NUTR 2050 Flashcards

Question

recommended grams of dietary fiber per day

Answer 1

females - 21-25 grams | males - 30-38 grams

Answer 2

protein in foods provide the body with amino acids used to build and maintain muscles, bone, enzymes and red blood cells - the body can use protein as a source of energy

Answer 3

are the “building blocks” of protein, containing nitrogen - 9 amino acids must be provided by the diet and are considered “essential amino acids” - foods of high protein include a balanced assortment of all the essential amino acids

Answer 4

- protein from milk, cheese, meat, eggs and other animal products - combinations of plant foods, such as gains or seeds with dried beans

Answer 5

a severe form of protein-energy malnutrition in young children; characterized by swelling, fatty liver, susceptibility to infection; cause is unclear

Answer 6

animal products and dried beans

Answer 7

- fats in food share the property of being soluble in fats but not in water - fats and oils are made up of various types of triglycerides which consist of 3 fatty acids attached to glycerol

Answer 8

a component of fats that is soluble in water; it is converted to glucose in the body

Answer 9

concentrated, 9

Answer 10

linoleic acid and alpha linolenic acid; must be supplied in the diet - these are found in phospholipids, which along with cholesterol, are primary lipids in the brain and other nervous system tissue

Answer 11

cholesterol and sex-hormone synthesis, components of cell membranes, vehicle for carrying certain vitamins that are soluble in fats only and suppliers of the essential fatty acids required for growth and health

Answer 12

is the parent of the omega-6 fatty acid family. One of the major derivatives of linoleic acid is arachidonic acid; which serves as a primary structural component of the central nervous system. Found in most veg. Oils and meats and human milk

Answer 13

is the parent of the omega-3 fatty acid family. It is present in many types of dark green vegatables, vegetable oils and flaxseed - derivatives of this essential fatty acid is Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) - EPA and DHA enter the body through intake of fatty, cold-water fish and shellfish and human milk - the body only stores small amounts of alpha-linolenic acid, EPA and DHA - recommended intake of EPA is 500mg daily even though most people in Canada and the US consume around 100mg

Answer 14

saturated and unsaturated

Answer 15

if one double bond is present in one or more of the fatty acids

Answer 16

if two or more double bonds are present

Answer 17

contain no double bonds between carbons and tend to be solid at room temperature - animal products such as butter, cheese and meats and 2 plant oils (coconut and palm) are rich sources of saturated fats

Answer 18

monoglycerides (glycerol+1 fatty acid) and diglycerides (glycerol+2 fatty acids)

Answer 19

- animal foods contain more saturated and less unsaturated fat than plant foods

Answer 20

- saturated fatty acids tend to increase blood levels of LDL cholesterol (the lipoprotein that increases heart-disease risk when present in high levels) - trans fatty acids raise blood LDL- cholesterol levels to a greater extent than do saturated fatty acids

Answer 21

evidence indicate that the type of fat consumed is most important to health than is total intake

Answer 22

- fats that elevate levels of LDL cholesterol (Which increases the risk of heart diseases) are regarded as “unhealthful” while those that lower LDL cholesterol and raise blood levels of HDL cholesterol (the one that helps the body get rid of cholesterol in the blood) are considered healthful

Answer 23

the body generally produces only ⅓ of the cholesterol our bodies use because more than sufficient amount of cholesterol are provided in most people’s diets - dietary cholesterol intake affects blood cholesterol level substantially less than do saturated and trans fat intake - leading sources of dietary cholesterol are eggs yolks, meat, milk and milk products, and fats such as butter - it is recommended that consumption of cholesterol intake should be minimal

Answer 24

chemical substances in foods that perform specific functions in the body - 14 vitamins have been discovered and are either fat soluble or water soluble - vitamins do not provide energy; but some play critical roles as coenzymes in chemical changes that take place in the body, known as metabolism

Answer 25

vitamins A, D, E and K and are present in the fat portions of food (**DEKA = fat-soluble vitamins) - fat-soluble vitamins are stored in the body’s fat tissues and the liver; these stores can be sizable and last from months to years when intake is low - excessive consumption of the fat soluble vitamins from supplements, especially of vitamins A and D, produces various symptoms of toxicity

Answer 26

- B-complex vitamins and vitamin C are soluble in water and found dissolved in water in foods

Answer 27

- except for vitamin B12, water-soluble vitamin stores in the body are limited and run out within a few weeks to a few months after intake becomes inadequate - toxicity symptoms from water-soluble vitamins, however, tend to last a shorter time and are more quickly remedied

Answer 28

chemical substances that activate enzymes

Answer 29

the chemical changes that take place in the body - other vitamins (vitamins C and E, and beta-carotene, which is a precursor of Vitamin A) act as antioxidants and perform other functions; repairing damage to cells due to oxidation, these vitamins help maintain body issues and prevent disease

Answer 30

some plant pigments, hormones and other naturally occurring substances that protect plants from insects, oxidization and other damaging exposures also appear to benefit human health - many of the phytochemicals that benefit health are pigments that act as antioxidants in the human body

Answer 31

- humans require 15 minerals - minerals consist of single atoms and carry a charge in solution - the charge carried by minerals allows them to combine with other minerals to form stable complexes in bone, teeth, cartilage and other tissues - the tendency of minerals to form complexes has implications for the absorption of minerals from food - the proportion of total mineral intake that is absorbed is less than for vitamins

Answer 32

- adults are about 60-70% water by weight - water provides the medium in which most chemical reactions take place in the body - water plays a role in energy transformation, the excretion of wastes and temperature regulation - people need enough water to replace daily losses from sweating, urination and exhalation - total water requirement of adult males is 15-16 cups from foods and fluids per day; females is 11 cups

Answer 33

drinking water, water in beverages and water that is part of food - people generally consume about 75% of their water intake from water and other fluids and 25% from foods

Answer 34

- alcohol tends to increase water loss through urination, so beverages such as beer and wine are not as “hydrating” as water is

Answer 35

are hydrating in people who are accustomed to consuming them

Answer 36

- problems arise when a cell’s need for nutrients differs from the amounts that are available - normal cell health and functions are maintained when a nutritional and environmental utopia exists within and around cells - this state of optimal cellular nutrient conditions supports homeostasis in the body - disruptions in the availability of nutrients, or the presence of harmful substances in the cell’s environment, initiate diseases and disorders that eventually affect tissues, organs and systems

Answer 37

- inadequate intake of an essential nutrient esults in obvious deficiency diseases - the length of time a deficiency of toxicity takes to develop depends on the type and amount of nutrient consumed and the extent of body nutrient reserves - after a period of deficient intake of an essential nutrient, tissue reserves become depleted and subsequently, blood levels of the nutrient decline. When the blood level can no longer supply cells with optimal amounts of nutrients, cell processes change. - if the deficiency continues, groups of cells malfunction, which leads to problems related to tissue and organ functions - eventually, some problems produced by the deficiency can no longer be reversed by increased nutrient intake - excessively high intakes of many essential nutrients produce toxicity diseases - signs of toxicity stem from an increased level of the nutrient in the blood and the subsequent oversupply of the nutrient to cells - for both deficiency and toxicity diseases, the best way to correct the problem is at the level of intake - most foods contain many nutrients, so poor diets are generally inadequate in many nutrients - dietary changes affect the level of intake of many nutrients; dietary changes introduced for the purpose of improving intake of a particular nutrient produce a “ripple effect” on the intake of other nutrients

Answer 38

- healthy humans have adaptive mechanisms that partially protect the body from poor health due to fluctuations in nutrient intake - these mechanisms act to conserve nutrients when dietary supply is low and to eliminate them when excessively high amounts are present - fluctuations in energy intake are primarily regulated by changes in appetite; if too few calories are consumed, the body will obtain energy from its glycogen and fat stores - although they provide an important buffer, these built-in mechanisms do not protect humans from all the consequences of poor diets

Answer 39

means “poor nutrition” and results from either inadequate or excessive availability of energy and nutrients - malnutrition can result from poor diets as well as from diseases that interfere with the body’s ability to use the nutrients consumed

Answer 40

results when a poor nutritional state is dietary in origin

Answer 41

is caused by a disease state, surgical procedure or medication (ex. Alcoholism, G.I Bleeding, AIDS)

Answer 42

advances in knowledge about nutrient-gene interactions in health and disease are revolutionizing the science and practice of nutrition - thousands of rare diseases related to a defect in a single-gene have been identified and many of these affect nutrient needs - phenylketonuria (PKU), galactosemia, and hemochromatosis are 3 examples of single-gene defects that substantially affect nutrient needs or utilization - most diseases related to genetic traits are not as well defined as are single-gene defects - components of foods consumed affect gene function by turning specific genes “on” or “off”, thereby affecting what metabolic reactions occur within the body - some examples of effects of nutrient-gene interactions on health status include: → consumption of high glycemic index carbohydrates appears to increase the risk of type 2 diabetes in individuals with a certain form of gene involved in insulin production and secretion → high alcohol intake during pregnancy in some women sharply increases the risk of fetal alcohol syndrome in her fetus, but the fetuses of other women with different genetic traits are not affected by high alcohol intake → regular consumption of green tea reduces the risk of prostate cancer in certain individuals with particular genetic trait

Answer 43

- women who are pregnant or breastfeeding, infants, children, people who are ill, and frail elderly people have a greater need for nutrients than healthy adults and elderly people do - as a result, they are at higher risk of becoming inadequately nourished than others

Answer 44

slow-developing, long-lasting diseases that are not contagious (eg. heart disease, cancer, diabetes); they can be treated but not always cured - the leading causes of death among Americans are heart disease and cancer - diets high in saturated and trans fats, and low in vegetables, fruits, and whole grain products, are linked to the development of heart disease - diet is related to 3 leading causes of death: diabetes, stroke and Alzheimer's disease

Answer 45

- adequate diets are most easily obtained by consuming foods that are good sources of a number of nutrients but not packed with calories; such foods are considered nutrient-dense foods - those that provide calories and low amounts of nutrients are considered empty-calorie foods - variety is a core characteristics of healthy diets because the essential nutrient and phytochemical content of foods differ - a healthy diet provides a balanced selection of food types and amounts

Answer 46

- people tend to classify foods as being “good” or “bad” but such opinions about individual foods oversimplify the potential contribution of these foods to a diet - all foods can fit into a healthful diet as long as nutrients needs are met at calorie-intake levels that maintain a healthy body weight

Answer 47

- nutrition labelling requires that almost all multiple-ingredient foods and dietary supplements be labeled with a Nutrition Facts panel - the act also requires that nutrient content and health claims appearing on package labels, such as “trans-fat free” and “helps prevents cancer” qualify based on criteria established by the Food and Drug Administration (FDA)

Answer 48

- the nutrition facts panel must list the content of fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, fiber, sugars, protein, vitamins A and C, calcium, and iron in a standard serving - nutrition facts panels contain a column that lists the % Daily value (or %DV) for each relevant nutrient; this information helps consumers decide for example, whether the carbohydrate content of a serving of a specific food product is a lot or a little - nutrient content claims made on food package labels must meet specific criteria. Product labeled “no trans fat” or “trans fat free” for example, must contain less than 0.5 grams of trans fat and of saturated fat

Answer 49

- products labeled “low sodium” must contain less than 140mg of sodium per serving

Answer 50

- food products must list ingredients in an ingredient label - the list must begin with the ingredient that contributes to the greatest amount of weight to the product and continue with the other ingredients on a weight basis

Answer 51

labels on dietary supplements cannot claim to treat, cure or prevent disease - dietary supplements can make other claims on product labels not approved by the FDA, such as “supports the immune system” or “helps maintain mental health” as long as the label doesn’t state or imply that the product will prevent, cure or treat disease - some foods are labeled as “enriched” or “fortified” - enrichment pertains only to refined grain products and covers some of the vitamins and one of the minerals lost when grains are refined - any foods can be fortified with added vitamins and minerals and its manufacturers most often do so on a voluntary basis to enhance product sales

Answer 52

- FDA considers herbal remedies to be dietary supplements - some herbal remedies act like drugs and have side effects, but they are not considered to be drugs and are loosely regulated - the extent to which herbs pose a risk to health depends on the amount taken, the duration of use and the user’s age, lifecycle stage and health status

Answer 53

- include a variety of products that have been modified to enhance their contribution to a healthy diet - foods are made “functional” by: → taking out potentially harmful components (eg. cholesterol from egg yolks and lactose from milk) → increasing the amount of nutrients and beneficial non-nutrients (eg. fiber-fortified liquid meals, calcium and vitamin c- fortified orange juice) → adding new beneficial compounds to foods (eg. “friendly” bacteria to yogurt and other milk products)

Answer 54

- in a class of functional foods by themselves (with probiotics) - are fiber like, indigestible carbohydrates that are broken down by bacteria in the colon; the breakdown products foster the growth of beneficial bacteria

Answer 55

is the term for live, beneficial “friendly” bacteria that enter food products during fermentation and aging processes

Answer 56

improvements in infant mortality in the past decades due to technological advances

Answer 57

outcome of delivery when a completely expelled or extracted fetus breathes, or shows any sign of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the cord has been cut or the placenta is still attached - 2/3 of deaths of liveborn infants occur within the first month after birth, or during the neonatal period

Answer 58

Infants born at low birthweight or preterm are at substantially higher risk of dying in the first year of life Low-birthweight and preterm infant outcomes are intertwined in that the shorter the pregnancy, the less newborns tend to weigh Rates of preterm delivery and low birthweight in the US have trended slowly upward since 1983 and remain higher in African American infants than in other infants Infants weighing 3500 to 4500 grams at birth (7-10 pounds) are least likely to die within the first year of life o They have better overall health status and mental development o less likely to have heart disease, diabetes, lung disease, hypertension later in life

Answer 59

focus on the reduction of low birthweight, preterm delivery, and infant mortality - Also, improving prenatal weight gain, access to care, and behaviours that adversely affect the outcome of pregnancy

Answer 60

Pregnancy begins at conception; that occurs approx. 14 days before a woman’s next menstrual period is scheduled to begin and ovulation occurs, avgs. 38 weeks or 266 days Pregnancy is given at 40 weeks because it is measured from the first day of the last menstrual period (LMP) The most common way of measuring pregnancy duration includes two non-pregnant weeks at the beginning The anticipated date of delivery is called “the estimated date of confinement” or EDC Assessment of duration of pregnancy as weeks from conception is correctly termed gestational age, whereas time in pregnancy estimated from LMP reflects menstrual age

Answer 61

a dark-shaped organ of nutrient and gas interchange between mother and fetus. At term, the placenta weighs about 15 percent of the weight of the fetus

Answer 62

Attempts to bring maternal physiological changes back to non-pregnant levels may cause more harm than good to the pregnancy Physiological changes can be divided into 2 groups: those occurring in the first half of pregnancy and those occurring in the second half - Approximately 10% of fetal growth is accomplished in the first half of pregnancy, and the remaining 90 percent occurs in the second half

Answer 63

considered maternal anabolic changes, they build the capacity of the mother’s body to deliver relatively large quantities of blood, oxygen and nutrients to the fetus in the second half of pregnancy

Answer 64

called maternal catabolic changes, energy and nutrient stores and the heightened capacity to deliver stored energy and nutrients to the fetus, predominate

Answer 65

A woman’s body gains a lot of water during pregnancy due to increased volumes of plasma and extracellular fluid, as well as amniotic fluid About two thirds of the expansion is intracellular (blood and body tissues) and one third is extracellular (fluid in spaces between cells) Plasma volume begins to increase within a few weeks after conception and reaches a maximum at approx. 34 weeks Early pregnancy surges in plasma volume appear to be the primary reason that pregnant women feel tired and exhausted easily Fatigue associated with plasma-volume increases in the second and third months of pregnancy declines

Answer 66

High gains are associated with increasing degrees of edema (swelling due to an accumulation of extracellular fluid) and weight gain o If not accompanied by hypertension, edema generally reflects a healthy expansion of plasma volume

Answer 67

Birth weight is strongly related to plasma volume: generally, the greater the expansion, the greater the new-born size

Answer 68

physiological changes during pregnancy are caused by hormones produced by placenta The placenta serves many roles, but a key one is the production of steroid hormones such as progesterone and estrogen

Answer 69

Changes in carbohydrate metabolism promote the availability of glucose to the fetus o Glucose is the fetus’s preferred fuel, even though fats can be utilized for energy o Continued availability of a fetal supply of glucose is accomplished primarily through metabolic changes that promote maternal insulin resistance o These changes are referred to as the diabetogenic effect of pregnancy and make normal pregnant women slightly carbohydrate intolerant in the third trimester of pregnancy

Answer 70

characterized by estrogen- and progesterone- stimulated increases in insulin production and conversion of glucose to glycogen and fat

Answer 71

rising levels of hCS and prolactin from the mother’s pituitary gland inhibit the conversion of glucose to glycogen and fat insulin resistance builds in the mother, increasing reliance on fats for energy

Answer 72

Maternal metabolism is rapidly converted toward glucogenic amino acid utilization, fat oxidation, and increased production of ketones with fasts that last longer than 12 hours - Although these metabolic adaptions help ensure a constant fetal supply of glucose, fasting eventually increases the dependence of the fetus on ketone bodies for energy

Answer 73

Nitrogen and protein are needed in increased amounts during pregnancy for synthesis of new maternal and fetal tissues - Estimated that 925 grams of protein are accumulated during pregnancy

Answer 74

Multiple changes occur in the body’s utilization of fats during pregnancy Overall, changes in lipid metabolism promote the accumulation of maternal fat stores in the first half of pregnancy and enhance fat mobilization in the second half Blood levels of many lipoproteins increase dramatically High levels of triglycerides indicate the existence of insulin resistance prior to pregnancy Insulin resistance before conception increases risk of diabetes and hypertension developing during pregnancy

Answer 75

placenta develops from embryonic tissue and is larger than the fetus Development of the placenta precedes fetal development

Answer 76

Hormone and enzyme production o Nutrient and gas exchange between the mother and fetus o Removal of waste products from the fetus - harmful substances (alcohol, drugs, viruses) pass through placenta to the fetus placenta is a barrier to the passage of maternal RBCs, bacteria, and many large proteins The placenta also prevents the mixing of fetal and maternal blood until delivery

Answer 77

Its structure, including a double lining of cells separating maternal and fetal blood, acts as a barrier to harmful compounds and controls rate of passage of nutrients and other substances into and out of fetal circulation

Answer 78

Placenta uses 30-40 percent of the glucose delivered by the maternal circulation If nutrient supply is low, the placenta fulfills its own needs before fetus Nutrient transfer across the placenta depends on a number of factors such as: o The size and the charge of molecules available for transport o Lipid solubility of the particles being transported o The concentration of nutrients in maternal and fetal blood Small molecules with little or no charge (water) and lipids (cholesterol and ketones) pass through the placenta easily, but large molecules (insulin and enzymes) aren’t transferred Nutrient exchange between the mother and fetus is unregulated for some nutrients, oxygen and carbon dioxide; It is highly regulated for other nutrients Nutrients cross placenta membranes by simple diffusion from blood with high concentration of the nutrients to blood with lower concentration Three primary mechanisms regulate nutrient transfer: facilitated diffusion, active transport, and endocytosis (or pinocytosis) The fetus receives small amounts of water and nutrients from ingestion of amniotic fluid By the second half of pregnancy, the fetus is able to swallow and absorb water, minerals, nitrogenous waste products, and other substances in amniotic fluid

Answer 79

The rate of human development is higher during gestation than any time thereafter Critical periods: pre-programmed time periods during embryonic and fetal development when specific cells, organs, and tissues are formed and integrated, or function levels established. Also called sensitive periods. o Critical periods are most intense during the first 2 months after conception

Answer 80

Critical periods of growth and development are characterised by hyperplasia, or an increase in cell multiplication The brain is the first organ that develops in humans, and the CNS The heart and adrenal glands come next after the CNS Some degree of hyperplasia takes place in a number of organs and tissues in the first year or two after birth and during the adolescent growth spurt

Answer 81

Cell multiplication continues at a lower rate after critical periods of cell multiplication and is accompanied by increases in the size of cells Cell size increases mainly due to an accumulation of protein and lipids inside of cells increases in cell size can be determined by measuring the protein or lipid content of cells Periods of hyperplasia-hypertrophy are followed by hypertrophy only During this phase, cells continue to accumulate protein and lipids, and functional levels continue to grow in sophistication, but cells no longer multiply

