Nutrition Flashcards
Advantages of breastfeeding in infants and children?
- Decreased frequency and severity of:
- Diarrheal illness
- Respiratory infections
- Necrotizing enterocolitis
- Otitis media - Decreased rate of:
- urinary tract infection
- bacterial sepsis - Lower risk of neonatal and infant death:
- Overall infant mortality
- Sudden infant death syndrome (SIDS) - Likely lower risk of chronic illness:
- Leukemia (ALL, AML)
- Diabetes (types 1 and 2)
- Obesity
- Atopic dermatitis and asthma
- Celiac disease and Crohn’s disease
Advantages of breastfeeding for the mother?
With cumulative lactation of 12 months or greater)
1. Reduced risk of cancer:
- Breast cancer risk (OR = 0.72)
- Ovarian cancer risk (OR = 0.63)
2. Reduced risk of cardiovascular disease:
- Obesity (OR = 0.92)
- Hypertension (OR = 0.88)
- Hyperlipidemia (OR = 0.81)
- Cardiovascular disease (OR = 0.91)
3. Reduced risk of diabetes type 2 (among women without gestational diabetes; OR = 0.80)
HIV infection and breastfeeding?
Exclusive breast feeding for 6 months
Complimentary feeding thereafter until 24 months
Mother be on lifelong antiretroviral medications
Baby on nevirapine (NVP) within 72 hours of birth
NVP continued for 6 weeks
What are micronutrients?
- vitamins
- trace elements <0.01% of the body weight
Factors contributing to trace elements deficiencies in children?
- Increased demand of growth
- Organs (e.g brain) can sustain permanent damage due to trace element deficiency (iron, iodine) - Gastroenteritis and malabsorption can cause loss of:
potassium, magnesium, vitamin A, and zinc
Describe zin deficiency?
Epidemiology - developing world
Associated conditions - malnutrition, iron deficiency
Chronic deficiency associations - dwarfism, hypogonadism, dermatitis, and T-cell immunodeficiency
Importance of zinc - supplementation reduces the incidence and severity of diarrhea, pneumonia, and possibly malaria
Production of vitamin D?
Cutaneous synthesis is the most important source [conversion of 7-dehydrochlesterol tovitamin D3(3-cholecalciferol)]
Factors that decrease cutaneous synthesis of vitamin D?
Increased skin pigmentation
Less time outside
Away from equator
Covering skin or sunscreens
Natural dietary sources of vitamin D?
- Fish liver oils
- Fatty fish andegg yolks
Note: Breast milk has a lowvitamin Dcontent.
Clinical manifestations of vitamin D deficiency?
- rickets
- hypocalcemia
- Laryngospasm (occasionally fatal)
- Increased risk of pneumonia and muscle weakness; delay in motor development
Features of rickets?
- Genu varum (bowed legs)or genu valgum (knock knees)
- Thickened wrists and ankles
- Prominence of the costochondral junctions (rachitic rosary)
- Indentation of the lower anterior thoracic wall (Harrison groove)
- Frontal bossing
- Craniotabes
Vitamin k deficiency? Deficiency causes what?
Necessary for the synthesis of clotting factors II, VII, IX, and X
- Deficiency can result in clinically significant bleeding
Causes of vitamin K deficency?
- Breastfed infants (lowvitamin Kcontent of breast milk; formula is fortified);
- Delayed feeding is an additional riskfactor
- Newborn gut is sterile has no intestinal synthesis ofvitamin K2
- Poor transfer ofvitamin Kacross the placenta
- Occult malabsorption ofvitamin K (e.g biliary atresia)
- Maternal medications (Warfarin, phenobarbitone, phenytoin)
- Poor intake PLUS use of broad-spectrum antibiotics
Clinical manifestation of vitamin K deficiency?
Vitamin k deficiency bleeding
1. Gastrointestinal (GI) tract
2. Mucosal and cutaneous tissue
3. Umbilical stump
4. Postcircumcision site
5. Intracranial bleeding (can cause convulsion, permanent neurological sequalae or death.
Prevention and treatment of vitamin K deficiency?
- Discontinuing the offending medications before delivery
- Administration ofvitamin Kto the mother may be helpful
- Neonatal parenteralvitamin Kimmediately after birth
- Fresh frozen plasma if parenteralvitamin Kdoes not correct the coagulopathy
Iron deficiency?
