Nutrition Flashcards
Only bacteria not killed by Holder pasteurization
B. cereus
“you cant be serious!”
Decreases with advancing GA and birthweight
Increase with advancing GA and birthweight
Fetal growth by GA
SGA vs IUGR
Estimated fetal energy expenditure
35-55 kcal/kg/day
Fetal energy sources
multiple gestation and fetal growth
neonatal caloric requirement
120-150 kcal/kg/day to balance energy expenditure and allow for proper growth
amino acids that are glucose precursors
Alanine
Glutamic acid
Aspartic acid
Essential amino acids
protein digestion
essential fatty acid deficiency:
- dermatitis (dry, scaly, snowflake)
- alopecia
- thrombocytopenia
- susceptibility to bacterial infection
- failure to thrive
triene:tetraene ratio of >0.2 is diagnostic
Mead (incr) : arachidonic acid ratio (dec)
can be prevented with as little as 0.5-1.0g/kg/day lipid
water soluble vitamins
vitamin B complex, vitamin C
not formed by precursors (except niacin from tryptophan)
dialy intake required to prevent deficiences
does not accumulate in the body (except vitamin B12)
most cross placenta by active transport
fat soluble vitamins
ADEK
synthesized from precursors
daily intake not typically required except in specific circumstances (ex. CF)
not easily excreted so can accumulate in the body and has potential for toxicity
placental transfer by simple or facilitated diffusion
Vitamin A
Retinol
- important for pulmonary epithelial growth and cellular differentiation
- deficiency may play a role in development of CLD
Deficiency:
- photophobia
- conjunctivitis
- abnormal epiphyseal bone formation and tooth enamel
- generalized scaling
- failure to thrive
Vitamin B1
Thiamine
Beriberi
- fatigue
- irritability
- constipation
- cardiac failure
Associated with pyruvate dehydrogenase complex deficiency and MSUD
Vitamin B2
Riboflavin
- Failure to thrive
- photophobia
- blurred vision
- dermatitis
- mucositis
Associated with glutaric aciduria type 1
Vitamin B6
Pyridoxine
- Dermatitis
- mucositis
- hypochromic anemia
- possible seizures
Associated with homocystinuria
Vitamin B12
Cobalamin
High risk: breast-fed infants of vegetarian mothers who do not ingest eggs or dairy products
- megaloblastic MACROCYTIC anemia with hypersegmented neutrophils (same as folic acid deficiency)
Associated with methylmalonic acidemia and homocystinuria
Biotin
- Alopecia
- dermatitis
- scaling
- seborrhea
Associated with:
- biotinidase deficiency
- beta-methylcrotonyl glycinuria
- propionic acidemia
- pyruvate dehydrogenase complex deficiency
think of why you take biotin as to what happens if you are deficient
Vitamin C
Ascorbic acid
Poor wound healing and bleeding gums
Associated with transient tyrosinemia
Vitamin D
Rickets
failure to thrive
possible tetany
Folic acid
Folate
HIGH risk: infants fed only evaporated milk or goat’s milk
- poor weight gain
- anemia- macrocytic with hypersegmented neutrophils
often coexists with iron deficiency
Vitamin E
Alpha-Tocopherol
Recommended concurrently with iron administration to protect from iron-induced hemolysis
Vitamin K
- coagulation
Associated with hemorrhagic disease of newborns
Chromium
regulates glucose levels because of role in insulin metabolism
Deficiency: unknown in humans
Copper
- critical for production of RBCs, hemoglobin formation
- important in absorption of iron
- associated with multiple enzyme activities
Deficiency:
- anemia
- osteopenia
- depigmentation of hair and skin
- neutropenia
- poor weight gain
- hypotonia
- ataxia later in life
Iron
- Component of hemoglobin and myoglobin required for transport of oxygen and carbon dioxide
- absorbed predominantly in duodenum and prox jejunum
- Vitamin C enhances absorption
Deficiency:
- anemia (microcytic, hypochromic)
- Failure to thrive
Manganese