Answer 82

The last phase of growth and development is maturation – the stabilization of cell number and size; occurs after tissues and organs are fully developed later in life

Answer 83

The fetus undergoes marked changes in body composition during pregnancy The general trend is toward progressive increases in fat, protein, and mineral content Some of the most drastic changes take place in the last 5 weeks of pregnancy

Answer 84

Variations are not generally due to genetic causes but rather to environmental factors such as energy, nutrient, and oxygen availability, and to conditions that interfere with genetically programmed growth and development Insulin-like growth factor-1 (IGF-1) is the primary growth stimulator of the fetus o It promotes uptake of nutrients by the fetus and inhibits fetal tissue breakdown o Levels of IGF-1 are sensitive to maternal nutrition; its levels are decreased by under nutrition o Low levels of IGF-1 decrease muscle and skeleton mass and produce asymmetrical growth

Answer 85

Risk of illness and death varies with size at birth and is particularly high for newborns experiencing intrauterine growth retardation (IUGR) For a portion of newborns, smallness at birth is normal and may reflect familial genetics Because IUGR Is complicated to determine, it is usually approximated by assessment of size for gestational age using a reference standard Infants are generally considered likely to have experienced IUGR if their weight for gestational age or length is low o Newborns whose weight is less than the 10th percentile for gestational age are considered small for gestational age or SGA o This is further categorized into disproportionately small for gestational age (dSGA) and proportionately small for gestational age (pSGA) o Newborns who weight less than the 10th percentile of weight for gestational age but have normal length and head circumference for age are considered dSGA o If weight, length, and head circumference are less than the 10th percentile for gestational age, then the newborn is considered pSGA

Answer 86

Infants who are dSGA look skinny, wasted, and wrinkly Have small abdominal circumferences, reflecting lack of glycogen stores in the liver, and little body fat It appears that these infants have experienced in utero malnutrition in the 3rd trimester of pregnancy and that is compromised liver glycogen and fat storage These infants are at risk of developing the “hypos” after birth (hypoglycemia, …) perform worse academically, greater risk for heart disease, hypertension, and type 2 diabetes in the adult years

Answer 87

Look small but well proportioned Believed that these infants experienced long-term malnutrition in utero due to factors such as pre-pregnancy underweight, consistently low rates of maternal weight gain, and inadequate dietary intake or chronic exposure to alcohol Generally, have a reduced number of cells in organs and tissues Exhibit fewer health problems at birth than dSGA but catch-up growth is poorer even with nutritional rehabilitation Remain short and lighter and have smaller head circumferences throughout life

Answer 88

Newborns with weights greater than the 90th percentile for gestational age are considered to be large for gestational age Related to pre-pregnancy obesity, poorly controlled diabetes in pregnancy, excessive weight fain in pregnancy

Answer 89

> 30% of implanted embryos are lost by reabsorption into uterus or expulsion before 20 weeks of pregnancy, roughly a third of these are recognized as miscarriages early losses of embryos and fetuses are caused by non-inherited chromosomes abnormalities, thyroid disorders, hormonal imbalances, reproductive tract infections, drug or alcohol abuse, or other disorders presence of nausea and vomiting early in pregnancy is related to low risk of miscarriage nausea and vomiting occur as side effect of healthy changes in hormonal levels women who enter pregnancy underweight are at higher risk of miscarriage elevated blood cholesterol or triglyceride concentration and high levels of markers of inflammation in first half of pregnancy are linked to risk of miscarriage use of multivitamin supplements are associated with reduced risk of one

Answer 90

infants born preterm are at greater risk of death, neurological problems reflected later in low IQ scores, attention deficit/hyperactivity disorder, and enrolment in special education also chronic health problems such as cerebral palsy underweight women who gain less than the recommended amount à high risk women entering pregnancy obese are also at increased risk, but to a lesser extent women who exercise during pregnancy à lower risk reasons for preterm delivery: genital tract infections, insufficient uterine-placental blood flow, placental abruption, pre-pregnancy underweight, low weight gain during, short inter-pregnancy interval and high levels of stress

Answer 91

process by which adverse nutritional and other exposures during critical periods of growth and development modify gene function - such changes may predispose individuals to develop cardiovascular disease, type 2 diabetes, hypertension, obesity, and other disorders later in life

Answer 92

concept that development can be modified by particular environmental conditions experienced by a fetus or infant - environmental exposures modify development through epigenetic mechanisms that program gene function while not changing DNA structure o the epigenetic mechanisms influence growth and development by silencing certain genes and activating others

Answer 93

rates of low birth weight are higher in women gaining too little weight during pregnancy · weight gain during pregnancy is an indicator of plasma volume expansion and positive calorie balance, and provides a rough index of dietary adequacy · pre-pregnancy weight status affects the relationship between weight gain and birth weight o higher the weight before pregnancy, the lower the weight gain needed to produce a healthy infant and vise versa o duration of gestation, smoking, maternal health status, gravida (# of pregnancies experienced), and parity (# of previous deliveries) influence birth weight · women who gain within recommendation are approx. half as likely to deliver low birth weight or SGA newborns

Answer 94

low rates of gain in the first trimester of pregnancy may down-regulate fetal growth and result in reduced birth weight and thinness · rate of weight gain is generally highest around mid pregnancy – prior to time fetus gains most of its weight · some weight (3-5 pounds) should be gained in the 1st trimester, followed by gradual and consistent gains thereafter. Weight should not be lost until after delivery · the fetus only comprises about a third of the total weight gained during pregnancy o the rest is the increased weight of maternal tissues · body fat stores increase the most between 10-20 weeks of pregnancy

Answer 95

women are gaining more weight during pregnancy and losing less after delivery · women of all pre-pregnancy weight statuses tend to lose about 14 pounds within the first 6 weeks after delivery, after that amount varies · weight losses of 1-2 pounds per month postpartum with diet and exercise are appropriate

Answer 96

energy requirements during pregnancy increase due to protein and fat tissue synthesis · protein synthesis occurs in fetal, placental, uterine, and breast tissues · most of the fat synthesized during pregnancy is used to buildup maternal fat stores · the increased need for energy in pregnancy averages 300 kcals a day or a total for pregnancy of 80,000 kcal · DRIs for energy intake are +340 kcal per day for the second trimester and +452 kcal per day for third trimester

Answer 97

45-65 percent of total caloric intake should come from carbs | · good sources: vegetables and fruit, whole-grain products containing fiber

Answer 98

alcohol passes through placenta to fetus, interrupts normal growth and development · large amounts can cause risk of abnormal mental development and growth in offspring · avoidance of alcohol is most necessary during second half of first trimester

Answer 99

71 grams daily for pregnant individuals | · protein requirements increase during pregnancy because of protein tissue accretion

Answer 100

estimated pregnant women should consume 33 % of total calories on average from fat · fat consumed is used as energy source for fetal growth and development · recommendation: 13 grams of linoleic acid daily, and 1.4 grams of the other essential fatty acid, alpha-linoleic acid · Recommendation for Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) o 300 mg per day

Answer 101

inadequate folate is associated with anemia and reduced fetal growth o Folate is involved in replication of DNA, gene expression, and amino acid metabolism à deficiency impairs these processes o Folate abnormalties: neural-tube defects (NTDs) are malformations of the spinal cord and brain, three major types: § Spina bifida (spinal cord failing to close), anencephaly (absence of the brain or spinal cord), encephalocele (protrusion of brain through skull) o Sources of folate: vegetables and fruit

Answer 102

increases during pregnancy due to its role as a component of phospholipids in cell membranes and a precursor of intracellular messengers o RDA for choline: 450 mg daily o Major sources: eggs and meat

Answer 103

plays important roles in reactions involved in cell differentiation o Deficiency: can produce malformations of the fetal lungs, urinary tract, and heart o High doses of retinoic acid: retinoic acid syndrome: small ears or no ears, abnormal or missing ear canals, brain malformation, and heart defects o Take no more than 5000 IU during pregnancy

Answer 104

supports fetal growth, addition of calcium to bone, and tooth and enamel o Lack of it: compromises feta as well as childhood bone development o Intake of 15 mcg (600 IU) daily

Answer 105

needed for fetal skeletal mineralization and bone health o Approx. 30 grams of calcium is moved from mother to fetus during pregnancy o In last quarter of pregnancy, 300 mg per day of calcium needed o Calcium and release of lead from bones - Lead in maternal blood can cross placenta and be taken up by fetus - Cause of concern because its related to miscarriage, preterm birth, low-birthweight infants, impaired central nervous system development - Women who do not consume enough calcium show greater increases in blood lead levels

Answer 106

limited amount of fluoride transferred from mother’s blood to developing enamel of fetus, however, major gains occur in the years after birth

Answer 107

women require about 1000 mg (1g) of additional iron for pregnancy o Iron deficiency and iron deficiency anemia is most common worldwide o Rates of iron deficiency are lower in 1st trimester, increase in second, and peak in third o Increases risk of preterm delivery and low-birthweight by 2-3 times o Pregnant women should take a 30 mg iron supplement daily after 12th week of pregnancy

Answer 108

needed for thyroid function and energy production, and fetal brain development o Deficiency can lead to hypothyroidism

Answer 109

Constituents in foods or dietary supplements other than those needed to meet basic human nutritional needs that are responsible for changes in health status · Examples: antioxidant pigments in plant foods and caffeine

Answer 110

Caffeine increases hear rate and stimulate central nervous system - Reducing caffeine intake doesn’t appear to improve pregnancy outcomes

Answer 111

Large increase in water during pregnancy is generally met by increased levels of thirst

Answer 112

Changes in the way certain foods taste, and the odor of foods, and other substances affect two out of three women during pregnancy

Answer 113

classified as an eating disorder, affects over half of pregnant women, compulsion to eat substances that are not food o Types: pagophagia (compulsive consumption of ice or freezer frost), amylophagia (compulsive consumption of laundry starch or cornstarch), geophagia (compulsive consumption of clay or dirt)

Answer 114

Diets of pregnant vegetarians are sometimes low in Vitamins B12 and D, calcium, iron, zinc, and the omega-3 fatty acids eicosapentaenoic, and socosahexaenoic acids · Protein intake is adequate in vegetarian diet but may be low in vegans · Protein sources: legumes and grains

Answer 115

Dietary supplements used by pregnant women come in pill, powder, chewable, liquid, and snack bar form · About 95% of pregnant women take a vitamin and mineral supplement regularly · Herbs are regarded by the public and health professionals as helpful, safe, and gentle o Many aren’t approved for use in pregnancy, about 1/3 are deemed unsafe

Answer 116

food-borne illness, placenta does not protect the fetus from listeria infection in the mother o Associated with spontaneous abortion and stillbirth in one-third of fetuses and mild infection in mothers o To prevent: pregnant women should not eat raw or smoked fish, oysters, unpasteurized cheese, raw or undercooked meat, or unpasteurized milk

Answer 117

can be transferred from mother to fetus and cause mental retardation, blindness, seizures, and death

Answer 118

mercury can pass from mother’s blood to the fetus, it is a fetal neurotoxin that can produce mild to severe effects on fetal brain development o Fetuses exposed to high amounts of mercury can develop intellectual disabilities, hearing loss, numbness, and seizures o High levels of mercury are likely to be in muscles of large fish such as sharks, swordfish, tilefish, albacore tuna, walleye, pickerel, and bass

Answer 119

Exercise during pregnancy benefits both the mother and her fetus and is encouraged · Women who exercise during pregnancy feel healthier, have an enhanced sense of well-being, and somewhat short labours · Reduces risk of developing gestational diabetes, hypertension, low back pain, excessive weight gain, and blood clots · Should exercise 3-5 times a week for 20-30 minutes

Answer 120

Nausea occurs in 8/10 pregnancies, vomiting in 5/10 · Symptoms of nausea begin around week 5 of gestation and disappear by week 12 · Actually occurs at all times, not just in the morning · Iron supplements may aggravate nausea and vomiting when taken in first trimester · Between 1-2 percent of pregnant women with nausea and vomiting develop hyperemesis gravidarum (characterized by severe nausea and vomiting lasting throughout pregnancy)

Answer 121

Continue to gain weight, Separate liquid and solid food intake, Avoid odors and foods that trigger nausea, Select foods that are well tolerated

Answer 122

Vitamin B6, Diclectin, multivitamin supplements, and ginger

Answer 123

Pregnancy is accompanied by relaxation of gastrointestinal tract muscles o This effect is attributed primarily to progesterone · Relaxation of muscular value known as cardiac or lower esophageal sphincter is thought to lead to the heart burn o Prevention and management: Ingest small meals frequently, Do not go to bed with full stomach, Avoid foods that seem to make heartburn worse

Answer 124

Relaxed gastrointestinal muscle tone is responsible for this | · Prevention: consume approx. 30 grams of dietary fiber daily

Answer 125

- The Montreal Diet Dispensary | - The WIC Program

Answer 126

Assesses usual dietary intake of pregnant women · Determines individual nutritional rehabilitation needs ·Teaches clients the importance of optimal nutrition · Provides regular follow-up and supervision

Answer 127

Serves nutritional needs of low-income women and families | · Provides nutritional assessment, education and counseling, food supplements, and access to health services

Answer 128

The roots of preeclampsia lie very early in pregnancy but there is no reliable means of identifying the exact reason for developing the condition. However, women with insulin resistance, obesity, very high triglyceride levels and other such characteristics do contribute in developing the disease. The risk of developing preeclampsia is higher in women who were born smaller for gestational age.

Answer 129

The functional units of the mammary gland are the alveoli Each alveolus is composed of a cluster of cells (secretory cells) with a duct in the center, whose job it is to secrete milk Myoepithelial cells surround the secretory cells

Answer 130

As the ductal system matures, cells that can secrete milk develop, the nipple grows and its pigmentation changes The luteal and placental hormones (placental lactogenic and chorionic gonadotropin) allow further preparation for breastfeeding Estrogen stimulates development of the glands that will make milk Progesterone allows the tubules to elongate and the cells that line the tubules to duplicate

Answer 131

The first stage begins during the last trimester of pregnancy Can be impacted by premature delivery, method of delivery, and other factors These may explain why mothers who deliver prematurely are often unable to develop full milk supply Second and third stages occur after birth

Answer 132

During the first stage of milk production, milk begins to form, and the lactose and protein content of milk increase. This stage extends through the first few days postpartum

Answer 133

This stage begins 2-5 days postpartum and is marked by increased blood flow to the mammary gland. Clinically it is considered the onset of copious milk secretion or 'when milk comes in'. Siginifcant changes in both milk composition and the quantity of milk that can be produced occur over the first 10 tens of the baby's life

Answer 134

This stage of breast milk production begins about 10 days after birth and is the stage in which the milk composition becomes stable

Answer 135

Prolactin us a hormone that stimulates milk production Stress, sleep and sexual intercourse also stimulate prolactin levels Oxytocin release is also stimulated by suckling or nipple stimulation. It also acts on the uterus, causing it to contract, seal blood vessels and shrink its size

Answer 136

Water, sodium, potassium and chloride are able to pass through alveolar cell membranes in either direction Immunoglobulin A and other plasma proteins are captured from the mothers blood and taken into the alveolar cells

Answer 137

The stimuli from the infant suckling are passed through nerves to the hypothalamus, which responds by promoting oxytocin release from the posterior pituitary gland The oxytocin causes concentration of the myoepithelial cells surrounding the secretary cells Milk is released through the ducts, making it available to the infant Other stimuli, such as hearing a baby cry, sexual arousal and thinking about nursing can also cause letdown and milk will leak from the breasts

Answer 138

Human milk consumption is changeable over a single feeding over a day, according to the age of the infant or gestation at delivery with the presence of infection in the breast, with menses and with maternal nutritional status

Answer 139

The first milk, colostrum is a thick often yellow fluid produced during lactogenic II It provides about 580-700 kcal/L and is higher in protein and lower in carbs and fat than mature milk Secretory immunoglobin A and lactoferrin are the primary proteins present in colostrum but other proteins present in mature milk are not present Has higher concentrations of sodium, potassium and chloride than more mature milk

Answer 140

This biological design of milk means that babies do not need water or other fluids to maintain hydration, even in hot weather

Answer 141

Human milk provides approx. 0.65 kcal/mL although the energy content varies with its fat composition Infants who are breastfed are thinner for their weight at 8-11 months than infants fed HMS, b but these differences disappear by 12-23 months of age and few differences are notable by 5 years of age

Answer 142

Lipids provide half of the energy of human milk Human milk fat is low at the beginning of a feeding in foremilk and higher at the end in the hind milk that follows Effect of maternal diet on fat composition When diets rich in polyunsaturated fats are consumed more polyunsaturated fatty acids are present in the milk When very low diets with adequate calories from carbs and protein are fed, more medium chain fatty acids are synthesized in the breast DHA Milk DHA levels are increased by maternal supplementation DHA is essential for retinal development Trans fatty acids Stemming from the mothers diet are present in human ilk Removal of trans fatty acids from many food products in Canada led to lower levels of trans fat in human milk Cholesterol Essential component of all cell membranes is needed for growth and replication of cells Early consumption of cholesterol through breast milk appears to be related to lower blood cholesterol levels later in life

Answer 143

Concentration of proteins synthesized in the breast are more affected by the age of the infant than maternal intake and maternal serum proteins Proteins and their digestive products, such as peptides, exhibit a variety of antiviral and antimicrobial effects Enzymes present in human milk might also provide protection by facilitating actions that present inflammation

