Nutrition Flashcards
GA of highest growth rate
mid 30s with decline after 36
growth rate MC vs DC twins
MC lower
decreases with increases in GA and BW
TBW
EC water
Na content
Cl content
increases with GA and BW
IC water
protein
fat
ca phos mg
iron
energy source of fetus
2/3 glucose from mother
1/3 placental lactate
remaining = maternal AA
fetal energy expenditure
35-55 kcal/kg/d
gross energy intake =
energy excreted + energy expended + energy stored
enteral vs intravenous goals for infants
enteral 100-130 kal/kg/d
intravenous 85 - 95 kcal/kg/d
major protein sources in neonates
whey and caseine
whey vs caseine re: cysteine and methionine content
whey has more cysteine and less methionine
whey to casein ratio colostrum
80:20
whey to casein ratio mature milk
55:45
whey to casein ratio in formula with predominant casein vs predominant whey
20:80
80:20 or 60:40
whey to casein ratio of preterm vs term
greater protein content and w:c in preterm
glucose precursor AAs
alanine glutamate aspartate
methylated in muscle protein AAs
homoscysteine
methionine
creatine
phosphatidylcholine
essential AA
branched chain: valine, isoleucine, leucine
histidine, lysine, methionine, phenylalanine, threonine, trytophan
conditionally essential
arginine
cysteine
glutamine
glycine
proline
taurine
tyrosine
non essential
alanine
asparagine
aspartate
glutamate
serine
kcal/g of protein
4
AA solutions have decreased ___ because ____
tyrosine and cysteine
decreased solubility
how much protein needed to avoid negative nitrogen balance in parenteral solutions
7-15%
1g protein = 1 g AA = 0.16 g nitrogen
enteral protein goals
3.5 - 4.5 g /kg/d = 3.2 - 4.1 per 100kcal
essential FAs
linoleic acid and alpha linoleic acid
a:b (n-c) e.i 18:3 (n-3)
a = total number of carbons
b = total number of double bonds
c = number of carbons from the terminal methyl end with the first double bond
most prevalent fatty acids in human milk
- oleic acid
- palmitic acid
SCHAD #C
< 6
MCHAD #C
6-12
LCHAD
12-20
VLCFA
> 22
what does linoleic acid give rise to and which pathway?
arachidonic acid in the n-6 pathway
what does alpha linoleic acid give rise to and which pathway?
eiscosapentaenoic acid
docosahexaenoic acid
n-3 pathway
how long of a delay in essential fatty acids can lead to EFAD
3-7 days
symptoms of EFAD
scaly dematitis
alopecia
thrombocytopenia
FTT
infections
how much IL is needed to prevent EFAD
0.5-1g/kg/d
how to diagnose EFAD
increased Holman index = triene:tretrene ratio
refers to mead acid:arachidonic
> 0.2
bc increased mead acid is from omega9 metabolism increasing T:T
kcal/1g fat
9
fats should provide ___% of total daily calories
30-50 (not more than 60%)
differences between 20% and 10% solutions of fat
10% has:
lower triglycerides
lower calories
higher phospholipid:triglyceride
–> may impair lipase in preterm so 10% not recommended
which lipid is 100% fish oil
omegaven
enteral goals of fat
4.8-6.6 g/kg/d
4.4 - 6.6g/100 kcal
kcal/1g carb
3.4
for positive nitrogen balance how much glucose do you need per gram of protein
6g
how much total calories should be from carbs?
35-65%
glucose utilization of preterm and term?
