accutane and Retin-A (fat soluble can pass through skin)
retinoid acid syndrome - small or missing ears, brain malformations, heart defects
<5,000 IU of retinol in supplements

103
Q

calcium requirement…

A

increases by 300 mg/d in 3rd tri

calcium absorption and bone reabsorption increases

104
Q

caffeine in pregnancy

A

no apparent long term consequences

4 cups is safe

105
Q

pica

A

eating disorder

consuming food you wouldn’t typically consume

106
Q

geophagia

A

eating soil

107
Q

pagophagia

A

freezer frost eating

108
Q

amylophagia

A

eating cornstarch

109
Q

nausea and vomiting

A

nausea in 8/10, vomiting 5/10
most common weeks 5-12
treat: B6, multivits, ginger

110
Q

hyperemesis gravidarum

A

severe nausea and vomiting throughout pregnancy

111
Q

exercise recommended for pregnancy

A

3-5 times week for 30 mins at 60-70% VO2 max

112
Q

good vs. bad cholesterol

A

good - HDL
bad- LDL
high LDL in obese mothers

113
Q

visceral fat

A

around organs, under muscle
more metabolically active
white fat
bigger effects

114
Q

subcutaneous fat

A

under skin surface, above muscles
brown fat
burns to produce heat and warm body

115
Q

hypertension (HTN)

A

> 140 mm Hg systolic or >90 mm Hg diastolic

affects 6-10% of pregnancies

116
Q

chronic HTN

A

diagnosed before pregnancy or 35 years old, history of HTN

117
Q

gestational HTN

A

diagnosed >20 weeks for first time
no proteinuria
tend to be overweight/obese with extra central body fat
6% of pregnancies

118
Q

preeclampsia/eclampsia

A

HTN diagnosed >20 weeks and proteinuria
headache, blurred vision, abdominal pain, low platelet count, abnormal liver enzyme levels
eclampsia = seizures
4% of first and 1.7% of subsequent pregnancies

119
Q

chronic HTN pregnancy risks

A

preterm delivery, fetal growth retardations, placenta abruption, Cesarean delivery

120
Q

proteinuria

A

urinary excretion of >.3 g protein in 24 hour urine sample

121
Q

cause of preeclampsia/eclampsia

A

unknown, maybe abnormal implantation and vascularization of placenta with poor blood flow

122
Q

recommendations for preeclampsia

A

adequate calcium and vit D, mutivits/minerals, >5 servings of colorful veggies and fruits, fiber, moderate exercise, recommended weight gain

123
Q

first approach for management of gestational diabetes

A

medical nutrition therapy to normalize blood glucose levels with diet and exercise

124
Q

type 1 diabetes during pregnancy

A

more hazardous than gestational or type 2
kidney disease, hypertension,
newborn mortality, SGA or LGA, hypoglycemia after birth

125
Q

dizygotic twins

A

fraternal, 2 eggs fertilized

70% of twins

126
Q

monozygotic twins

A

identical, 1 egg

30% of twins

127
Q

chorion

A

outer membrane, around amniotic sac

128
Q

3 possibilities of placentas/sacs

A

2 amniotic sacs, 2 chorions, 2 placentas
1 amniotic sac, 1 chorion, 1 placenta (most risk for problem because shared sac and placenta)
2 amniotic sacs, 1 chorion, fused placentas

129
Q

vanishing twin phenomenon

A

6 to 12% of pregnancies begin as twins with only 3% born as twins
silently occur into uterus within 1ist 8 weeks

130
Q

___% chance of transmitting HIV to fetus

A 
20%
34 million people have HIV
placenta normally barrier for virus and bacteria,
can also be passed through breast milk 
not related to adverse pregnancy outcome
131
Q

calcium RDA for pregnant teens

A

1300 mg

132
Q

alveolus

A

functional units of mammary gland
hallow cavities
secretory cells with duct in center

133
Q

letdown

A

milk ejection

myoepithelial cells contract to cause milk to be secreted into ducts

134
Q

lobes

A

groups of alveoli

135
Q

lactiferous sinuses

A

dilations behind nipple for storage of milk, drains into opening of nipple

136
Q

lactogenesis

A

milk production
lactogenesis I - pre birth to 2-5 days after, begins in form of colostrum
lactogenesis II - 2-5 days after birth, milk “comes in”
lactogenesis III - ~10 days after birth, milk composition is stable

137
Q

prolactin

A

produced by pituitary
triggers cells in alveoli to produce milk
released in response to suckling
inhibits ovulation

138
Q

oxytocin

A

produced by pituitary
stimulates milk let down from acinus into dcut
tingling of breast
causes uterus to contract

139
Q

human milk is only food source needed for…

A

first 6 months

solid food at 4-6 months for jaw development

140
Q

colostrum

A

first milk secreted during first few days postpartum
very high in proteins (secretory IgA and lactoferrin)
lower calories
high vit A - yellow color

141
Q

IgA

A

component of immune system

starts coating intestinal lining to create barrier against pathogenic bacteria

142
Q

lactoferrin

A

barrier to protect bad bacteria, bind to receptors on bacteria and produce peroxides to kill it

143
Q

energy in human milk

A

20 Kcal/oz

lower than milk substitute

144
Q

lipids in human milk

A

~1/2 energy in human milk

fat content remains stable but depends on what mother eats

145
Q

casein

A

main protein in mature human milk
white appearance
total protein content lower than cows milk

146
Q

whey

A

proteins the remain soluble in water after casein is precipitated out

147
Q

non protein nitrogen

A

20-25% of nitrogen in human milk

used to make non essential amino acids, hormones, etc.