Answer 144

``` Major class of protein in mature milk from women who deliver either at arm or preterm Casein, calcium phosphate and other ions such as magnesium and citrate appear as an aggregate and are the source of milks white appearance ```

Answer 145

Proteins that remain soluble in water after casein in precipitated from milk by acid or enzymes The enzymes present in whey proteins aid in digestion and protection against bacteria

Answer 146

Some of this nonprotein nitrogen is used to produce other proteins with biological roles such as hormones, growth factors, free amino acids, nucleic acids, nucleotides and carnitine Nucleotides appear to play important roles in growth and disease resistance

Answer 147

Lactose enhances calcium absorption Oligosaccharides Can be free or bound to proteins as glycoproteins or bound lipids as glycolipids or they can bind to other rides are classified as glycan's Prevent the binding of pathogenic microorganisms to the gut thereby preventing infection and diarrhea

Answer 148

Colostrum has approx. twice the concentration of vitamin A as mature milk does Beta-carotene

Answer 149

Vary with maternal diet and exposure to sunshine Maternal exposure to sunlight has been reported to increase vitamin D3 level milk tenfold Unknown how much maternal and infant vitamin D status when sunlight exposure is insufficient, through researchers are actively pursuing the answer

Answer 150

Levels of alpha-tocopherol decrease from colostrum to transitional milk and to mature milk, whereas beta and gamma tocopherols remain stable throughout each stage of lactation Levels of vitamin E in preterm milk have been reported to be the same and higher than in term milk

Answer 151

Approx. 5% of breastfed infants at risk for vitamin L deficiency based on vitamin K dependent clotting factors

Answer 152

Clinical problems relating to water-soluble vitamins are rare in infants and nursed by mothers with inadequate diets Vitamin B is considered most likely to be deficient in human milk: levels of B6 in human milk directly reflect maternal intake

Answer 153

Are bound to whey protein in human milk; therefore their content in milk is less influenced by maternal intake of these vitamins than are the other water soluble vitamins Folate levels increase with the duration of lactation despite a decrease in maternal serum and red blood cell folate B12 deficiency or low levels of B12 in milk, has been reported for women who have had gastric bypass surgery have hypothyroidism, consume vegan diets have latent pernicious anemia, or are generally malnourished

Answer 154

Monovalent ion secretion is managed closely by the alveolar cells, in balance with lactose to maintain the isosmotic composition of human milk Mineral content is low in breast milk than in cow's milk Bioavailability Breastfed infants have little risk of anemia despite the seemingly low concentration or iron in human milk

Answer 155

Importance of zinc to human growth is well established Bound to protein and is highly available in comparison to cow's milk and cow's milk-based HMS Rare cases of zinc deficiency which appears as intractable diaper rash, have been noted in exclusively breastfed infants A defect in the mammary gland uptake of zinc has been described as the cause of low milk concentration when maternal serum zinc concentrations are normal

Answer 156

Copper, selenium, chromium, manganese, nickel, and flouring | Levels of trace minerals in human milk are not altered by the mother's diet or supplement use expecting fluoride

Answer 157

The flavour of human milk is an important taste experience for newborn infants but flavour is often ignored when benefits of human milk or its composition are considered Exposing infants to a variety of flavours in human milk may contribute to their interest in and consumption of human milk as well as their acceptance of new flavours in solid foods

Answer 158

Increases oxytocin levels, a hormone that stimulates uterine contractions minimizes maternal postpartum blood loss and helps the uterus to return to non-pregnant size Psychological benefits including increased self-confidence and facilitated bonding with their infants Women who nurse at a younger age and for longer duration have lower risk of breast and ovarian cancer and rheumatoid arthritis

Answer 159

The balance of nutrients in human milk matches human infants requirements for growth and development closely; no other animal milk or HMS meets infant needs as well Human milk is isosmotic and therefore meets the requirements for infants without other forms of food or water Human milk provides generous amounts of lipids in the form of essential fatty acids, saturated fatty acids, medium-chain triglycerides and cholesterol Long chain polyunsaturated fatty acids, especially docosahexaenoic acids (DHA) which promotes optimal development of the of the central nervous system are present in human milk Minerals in breast milk are largely protein bound and balanced to enhance their availability and meet infant needs with minimal demand on maternal reserves

Answer 160

Cellular components in human milk are especially high in colostrum but are also present for months in mature human milk in lower concentrations The function of macrophages in human milk includes phagocytosis of fungi and bacteria, killing of bacteria and production of the complement proteins, lysozyme and lactoferrin and immunologlobin A and G Binding proteins in human milk bind iron and vitamin B12, making the nutrients unavailable for pathogens to grow in infants gastrointestinal tract Growth factors and hormones in human milk, such as insulin, enhance th maturation of the infants gastrointestinal tract These substances also help to protect the infant, espcially neonates, against viral and bacterial pathogens

Answer 161

Reduced infant illness is evidence in countries with high infant illness and death rates, poor sanitation and questionable water

Answer 162

Lower rate of acute illnesses in breastfed children, breastfeeding also seems to protect against chronic childhood diseases including celiac disease, inflammatory bowel disease, and leukemia

Answer 163

Breastfed infants typically are leaner than HMS-fed infants at one year of age without any difference in activity level or development

Answer 164

The differences in cognitive function are also greater in premature infants fed human milk than those HMS Fatty acid composition of milk plays an important role in neuropsychological development bolsters the credibility of psychological or cognitive benefits from breastfeeding

Answer 165

Breastfeeding may be used to reduce infant discomfort during minor invasive procedures

Answer 166

Milk production can range from 450-1200mL over day in women who are nursing one infant Milk increases to meet the demand of twins, triplets, infants and toddlers suckling simultaneously; it can also be increased by pumping the milk

Answer 167

Does not determine the amount of milk production tissue Women with small breasts can produce the same amount of milk as a women with large breasts, although the latter woman may be able to feed her infant less frequently to deliver the same volume of milk compared with a woman with smaller breasts

Answer 168

Women who are able to establish an adequate volume of milk in the first 2 weeks postpartum are more likely to still have enough milk for their infant at 4-5 weeks This recommendation is consistent to build a good milk supply

Answer 169

Evidence does suggest that women who undergo breast reduction surgery may be at risk for unsuccessful lactation, as evidence by lower breastfeeding rates and duration and greater perception of insufficient milk supply than among women without prior breast surgery

Answer 170

Compression of ducts leading to poor milk production

Answer 171

Breasts and nipples begin to sore in the first trimester of pregnancy, but the tenderness usually subsides by the end of the first trimester Gentle massage is recommended by the La Leche League to get women accustomed to handing their breasts and prepare them from expressing milk

Answer 172

Mothers learn from health professionals

Answer 173

Women use their hand to shape and position the breast so that the infant can easily latch Infants who are properly attached at the breast have all or most of the areola in their mouth Mother should hear swallowing, but not smacking, clicking or slurping Infants who are positioned correctly at the breast start to suckle almost immediately, change from quick short sucks to slow deep sucks, and remain relaxed

Answer 174

Gag reflex is the reflex that prevents taking food and fluids into the lungs This reflex is developed by 28 weeks gestation Oral search reflex infant opening his or her mouth wide in proximity to the breast while thrusting the tongue forward The rooting reflex results in the infant turning to the side when stimulated on the side of the upper or lower lip

Answer 175

Suction created within the baby's mouth causes the mother's nipple and areola to elongate and form a treat The baby then raises the anterior portion of the tongue to complete the process The baby depresses and retracts the posterior portion of her tongue that channels milk to the back of the oral cavity

Answer 176

When infants are hungry they begin to bring their hands to their mouth such on then and start moving their head from side to side with their mouth open

Answer 177

Stomach emptying occurs in about 1 and a half hours for breastfed infants Milk intake and weight gain of these infants in the first 4 months of life were similar to those of infants whose feedings were distributed over 24 hours

Answer 178

Malnourished infants become sleepy and unresponsive, and have a weak cry and few wet diapers By 5-7th day postpartum infants who are getting adequate nourishment have wet diapers approx. 6 times a day and have 3-4 soft, yellowish stools per day

Answer 179

Breastfed babies may have straighter teeth due to the development of a well-rounded dental arch

Answer 180

Breastfed infants should be given a supplement of 400 IU of vitamin D per day beginning in the first 2 months of life

Answer 181

A plan for monitoring maternal weight change, infant growth or nutrient status round out the nutrition assessment process

Answer 182

First 6 months and 400 cal per day afterward 623 cal per day assuming 750 grams of milk produced at 0.67 kcal/g and 80% percent efficiency Assessment of adequacy of energy intake of breastfeeding women should always be made within the context of the mother's overall nutritional status and weight changes and the adequacy of the infants growth

Answer 183

Protein-calorie malnutrition results in an energy deficit that reduces the volume of milk produced but does not usually compromise the composition of the milk

Answer 184

Studies of weight loss during lactation also suggest that modest energy restriction can be accomplished without large decreases in the quality of the maternal diet, but that the macronutrient content of the diet of the milk differentially Greater energy deficit through higher milk-fat content milk to when they consumed a high carbohydrate diet

Answer 185

Increasing energy expenditure on weight and lactation suggest that it is safe

Answer 186

Supplementation should target specific nutritional needs of individual women Supplementation strategies should take into account ho nutrients are secreted into human milk and the potential for nutrient-nutrient interactions in mother and their infants

Answer 187

The goal is to be adequately nourish the mother and child, not to force women to use supplements and/or products that are not part of their normal eating patterns Vegetarian intakes of protein are generally adequate as long as energy intake is adequate

Answer 188

Crying for more than three hours a day when the cause is not medical problem Women should be encouraged to exclude only those foods that seem to cause problems and to be careful to replace nutrients that might be lost by avoiding classes of foods

Answer 189

Infants who are breastfed for 6 months experience fewer illnesses from gastrointestinal infection than do infants who are given HMS and breast milk at 3 or 4 months of age Deficits in growth have not been demonstrated among infants in developing or developed countries who are exclusively breastfed for 6 months or longer

Answer 190

Overweight and obesity prior to pregnancy and excess weight gain during pregnancy are associated with shorter duration of breastfeeding Lower prolactin responses early postpartum and resulting difficulty in establishing adequate milk supply

Answer 191

Low income women often lack the education, support and confidence to interpret the abundant and pervasive mixed messages on infant feeding practices

Answer 192

``` Embarrassment Time and social constraints and concerns about loss of freedom Lack of support from family and friends Lack of confidence Concerns about diet and health practices Fear of pain in adolescents ```

Answer 193

To promote and model optimal breastfeeding practices during prenatal care, at delivery and after discharge

Answer 194

Provide training in breastfeeding promotion to pediatric practices and individuals through webcasts to teleconferencing technology Develop model residency program curricula for obstetrics, pediatrics and family medicine Provide technical assistance and resources to physicians, residents, public health representatives and families Strengthen and expand national collaborative networks and action groups at local, state, and regional levels to implement effective breastfeeding strategies and initiatives in underserved populations Assess changes in breastfeeding rates in physicians practices after the practice implements breastfeeding education, counseling interventions and ongoing support for mothers

Answer 195

Provides women with an opportunity to begin a dialogue with her provider about the infant feeding decision Toward the end of pregnancy, women need information on what to expect in the hospital or birthing center and practical tips for initiating breastfeeding Although not all women will choose to breastfeed, the goal of prenatal breastfeeding education is to empower every woman with sufficient knowledge to make an informed decision about how to feed her baby In recognition of the benefits of breastfeeding and the important role of health professionals in promoting and supporting breastfeeding, preferred infant feeding method

Answer 196

In effort to promote, protect and support breastfeeding in hospitals and birthing centers worldwide, WHO and UNICEF established the baby friendly hospital intiative 1992 The WHO and UNICEF came together to try to revitalize the international community in breastfeeding promotion with the global strategy for infant and young child feeding

Answer 197

Younger women and women with lower socioeconomic status are more likely to stop breastfeeding by 4 weeks postpartum and cite sore nipples, inadequate milk supply, feeling that the infant is not satisfied and infant problems as reasons for stopping Mothers should be armed with information on sources of trained, skilled and available help in the community, such as lactation consultants, peer counselors, the WIC program, or La Leche League, should question or complications arise

Answer 198

Neonatal jaundice is a yellow discharge of the skin caused by too much bilirubin in the blood Common and usually benign condition that resolves on its own or with intervention

Answer 199

Is a by-product of the normal physiologic degradation of hemoglobin Since higher levels of hemoglobin are necessary in utero to carry oxygen delivered to the fetus by the placenta, the normal full-term infant has a hematocrit of 50-60% As soon as the infant is born it breathes, the need for high hemoglobin is gone and excess erythrocytes are destroyed The released hemoglobin is broken down by the reticuloendothelial system; bilirubin, an insoluble by product of the breakdown of hemoglobin, is released into the circulation bound to albumin or another transport protein

Answer 200

Limited ability of the newborns immature liver to process large amounts of bilirubin as effectively as a mature liver Excessive bilirubin is deposited in various tissues, including the skin, muscles and mucous membranes of the body, causing the skin to take on a yellowish colour Bilirubin levels in physiologic jaundice are usually less than 12mg of bilirubin per dl of blood of infants of white or black decent