- role in enzyme activation (ex. superoxide dismutase)
- important for normal bone structure
- role in CHO metabolism
Deficiency: unknown
Selenium
- cofactor for glutamine peroxidase
Deficiency: cardiomyopathy
Zinc
- important component of several enzymes (ex. carbonic anhydrase)
- important for growth
Deficiency:
Acrodermatitis enteropathica:
- AR
- abnormality of zinc absorption or transport
- FTT, alopecia, diarrhea, dermatitis (perianal), ocular changes, rash, nail hypoplasia/dysplasia
Acquired deficiency:
- preterm infants receiving inadequate amounts of zinc
- maternal zinc deficiency–> FGR, congential anomalies
- infants with malabsorption, poor weight gain, poor wound healing, anemia (iron deficiency)
SGLT1
apical surface
galactose and glucose
active transport
less efficient in newborn- especially preterm
GLUT5
apical surface
fructose
facilitated/passive transport
GLUT2
basal surface
galactose, glucose, fructose
TPN cholestasis
reduce copper and manganese
Bacteriocidal in breastmilk
secretory IgA
lactoferrin
colostrum ratio W:C
80:20
Mature milk W:C
55:45
preterm BM has more ?? than mature milk
PROTEIN!
Formula is higher in ??? compared to human milk
Na
Ca
K
Cl
Mg
Ph
amino acids
Normal magnesium
1.7-3.6
Symptoms of <1.2
components preserved with pasteurization
vit A, D, E
lactose
LCPUFA
epidermal growth factor
IgA, IgG
which Ig is destroyed with pasteurization?
IgM
zinc deficiency
acrodermatitis enteropathia
defective zinc uptake in the duodenum and jejunum because of abnormality in zinc transporter protein ZIP4
FTT, alopecia, diarrhea, perianal dermatitis, rash (crusted, erythematous involving face/extremeties/anogenital areas)
at what age does fetal lactase reach adult concentrations?
36 weeks
what % of protein should be in the diet to prevent a negative nitrogen balance?
7-15%
what requires the greatest amount of energy expenditure in a neonate?
resting metabolic rate
40-60 kcals/kg/day
selenium
essential component of glutathione peroxidase, protecting the body from oxidant damage
chromium
plays a role in carbohydrate and lipid metabolism
clinical deficiency remains to be described
copper
red blood cell production
hemoglobin formation
iron absorption
iron
not routinely included in TPN due to :
- concerns about iron overload
- suppression of immune function
- propagation of free oxygen radicals
zinc
important for bone formation
function of transcriptional factors and steroid receptors
cause of renal agenesis
ureteric bud fails to develop
hormon that plays the biggest role in placental regulation of fetal nutrient supply
placental lactogen
brain and eye development
LCPUFA
omega 3 and omega 6
decreases with advancing GA/BW
total body water
extracellular water
sodium content
chloride conten
increases with advancing GA/BW
intracellular water
protein
fat
calcium, phosphorus, magnesium
iron
Differences in body composition in SGA vs AGA
SGA infants have:
1. reduced total body mass
2. reduced lean mass
3. reduced bone mineral contant
4. reduced muscle mass –> lower nitrogen content
5. lower fetal plasma glucose/insulin –> lower glycogen contant in liver and muscle
glucose and galactose transport
ACTIVE transport across apical surface via SGLT1 (help from N/K pump)
less efficient in the newborn, especially preemie
crosses into circulation via GLUT2
fructose transport
FACILITATED/PASSIVE transport via GLUT 5
crosses into circulation via GLUT2
neonate has adequate carb DIGESTION because of?
normal glucoamylase
normal glucosidases/disaccharidases
except for lactase
neonate has adequate carb ABSORPTION becaues of?
largely adequate digestion
colonic salvage pathway
fat malabsorption minimized in preemie due to:
- lingual lipase, gastric lipase, lipases in BM –> TG breakdown
- increased amounts of more easily digested MCFA in BM
intestinal absorption