preterm: 5-8 mg/kg/min
term: 3-5 mg/kg/min
importance of b12
(cobalamin)
folate, CHO and fat metabolizm
importance of folate
coenzyme for amino acid and nucleic acid metabolism
risk factors for b12 deficiency
breastfed babies with vegetarian moms
methylmalonic acidemia
homocystinuria
risk factors for folate deficiency
evaporated milk
goats milk
iron deficiency
b12 or folate deficiency blood smear
megaloblastic macrocytic anemia
hypersegmented neutrophils
importance of vitamin e
antioxidant
protects again iron induced hemolysis
importance of vitamin k
carboxylation of prothrombin into active form
coagulation
maternal meds that decrease neonatal vit k
anticonvulsants
warfarin
antiTB
features of vit A deficiency
- pulmonary epithelial growth and differenciation
- photophobia, conjunctivitis,
- abnormal epiphyseal bone formation and tooth enamel
- generalized scaling
- FTT
features of vitamin B1 deficiency
(thiamine)
beriberi: fatigue, irritability, constipation and cardiac failure
a/w pyruvate dehydrogenase complex deficiency and MSUD
features of vitamin B2 deficiency
(riboflavin)
FTT, photophobia, blurred vision, dermatitis, mucosititis
a.w glutaric aciduria type 1
features of vitamin B6 deficiency
(pyridoxine)
dermatitis, mucositis, hypochromic anemia, possible seizures
a.w homocystinuria
features of b7 deficiency
(biotin)
alopecia dermatitis, scaling, seborrhea
a.w:
biotinidase deficiency
betamethylcortonyl glycinuria
propionic acidemia
pyruvate dehydrogenase complex deficiency
features of vit c deficiency
poor wound healing and bleeding gums
a.w transient tyrosinemia
features of vit d deficiency
rickets
ftt
tetany
function of chromium
regulates glucose - insulin metabolism
function of copper
- RBC and Hgb formation
- absorption of iron
function of iron
Hgb and myoglobin component
transport o2 and co2
absorbed in duodenum and prox jejunum
vit c enhances absoprtion
function of manganese
enzyme activation
normal bone structure
CHO metabolism
function of selenium
cofactor for glutamine peroxidase
can lead cardiomyopathy without it
function of zinc
- component of enzymes like carbonic anhydrase and carboxypeptidase
- growth
hormones in breast milk
cortisol
epidermal growth factor
enzymes in breast milk
bile salt dependent lipase
importance of inositol
- membrane synthesis
- reduces retinal damage
- enhance surfactant
- greater in BM than formula
importance of choline
CNS development
component of ACh and phosphatidylcholine
low in milk
hind milk in comparison to foremilk
higher fat
low glucose
equal protein
premature vs mature milk
increased protein initially but decrease
increased electrolytes
inadequate ca phos, vit d
drugs that are contraindications to breastfeeding
cocaine
cyclosporine
methotrexate
phencyclidine
radioactive agents
what is reduced by storing at 0-4degC BM
bactericidal activity after 72 hours of storage
what is reduced with freezing at - 20 deg C BM
pH by 3%
lactoperoxidase
cellular activity # and function
what is reduced by pasturization at 56 degC BM
water soluble vitamins
lipase amylase lactoperoxidase
antioxidants
adiponectin, insulin
cellular activity
bacterial growth
ifng, tnfa, il1b il10 hgf
what is reduced by pasteurization at 62 degC BM
watersoluble vitamins
lipase amylase lactoperoxidase
antioxidants
adiponectin, insulin
cellular activity
bacterial growth
ifng,tnfa, il1b il10 hgf
igA lactoferrin and lysozyme
protein denaturalization
what is reduced by microwaving BM
iga
lysozyme
vit C
which formula has higher lactose? preterm or term
term
which formula has higher fat content preterm or term
preterm
which formula has higher MCT? preterm or term
preterm
which formula has higher protein? preterm or term
preterm
which formula has higher Ca, phos, iron? preterm or term
preterm
which formula has higher vitamins and trace elements? preterm or term
preterm
which elements should you decrease in TPN cholestasis?
manganese and copper
which elements should you increase in TPN cholestasis
zinc
which elements should you decrease in renal insufficiency
chromium and selenium
after how many days does risk of cholestasis become independent of weight?
90
what is biggest culprit in pn cholestasis?
phytosterols
nitrogen balance =
nitrogen intake - nitrogen lost =
protein intake in g/d x 0.16 - (urine losses by urinary urea concentration+ estimate stool loss = 4g)
GIR =
(rate X dex%)/(weight x 6)
tissues richest in LCPUFAs
retina (photoreceptors) and brain
especially docosahexanoic acid
basal ganglia deposition from PN can lead to neurotoxicity if excess ______
manganese
synthesis of glutathione requires which AA?
cysteine
vit D measurement
25 OH vit D
copper requirement enterally
120 mcg/kg/d
predominant storage site for zinc
bone
zinc requirement
350 mcg/kg/d
component of milk that protects against NEC
platelet activating factor acetylhydrolase
rate of sucking:swallowing
6-8:1
MoA lactoferrin in antimicrobial effects
lactoferrin converted to lactoferricin by pepsin
lactoferricin directly destroys microbes
typical manifestation of zinc deficiency?
rash
zinc absorption is enhance by enteral intake of ____
protein
copper absorption is impaired by enteral intake of ____
ascorbic acid
lipoprotein lipase location
adipose
free water deficit =
4 x wt(kg) x desired change in Na
ketogenic AAs (don’t form glucose)
leucine and lysine