Answer 201

``` Hemolytic disease Erythrocyte disorders Extraversion of blood Inborn errors of metabolism/conjugation defects Hypothyroidism Polycythemia Macrosomia infant of diabetic mother Intestinal obstruction; delayed passage of meconium Sepsis ```

Answer 202

Two separate entities, they can have an interactive effect on each other Infants with breast milk jaundice who manifest higher levels of bilirubin in the second and third weeks of life, often over 15 mg/dl have been noted to have had relatively high serum bilirubin concentration during the first 3 to 5 days of life due to breast-non-feeding jaundice, hemolysis or unknown etiology Then the ingestion of mature milk and a consequent enhancement of the enterohepatic circulation may enlarge the pool even further

Answer 203

Phototherapy involves placing the newborn under special fluorescent lights that, like sunlight, assist in removing jaundice from the skin The light is absorbed by the bilirubin, changing it to a water-soluble product, which can then be eliminated without having to be conjugated by the liver Many health professionals believed that new born infants wold become dehydrated if they were not supplemented with water of formula during the first days of breastfeeding The benefits of early and frequent breastfeeding in the first days of life for prevention of hyperbilirubinemia through maintaining hydration and stimulating the passage of stool are now well documented

Answer 204

weight of newborn is a key measure of health status during pregnancy. - Average gestation (aka: full-term) 40 week infant (average range 37-42 weeks). - Usual weight for full term infant = 2500-3800 grams (5.5-8.5 lbs)

Answer 205

born before 37 weeks of gestation.

Answer 206

death that occurs within the first year of life. - Global rate increasing - 8.2% of live births in US in 2009 were low birth weight (less than 2500grams or 5.5 lbs) - Preterm birth is a key risk factor for infant death.

Answer 207

efforts to improve situation are underway on many levels. USA improved access to specialized care is credited in part for the decline in infant mortality rate. - This is a multifaceted problem though impacted by the following factors: - Social and economic status of the families and women - Access to health care - Medical interventions - Teen pregnancy rates - availability of abortion services - Failure to prevent preterm and low birth rate births.

Answer 208

The Early Periodic Screening, Detection and Treatment program is part of Medicaid and provides routine checkups for low-income families. - is a major source of preventive and routine care - provides immunizations during infancy - Nutrition is included in SOME national prevention programs such as - The Special Supplements food program for Women, Infants and Children (WIC) - the Centers for Disease Control (CDC)

Answer 209

- indicators of healthy newborn status include | - birthweight, length, head circumference for gestational age

Answer 210

Fetal undergrowth from any cause, resulting in a disproportionality in weight, length, or weight-for-length percentiles for gestational age. Sometimes IUGRestriction.

Answer 211

above 90th percentile

Answer 212

between 10-90th percentile

Answer 213

- need to understand process of development to understand infant’s nutritional needs. - Organs and systems developed during gestation continue to increase in size and complexity during infancy. - The central nervous system is still immature neurons are less organized à results in inconsistent cues of hunger or other needs.

Answer 214

an automatic response that is triggered by a specific stimulus. (is unlearned). They fade as they are replaced with meaningful movements during the first few months of life

Answer 215

action that occurs if one cheek is touched resulting in the infant’s head turning to that cheek and opening its mouth

Answer 216

a reflexive movement of the tongue moving forward and backward; earliest feeding skill

Answer 217

reflects the infant’s ability to control voluntary muscle movement - development is top down (control head first then body) - muscle development is central to peripheral (ie; learn to move shoulders before hands) - development of motor skills increases nutrient needs and energy needs

Answer 218

a fixed time period in which a certain behaviour emerges. -Piaget and Erikson’s stages are filled with critical period examples as they have windows/ages for subsequent learning to occur

Answer 219

an early learning system in which the infant’s senses and motor skills provide input to the central nervous system. -The interaction with the environment stimulates the child’s cognitive development, and brain structures get more use and create more pathways.

Answer 220

by 3rd trimester fetus is swallowing amniotic fluid which stimulates the lining of intestinal wall to develop. - at birth, innards are mature enough to digest fats, protein, and simple sugars, and to absorb fats and amino acids. - After birth as child develops, coordination of peristalsis continues and GI tract improves

Answer 221

impact intestinal wall and development of intestinal mucosa. These are found in infant formulas and supplements.

Answer 222

movement of the stomach contents backward into the esophagus due to stomach muscle contractions. The condition may require treatment depending on its duration and degree. AKA GERD

Answer 223

measure of the # of particles in a solution which predicts the tendency of the particles to move from high concentration to low concentration. - Colon bacterial flora - Water and fluid balance in the body

Answer 224

- Ability to respond to and understand infant’s cues improve over time. - new parents have to learn the temperament of their children - Temperament = has a bio basis and includes emotional reactions to new situations, activity level, and sociability. - good fit between parent and child temperament helpful.

Answer 225

- higher per pound of body weight than at any other time of life. - average range of energy a day = 80-120 kcals PER KG of body weight - the average energy need in the 1st 6 months of life = 108 cal per KG of body weight - average from 6-12 months = 98 cal/kg. - Factors like: weight, growth, sleep/wake cycle, Physical activity and metabolism influence the wide range of energy needs for infants.

Answer 226

- Birth to 6m = 2.2g/kg body weight - 6-12m – 1.6g/kg body weight - Protein needs influenced by body composition since active muscles need more protein for maintenance. - MOST infants who breastfeed get the required amount of protein - bottle feeding excess formula may increase amount of protein to over DRI.

Answer 227

- no specific recommended intake level of fat for infants. - breast milk provides 55% of energy from fat and reflects adequate intake of fat by infants. - Cholesterol intake should not be limited in infants as they need it for metabolite and brain development. - short and medium chained amino acids are more readily absorbed by the child compared to long-chain. - Infants need fat to supply the liver, brain, muscles and heart with enough energy. - Young infants cannot tolerate fasting for long because it quickly uses carbs and fat energy sources. à Less severely…this explains why infants can’t sleep through the night. - Fats in food provide the alpha-acids (essential fatty acids) needed for hormones, steroids, endocrine and neuro development. - Full term breastfeed babies do not need supplements for fats or essential fatty acids.

Answer 228

highest of any period after birth because of growth

Answer 229

DRI = 0.1mg daily for infants less than 6 months DRI = 0.5 mg daily for 7-12 months -Forms enamel of teeth, including those not yet visible! -Too much may result in teeth discolouration -In more urban areas tap water is fluorinated

Answer 230

- required for bone mineralization - recommended for infants at about 400 IU per day (if breastfeeding only). Supplements not needed if taking a supplemented formula. - Vit D not supplied in human milk in sufficient amounts - Apply sunscreen to infants to prevent Vit D creation from sunlight.

Answer 231

- Major component of extracellular fluid and regulator of fluid balance. - Estimated minimum requirements = 120mg for 0-5 month olds - 200mg for 6-12months - Breast milk sodium content used as basis for determining requirements and formula typically match - Young infants do not sweat as much as older children so there are not major losses for infants (aka: less alarm if infant is less thirsty).

Answer 232

-DRI updated in 2010…0.27mg of elemental iron daily and older infants (7-12m) 11mg daily.

Answer 233

- Not a nutrient but can be associated with iron and calcium status during infancy - Elevated lead in blood can be toxic to brain and development - Infants may be exposed accidentally to environmental forms of lead (paint, toys, etc) - Lead poisoning screening recommended around 9-12 months

Answer 234

- tracking growth and length/weight helps identify health problems early. - growth reflects nutritional adequacy, health status and family influences. - Accuracy requires calibrated scales, recumbent-length measurement board and headpiece, no stretch tape, etc. - standard techniques should be used which requires practice and consistency - Errors in plotting growth less frequent when computer software collects data from electronic scales.

Answer 235

- Recommended = exclusive breast feeding for the first 6 months of life, and continuation until 12m. - Safe practices for breast feeding include; encourage it as soon after birth as possible or as soon as mother’s milk is available, teach safe milk handling and storage. - Infants less than 6 months old should NOT receive any other form of food - Formula for full-term newborns are usually 20 cal per fluid oz - For premature infants, formula should usually be about 22-24 cal/fl oz OR as directed by doctor

Answer 236

- should NOT be used during infancy, no matter the type of cow’s milk! - Iron deficiency anemia has been linked to early introduction of whole cow’s milk, which could be due to gastrointestinal blood loss, low absorption of other minerals, or lack of other iron-rich foods.

Answer 237

- American Academy of Pediatric recommend the limited use of these types of formula when breast milk is unavailable. - National Institute of Health released a report in 2010 noting that soy formulas may impact developmental and long-term reproductive risks, with hormone-like components. - Soy milk is not recommended for use of managing infantile colic - Lactose-free and hydrolyzed formulas are good alternatives to soy protein-based formulas if necessary

Answer 238

- Infants are born with feeding reflexes and regulation mechanisms. - In early infancy, self-regulation of feeding occurs by the pleasure of the sensation of fullness…inherent preferences are in place for sweet taste - After first 4-6 weeks, reflexes fade and infants learn to purposefully signal wants and needs - Children cannot verbalize hunger until about age 3 - there is an interplay between environmental and biological influence of feeding. Mental health of caregiver and or economic status for example influence when and how or if child is fed. - Infant is probably able to start being spoon fed when they can move tongue side to side without moving head, can sit upright with head up with little to no support. - The parent’s ability to read infant cues of hunger, satiation, etc may influence the progression of feeding skills.

Answer 239

watching food being opened, tight fists or reaching for spoon, showing irritation if feeding is too slow, starts to play with food as they get full, turning away from food, spitting out food when full.

Answer 240

- begin with food offered on a spoon in small portions (1-2 tbs) a meal with 1-2 meals a day. - offering on a spoon stimulates 6month olds’ muscle movement in mouth - spoon feeding is very different for baby as it is not warm and soft in the mouth like the breast, nor is the food the same texture or liquid. Baby may therefore suck food off spoon at first. - If the baby cannot extend tongue past lower lip then it’s not ready to be spoon fed - stimulate feeding by slightly pressing spoon against lower lip to open mouth - keep baby’s chin slightly down to protect airway - pace of eating should be based by watching for it to swallow - First meals may be small (5-6 baby spoons) and last about 10 minutes depending on the baby’s interest

Answer 241

- improper positioning associated with choking, discomfort and ear infections - semi-upright feeding (like in car seat) is ideal for the first few months. - propping bottle or placing on pillow increases risk of choking and overfeeding. - When spoon feeding child should have enough head and foot support, and feeder should sit directly in front to minimize the turning of the head. (Use seatbelt in highchair and/or keep hips and legs at 90 degrees). - Identifying early feeding problems or abnormalities in seemingly healthy infants can indicate other health or developmental issues. Get them checked. (E.g: some reluctant feeders may later be diagnosed with lactose intolerance).

Answer 242

Discontinuation of breastfeeding or bottle-feeding and substitution of food for breastmilk or formula…usually completed by toddlerhood.

Answer 243

- Recommended age for weaning infant from breast or bottle to a cup is 12-24m. - if infants are not exclusively breastfed they may need additional fluids offered as they will not have developed the skills required to drink from a cup. - ability to lift tongue and control liquid emerges around 1y - At first, typical portion size of fluid is 1-2 oz - an infant who is weaned too soon may plateau in weight because of decreased total energy - Changing from bottle to sippy cup is NOT developmental progress towards an open cup but can be helpful

Answer 244

- Infants progress from swallowing only fluids to pureed soupy foods at about 6 months - mouth is super sensitive to texture…food with soft lumps too soon may cause discomfort or choking - At about 6-8 months children are ready for lumpy food to elicit munching and jaw movements - By 8-10m, able to chew and swallow soft lumpy food without choking - Mature chewing skills are not developed/mature until toddlerhood.

Answer 245

- 1st food generally recommended at 6 months is baby cereal mixed with water or breast milk. - rice cereal usually first because it is hypoallergenic and easily digestible. - Some parents add baby food because they think this will make the infant sleep longer. NOT GOOD as the early introduction of cereal before infant has developed ability to eat with a spoon is bad. - Some families are instructed to add dry rice as part of treatment for gastrointestinal problems because it thicken infant formula. - Fruits and vegetables, such as pears, applesauce or carrots are also sometimes first foods for infants. - First foods depend on culture and ethnicity. - Add only one new food at a time over 2-3 days. - Commercial baby foods are not a necessity for infants…some baby foods express parent’s preferences rather than nutrient needs or desires of infant. - Other foods like yogurt, soft-cooked bean, mashed potatoes, hot cereal and cheerios are more appropriate for 9-13 month olds.

Answer 246

- choosing foods based on parent’s likes and dislikes is bad and problematic. - Food associated with choking in children = hot dog pieces, jelly beans, peanuts and other nuts, whole grapes, stringy meats, sticky foods, hard or raw fruits/veggies. - choking often associated with immature chewing skills

Answer 247

- Breastmilk or formula generally provides adequate water for healthy infants for the first 6 months - drooling does not indicate increased need for water - all forms of fluid contribute to an infant’s water needs - sports drinks and cola NOT recommended at all in infants - vomiting and diarrhea may result in increasing water intake as they dehydrate infants faster than other children, and infants do not have a way to signal parent for water. - juice is not needed in infants…don’t give until at least 1year of age

Answer 248

- common for new parents to interpret all signs of discomfort as hunger, when really it might just be irregular sleep/wake cycles of the infant. - Infants who are quite sensitive to what is happening are likely to be irritable and hungry if they cry frequently. - infants who sleep through usual household noises are less reactive to immediate environment and are likely offered food less frequently. - constant feeding at amounts over DRIs each time is a sign that the parent is interpreting all signs of discomfort as feeding…Risk of over feeding - spitting food by moving tongue back and forth may be seen as not hungry, when really infant is trying to learn how to grab food off of spoon and swallow

Answer 249

- learn based on experiences with food - breastfed infants may be exposed to a wider variety of tastes within breastmilk itself than infants offered only formula. - There are genetic dispositions for sweet tastes and against bitter foods may modify food preferences.

Answer 250

- keeping healthy infants at home may include lifestyle changes for other family members and parents. - according to Health Expert panel on Cardiovascular Health Risks infants have lower long-term risks if they are breastfed and not exposed to smoke. - according to American Academy of Pediatrics recommends that infants not be exposed to screen time - infants should not be exposed to a daily exercise routine/movements as they are still developing and to much movement can harm tissues.

Answer 251

- Specific supplements are recommended for breastfed infants in US and Canada under certain circumstances: - Fluoride if family doesn’t live in a place with it already in the water … OR if breast milk is the only form of nutrition. - If breast milk is the only form of nutrition, term infants at age four months are recommended to have supplemental iron at 1mg/day until food makes up for it. - Supplemental iron if breast milk only form for pre-term infants at 2mg/kg per day starting at age 1 month until 12 months, to prevent iron deficiency. - Vitamin B12 if the mother is vegan - Vitamin D if breastmilk is the only form of nutrition may be prescribed. - If low birth weight or born early, vit A and E and iron may be prescribed as these things usually are absorbed in the last weeks of pregnancy.

Answer 252

Condition of inadequate weight or height gain thought to result from an energy deficit, whether or not the cause can be identified as a health problem. Is usually diagnosed later in childhood. - May be a result of inadequate intake of fats, limited access to food, and or food/knowledge deficit. - Term implies someone failed so can be added pressure to parents who may not be in good financial standing, or just in general. - Can be a result of environmental factors such as maternal depression, drug abuse in the home, mental illness, needy sibling, etc.

Answer 253

General term used to group specific diagnoses that limit daily living and functioning and occur before age 21.

Answer 254

- not as simple as feeding the baby - correction will need proper assessment by a dietician to make a plan and provide follow up - Other interventions include: gaining agreement of the caregivers, enrolling infant in early intervention, assessing social supports.

Answer 255

A condition marked by a sudden onset of irritability, fussiness, or crying in a young infant between 2 weeks and 3 months of age who is otherwise growing and healthy. - parents usually assume child has abdominal pain - prebiotics and probiotics noted to helping but NOT actually definitive proof that they work. - response to colic is often to change formula if the infant is not breastfeeding. - Recommendations to reduce or eliminate colic = swaddling, rocking, bathing,

Answer 256

- this is a medical diagnosis - inadequate iron intake due to a overconsumption of a limited variety of food - less frequent in infants, more often in toddlers - low weight infants, elevated lead levels and generalized undernutrition, and living below the poverty line may have increased risk of Iron-deficiency Anemia - if breast milk is sole form of nutrition, supplemental iron may be prescribed depending on the infant’s age, gestation and length. - older infants get iron in fortified cereals - the level of iron in iron-fortified formula is 15 mg/liter, or 11.5 mg per quart, based on the RDA of 6mg of iron for infants up to 6 months and 10 mg for infants from 6-12m.

Answer 257

- may be attributed to food and nutrition components such as breast milk or the use of an iron supplement. - not necessarily a result of food, so changing the food may not help as it might be a bacterial infection! - Young infants typically have more stools than older infants, and soon after food intake - Infants fed soybean based formulas may have increase in constipation compared to those fed cows milk. - Insure enough hydration and fluids to avoid constipation. Laxatives or prune products are risky for young infants as it may cause fluid imbalance, but may be okay for older infants. - high fiber foods not recommended for infants with constipation because they present a choking hazard. - if the infant has a bout of diarrhea, insure increased fluid intake to keep child hydrated.

Answer 258

- Baby bottle caries are found in children over 1 year, but are initiated by feeding practices during infancy. - Infants have high oral needs and explore the world with their mouth, and derive pleasure and soothing from sucking. - if using a baby bottle while putting child to sleep can result in milk or formula or whatever is in the cup pooling in the mouth and resulting in caries - the shorter more vertical tubes in the ears of infants are under different pressure during sucking from a bottle, if infant is laying down, liquid does not empty from the tubes increasing the risk of ear infections. - Feeding practices to limit baby bottle caries and ear infections = limit use of bottle as part of a bedtime routine, offer juice in a cup, not a bottle, put only water in a bottle if offered for sleep, and examine and clean emerging teeth to prevent caries from developing.

Answer 259

- infants develop immune system over a few years and while breastfeeding, mother’s immune system may confer immunological-active compounds to the infant. - Breastmilk vs. formula fed children differ in antibodies. - Allergy testing is different in infant compared to children - Because infant intestinal tract is more sensitive in general, it is difficult to determine what is food intolerance vs. allergy. - prevalence of true food allergies is higher in younger than older children. - 6-8% of children under 4 years of age have allergies that started in infancy - most common allergic reactions are respiratory and skin symptoms, such as wheezing or skin rashes. - it may take several years before a specific allergens can be identified.

Answer 260

formula that contains enzymatically digested protein, or single amino acids, rather than protein as it naturally occurs in food… very expensive and have a taste that older infants might reject. - Family with known allergy or intolerance may reduce infant’s risk by breastfeeding and/or postponing the introduction of the allergen. - Allergy or intolerance more common with non-food items like grass, and dusts.

Answer 261

- medical diagnosis on specific gastrointestinal testing for the activity of the enzyme lactase. - Many adults self-diagnose as having an intolerance if they have abdominal cramps, sensitivity, nausea etc after eating foods with lactose.

Answer 262

a form of sugar or carbohydrate composed of galactose and glucose. - Even infants who breastfeed are likely to develop lactose intolerance because it has lactose in it - because nutritional value of lactose containing foods, introducing foods low in lactose for children who showing signs of intolerance during infancy may be a good idea.

Answer 263

- infants fed vegetarian diets grow just as well as others - if the vegetarian diet is restrictive there is an association with slower growth rates, especially if there is not enough breastmilk. - Vegetarian diets range from adequate to inadequate depending on the adequacy of ingestion. - Fortified foods are especially important for vegetarian infants.

Answer 264

screening for rare conditions that may cause disability or death

Answer 265

a rare genetic condition of carb metabolism in which a blocked or inactive enzyme does not allow breakdown of galactose, causing serious illness in infancy.

Answer 266

Condition in which thyroid hormone is not produced in sufficient quantities, interfering with growth and mental development if untreated in infants.

Answer 267

- DRIs are based on growth of typical infants, not on catch-up growth (period of time shortly after a slow growth period when the rate of weight and height gain is likely to be faster than expected for age and gender). - Pre-term infants need increased iron

Answer 268

condition in which body pools of calcium are unbalanced, and low levels are measured in blood as a part of a generalized reaction to illness. - Human milk-fortifiers are used to boost energy as well as to provide additional vitamins and minerals in some infants in neonatal intensive care units…intended to bridge the gap between breast milk and the needs of very low birth weight infants. - Vitamin A supplements have been proven to help low birth weight infants to reduce lung and breathing problems during recovery.

Answer 269

ncremental gains in infants of various birthweights, weight, and height and head circumference are included in WHO 2009 growth tables.

Answer 270

- First growth of nutritional care is to maintain growth for age and gender despite whatever health or illness complications. - assessing growth needs to be consistent and accurate to insure that the growth is interpreted correctly. - Usually, providing good nutrition and energy results in good growth, but not always (e.g: being born with kidney disease).

Answer 271

- The body composition of infants born preterm is not the same as that of term infants…body fat build up is the late sign of recovery from preterm delivery. - Treatment of the infant’s medical condition may also affect growth expectations; for eg. Fluid accumulation may artificially increase weight. - Development outcomes, such as performing well later in regular education classrooms, are more of a focus than physical growth tracking in long term. - All preterm growth charts show typical increase in head circumference as normal healthy recovery from preterm birth.

Answer 272

- Gestation-adjusted age is calculated by subtracting gestational age at birth from 40 weeks. The remaining number is divided by 4 to get the months. - Subtract that number from current age to get gestational age for that preterm infant. - Ie; if infant is born at 30 weeks, they are 10 weeks early, therefore 2.5 months preterm. When that child is 3 months old, she is really 2 weeks old based on the correction for gestational age.

Answer 273

small head size for age and gender by cm or inches of head circumference.

Answer 274

large head size for age and gender by cm or inches of head circumference.

Answer 275

slower in infancy but steady. This slower growth is reflected in a decreased appetite, however young children need adequate calories and nutrients to meet the nutritional needs.

Answer 276

The eating and health habits established at this early stage of life may impact food habits and subsequent health later in life.

Answer 277

children b/w the ages of 1 and 3 years. This stage of development is characterized by a rapid increase in gross and fine motor skills with subsequent increases in independence, exploration of the environment, and language skills.

Answer 278

children are b/w 3 and 5 years of age. Characteristics of this stage of development include increasing autonomy; experiencing broader social circumstances, such as attending preschool or staying with friends and relatives; increasing lang skills and expanding ability to control behaviour.

Answer 279

It is important for children to be accurately weighed and measured at periodic intervals . Toddlers less than 2 years of age should be weighed without clothing or a diaper. The recumbent length of toddlers should be measured on a length board and moveable foot board. Proper measurement of this length requires 2 adults - one at the child’s head and making sure the crown of the head is placed firmly against the headboard, and the other making sure that the child's legs are fully extended and placing the foot board at the child's heel. Preschool children should be weighed and measured w/o shoes and in lightweight clothing. Calibrated scales should be used and a height board should be used for measuring stature.

Answer 280

Most children begin to walk independently at about their first birthday. At first the walking is more like a “toddler” with a wide based gait. After practicing, the toddler achieves steadiness and soon will be able to stop, turn, and stop without falling over. Gross motor skills such as sitting on a small chair, climbing on furniture, develop rapidly at this age. At about 15 months of age, children can crawl up stairs, and by 18 months of age they can run stiffly. Most toddlers can walk up and down stairs one step at a time by 24 months of age and jump in place. At about 30 months, children have advances to going up stairs by alternating their feet. By 36 months of age, children are ready for tricycles. Toddlers are fascinated by their new found skills, showing a readiness to put the skills into practice and to develop new skills. Toddlers have no sense of dangerous situations At this age children are especially vulnerable to accidental injuries and ingestion of harmful substances. Leading cause of death among young children is unintentional injuries. Parents and caregivers have to constantly watch over the child preferably in environments made “child safe”

Answer 281

With newly acquired physical skills, exploring the environment accelerates, and exerting their newfound independence becomes important to them Toddlers now have the power to control the distance b/w themselves and their parents. Toddlers often “orbit” around their parents like planets, moving away, looking back, moving further and then returning The child moves from being primarily self centered to being more interactive The toddlers now have the ability to explore the environment and develop new relationships. Fears of certain situations, such as separation, darkness, wind, rain, etc. commonly emerge during this period as the child learns to deal with the changes in the environment. Children develop rituals in their daily activities to deal with these fears. Social development involves imitating others, such as parents, caretakers, siblings, and peers, during this time. The child begins to learn about the family's cultural customs, including those related to meals and food. Dramatic development of language skills occurs from age 18 to 24 months. The vocabulary erupts to 10 to 15 words at 18 months to 100 or more words at 2 years or age. The toddler soon begins combining words to make simple sentences. By 36 months of age the child uses 3 word sentences. An important social change for toddlers is increased determination to express their own will. This expression often comes in the form of negativism and the beginning of temper tantrums, which give this stage of development its label of the “terrible twos” With an increase in motor development coupled with an increasing quest for independence, toddlers to more and more things, pushing their capability to the limit. Thus the toddler becomes easily frustrated and negative. The child seeks more independence and at the same time needs the parents and caregivers for security and reassurance. Toddler behaviour uncannily parallels the same type of behavior commonly seen in adolescents.

Answer 282

Most babies begin to wean from the breast or the bottle at about 9 to 10 months of age, when their solid food intake increases and they learn to drink from a cup. Parents need to pay attention to cues of readiness for weaning, such as disinterest in breastfeeding or bottle feeding The time it takes to wean is variable and depends on both the child and the mother. Weaning will be easier for those babies who adapt well to change. Weaning is a sign of the toddler's growing independence and is usually complete by 12 to 14 months of age, although the age varies from child to child Gross and fine motor development during the toddlers years enhances children's ability to chew foods of different textures and to self feed. b/w 12 to 18 months of age, toddlers are able to move the tongue from side to side and learn to chew food with rotary rather than just up and down movements. Toddlers can now handle chopped or soft table food. At about 12 months children have a refined pincer grasp them enables them to pick up small objects, such as cooked peas and carrots, and put them in their mouths. Children will be able to use a spoon around this age, but not very well. At 18 to 24 months, toddlers are able to use the tongue to clean the lips and gave well developed rotary chewing movements. Now the toddler can handle meats, raw fruits and vegetables, and multiple food textures. A strong need for independence in self feeding emerges during the toddler ages. "I do it!" and "No, no, no!" are commonly heard phrases in households where toddlers reside. As toddlers practise their newly found skills, they become easily distracted. Parents need to realize that their toddler's sometimes-fierce independence is part of normal 5 growth and development and represents an ongoing process of separation from dependency on the parents and caretakers. Increasing fine motor and visual motor coordination skills allows toddlers to use cups and spoons more effectively. Although skill with a spoon increases during the second year, toddlers prefer to eat with their hands. Initial attempts at self-feeding are inevitably messy, but represent an important stage of development. It is important that parents and caretakers keep distractions, such as television, to 'a minimum during mealtimes, and allow their children to practise self-feeding skills and to experience new foods and textures. The child derives pleasure in self-feeding and exploring new tastes. Learning to self-feed allows the child to develop mastery of an important part of everyday life. Adult supervision of eating is imperative due to the high risk of choking on foods at this age. Toddlers should always be seated during meals and snacks, preferably in a high chair or booster seat with the family, and not allowed to "eat on the run." Foods that may cause choking, such as hard candy, popcorn, nuts, whole grapes, and hot dogs, should not be served to children less than 2 years of age.

Answer 283

The toddler's need for rituals, a hallmark of this stage of development, may be linked to the development of food jags. Many toddlers demonstrate strong food preferences and dislikes. They can go through prolonged periods of refusing a particular food or foods they previously liked. The intensity of the refusal or the negative attitude toward a particular food will be influenced by the child's temperament. To circumvent food jags, parents can serve new foods along with familiar foods. New foods are better accepted if they are served when the child is hungry and if she sees other members of the family eating these foods. Eventually, toddler's' natural curiosity will get the best of them. Toddlers are great imitators, which includes imitating the eating behavior of others. Mealtime is an opportunity for toddlers to practise newly acquired language and social skills and to develop a positive self-image. It is not the time for battles over food or "force-feedings." Establishing the habit of eating breakfast is an important part of healthy eating behaviours. Family mealtime provides an opportunity for parents and caretakers to model healthy eating behaviors for the young child.

Answer 284

Parents need to be reminded that toddlers naturally have a decreased interest in food because of slowing growth, and a corresponding decrease in appetite. Toddlers need toddler-sized portions. One rule of thumb for serving size is 1 tablespoon of food per year of age. Applying this rule, a serving for a 2-year-old child would be about 2 tablespoons. It is better to give the child a small portion and allow him to ask for more than to serve large portions. Parents often overestimate portion sizes needed by their young child, which may contribute to labeling the child as a "picky" eater. Because toddlers can't eat a large amount of food at one time, snacks are vital in meeting the child's nutritional needs. It is important, however, that toddlers not be allowed to "graze" throughout the day on sweetened beverages and foods such as cookies and chips. These foods can blunt their limited appetite for basic foods at meal and snack times. In considering the toddler's need for rituals and limit setting, parents and caretakers need to establish regular but flexible meal and snack times, allowing enough time between meals and e snacks for the toddler to get hungry. It is important that toddlers be allowed to control the amount of food eaten by hunger rather than by parental pressure to eat more.