148
Q

fat soluble vits in human milk

A 
A - most in colostrum 
D -
E
K - 5% of breasted infants at risk of deficiency 
coagulation factors, bleeding 
k injection at birth
149
Q

___ expressions/day for first couple weeks are necessary to stimulate adequate milk production

A

8-12

every 1.5-2 hours

150
Q

optimal duration of breastfeeding

A

AAP - 1 year or longer

US surgeon general - exclusively for 6 months and best to breastfeed for 12 months

151
Q

rooting reflex

A

turns to side when stimulated on that side

152
Q

hunger signaled by …

A

bringing hands to mouth, sucking on them, moving head from side to side
crying

153
Q

feeding frequency

A

10-12 feeding/day

stomach emptying occurs in ~1.5 hours

154
Q

normal weight loss for newborns

A

~7% of birth weight in 1st week

of 10% needs to be evaluated

155
Q

by day 5 to 7, infants should have ___ wet diapers and __ soiled per day

A

6 wet

3-4 soiled

156
Q

energy needs for lactation

A

+330 for 1st 6 months, +400 afterward

157
Q

letdown failure

A

milk does not eject from breast, very uncommon
oxytocin nasal spray may be prescribed
relaxation techniques

158
Q

engorgement

A

when supply and demand process not yet established

most common from day 2-3

159
Q

mastitis in ___% of breastfeeding women

A

1-33%

most common at 2-6 weeks

160
Q

most common reason for cessation of breastfeeding

A

low milk supply (real or perceived)
from insufficient breastfeeding/pumping, ineffective emptying, stress
drug to increase prolactin (after day or two)

161
Q

effect is ___ for majority of drugs (for breastfeeding))

A

unknown

162
Q

HIV transmission rates for breastfeeding

A

5 to 20% depending on duration
goes up to 40-50% for 1-2 years
US says don’t do it
choice not clear in developing counties - more risk of death from bad water

163
Q

alcohol and breastfeeding

A

passes to breast milk

peak plasma levels 30-60 mins after consumption if w/o food, and 60-90 min if with food

164
Q

alcohol decreases ….

A

oxytocin and let down

165
Q

alcohol and breastfeeding affects…

A

odor of milk, volume baby wants to consume, sleep pattern

166
Q

smoking and lactation

A

health risks for infant
not good, but better than not breastfeeding
1/2 life of nicotine is 95 mins so delay feeding after smoking

167
Q

milk banks and cost

A

~12 in north America

$3.50 / ounce

168
Q

jaundice

A

yellow color, 40% of full term 80% of preterm

caused by high levels of bilirubin (hyperbilirubinemia)

169
Q

bilirubin

A

breakdown product of heme

170
Q

bilirubin metabolism

A

fetal stage, high levels of hemoglobin to carry oxygen
high levels of hemoglobin at birth
RBC begin to breakdown after birth, high hemoglobin not needed
usually processed by liver and excreted in stool
liver not fully mature so jaundice is common

171
Q

Total serum bilirubin (TSB)

A

balance between rate of production and rate of excretion

172
Q

physiological jaundice

A

resolves on own with no damage
begins 1st day, peak 6-7 days
bilirubin <12mg/dL
cause: normal heme breakdown

173
Q

pathological jaundice

A 
if hyperbilirubinemia become severe, elevated bilirubin can cause permanent neurological damage 
rises rapidly and lasts longer
bilirubin >8mg/dL in 1st day 
medical intervention with phototherapy 
cause: various pathological conditions
174
Q

most frequent cause for hospital readmission for newborn

A

hyperbilirubinemia

175
Q

kernicterus or bilirubin encephalopathy

A 
bilirubin toxic to cells and may cause brain damage 
cells do not regenerate 
mortality rate 50%
survivors: cerebral palsy, etc. 
baby blood brain barrier not developed
176
Q

breast non-feeding jaundice/breastfeeding failure jaundice

A 
early onset (Day 1-2), peaks 2-5
due to suboptimal breastfeeding
177
Q

breast milk jaundice syndrome

A

late onset (day 3-5), peak 2nd to 3rd week
baby starving
potentially due to substances in milk that increase bilirubin in reabsorption or individual variation in processing
cause is unknown
typically reabsorbs itself and is extension of physiological jaundice

178
Q

treating jaundice

A

phototherapy- light absorbed in bilirubin changing it to water soluble product that can be excreted
encourage continuation of breastfeeding

Nutrition 325 (3 decks)

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