Deficiency causes
- preventable intellectual impairment, Deficiency in pregnancy causes fetal loss and brain damage (cretinism)
Clinical features
- Enlarged thyroid (goiter) is a sign of deficiency
Prevented by iodine supplementation before conception or during the 1st trimester of pregnancy
Note: Postnatal iodine deficiency causes impaired mental function and growth retardation
Underweight?
low weight for height
- Poor weight gain or loss from acute malnutrition, illness, etc
Stunting?
low height for age
- Growth retardation, ‘chronic malnutrition’ diet deficiency in minerals and vitamins
Wasting?
MUAC < 13.5cm (risk) or <11.5cm (severe malnutrition)
- Acute starvation, hunger (emergency situations)
Obesity?
BMI >30
- Very high energy intake and/or sedentary lifestyles
Low birth weight?
birth weight < 2500g
- Intrauterine growth retardation and/or prematurity
Marasmus?
Very low weight/height or weight/age
- Severe deficiency of energy intake or excessive energy requirements
Kwashiorkor?
nutritional edema
- Deficiency of some nutrients, particularly those involved with anti-oxidant protection (glutathione, vitamins A, C, and E, and essential fatty acids) or cofactors (zinc, copper, selenium).
Severe acute malnutrition?
- The presence of bilateral pitting oedema or WFH of <-3Zscore or
- 6-59 months MUAC <11.5cm
- 5 -9 years MUAC <13.0cm
- 10 – 15 years <16.0cm - In adolescents bilateral pitting oedema or MUAC <18.5cm or Body-Mass-Index (BMI) <16.0
Wasting in 6-59 months?
moderate
- MUAC: 11.5 - 12.4 cm
- W/HT Z score: -2 to -3
severe
- MUAC: <11.5cm
- W/HT Z score: <-3
Kwashiorkor in 6-59 months?
moderate
- no symmetrical and pitting edema
severe
- symmetrical and pitting edema
Grading edema?
- Oedema + - localized to the feet
- Oedema ++ - below knee, may affect even hands but not the face
- Oedema +++ - generalized/periorbital
Body mass index?
BMI = weight in kg/(height in meters)2
- For children, BMI is age and gender specific
- BMI-for-agecan be used from birth to 20 yr
- Screening tool forthinness(less than −2 SD)
- Overweight(between +1 SD and +2 SD)
- Obesity(greater than +2 SD)
Risk factors for severe malnutrition?
- Poor family dynamics
- mother pregnant or poorly educated, father unemployed or separated, parental illness - Sub-optimal nutrition
e.g., lower breastfeeding rates or earlier weaning
Energy conservation in malnutrition?
- Utilization of fat, proteins (muscle, skin, GIT)
- Reducing physical activity, growth, reducing basal metabolism
- Reduced functional reserve of organs
- Reduced inflammatory and immune responses
Consequences of reductive adaptation of the liver in malnutrition?
- Reduced gluconeogenesis (prone to hypoglycaemia)
- Reduced protein production (albumin, transferrin)
- Less able to cope with excess dietary protein
- Less able to excrete toxins
- Reduced heat production (vulnerable to hypothermia)
Reductive adaptation of the kidneys in manutrition?
- Reduced GFR
- Less able to excrete excess fluid and sodium
- Fluid easily accumulates in the circulation
- Increasing the risk of fluid overload
Reductive adaptation of the heart in malnutrition?
- Smaller and weaker
- Reduced output
- Fluid overload readily leads to death from cardiac failure.
Consequences of reductive adaptation of electrolytes?
- Increased intracellular sodium concentration
- leaky cell membranes
- reduced activity of the sodium/potassium pump
- Excess body sodium, fluid retention, and edema - Potassium leaks out of cells
- Excreted in urine
- Electrolyte imbalance, fluid retention, edema, and anorexia - Loss of muscle protein is accompanied by loss of potassium, magnesium, zinc, and copper.
Reductive adaptation of the GIT?
- Less gastric acid and enzymes
- Reduced mortility
- Bacterial may colonization of stomach and small intestine
- Damaging mucosa and deconjugating bile salts - Digestion and absorption are impaired.
- Cell replication and repair are reduced
- Increased risk of bacterial translocation through the gut mucosa
Reductive adaptation of immune function?
- Impaired immune function especially cell-mediated
- The usual responses to infection may be absent
- Increased the risk of undiagnosed infection
Reductive adaptation of hematology?
- Red cell mass is reduced
- Releasing iron (requires glucose and amino acids to be converted to ferritin)
- Increasing the risk of hypoglycemia and amino acid imbalances
- Unbound iron promotes pathogen growth and formation of free radicals (If conversion to ferritin is incomplete)
Reductive adaptation of micronutrient deficiency?
Inability to deactivate free radicals
- Cause cell damage
- Edema and hair/skin changes are outward signs of cell damage