Answer 285

Preschool-age children continue to expand their gross fine motor capabilities. At age 4, the child can hop, jump on one foot, and climb well. The child can ride a tricycle, or a bicycle - with training wheels, and can throw a ball overhand.'

Answer 286

Magical thinking and egocentrism characterize the preschool period. Egocentrism does not mean that the child is selfish, but rather that the child is not able to accept another's point of view. The child is beginning to interact with a widening circle of adults and peers. During the preschool years, children gradually move from primarily relying on external behavioral limits, such as those demanded by parents and caregivers, to learning to limit behavior internally. This transition is a prerequisite to functioning in a school classroom.' Also during this time, children's play starts to become more cooperative, such as building a tower of blocks together. Toward the end of the preschool years, children move to more organized group play, such as playing tag or "house." Control is a central issue for preschool children. They will test their parents' limits and still resort to temper tantrums to get their way. Temper tantrums generally peak between the ages of 2 and 4 years. The child's challenge is to separate, and the parent's challenge is to appropriately set limits and at the same time to let go, another parallel with adolescence. Parents need to strike an appropriate balance for setting limits. Too-tightly controlled limits can undermine the child's sense of initiative and cause him or her to act out, whereas loose limits can cause the child to feel anxious and that no one is in control. Language develops rapidly during the preschool years and is an important indicator of both cognitive and emotional development. Between ages 2 and 5, children's vocabularies increase from 50 to 100 words to more than 2000 words, and their language progresses from two- to three-word sentences to complete sentences

Answer 287

The preschool-age child can use a fork and a spoon and uses a cup well. Cutting and spreading with a knife may need some refinement. Children should be seated comfortably at the table for all meals and snacks. Eating is not as messy a process during the preschool years as it was during toddlerhood. Spills still do occur, but they are not intentional. Foods that cause choking in young children should be modified to make them safer, such as cutting grapes in half lengthwise and cutting hot dogs in quarters lengthwise and then cutting into small bites. Adult supervision during mealtime is still imperative.

Answer 288

As during the toddler years, parents of preschool-age children need to be reminded that the child's rate of growth continues to be relatively slow, with a relatively small ap-petite and food intake. Growth occurs in "spurts" during childhood. Appetite and food intake increase in advance of a growth spurt, causing children to add some weight that will be used for the upcoming spurt in height. Therefore, the appetite of a preschool-age child can be quite variable. Preschool-age children want to be helpful and to Please their parents and caretakers. This characteristic makes the preschool years a good time to teach children about foods, food selection, and preparation by involving them in simple food-related activities. For instance, outings to a farm. ers' market can introduce children to a variety of fresh vegetables and fruit. Allowing children to be invoked in meal-related activities, can be quite instructive. Families of preschool-age children need to continue to be encouraged to eat together.

Answer 289

An important principle of nutrition for young children, and one with direct application to child feeding, is children's ability to self-regulate food intake. If allowed to decide when to eat and when to stop eating without outside interfer-ence, children eat as much as they need. Children have an innate ability to adjust their caloric intake to meet energy needs. The preschool-age child's intake may fluctuate widely from meal to meal and day to day. But over a week's time, the young child's intake remains relatively stable. Parents who try to interfere with the child's ability to self-regulate intake by forcing the child to "clean her plate" or using food as a reward are asking the child to overeat or undereat. Although children can self-regulate caloric intake, no inborn mechanisms direct them to select and consume a well balanced diet. Children learn healthful eating habits. Parents give up some control over what their preschool child eats it the child spends more time away from home in a child care center or with extended family members. Preschool-age children continue to learn about food and food habits by observing their parents, caretakers, peers, and siblings, and they begin to be influenced by what they see on television and through other forms of media. Their own food habits and food preferences are established at this time.

Answer 290

Parents of a preschool-age child often describe their child's ap-petite as "picky." One reason a child may want the same foods all of the time is because familiar foods may be comforting to her. Another reason is that the child may be trying to exert control over this aspect of her life. The child's eating and food selection can easily become a battleground between parent and child and this scenario should be avoided. Some practical suggestions for parents and caretakers of children this age include serving child-sized portions and serving the food in an attractive way. Young children often do not like their foods to touch or to be mixed together, such as in casseroles or salads. They typically do not like strongly flavored vegetables and other foods, or spicy foods, at this young age. Just as with toddlers, parents of preschool-age children should not allow their children to eat and drink indiscriminately between meals and snacks. This behavior often causes a blunted ap-petite at mealtime. Children should not be forced to stay it the table until they have eaten a certain amount of food as determined by the parent.

Answer 291

Temperament is defined as the behavioral style of the child, or the "how" of behavior. Three temperamental clusters have been defined: the "easy" child (about 40 percent of children), the "difficult" child (10 percent), and the "slow-to-warm-up" child (15 percent). The remaining children, classified as "intermediate-low" or "intermediate-high," demonstrate a mixture of behaviors but gravitate toward one end of the spectrum. Children's temperaments affect feeding and mealtime behavior. The "easy" child is regular in function, adapts easily to regular schedules, and tries and accepts f new foods readily. The "difficult" child, on the other hand, is characterized by irregularity in function and slow adaptability. This child is more reluctant to accept new foods and can be negative about them. The "slow-to-warm-up" child exhibits slow adaptability and negative responses to many new foods with mild intensity. With repeated exposure to new foods, this child can learn to accept them Over time with limited complaining. The "goodness of fit" between the temperaments of the child and the parent or caretaker can influence feeding and eating experiences. A mismatch can result in conflict over eating and food. Parents and caretakers need to be aware of the child's temperament when attempting to meet nutritional needs. The difficult or slow-to-warm-up child may pose special challenges that need to be addressed by gradually exposing the child to new foods and not hurrying him or her to accept them

Answer 292

It is clear that children's food preferences to determine what foods they consume. Children naturally prefer sweet and slightly salty tastes and generally reject sour and bitter tastes. These preferences appear to be unlearned and present in the newborn period. Children eat foods that are familiar to them, a fact that emphasizes the importance environment plays in the development of food preferences. Children tend to reject new foods but may learn to accept a new food with repeated exposure to it. It may, however, take eight to ten exposures to a new food before it is accepted. Children who are raised in an environment where all members of the family eat a variety of foods are more likely to eat a variety of foods. Children also appear to have preferences for foods that are energy dense due to high levels of sugar and fat. These preferences may develop because children associate eating energy-dense foods with pleasant feelings of satiety, or because these types of foods may be associated with special social occasions such as birthday parties. The context in which foods are offered to a child influences the child's food preferences. Foods served on a limited basis but used as a reward become highly desirable. Restricting a young child's access to a palatable food may actually promote the desirability and intake of that food. Coercing or forcing children to eat foods can have a long-term negative impact on their preference for these foods.

Answer 293

More than half of all food advertisements were aimed specifically at children, and the majority of these advertisements were for fast-food chains or sweetened cereals. - The ads associated the advertised product with fun and/or excitement and energy. - Fast-food ads seemed to focus on building brand recognition through the use of licensed characters, logos, and slogans and were less likely to show food during the ads.

Answer 294

- DRI's have been established for the energy needs of young children. - The formula for Estimated Energy Requirements (EER) for children ages 13-36 months is (89 x weight of child [kg) - 100) + 20 (kcal for energy deposition). For example, a healthy 24-month-old girl who weighs 12 kg would have an EER of (89 x 12 kg- 100) + 20 = 988 kilocalories. - Beginning at age 3, the DRI equations for estimating energy requirements are based on a child's gender, age, height, weight, and physical activity level (PAL). - Categories of activity are defined in terms of walking equivalence. - Energy needs of toddlers and preschool-age children reflect the slowing growth velocity of children in this age group.

Answer 295

- Recommended Dietary Allowances (RDAs) have been established for protein. - These recommendations are easily met with typical American diets as well as with vegetarian diets. - Adequate energy intake to meet an individual child's needs has a protein-sparing effect; that is, with adequate energy intake, protein is used for growth and tissue repair rather than for energy. - Ingestion of high-quality protein, such as milk and other annual products, lowers the amount of total protein needed in the diet to pros ide the essential amino acids.

Answer 296

- DRIs for vitamins and minerals have been established for the toddler and preschool-age child. - Most children from birth to years are meeting the targeted levels of consumption of most nutrients, except for iron, calcium, and zinc.

Answer 297

- Iron deficiency and iron-deficiency anemia are prevalent nutritional problems among young children. - A rapid growth rate coupled with frequently inadequate intake of dietary iron places toddlers, especially 9- to 18-month-olds, at the highest risk for iron deficiency. - Iron deficiency anemia is more common among low income children and among African-American and Mexican-American children. - The full impact of this nutrition problem is profound. Iron-deficiency anemia in young children appears to cause long-term delays in cognitive development and behavioral disturbances). - Iron deficiency can be defined as absent bone marrow iron stores, an increase in hemoglobin concentration of

Answer 298

- It is recommended that children 1 to 5 years of age drink no more than 24 ounces of cow's milk, goat's milk, or soy milk each day because of the low iron content of these milks. - Larger intakes of these milks may displace high-iron foods. - For detecting iron deficiency, it is recommended that children at high risk for iron deficiency, such as low-income children and migrant and recently arrived refugee children, be tested for iron deficiency between the ages of 9 and 12 months, 6 months later, and then annually from ages 2 to 5 years. - For children who are not at high risk for iron deficiency, selective screening of children at risk only is recommended by the CDC. - Children at risk include those who have a low-iron diet, consume more than 24 ounces of milk per day, have limited access to food because of poverty or neglect, and who have special health care needs, such as an inborn error of metabolism or chronic illness.

Answer 299

- Treatment of iron-deficiency anemia includes supplementation with iron drops at a dose of 3 mg/kg per day, counseling of parents or caretakers about diets that prevent iron deficiency, and repeat screening in four weeks. - Dietary recommendations include increased consumption of lean meat, fish, and poultry and the inclusion of sources of vitamin C at meal time to increase the absorption of non-meat sources of iron. - An increase of >1 g/dL in hemoglobin concentration, or >3% in hematocrit, within 4 weeks of initiation of treatment confirms the diagnosis of iron deficiency. - If the anemia is responsive to treatment, dietary counseling should be reinforced, and the iron treatment should he continued for two months. - At that time, the hemoglobin and hematocrit should be rechecked, and the child should be reassessed in six months. - If the hemoglobin and hematocrit do not increase after four weeks of iron treatment, further diagnostic tests are needed. - Iron status will not improve with iron supplements if the cause of the anemia is not directly related to a need for iron.

Answer 300

- A primary cause of dental decay is habitual use of a bottle or a no-spill training cup with milk or fruit juice at bedtime or throughout the day. - Prolonged exposure of the teeth to these fluids can produce early childhood caries (ECC), formerly called "nursing bottle caries" or "baby bottle tooth decay." - Upper front teeth are most severely affected by decay, which is where fluids pool when toddlers fall asleep while drinking from a bottle. - Toddlers with baby-bottle tooth decay are at increased risk for caries in the permanent teeth. - Food sources of carbohydrates such as milk and fruit juice can have direct effects on dental caries development because Streptococcus mutans, the main type of bacteria that cause tooth decay, use carbohydrates for food. - Bacteria pre-sent in the mouth excrete acid that causes the tooth decay. - Consequently, the more often and longer teeth are exposed to carbohydrates, the more the environment in the mouth is conducive to the development of tooth decay. - Foods containing carbohydrates that stick to the surface of the teeth, such as sticky candy like caramel, are strong caries promoters. - Rinsing the mouth with water or brushing teeth to get rid of the carbohydrate stuck to teeth reduces caries formation. - Young children allowed to "graze" or indiscriminately eat or drink throughout the day likely expose their teeth to carbohydrates for a longer period of time, which encourages bacteria proliferation and tooth decay. - Crunchy foods such as carrot sticks and apple slices, when age-appropriate, are good choices for snacks because they are less likely to promote tooth decay than are sticky candies.

Answer 301

- Children need a source of fluoride in the diet, preferably from fluoridated water and the use of fluoridated toothpaste. - If the water supply is not adequately fluoridated, a fluoride supplement is recommended. - Children ages 6 months to 3 years need 0.25 mg of fluoride per day if their local water supply has

Answer 302

- Constipation, or hard and dry stools associated with painful bowel movements, is a common problem of young children. Sometimes "stool holding" develops when the child does not completely empty the rectum, which can lead to chronic overdistension so that eventually the child is retaining a large fecal mass. - Then having a bowel movement can become painful to the child, which leads to more "stool holding," and a vicious cycle ensues. - Diets providing adequate total or dietary fiber for age and appropriate amounts of fluid guard against constipation. Some of the best food sources of dietary fiber for toddlers and preschoolers are whole-grain breads and cereals, legumes, and fruits and vegetables appropriate for age. - Too much fiber should be avoided, however. Young children easily develop diarrhea from high amounts of fiber, and high-fiber foods may displace other energy-dense foods and may decrease the bioavailability of some minerals, such as iron and calcium.

Answer 303

- The major sources of lead exposure for young children are airborne lead, which has decreased in recent decades with the elimination of lead from gasoline and with the enforcement of industrial emissions standards, and leaded chips from deteriorating lead paint. - Young children are particularly at risk for developing high levels of lead because, they enjoy putting things in their mouths. - Damage caused by lead exposure may begin during pregnancy as lead is transported across the placenta to the fetus. - Blood lead levels peak at about 2 years of age. There are racial, ethnic, and socioeconomic disparities in children with high lead levels, with higher rates found in children living in poverty, children of minority groups, and recent immigrants. - High blood lead levels affect the functioning of many with tissues in the body, including the brain, blood, and kidneys. - Low level exposure to lead is associated decreases in IQ and impaired motor, behavioral, and physical abilities. - Elevated blood lead levels may decrease growth in young children. - However, some more recent research indicates that the physical and mental development of children may be affected by blood lead levels

Answer 304

- Some of the risk factors for elevated blood lead levels are also the same risk factors for iron-deficiency anemia, such as young age, poor nutrition, and low socioeconomic status." - Iron-deficiency anemia is associated with pica, the ingestion of non-food items, such as paint chips, which is a risk factor for lead ingestion. - Some studies suggest that adequate iron intake may decrease lead absorption, which reinforces the benefits of treating iron-deficiency anemia in young children. - Some studies suggest that vitamin C may increase lead excretion. Although the evidence is not strong enough to recommend for or against vitamin C supplementation for children with elevated blood lead levels, it is important for young children to have sources of vitamin C in their diets for the prevention of iron deficiency. - There is good evidence that dietary calcium competitively decreases lead absorption, but there is no clinical evidence that supplementing calcium beyond the adequate intake for age has a clinical effect on elevated blood lead levels. - Low-fat diets are not recommended for the treatment of elevated blood lead levels in young children. - Eliminating sources of lead in the child's environment is the most important step toward eliminating elevated blood lead levels in children. In addition, preventing iron deficiency and promoting a well-balanced diet that includes good sources of calcium and vitamin C help to prevent this problem in young children.

Answer 305

- Healthy People 2020 NWS-12 objective is to eliminate very low food security among children.' - Food insecurity is more likely to exist in households with children, particularly those headed by single women or single men, in lower-income-level households (near or below the federal poverty line), and Black and Hispanic households. - Food security is particularly important for young children because of their high nutrient needs for growth and development. - Young children are a vulnerable group because they must depend on their parents and caretakers to supply them with adequate access to food. - It appears that children who are hungry and have multiple experiences with food insufficiency are more likely to exhibit behavioral, emotional, and academic problems as compared to other children who do not experience hunger repeatedly.

Answer 306

- Young children are especially vulnerable to foodborne illnesses because they can become ill from smaller doses of organisms. - Key foodborne pathogens include Campylobacter species and Salmonella species, which are the most frequently reported foodborne illnesses in the U. S., and the pathogen E. coli 0157:H7, which is the most commonly identified Shiga toxin—producing E. Coli (STEC) in North America." - The highest rate of Campylobacter species infections is seen in children under age 1. - Campylobacter is transmitted by handling raw poultry, eating undercooked poultry, drinking raw milk or non-chlorinated water, or handling infected animal or hu-man feces. - The most common cause of Salmonella food poisoning is consumption of foods containing undercooked or raw eggs, such as raw cookie dough containing eggs. - It is a serious disease and can cause bloody diarrhea and hemolytic uremic syndrome (HUS). - Outbreaks of E. coli have been associated with ingestion of contaminated, undercooked hamburger meat, unpasteurized apple cider and juice, and unpasteurized milk. - Employing proper food storage and preparation techniques at home, in child care centers, and retail food establishments is essential for decreasing the incidence of foodborne illnesses in young children. - One food safety education program, called FightBAC TM, was developed by the Partnership for Food Safety Education, a public/ private partnership of industry, state and consumer organizations, and government agencies, including the CDC and EPA. FightBAC has four food-safety practice messages: 1) Clean: Wash hands and surfaces often. 2) Separate: Don't cross-contaminate. 3) Cook: Cook to proper temperatures. 4) Chill: Refrigerate promptly.

Answer 307

- No significant difference in prevalence of overweight and obesity was found between male and female children, but differences do exist by race/ethnicity. - Non-Hispanic black and Hispanic children have a higher prevalence of obesity than their non-Hispanic white counterparts. - Obesity is a multi faceted problem that is difficult to treat, making prevention the preferred approach.

Answer 308

- Body mass index-for-age percentile is recommended as the screening tool for assessment of pediatric overweight and obesity. - A BMI-for-age percentile of 85th to 94th is defined as overweight, and a BMI-for-age > 95th is defined as obesity. - For these young children, a weight-for-length >95th percentile is considered to be overweight. - Early BMI rebound in children increases the risk of adult obesity. Other essential components of assessment include 1) evaluation of the child's medical risk, including parental obesity, family medical history, and evaluation of weight-related problems such as sleep and respiratory problems, and 2) behavior risk assessment, including dietary and physical activity behaviors. - Another aspect of the behavioral assessment is evaluation of the child's and/or family's attitudes toward and capacity to change some behaviors.

Answer 309

- Prevention is the best approach for overweight and obesity. - All children should be targeted for prevention of overweight and obesity from birth by instituting lifestyle behaviors that prevent obesity. - The expert panel has identified the following target behaviors in the prevention of pediatric overweight and obesity based on available evidence and on analysis of available data and expertise: • Limiting sugar-sweetened beverages • Encouraging consumption of recommended amounts of fruits and vegetables • Limiting television and other screen time by allowing a maximum of 2 hours of screen time per day and removing televisions and other screens from children's bedrooms • Eating breakfast every day • Limiting eating out at restaurants, especially fast food restaurants • Limiting portion sizes • Eating a diet rich in calcium • Eating a diet high in fiber • Eating a diet that follows the Dietary Reference Intakes for macronutrients (carbohydrates, protein, and fat) • Promoting moderate to vigorous physical activity for at least 60 minutes each day • Limiting energy-dense foods - Parenting techniques, such as finding reasons to praise the child's behavior but never using food as a reward, foster the development of healthy eating behaviors in children and help children to self-regulate food intake

Answer 310

- Heart disease is the number-one cause of death in the United States today. - A leading risk factor for cardiovascular disease, which includes, disease of the heart and blood vessels, is ele-vated levels of LDL cholesterol. - Children with familial hyperlipidemias and obese children can have high levels of LDL cholesterol. - High intakes of saturated fat, trans fatty acids, and, to a lesser extent, dietary cholesterol elevated LDL cholesterol levels in children and adults alike. - Other nutrition-related risk factors for cardiovascular disease include high triglyceride levels and high body mass index. - Fatty streaks, which can be precursors to the buildup of fat deposits in blood vessels, have been found in the arteries of young children. Some experts believe that these streaks can represent the begin-ning of atherosclerosis and cardiovascular disease. - the American Heart Association (AHA) recommends that all children be screened for risk factors of developing future cardiovascular disease. - Furthermore, the AHA recommends that all children have an overall healthy eating pattern while maintaining an appropriate body weight, desirable lipid profile, and desirable blood pressure. - Avoidance of smoking is encouraged as well as daily physical activity and the reduction of sedentary time." - The recommended diet includes fruits and vegetables, whole-grain breads and cereals, the use of nonfat or low-fat dairy products, and two servings of fish weekly. - The use of vegetable oils and soft margarines low in saturated fat and trans fatty acids instead of butter or most other animal fats is recommended. - The recommendations also include reducing intake of sugar-sweetened beverages and foods and reducing salt intake. - For children ages 2 to 3 years, 30-35 percent of total energy from fat is recommended. For children 4 years of age or older, the recommendation is 25-35 percent of total energy from fat. - A trans fatty acid intake

Answer 311

- Children who consume a variety of basic foods can meet all of their nutrient needs without vitamin or mineral supplements. - Eating a diet of a variety of foods is the preferred way to get needed nutrients because foods contain many other substances, such as phytochemicals, in addition to nutrients that benefit health. - The AAP recommends vitamin and mineral supplementation for children who are at high risk of developing or have one or more nutrient deficiencies. - Children at risk of nutrient deficiency according to the AAP include those 1. With anorexia or an inadequate appetite or who follow fad diets 2. With chronic disease 3. From deprived families or who suffer from parental neglect or abuse 4. Who participate in a dietary program for managing obesity 5. Who consume a vegetarian diet without adequate intake of dairy products 6. With failure to thrive - Despite these recommendations, survey data indicate that young children are major users of supplements. - The most common type of supplement used by children was multivitamins and multiminerals. - Children most likely to receive supplements were underweight or at risk for underweight. - Considering characteristics of families who give their children supplements, such as a greater household income, the children most likely to receive a supplement are those at low risk of developing nutrient deficiencies—in other words, children who would most likely benefit from supplements are less likely to receive them. - If given to children, vitamin and mineral supplement doses should not exceed the DRI for age. - Parents and caretakers should be warned against giving high amounts of vitamins and minerals to children, particularly vitamins A (retinol) and D

Answer 312

- the use of herbal remedies for various disorders if increasing as is the use of complementary and alternative medicine practices in general. - Parents and caretakers Who take herbs are likely to give these products to their children. - Few definitive studies exist on the effectiveness of these substances in preventing disease and promoting health in adults, much less in children. - However, some reports have linked herbal preparations to adverse effects. - Information on herb use should be obtained during the nutrition assessment of a child to rule out herbs as a source of health problems. - Currently, herbal supplements are not regulated and using the products can lead to uncertain results. - Parents should be advised of the potential risks of herbal therapies and the need for close monitoring of their child if they choose to give herbs to their child.

Answer 313

- A primary recommendation is that young children eat a variety of foods. - This recommendation is more easily achieved if healthful food preferences and eating habits are acquired during the early years. - Food preferences in conjunction with food availability form the foundation of the child's diet. - Limited food selection, therefore, will influence the adequacy of the child's diet by decreasing variety. - Two sets of guidelines for young children's diets are available: the Dietary Guidelines for Americans and the MyPlate. - Recommendations for energy and nutrient intake are represented in the DRIs.

Answer 314

- Meats, which are good sources of iron, can be ground or chopped to make them easier for toddlers to chew. - Fortified breakfast cereals and dried beans and peas are also good sources of iron. - "Toddler" milks, or iron-fortified commercial formula for toddlers, are available. - Healthy children who consume a variety of foods, and whose milk intake is less than 24 ounces daily, obtain adequate iron without these special products. - It would be better for parents of healthy children to spend their food dollars on a variety of healthy foods rather than on special products that were originally designed for children with illnesses and are expensive and unnecessary for healthy children.

Answer 315

- Ample dietary fiber intake has been associated with the prevention of heart disease, certain cancers, diabetes, and hypertension in adults. - Whether fiber helps prevent these problems as young children become adults is not known, but it is clear that fiber in a child's diet helps prevent constipation and is part of a healthy diet. - Too much fiber in a child's diet can be detrimental, however, because high- fiber diets have the potential of reducing the energy density of the diet, which could impact growth. - High-fiber diets could also impact the bioavailability of some minerals, such as iron and calcium. - Total fiber is the sum of dietary fiber and functional fiber. - Including fruits, vegetables, and whole-grain breads and cereal products in the diet can increase the dietary fiber intake of children. Those who meet the recommendation consume more breads and cereals, fruits, vegetables, legumes, nuts, and seeds than those who do not. - Children with adequate fiber intake tend to have lower intakes of fat and cholesterol, and higher of vitamins A and E, folate, magnesium, and iron, those children who have low dietary fiber intakes.

Answer 316

- An appropriate amount of fat in a young child's diet can be achieved by employing the principles of the Dietary Guidelines for Americans and the MyPlate that promote a diet of whole-grain breads and cereals, beans and peas, fruits and vegetables, low-fat dairy products after 2 years of age, and lean meats. - Foods high in fat are used sparingly, especially foods high in saturated fat and trans fatty acids. - However, an appropriate amount of dietary fat is necessary to meet children's needs for energy, essential fatty acids, and fat-soluble vitamins. - Good sources of the essential fatty acid linoleic acid are peanut, canola, corn, safflower, and other vegetable oils. - Flaxseed, soy, and canola oils are good sources of the essential fatty acid alpha-linolenic acid. - It is important to include sources of fat-soluble vitamins in the diets of young children. - Good sources of vitamin A include whole eggs and dairy products. - Sources of vitamin D include exposure to sunlight and vitamin D—fortified milk. - The American Academy of Pediatrics recommends a daily intake of 400 IU of vitamin D for all healthy children, while the DRIs for vitamin D were increased to 600 IUs for children 1-8 years of age. - Corn, soybean, and safflower oils are excellent sources of vitamin E. Vitamin K is widely distributed in both animal and plant foods.

Answer 317

- Adequate calcium intake in childhood affects peak bone mass. - A high peak bone mass is thought to be protective against osteoporosis and fractures later in life. - However, many children do not consume adequate calcium. - The DRIs for calcium intake is 700 mg/day for children ages 1 to 3 years and 1,000 mg/day for children ages 4 to 8 years. - An important aspect of adequate calcium intake in toddlers and preschoolers is the development of eating patterns that will lead to adequate calcium intake later in childhood - Dairy products are good sources of calcium, as are canned fish with soft bones such as sardines, dark green leafy vegetables such as kale and bok choy, tofu made with calcium, and calcium-fortified foods and beverages such as calcium-fortified orange juice. - Nonfat and low-fat dairy products are low in saturated fat while still serving as a good source of calcium.

Answer 318

- Healthy toddlers and preschoolers will consume enough fluid through beverages, foods, and sips and glasses of water to meet their needs. - Fluid requirements increase with fever, vomiting, diarrhea, and when children are in hot, dry, or humid environments. - Consumption of milk has decreased among young children since the late 1970s, but consumption of carbonated soft drinks has increased by about the same amount. - According to food consumption surveys, young children consume large amounts of sweetened beverages, including fruit juice, soft drinks, and sweetened iced tea, to the detriment of the overall nutritional balance of their diet and oral health. - Consumption of sugar-sweetened beverages and 100 percent fruit juice begins at a young age and has increased in recent years. - Children with high consumption of regular soft drinks (more than 9 ounces per day) consume more calories and less milk and fruit juice than those with lower consumptions of regular soft drinks. - Water is a good and underused "thirst quencher" for toddlers and preschoolers, as long as milk (2 cups) is part of their regular diet and fruit juice consumption is

Answer 319

- Young children meet their energy needs. - In general, young children consume more than enough protein and fat. - Nutrient and food intakes of preschool children ages 24 to 60 months, mean intakes of zinc, folic acid, and vitamins D and E were consistently below the recommended levels - Low intakes of zinc, vitamin E, and iron were found in toddlers ages 12 to 18 months, a time of dietary transition - Vitamin E intakes less than the estimated average requirement were found in toddlers and preschoolers - toddlers met or exceeded the estimated energy requirements. - The diets of children who ate fast food were found to be higher in total energy, total fat, total carbohydrate, added sugars, and sugar-sweetened beverages, and to have less fiber, less milk, and fewer fruits and non-starchy vegetables than the diets of children who did not eat fast food. - Increased added sugar consumption was associated with decreased nutrient and food-group intakes and increased percentage of children not meeting the DRIs. - Children's portions sizes have remained constant over the years except for meat portions, which have decreased. - This stability in portion sizes of young children over time reinforces the hypothesis that young children are capable of self-regulating energy intake. - Portion sizes were positively related to both body-weight percentiles and energy intake. - It seems that young children self-regulate energy intake by adjusting portion size.

Answer 320

- When working with families from different cultures, it is important to learn as much as possible about the culture's food-related beliefs and practices. - Ask the parents and caretakers about their experiences with food, including foods used for special occasions. - It is also helpful to know whether foods are used for home remedies or to promote certain aspects of health. - Cultural beliefs influence many child feeding practices, such as what foods are best for young children, which cause digestive upsets, or which help relieve illnesses. - It is important for the health provider to build on the cultural practices of the family and to reinforce the positive practices while attempting to affect change that could be more beneficial to the young child.

Answer 321

- Young children can grow and develop normally on vegetarian or vegan diet, as long as their dietary patterns are intelligently planned. - Vegetarian diets are rich in fruits, vegetables, and whole grains, the consumption of which is encouraged for the general population. - However, young children in particular need some energy-dense foods to reduce the total amount of food required. - The amount of vegetarian foods needed to meet nutrient needs may be more food than young children can eat. - Young children need to eat several times a day to meet their energy needs because their stomachs cannot hold a lot of food at one time. - Children who are fed vegan and macrobiotic diets tend to have lower rates of growth, although still within normal ranges, during the first 5 years of life compared to children given a mixed diet. - Strict vegan diets, which exclude all foods of animal origin, may be deficient in vitamins B12 and D, zinc, and omega-3 fatty acids, and may also be low in calcium, unless fortified foods are consumed. - Protein needs are usually met if the diet is adequate in energy and a variety of foods are included. - Children on vegan diets should receive vitamin B12 supplements or consume fortified breakfast cereals, textured soy protein, or soy milk fortified with vitamin B12. - The vitamin B12, status of children following vegetarian and vegan diets should be monitored on a regular basis, as vitamin B1,—deficiency may cause vitamin B12—deficiency anemia. - Iron-deficiency anemia is an infrequent problem among children consuming a vegetarian diet. - Vitamin D adequacy can be achieved through diet or by sun exposure. - Good sources of vitamin D for children include fortified soy milk, fortified breakfast cereals, and fortified margarines. - Zinc is found in foods of animal origin. - Plant sources of zinc include legumes, outs, and whole grains. - Vegetable products are also lacking in omega-3 fatty acids. - Therefore, including a source of these fatty acids, such as canola or soybean oils, is advisable. - Foods containing phytates, such as unrefined cereals, may interfere with calcium absorption - Good sources of calcium for children on strict vegetarian diets include calcium-fortified soy milk, calcium-fortified juice and breads, tofu processed with blackstrap molasses, sesame seeds, tahini (sesame butter), almond and almond butter, and certain vegetables such as broccoli and kale. - Calcium in vegetables such as spinach, Swiss chard, beet greens, and rhubarb is not well absorbed because insoluble calcium oxalate is formed with the high amounts of oxalate in these vegetables. - Supplements may be necessary for some children with inadequate intakes that are not remedied by dietary means. - Guidelines for vegetarian eating practices for young children include: • Provide 3 meals and 2 to 3 snacks per day. Avoid serving bran and excessive intake of bulky foods, such as raw fruits and vegetables. • Encourage eating nutrient-dense foods such as cheese, avocado, soy cheese, hummus, nut butters, tahini, and tofu. • Provide an omega-3 fatty acid source, such as canola oil, soybean oil, tofu, soybeans, walnuts, and wheat germ. • Avoid excessive restriction of dietary fat. • Ensure an adequate intake of calcium, zinc, iron, and vitamins B12 and D.

Answer 322

- Nutrition standards for child care services exist and specify minimum requirements for amounts and types of foods to include in meals and snacks, as well as food-service safety procedures. - These standards also address nutrition learning experiences and education for children, staff, and parents as well as the physical and emotional environment in which meals and snacks are served. - It is recommended that children in part-day programs (4 to 7 hours per day) receive food that provides at least one-third of their daily energy and nutrient needs in at least one meal and two snacks or two meals and one snack. - A child in a full-day program (8 hours or more) should receive foods that meet one-half to two-thirds of the child's daily needs based on the DRIs in at least two meals and two snacks or three snacks and one meal. - Food should be offered at intervals of not less than 2 hours and not more than 3 hours and should be consistent with the Dietary Guidelines for Americans - Healthy People 2020 Nutrition and Weight Status. objective NWS-1 is to increase the number of States with nutrition standards for foods and beverages provided to preschool children in child care and Physical Activity .objective PA-9 is to increase the number of States with licensing regulations for physical activity in child care.

Answer 323

- Physical activity is an important component of a healthy lifestyle. - Physical activity helps to maintain energy balance while strengthening muscles. - Inactivity is thought to be a major contributor to the increasing prevalence of obesity - The Dietary Guidelines for Americans 2010 recommend that children engage in active play several times a day. - Some suggested activities for preschoolers from MyPlate" include: Outdoor Activities: • Games in the yard or park • Family walks after dinner • Walking the dog together • Freestyle dance • Playing catch • Family bike rides on the weekend Indoor Activities: • Follow the Leader • Playing with a dog • Hide and Seek • Ring around the Rosy • Simon Says • Walking around the shopping mall or museum - The AAP suggests that toddlers, under the supervision of an adult caregiver, engage in activities such as walking in the neighborhood, park, or zoo and free play outdoors. - For the preschool-age child, the AAP lists appropriate activities as running, swimming, tumbling, throwing, and catching, under adult super-vision. - No television viewing is recommended for children less than 2 years of age, while screen time should be limited to less than 2 hours per day for all other age groups. - Removing screens from children's bedrooms is also recommended. - Parents are encouraged to set a good example for their children by being physically active themselves and limiting the amount of time that the family spends watching TV and playing computer video games.

Answer 324

- Components of a nutrition assessment include a food/ nutrition-related history, pertinent biochemical measurements, anthropometric measurements such as weight, height, body mass index percentile, and a medical history. - Based on this information, the nutrition professional can identify any nutrition diagnoses, design a nutrition intervention plan with family input, and make a plan for monitoring and evaluation.

Answer 325

- The special supplemental nutrition program for women, infants and children is one of the most successful federally funded nutrition programs in the U.S. - Participation in WIC services improves the growth, iron status, and duality of dietary intake of nutritionally at-risk infants and children up to age 5 years. - "Nutrition risk" means a child has a medical or dietary-based condition that places the child at increased risk. Such conditions include iron-deficiency anemia, underweight, overweight, or a chronic illness such as cystic fibrosis, or consumption of an inadequate diet. - Children receive nutrition assistance, education, and follow-up services by specially trained registered dietitians and nutritionists. - Vouchers for food items such as milk, juice, eggs, cheese, peanut butter, and fortified cereals are given to eligible families. These vouchers are exchanged for the food items at authorized retailers.

Answer 326

- The Farmers' Market Nutrition Program (FMNP) is a special seasonal program for WIC participants. - This program provides vouchers for the purchase of locally grown produce at farmers' markets. - The program is designed to help low-income families increase their consumption of fresh fruits and vegetables.

Answer 327

- Administered by the U.S. Department of Health and Human Services, Head Start and Early Head Start are comprehensive child development programs, serving children from birth to 5 years of age, pregnant women' and their families. - The overall goal is to increase the readiness for school of children from economically disadvantaged families. - A range of individualized, culturally appropriate services are provided through Head Start and related agencies, including educational, health, nutritional, social, and other services.

Answer 328

- The Supplemental Nutrition Assistance Program (SNAP), administered by the USDA, is designed to help adults in low-income households buy food, thereby improving food security and nutrition of participants. - The monetary amount of food vouchers provided to an eligible household depends on the number of people in it and the income of the household. - Each state must develop a nutrition education plan for SNAP recipients based on federal guidance. - Participation in SNAP is associated with increased intakes of a number of nutrients and a decrease in food insecurity by roughly 30 percent.

Answer 329

the twenties involves becoming independent, leaving home, finishing school, starting a career and choosing a partner. Planning, buying and developing food are newly developing skills for many. The thirties could be characterized by having children, providing for and caring for family, building a career. There may be renewed interest in nutrition “for the kids’ sake.”

Answer 330

the forties are a period of active family responsibilities, as well as expanding work and professional roles. Managing schedules and meals becomes a challenge. The fifties is referred to as the sandwich generation. Many, especially women juggle the roles of caring for children and aging parents while maintaining a career. Health concerns are added to the picture as they are dealing with a chronic diseases or managing identified risk factors to prevent diseases

Answer 331

In their early sixties, many adults are making the transition to retirement and are empty nesters. They are able to give greater attention to physical activity and nutrition. Food choices and lifestyle factors may take on added significance for those who are dealing with a chronic disease.

Answer 332

The span of years between ages 20 and 64 is the time when diet, physical activity, smoking and body weight strongly influence the future course of health and wellness. The onset and severity of 5 to 10 leading causes of death in adults (cancer, heart disease, stroke, diabetes, and liver disease) have risk factors that can be modified through changes in nutrition and physical activity.

Answer 333

- Nutrition status and factors that promote or interfere with achieving optimum nutrition status of the adult population are tracked using standard indicators. - Data at the local, state and national level are used to identify problem areas, shape interventions and measure progress. - The monitoring process starts with assessing food intake, nutrient adequacy and weight status at the individual level. The data are summarized across population groups. At the national level, data on many cross-cutting indicators of chronic disease risk are collected and reported. - What adults eat is not strictly a matter of individual choice; what they eat and the resulting nutrition status are shaped by many external factors (examples: where people learn, work, play and the community they live in.) - 5 determinants of population health are depicted: biology and genetics, individual behaviour, social environment, physical environment and health services. The latter 3 categories (social, physical and health services) are referred to as the social determinants of health.

Answer 334

Some population groups have a higher prevalence of chronic disease than others. · Obesity patterns vary by race/ethnicity and income. Among women, non- Hispanic Black women have the highest obesity rates, followed by women of Mexican origin. · Association exists between family income and obesity prevalence among white females of all ages · The number for new cases of cancer has increased for Aboriginal American women · Blacks and Hispanics are 77% and 66% more likely to be diagnosed with diabetes than whites - Some groups have genetic predisposition for certain diseases: · Aboriginal Americans have a predisposition for diabetes · Asians develop cardiovascular disease at lower BMI and smaller waist circumference · African Americans have greater salt sensitivity and earlier onset of hypertension Groups experiencing health disparity not only have higher prevalence of certain conditions and experience worse heath, but also tend to have less access to environmental conditions that support health. Strategies directed to the social determinants of health are necessary to get at the fundamental causes behind health disparity

Answer 335

- Men and women continue to develop bone density until roughly age 30 - Muscular strength peaks around 25-30 years of age. - The type and amount of physical activity has a significant impact on body composition, including lean body mass, fat accumulation and relocation and bone density. - Hearing loss begins as early as 25, and vision changes often become noticeable by age 40.

Answer 336

- The decline of estrogen production in women begins perimenopause and continues through menopause, the end of reproductive capacity. - Menopause is associated with an increase in abdominal fat and significant increase in risk of cardiovascular disease and accelerated loss of bone mass. - Obesity is associated with higher estrogen levels in men and women. -Men experience a gradual decline in testosterone level and muscle mass. - Physical activity and weight training to increase muscle mass result in small and transient increases in testosterone level.

Answer 337

Bone: Around age 40 men and women begin to gradually lose bone mass, this loss is accelerated in women after menopause · Adiposity: the years between ages 20 and 64 are typically associated with a positive energy balance with an increase in weight and adiposity and a decrease in muscle mass. By middle adulthood, physical changes become apparent with the decline in size and mass of muscles and an increase in body fat.

Answer 338

- Nutritional injury may be minor of short duration and reversible, or if it continues, permanent changes in cells and tissues can develop - Health problems related to nutrition originate within cells. - Poor nutrition can result from both inadequate and excessive levels of nutrient intake -Adequacy, variety and balance are key characteristics of healthy diets. - Poor nutrition can influence the development of certain chronic diseases - Nutritional health can be viewed as a continuum ranging from “healthy” and resilient to terminal state in which the body systems shut down and life ceases. - Altered nutrition intakes produce early changes in metabolic process that are preclinical stages of illness - In the absence of signs and symptoms and awareness of a “problem” adults might not be especially concerned about food choices or motivated to adjust lifestyle behaviours

Answer 339

In this state, metabolic systems are in homeostasis and organs are functioning at optimum levels. The body’s defenses and immune system can counter assaults from toxins, pathogens and stress. Nutritional guidance and education are used to encourage adequate intake of a variety of healthful foods.

Answer 340

This early, subclinical state of nutritional harm occurs when intake does not meet needs. Nutrients are drawn out of other body compartments such as protein out of muscle or lung tissue and calcium from bones. When substrates are not available in appropriate amounts, adaptive mechanisms kick in but they reach limits.

Answer 341

insufficient or excessive intake of nutrients or energy leads to observable changes. By this stage immune function is affected and there is reduced resistance to pathogens, chemical exposures, radiation and stress including the continued stress of nutrient imbalance. Dietary guidance, nutrition counselling and medical nutrition therapy, delivered individually or in groups are potential interventions to assist individuals in making changes at this stage

Answer 342

If changes aren’t made and the nutritional injury persists, frank signs and symptoms of illness are now present and a medical diagnosis is made. A clear medical diagnosis is the turning point for serious lifestyle change for some adults.

Answer 343

at this stage, altered metabolism and structural changes in tissues become permanent and irreversible. Major adjustments of life are necessary to self-manage the chronic disease and accommodate conditions that have significant impact on quality of life. Intervention at this stage is aimed at managing the condition, preventing further complications, reducing the degree of disability, and optimizing quality of life.

Answer 344

At the final stage in the continuum, complications advance, body systems shut down and life ceases.

Answer 345

- Metabolic rate and energy expenditure begin to decline in early adulthood. These reductions generally correspond to declines in physical activity and lean muscle mass. -In young, healthy adults there is compensatory adjustments between physical activity and calorie intake - The current trend of higher body weight and increasing rate of overweight and obesity through the adult decades indicates that behavioural, social, and environmental factors supersede the innate physiological ability to adjust caloric intake with energy expenditure.

Answer 346

- Energy needs are based on an individual’s basic metabolic rate (BMR), the thermic effect of food, and activity thermogenesis. - The largest component of daily energy expenditure, 60-70% for most adults, is the involuntary process of internal chemical activities that maintain the body. - The brain, liver, gastrointestinal tract, heart, and kidney make up less than 5% of body weight, the metabolic processes and functions of these organs account for about 60% of BMR. - Additional energy is required for the digestion, absorption, and metabolism of food- referred to as the thermic effect of food (TEF). TEF is lower in some obese individuals, suggesting that more efficient digestion and absorption of food may be a factor in obesity. - The most variable component of energy expenditure is activity thermogenesis- includes energy expended through exercise and non-exercise activity. - The doubly labeled water technique (DWL) is a very precise method of measuring energy utilization in real living conditions. Subjects are given a dose of “tagged” water containing “heavy” isotopes of hydrogen and oxygen. - Excretion of isotopes in saliva and urine is used to calculate average energy utilization over several days. - Indirect calorimetry is used to determine resting energy expenditure (REE), a measure closely related to basal metabolic rate. Indirect calorimetry is done by measuring the exchange of gases during respiration, for a specific period of time, using a metabolic cart in hospitals or newer portable technology and handheld devices in clinics and gyms. - REE can also be calculated using a validated estimation formula. The Mifflin-St. Jeor formula requires accurate measures of height (cm) and weight (kg). - Mifflin-St. Jeor Energy Estimation Formula: · Males REE: (10× wt) + (6.25 × ht) – (5 × age) + 5 · Females REE: (10 × wt) + (6.25 × ht) – (5 × age) – 161 - After the REE has been determined the value is multiplied buy an activity factor to arrive at the estimated daily calorie expenditure.

Answer 347

- A pound of body weight is the equivalent of approximately 3500 calories. To lose 1 lb a week, an adult would need to create a negative calorie balance of 500 calories daily - These 500 calories can be generated from a combination of decreased calorie intake and increased physical activity. - A positive balance of just 100 extra calories per day will result in a gain of 10 lbs in a year

Answer 348

- A myriad of lifestyle, social and environmental factors make consumption of extra calories easy and burning those calories up thorough physical activity more difficult. - Reduction of total energy intake enhances weight loss regardless of the macro consumption of the diet.

Answer 349

- Macronutrient (carbohydrate, fat and protein) intake are expressed in ranges of percent of total calorie intake and account for the fact that various eating patterns can be healthful. - Acceptable macronutrient distribution ranges for adults are: · Fat: 20-35 % of calories · Carbohydrate: 45-65 % of calories · Protein: 10-35% of calories

Answer 350

Dietary fiber decreases the energy density of the diet and a high-fiber diet is linked with lower body weight and less weight gain overtime. Viscous Fiber such as that in oatmeal, decreases the absorption of cholesterol, increases fecal excretion of cholesterol- rich bile and results in lower blood levels of total and LDL cholesterol. Fermentable Fiber such as the skin of fruits and wheat or corn bran, enter the colon undigested and is fermented by gut bacteria. Through these mechanisms fiber is associated with beneficial impacts on obesity, diabetes, inflammatory bowel disease, and cardiovascular disease. Functional Fiber has been approved as a food ingredient by FDA and is being added to many food products.

Answer 351

low vitamin D intake is associated with decreased calcium bioavailability. Combined with low dietary calcium intake, this leads to loss of calcium from bones, which in turn leads to osteopenia (progression to osteoporosis.) Vitamin D assists calcium absorption from the gut, calcium resorption from bones by osteoclasts and calcium resorption from the distal renal tubules.

Answer 352

Vitamin A and E are fat-soluble vitamins with strong antioxidant functions. Oxidation reactions produce free radicals which start chain reactions that damage cells. Antioxidants terminate these chain reactions. Both are also involved in the functioning of the immune system. Vitamin A is essential in maintaining the integrity of the skin and mucosal cells which function as a mechanical barrier and defend the body against infection. Vitamin A plays a central role in the development and differentiation of white blood cells that defend the body against pathogens. Vitamin E has anti-inflammatory properties and is involved in maintenance and repair of cellular membranes.

Answer 353

these are involved in the conversion of homocysteine to methionine. They become methyl donors during RNA replication. Methylation is a reversible process and is going on in billions of cells at all times, but it is especially crucial during fetal development, adolescence and aging. Folic acid is protective against some types of cancer but intake at the highest levels from food and/ or supplements can be cancer promoting in individuals with pre-existing cancer lesions

Answer 354

high sodium decreases vasodilation and raises blood pressure and potassium increases vasodilation. High potassium intake is associated with low blood pressure.

Answer 355

a cellular magnesium deficit elicits a calcium-activated inflammatory cascade independent of injury or pathogens. Elevated C-reactive protein (CRP) an indicator of low grade or chronic inflammation is more frequently found in adults with magnesium intakes below 50 % of the RDA. Eating a small handful of peanuts (1/4 C) daily is an easy way to increase magnesium intake.

Answer 356

- Dietary guidance systems are sets of dietary and lifestyle recommendations, based on the latest scientific evidence related to nutrition and health that are developed to promote health and prevent disease. - Another component of dietary guidance system is recommendations for community action and policy changes to help create an environment where achievement of the dietary and lifestyle recommendations is possible. -voluntary health organizations also make science-based dietary recommendations for healthy adults related to the organization's mission.

Answer 357

- The recommendations represent a total diet approach that allows flexibility. The aim is the selection of combination of foods and beverages that provide energy and nutrients and constitute an individual’s complete daily intake on average, over time. - The goal is a nutrient rich total diet- a balanced grouping of a variety of food groups, consumed in moderation- that is culturally appealing offers pleasurable eating experiences and promotes health among Americans. - There are 2 important cautions when applying the food patterns to yourself and other adults 1. “Choose nutrient- dense foods”. The recommended amounts in the USDA food patterns assume all choices are nutrient – dense forms without added sugar and keep oil within the recommended amount. The dilemma is that nutrient – dense food choices are available in the marketplace but they often are not the form typically consumed. Energy, total fat, saturated fat, cholesterol and sodium exceed limits in all USDA patterns often by substantial margins even when the recommended quantity is selected. 2. “Not too much”. Portion sizes specified by MyPlate are smaller than the amounts in conventional food packaging and as commonly served in restaurants. Large serving sizes increase calorie intake but also contribute more fat and added sugar. - Three eating styles have been associated with the positive impacts on heart disease, cancer and diabetes. The strongest evidence supports the DASH diet (featuring fruits and vegetables, low-fat diary, and low sodium) but the Mediterranean style of eating (vegetables, fish and seafood and olive oil) and vegetarian diets (fruits and vegetables and meat and alternatives) also have scientific support.

Answer 358

- Adults consume an average of 400 calories per day as beverages. - Beverages include: soda, energy & sport drinks, alcoholic beverages, milk, 100% fruit juices, and fruit drinks. -Another issue is that calories consumed in liquid form may have less satiety value and may not be compensated for with adjustments in food intake. -Except for milk and fruit juices, beverages contribute little to essential nutrient needs.

Answer 359

- While moderate alcohol intake is a recognized contributor to heart health, alcohol also increases the risk of oral, esophageal, liver and colorectal cancers and breast cancer in women. - Rates of alcohol decline with age - France and Italy have the highest levels, while Canada and the United Kingdom have the strictest guidelines

Answer 360

- The food and nutrition board defines the adult adequate intake (AI) level for water based on median total water intake from NHANES III data for young adults aged 19 to 30 years. - Total water AI for adults: · Men: 3.1 liters (125 oz) · Women: 2.7 liters (91 oz)

Answer 361

- Caffeine is a stimulus is stimulant that relaxes the esophageal sphincter (leads to acid reflux) has a laxative effect, and temporarily increases urine production at high doses. - The food and nutrition board concluded that caffeine containing beverages contribute to daily total water intake

Answer 362

- Dietary supplements include: vitamins, minerals, amino acids, herbal and botanical supplements, enzymes, prebiotics and probiotics. - Supplemental vitamin and mineral use gradually increases with age - Botanical and herbal supplements are used by many adults to treat or prevent a particular health- related concern.

Answer 363

Functional foods is the term used for food products or ingredients that have a physiological benefit beyond the nutritional value provided

Answer 364

- The eating competence model offers a paradigm for nutrition education and dietary guidance that is different from but complementary to dietary guidelines that are focused on risk reduction. - The goal is to encourage competent eaters who are positive, comfortable and flexible with eating and are matter of fact and reliable about getting enough to eat of enjoyable, nourishing food. - The model has 4 components: 1. Eating attitudes: positive interest in foods and eating; self-trust about managing food and eating; and finding harmony among food desires, food choices and amounts eaten. 2. Food acceptance: Recognizes that enjoyment and pleasure are primary motivators for food selection, and that nutritional excellence is supported by enjoyment of a variety of food. Food acceptance means being comfortable eating a preferred food, but it also means being able to settle for less-preferred food when necessary to satisfy caloric or other nutritional needs 3. Regulation of food intake: emphasis internally regulated eating and attention to sensations of hunger and fullness. One who has learned self-regulation has the ability to tolerate hunger when there is confidence that adequate, rewarding food will be available, the ability to stop when satisfied and the ability to accept the body weight that evolves from internally regulated eating 4. Eating Context: puts priority on structure and meal planning. The model teaches that going to some trouble to procure rewarding food, scheduling eating times and setting aside time to eat are important. Intentional deliberate eaters are able to postpone snacking and grazing when they are confident that there will be satisfying food at their next meal - Within the eating competence model, nutrition education and dietary guidance are used to help people be more attuned to their needs and feelings to encourage them to try and learn to like a wide variety of nutritious foods and to remind them of the importance of taking time and having the self-discipline to plan and prepare satisfying meals

Answer 365

- Healthy eating and increased physical activity are the featured duo for combating obesity at the individual and population level and are primarily and secondary prevention strategies for several chronic diseases. - Physical activity increases muscle strength, balance and endurance; it supports physical and mental health and improves cognitive function; and it helps manage weight and reduces risk factors for disease

Answer 366

- The degree of benefit increases as the duration and intensity increases - The amount of physical activity needed to achieve positive effects is 2.5 hrs per week. - Overcoming a sedentary lifestyle is a challenge; many segments of the adult population get little or no physical activity

Answer 367

- Healthy people 2020 objectives include reducing the proportion of adults who engage in no leisure- time physical activity and increasing the proportion of adults who meet current federal guidelines for aerobic physical activity and muscle- strengthening activity - Personal, social and environmental factors play a role in physical activity. Socioeconomic constraints, cultural preferences and baseline levels of sedentariness or obesity are barriers; while community-wide campaigns, social encouragement and access to facilities help promote physical activity - Widespread efforts to change the environment to foster a variety of opportunities for physical activity and accommodate a wide range of preferences and abilities have developed into the active living movement.

Answer 368

- Individuals who are habitually sedentary should progressively increase the duration and intensity of regular physical activity to allow for adaptations in capacity and efficiency of the body’s structures and functions. - Favourable body composition changes occur with the adoption of regular physical activity. - Abdominal fat loss is greater during exercise- induced weight loss and among those with the greatest level of adiposity.

Answer 369

-Adults engaged in competitive sports may have increased nutrient needs to meet demands of training, competition and recovery. - Nutritional ergogenic aids- nutritional products that are purported to enhance performance- range from caffeine and protein powders to sport drinks and energy gels and bars. - Water is sufficient for hydration for routine physical activity

Answer 370

- Nutrition intervention for adults takes place at many levels and in many settings - Education and counseling can be directed to the individual to increase knowledge and encourage behaviour change - Other interventions affect availability and access to healthful foods, such as menu guidelines for worksite cafeterias and food policies for organization sponsored events, community gardens and limits on the number of fast-food outlets in low-income neighbourhoods - Community campaigns promote healthy eating messages to the general public or specific messages tailored to identified needs and risk factors within subgroups - Reducing risk and improving the nutritional and health status of adults requires multiple strategies that combine individual, social, organizational, and policy-level changes

Answer 371

- Sisters together: Move more eat better, is a health awareness program that encourages African American women 18 years and older to maintain a healthy weight by becoming more physically active and by eating nutritious foods. - The program design combines social marketing and community building strategies -Sisters together initiatives bring together respected leaders and organizations in the community that have goals similar to those of sisters together, address women’s issues and concerns and have credibility with African American women in the community - Core activities are determined at the local level and are designed to fill knowledge gaps, reduce barriers, increase opportunity, provide social support and to complement other community resources. -Activities are selected to match the expressed needs of women in the community - Approaches encourage physical activity versus exercise and feature traditional ethnic foods and flavours but with more health-conscious ingredients and preparation methods

Answer 372

- Living in poverty is linked to poor diets, increased rates of obesity and adverse health outcomes. – Lack of money and other resources for food disrupts eating patterns and reduces food intake - Improving the food security of the population is part of the national health goal of eliminating health disparity - The poverty threshold is derived by calculating the cost of foods needed for basic dietary requirements and multiplying the cost by 3 - The largest of all nutrition assistance programs is the Supplemental Nutrition Assistance Program (SNAP) - The updated program provides food and nutrition education - Governmental and private organizations help individuals and families gain consistent access to safe, wholesome foods that are culturally acceptable

Answer 373

Obesity is defined as having an excess accumulation of adipose tissue. It results from a long-term energy-in/energy-out imbalance involving excess calorie consumption and low energy output through physical activity . Obesity and overweight are high for all segments of the population but vary across age, gender, race and income categories.

Answer 374

Adipocytes (fat cells) are not passive deposits of excess fat. They comprise an active endocrine organ that secretes hormone-like factors associated with chronic low-grade inflammation and insulin resistance. These mechanisms play a role in the development or progression of the major chronic diseases Persons who are obese face psychosocial complications including: low self-esteem, and depression Obesity is also associated with a shorter life expectancy

Answer 375

Complex and chronic conditions, stemming from numerous interacting physiological, individual, environmental and genetic factors that affect the type, frequency and quantity of food and beverages consumed and the body’s metabolic processes. Internal mechanisms that govern energy metabolism and appetite regulation are altered by obesity At the individual level, psychological, socioeconomic, lifestyle, and cultural factors all play a role in attitudes, behaviours and lifestyle patterns related to the development of obesity Life changing events such as a transition to college life and pregnancy are associated with weight gain Environmental factors contribute to the obesity epidemic Technological advances in every dimension of life have replaced physical activity with sedentary activity

Answer 376

Body mass index (BMI) is significantly correlated with total body fat. BMI, calculated from height and weight, is used internationally for classifying overweight and obesity. The formula is BMI= kg body weight divided by height in meters, squared. Overweight in adults is defined by BMI of 25-29.9 and obesity by BMI of 30 or greater Although BMI approximates body fat for most healthy individuals there are exceptions: Athletes or others with greater than average percentages of muscle mass Individuals with dense, large bones Dehydrated and overhydrated individuals Sedentary or disabled individuals with atrophied muscles and increased fat deposits Obesity is further classified as I, II, III using BMI Severe obesity defined as a BMI of 40 or more, is a dangerous condition that places the person at extremely high risk for cardiovascular and other diseases as well as physical disability and severely impaired quality of life

Answer 377

``` The distribution of body fat is a more important indicator of health risk than weight or BMI Body fat or adipose tissue is stored in three compartments: subcutaneous fat layered underneath the skin, visceral or intra-abdominal fat packed between internal organs and ectopic fat stored in the liver, pancreas, heart and skeletal muscles. Visceral fat, recognized as the “pot belly” or apple shape is highly correlated with metabolic abnormalities and chronic diseases. Waist circumference (WC) is used to assess central adiposity and it allows further stratification of risk beyond BMI To assess WC place a tape measure around the abdomen just above the hip bone, level with the naval and parallel to the floor. Measure after exhaling ```

Answer 378

After the need for weight management is identified a comprehensive assessment is used to understand the individual’s experience with overweight, current eating and physical activity patterns , psychosocial and medical factors and his/her motivation and readiness to change and goals. Motivation: Several factors contribute to understanding the client’s motivation to engage in a weight-loss program Patient’s nutrition knowledge, food access, food selection, and functional capacity to prepare food and engage in physical activity are all important for individualized treatment planning.

Answer 379

Comprehensive, multicomponent weight management program is needed for successful weight loss, including diet, physical activity and behaviour therapy A successful weight-loss plan for the individual includes an eating plan that reduces caloric intake relative to calories burned, provides for nutrient needs at a safe level, incorporates physical activity and is compatible with the individual’s lifestyle

Answer 380

Relatively small amounts of weight loss can reduce or prevent the health risks associated with obesity Goals of weight management are to: prevent further weight gain, reduce body weight and maintain a lower body weight for the long term A moderate rate of weight loss of ½ to 1lb per week is recommended but accelerated weight loss of up to 2lb per week can be used and may provide positive reinforcement to continue A weight loss of ½, 1 or 2lb per week requires a calorie deficit of 300, 500 or 1000 kcal/day

Answer 381

The nutrition prescription for weight loss is an eating plan that is deficient in calories but otherwise meets guidelines for healthy eating Replacing one or two meals a day with meal replacements is helpful for individuals who have difficulty with portion control. Very-low energy diets can produce rapid weight loss but should only be used under close medical supervision

Answer 382

Successful programs developed for weight management, diabetes education and other lifestyle changes utilize cognitive behavioural therapy Programs are 12 to 16 weeks long to build knowledge, modify beliefs and attitudes and integrate new behaviours through a combination of skills training and analysis of behaviour and thought processes Components of weight-management programs based on cognitive behavioural therapy : Realistic goals Caloric deficit: develop an individualized meal plan with intake adjusted to lose weight gradually Meal plan Skill development: provide tools and skills training including teaching practicing within sessions homework, review and feedback Problem-solving techniques Self-monitoring and self-management: provide tools for keeping food and activity records and build confidence in ability to monitor and adjust Cognitive restructuring: help client examine thought processes and recognize dysfunctional thinking Stress management: teach strategies other than eating to deal with stress Support system: encourage having someone to check in with and receive support Regular exercise Maintenance : make available support for weight loss ad for maintenance of the loss Long-term effectiveness: weight-management plan is built around learning and practicing behaviours that can be maintained for lifetime

Answer 383

For obese individuals, exercise should be initiated slowly and the intensity gradually Depending on body size, fitness level, and exercise intensity, 30 mins of moderate physical activity 5 days a week would burn approximately 1000 calories Physical activity is crucial to the prevention of weight regain

Answer 384

After 6 months the rate of weight loss usually declines and weight plateaus, due in part to a decline in metabolic rate- the body’s physiological response to protect against starvation This metabolic compensation termed an energy gap is about 8 kcal/lb lost/day A widely held misconception is that the most people regain all lost weight and more Individuals who successfully maintain weight loss use more behavioural strategies to support weight loss and maintenance These behaviours include: consistently controlling caloric intake, exercising more often and more strenuously, tracking weight and eating breakfast Some health plans employ lifestyle coaches who provide telephone and email coaching to assist patients in sustaining behavioural changes in maintaining the health benefits of reduced risk for diseases

Answer 385

Weight-loss surgery is reserved for a limited number of patients with clinically severe obesity who meet criteria established by the National Institutes of Health In such patients, surgery is the most effective therapy for weight management and has been shown to result in improvement or resolution of obesity related comorbidities Surgical procedures reduce stomach size and restrict intake (stapling) or produce malabsorption by bypassing a section of the small intestine Patients considered for gastric surgery must be highly motivated to adhere to aftercare guidelines to prevent the onset of postoperative complications and prevent long-term nutritional deficiencies Patients treated with bariatric surgery are at risk for monitoring of serum nutrient levels

Answer 386

physical transformation of a child into a young adult

Answer 387

sexual maturation, increases in height and weight, accumulation of skeletal mass, and changes in body composition

Answer 388

should be used to assess biological growth and development and the individual nutritional needs of adolescents rather than chronological age

Answer 389

“Tanner Stages” is a scale of secondary sexual characteristics (based on breast development/testicular and penile development, and appearance of pubic hair) that allows health professionals to assess the degree of pubertal maturation among adolescents, regardless of chronological age

Answer 390

breast development: prepubertal; mipple elevation only | pubic hair growth: prepubertal; no pubic hair

Answer 391

Breast Development: Small, raised breast bud | Pubic Hair Growth: Sparse growth of hair along labia

Answer 392

Breast Development: General enlargement of raising of breast and areola Pubic Hair Growth: Pigmentation, coarsening, and curling, with an increase in amount

Answer 393

Breast Development:Further enlargement with projection of areola and nipple as secondary mound Pubic Hair Growth: Hair resembles adult type, but not spread to medial thighs

Answer 394

Breast Development:Mature, adult contour, with areola in same contour as breast, and only nipple projecting Pubic Hair Growth: Adult type and quantity, spread to medial thighs

Answer 395

Genital Development: Prepubertal; no change in size or proportion of testes, scrotum, and penis from early childhood Pubic Hair Growth: Prepubertal; no pubic hair

Answer 396

Genital Development: Enlargement of scrotum and testes; reddening and change in texture of skin of scrotum; little or no penis enlargement Pubic Hair Growth: Sparse growth of hair at base of penis

Answer 397

Genital Development: Increase first in length, then width of penis; growth of testes and scrotum Pubic Hair Growth: Darkening, coarsening, and curling; increase in amount

Answer 398

Genital Development: Enlargement of penis with growth in breadth and development of glands; further growth of testes and scrotum, darkening of scrotal skin Pubic Hair Growth: Hair resembles adult type, but not spread to medial thighs

Answer 399

Genital Development: Adult size and shape genitalia | Pubic Hair Growth: Adult type and quantity, spread to medial thighs

Answer 400

The first signs of puberty among females are the development of breast buds and sparse, fine pubic hair occurring on average between 8-13 years of age

Answer 401

the process of menstruation

Answer 402

the occurrence of the first menstrual cycle | ranges from 10.5-16.5 years, avg. 12.4 years

Answer 403

ranges from 9.5-14.5 years

Answer 404

begins around 8-13 and ends around 13-18 years

Answer 405

ranges from 10-15 years

Answer 406

First signs of puberty among males involve enlargement of the testes and change in scrotal coloring occurring during SMR stage 2 The average age of “spermarche” is 14 years Males show a great deal of variation in the chronological age at which sexual maturation takes place

Answer 407

one of two male reproductive glands located in the scrotum

Answer 408

begins around 10.5-16 and ends around 13.5-17.5 years

Answer 409

begins around 10.5-14.5 and ends around 12.5-16.5 years

Answer 410

begins around 9.5-13.5 and ends around 13.5-17 years

Answer 411

ranges from 11-16 years

Answer 412

A sense of personal identity, a moral and ethical value system, feelings of self-esteem or self-worth, and a vision of occupational aspirations develop

Answer 413

11 to 14 years Development and an increased awareness of sexuality are central tasks Dramatic changes in body shape and size can lead to the development of poor body image and eating disorders Peer influence is very strong, and teens strive to “fit in” with their peer group which can lead to adopting different food preferences and making food choices based on these influences Since chronological age has a wide range during which pubertal growth and development begins and proceeds, this can lead to personal dissatisfaction o Males considered to be “late bloomers” often feel inferior to their earlier matured peers and may turn to steroids/supplements o Females who mature early may have more eating problems and poorer body image and are more likely to initiate behaviours such as smoking, alcohol, and engaging in sexual intercourse Concrete thinking, egocentrism and impulsive behaviour is dominated whereas abstract reasoning is not yet developed and individuals lack the ability to see how their current behaviour can affect their future health

Answer 414

15 to 17 years Development of emotional and social independence from family Conflicts over personal issues, include eating and physical activity Peer groups are more influential and influence on food choice peaks Adolescents may believe they are invincible during this stage Abstract reasoning skills emerge rapidly, however are not necessarily applied to all areas of life o Concrete thinking skills are used if teens feel overwhelmed or experience psychosocial stress

Answer 415

18 to 21 years Development of personal identity and individual moral beliefs Growth is largely concluded and body images issues are less prevalent Increased confidence in ability to handle sophisticated and social situations, which is accompanied by reductions in impulsive behaviours and peer pressure as personal choices emerge Abstract thinking capabilities are realized and future goals/interest are developed Perspectives of others and future consequences are now fully understood

Answer 416

Cognitive-affective, behavioural, and biologic | Attitudes, beliefs, food preferences, self-efficacy, and biological changes

Answer 417

Microenvironmental and immediate social environmental Immediate social environment such as family, friends, and peer networks, and other factors such as school, fast-food outlets, and social and cultural norms

Answer 418

Food availability, food production and distribution systems, and mass media and advertising Plays a more distal and indirect role in determining food patterns, yet can exert a powerful influence on specific food choices Lack of time is a major barrier among adolescents due to participation in extracurricular activities, employment, or taking care of younger children in a family for part of the day, along with the increased need for social and peer contact, and increasing academic demands. This leads to snacking, skipping meals, and eating foods that are cheap and quick, such as vending machine snacks and fast foods. Snacks amount for 23%-39% of daily food energy, with 27%-35% of discretionary calories, 24% of total fats, and 31%-43% of added sugars 83% of adolescents report snacking with a mean of 1.7 snacks per day Soft drinks are the most common chosen snacks amounting to 9% of total energy intake and 45% of added sugar intakes Other snacks include fruit drinks, dairy desserts, salty snacks, and pizza Breakfast is the most commonly skipped meal with up to 27% skipping it daily Can lead to dramatically decreased intakes of energy, protein, fibre, calcium, and folate Fast food accounts for 17% of total energy intake (teens consume 2-3 times/week) High in saturated fat and low in fibre, vitamins, and minerals To make better choices; ask for juice, water, or milk instead of soft drinks, or order small sandwiches instead of larger choices, choose a salad or baked potato instead of French fries, order grilled items opposed to fried Fruit cups, pancakes, oatmeal, and fruit-and-yogurt parfait are better fast-food choices for breakfast Adolescents who consume family meals have higher intakes of calcium, folate, fibre, iron, and vitamins A, C, E, B6, and B12.

Answer 419

Increases in lean body mass, skeletal mass, and body fat that occur during puberty result in energy and nutrient needs that exceed those at any other point in life However there is no optimal nutrient and energy intakes during adolescence due to little available data The DRIs provide the best estimate of nutrient requirements for adolescents Note, that these values are based on chronological age, whereas developmental age (SMR status) is more accurate

Answer 420

any bodily movement produced by skeletal muscles, which results in energy expenditure Energy: a subset of physical activity that is planned, structured, and repetitive and is done to improve or maintain physical fitness

Answer 421

a set of attributes that are either health- or skill-related All adolescents should be physical active daily, and engage in muscle- and bone-strengthening activities at least 3 days per week More males than females meet daily physical activity guidelines o Positive individual factors include confidence in one’s ability (self-efficacy), perceptions of physical or sport competence, having positive attitudes towards physical activity, enjoying physical activity, and perceiving positive benefits (weight control, improved appearance, staying in shape) o Social factors include peer and family support o Environmental factors associated with physical activity are having safe and convenient places to play, sports equipment, transportation

Answer 422

Energy intakes are influenced by activity level, basal metabolic rate (BMR – closely associated with amount of lean body mass), and increased requirements to support pubertal growth and development Males have higher caloric requirements than females due to greater increases in height, weight, and lean body mass Physical growth and development during puberty is sensitive to energy and nutrient intakes, and when energy intakes fail to meet requirements linear growth may be retarded and sexual maturation may be delayed

Answer 423

Needs are influenced by the amount of protein required for maintenance of existing lean body mass, plus allowances for the amount required to accrue additional lean body mass during adolescent growth spurt Estimated protein needs is 0.85g/kg body weight/day Protein requirements are highest for females aged 11-14 years and males aged 15-18 years, when growth is at its peak %Daily energy from protein: 10-30

Answer 424

Rich foods such as fruit, vegetables, whole grains, and legumes are the main source of dietary fibre and provide a primary source of dietary energy Sweeteners and added sugars provide approximately 21% of energy intake %Daily energy from carbohydrates: 45-65

Answer 425

Important for normal bowel function and may play a role in the prevention of chronic diseases such as certain cancers and type 2 diabetes mellitus Adolescents have intakes well below the AAP and DRI recommendations

Answer 426

Dietary fat and essential fatty acids are required for normal growth and development %Daily energy from fat: 25-35, with no more than 10% from saturated fat Approx. 2/3 of teens meet the recommendations for fat intake

Answer 427

Adequate intake of calcium is crucial to physical growth and development since it is the main constituent of bone mass (about half of peak bone mass is accrued during adolescence) Calcium needs and absorption rates are higher during adolescence; females have the greatest capability to absorb calcium around the time of menarche whereas rates in males peak during early adolescence a few years later Females in particular need an adequate intake of calcium, however many do not consume the DRI requirement which is not adequate to support the development of optimal bone mass (supplements may be taken) Dairy intake is usually not adequate to meet daily needs therefore adolescents may have to turn to calcium-fortified foods Calcium intake is highly correlated with energy intakes, therefore females who restrict caloric intake are at high risk of inadequate calcium intakes

Answer 428

The rapid rate of linear growth, the increase in blood volume, and the onset of menarche increase a teen’s need for iron Iron needs are based on sexual maturation level and are highest during adolescent growth spurt in males, and after menarche in females Serum iron, plasma ferritin, and transferrin saturation: measures of iron status obtained from blood plasma or serum samples Iron deficiency occurs more frequently in all adolescents whereas iron-deficiency anemia occurs almost exclusively in females Most adolescent males and young adolescent females consume less than the DRI however the prevalence of very low iron intake is much higher among older adolescent females

Answer 429

Fat-soluble vitamin that plays an essential role in facilitating intestinal absorption of calcium and phosphorus that is required to maintain adequate serum levels of these minerals. It can be synthesized by the body through exposure of skin to ultraviolet B rays of sunlight Essential for optimal bone formation There is an inverse relationship between vitamin D and serum parathyroid hormone (PTH). Even in the earliest stages of vitamin D deficiency, PTH is elevated in order to maintain serum calcium levels through demineralization of bone Over the past few decades, females showed greater decreases in serum vitamin D status than did males, which is concerning given female’s already low intake of calcium during adolescence and higher risk of osteoporosis later on in life Most adolescents are not vitamin D deficient however many do not have sufficient vitamin D status, especially in high-risk groups particularly black teens and those who live in northern climates

Answer 430

Integral part of DNA, RNA, and protein synthesis, thus increased requirements for folate is during puberty. Significant portions of adolescents do not have adequate folate status. Red blood cell and serum folate levels drop during adolescence as sexual maturation proceeds, suggesting that increased folate needs during growth and development are not being met Adequate intakes of folate prior to pregnancy can reduce the incidence of spina bifida and other anomalies and my reduce Down Syndrome Therefore all women of reproductive age (14-55) should consume adequate folic acid, preferably through dietary sources Many adolescents consume adequate amounts of folate however those who skip breakfast or do not commonly consume orange juice and read-to-eat cereals have an increased risk of low consumption of folate

Answer 431

On average, adolescents consume diets inadequate in several vitamins and minerals, including folate; vitamins A, B6, C, and E; and iron, zinc, magnesium, phosphorus, and calcium (also dietary fibre is low), with more than 1/3 of females consuming inadequate levels of all these nutrients Diets consume exceed recommendations for total and saturated fats, cholesterol, sodium, and added sugar Few adolescents meet recommendations for fruit or vegetable consumption Majority of male adolescents, and half of the females, consume adequate intakes of grains however intake of whole grains are below recommendation Intake of dairy products is very low especially in females, and meat/alternatives was low as well

Answer 432

Nutrition screening should include common concerns such as overweight, underweight, eating disorders, hyperlipidemia, hypertension, iron deficiency and/or anemia, food insecurity, and excessive intake of high-fat or high-sugar foods and beverages Nutrition screening should include an accurate measure of height and weight, and calculation of BMI, and should be plotted on age- and gender-appropriate growth charts o Underweight: less than 5th percentile o Healthy weight: 5th percentile to less than 85th percentile o Overweight: 85th to less than 95th percentile o Obese: equal to or greater than 95th percentile

Answer 433

Adolescents who have a poor diet characterized by an excessive intake of high-fat or high-sugar foods and beverages or meal skipping should be provided with nutrition counselling that provides concrete examples of ways to improve dietary intake Adolescents who consume vegan diets must be assessed for adequacy of vitamin and mineral intake (particularly vitamins D and B12, iron and zinc) and total fat and essential fatty acid intakes. Diets that are low in fat may not supply an adequate ratio of linoleic acid to alpha-linolenic acid (5:1 to 10:1) to facilitate metabolism of alpha-linolenic acid to DHA Adolescents, who consume vegetarian diets, particularly if they do so for health- or weight-related reasons, should be carefully assessed for the presence of eating disorders, chronic dieting, and body-image disturbances. Many adolescents adopt vegetarian diets as a mean to restrict fat intake or practicing self-denial.

Answer 434

Teenagers tend to be present-oriented and tend not to be concerned about how their eating will affect them in later years. They are concerned about immediate, socially relevant issues such as their physical appearance, achieving and maintaining a healthy weight, and having lots of energy, therefore focusing on the short-term benefits will have more appeal to them Parents serve as role models in the home environment for eating behaviour therefore they should be nutritionally educated as well Teenagers eat what is available and convenient, therefore parents should stock the kitchen with nutritious, ready-to-eat foods, limiting high-sugar School-based programs play important roles in healthy eating and physical activity Young adolescence is an ideal time to teach students how to assess their own behaviour and set goals for change since they are beginning the social process of individuation Nutrition education and teaching methods should be on behaviour change strategies and skill acquisitions to make healthful food decisions Community parks and recreational programs are essential for promoting physical activity among young people since most physical activity occurs outside of the school setting

Answer 435

Risk factors for the development of overweight and obesity among children and adolescents include having at least one overweight parent; coming from a low-income family; being of African American, Hispanic, or American Indian/Native Alaskan race/ethnicity; and being diagnosed with a chronic or disabling condition that limits mobility. Additional factors include inadequate levels of physical activity and consuming diets high in total calories and added sugars and fats Weight status should be assessed by calculating BMI 90% of overweight adolescents can be expected to remain overweight into adulthood Hypertension, dyslipidemia, insulin resistance, type 2 diabetes mellitus, sleep apnea, hepatic diseases, body image disturbances, and lowered self-esteem are health implications

Answer 436

Adolescents with an overweight BMI start here is they do not exhibit significant comorbid conditions and/or have not completed their adolescent growth spurt Daily treatment includes 5 servings of fruit/vegetables, limiting sweetened-beverages, 60 minutes of physical activity, and limited screen time

Answer 437

Monitoring of food and nutrition behaviours by the adolescent and/or parents Goals in stage 1 reinforced, and several are modified Screen time limited (1hr) and a meal plan is introduced, with journal or log books provided Provided by health care provider

Answer 438

More frequent client contact than stage 2 Provided by a team of specialized health-care professionals More structured eating and physical activity plan

Answer 439

Youth with significant, chronic comorbid conditions Provided by a tertiary weight-management center that specializes in obesity Meal replacement, low-energy diet, medication, and surgery is possible Gastric bypass: adolescents must have BMI >35 with major medical complications or >40 with minor comorbidities. Teens should have completed majority of their adolescent growth spurt. Important to monitor protein, iron, calcium, vitamins D B6 B12, thiamine, and folic acid after surgery

Answer 440

The DRI’s for adolescents are based on chronological age Energy and protein needs based on velocity of growth (height) will provide a better estimate than biological age For adolescents aged 9-18: o 45-65% of daily energy from carbohydrates o 25-35% of daily energy from fat o 10-30% of daily energy from protein Since energy requirements vary due to difference in growth, the DRI equations for estimating energy (EER) may be used in specific cases. These estimates vary in adolescent years by gender, physical activity level, weight status, basal metabolic rate (BMR), and pubertal growth and development

Answer 441

ron: The body is believed to adapt (decreased loss, increased absorption) to a long-term low iron environment as occurrence of iron deficiency anemia is similar in vegetarians as opposed to general population Increased iron needs related to rapid rate of linear growth, increase in blood volume and menarche in females Absorption can be improved by soaking and sprouting beans, seeds, grains, fermentation (miso, tempeh) Zinc: Large increase in needs, especially in males (for sexual maturation/growth) Decreased bioavailability, but dependent on level of phytic acid content Overt deficiency not seen but diet intake below needs Potentially use fortified foods/supplement with multivitamin Calcium and vitamin D: Critical to ensure peak bone mass achieved **~4x more calcium absorbed during early adolescence compared to adulthood** Absorption affect by oxalates and phylates Weight-bearing activities may lead to increased bone mineral density Calcium fortified juice, breakfast cereal Supplement vitamin D if inadequate sun or not using fortified soymilk B12: Include at least 3 good sources per day (vegetarian support formulas, fortified soy milk, fortified mean analog, nutritional yeast) Vegetarian diets are rich in folacin which mask a B12 deficiency Omega-3 fatty acids: ALA conversion to EPA and DHA is low; need sufficient ALA in diet (flaxseeds, walnuts, canola oil, soy) DHA supplements can be used (or sea vegetables) Soy milk and other foods now fortified with DHA and EPA Iodine: Only an issue if sea salt or Kosher salt used instead of iodized salt Bread/sea vegetables can be a source

Answer 442

Girls have better fruit and vegetable intake and are more likely to skip breakfast and diet to lose weight Boys consumed more salt, sugar, and fat, and were more engaged in sports Consumption of soft drinks/energy drinks increased with each grade, whereas breakfast consumption decreased with each grade

Answer 443

Goal for adolescence is 90 minutes per day with 60 minutes of moderate and 30 minutes of vigorous activity. Reducing screen time as well as education materials help to reach this goal Girls perceived barriers to physical activity Lack of time Involvement in technology Peers, parents, teachers Competition/body centred issues Safety

Answer 444

iological Growth: puberty, sexual maturation rating (SMR), and changes in weight, body composition, and skeletal mass Psychosocial Development: The “Teen” Brain: Ability to plan, problem solve may be limited Live in the moment; limited consideration of long-term consequences Reward benefits much more important than possible risks

Answer 445

Healthy behaviour is influenced by role models and peers, lack of physical activity due to lack of resources,, unhealthy school nutrition environment, media, finances, and excess screen time. Determinants are interrelated (smoking linked to lack of physical activity)

Answer 446

Three clinically diagnosed/defined disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder (BED) National Eating Disorder Information Centre (NEDIC): develops information and resources on eating disorders, runs prevention/awareness campaigns, runs workshops and presentations, and staffs a telephone helpline

Answer 447

The demonstrated ability to carry out activities of daily living More important than chronological age in assessing the health status of older adults

Answer 448

Of all psychological changes associated with aging, loss of lean body mass and the concomitant gains of body fat may well be the most important in determining functional age

Answer 449

Use it or lose it applies to both the body and the mind Keep learning to maintain acute brain function, stay active to build muscle and bone, eat well to maintain and repair tissue, and cultivate a conscientious way of life to improve longevity

Answer 450

This acronym is a reasonable summary of warning signs associated with poor nutritional health Disease, eating poorly, tooth loss/mouth pain, economic hardship, reduced social contact, multiple medicines, involuntary weight loss/gain, needs assistance in self-care, elder years above 80

Answer 451

not as sensitive as that of younger adults, placing them at higher risk of dehydration

Answer 452

lead to malnutrition in older adults are decreased absorption of vitamins D and B12 and increased storage of vitamin A and iron

Answer 453

In general, older adults eat better than younger adults, but they do not consume enough vitamin A, D, E, K (men), choline, calcium, magnesium, or potassium to meet recommended intake levels Vitamin and mineral supplements can be helpful for older adults who have lost their appetite, avoid certain food groups, have poor diets due to food insecurity, loss of function, dieting or depression, or who have gastrointestinal bacterial overgrowth that prevents nutrient absorption

Answer 454

especially important for older adults, who may be more vulnerable to infection for many reasons, such as higher prevalence of chronic diseases, sensory and functional losses, and decreased resilience in healing and recovery from illness