Nutrition Flashcards
T or F: you must drink high carb drink if involved in competitive sports + nutrition.
False
Well balanced diet!
T or F: you change a child’s diet as per sport they are involved with.
False.
Well balanced diet!
What does a well balanced diet look like in % of carb, protein, fat?
Carb: 50% = near
Protein: 20%
Fat: 30%.
“1/4 fat, 1/4 protein, 1/2 carb”
What fluids does CPS recommend for athletes?
- cold water 2-3h pre activity
- during: fluids every 20 min.
water fine if < 1h
if > 1h or hot= sports drink (carb, salt) - replace sweat after via water
What timing of meals does CPS recommend for athletes?
- meal 3h pre event
- recover food 1-2h after (include protein + carb)
How do you optimize nutrition for prem with BPD?
- fortified human milk or preterm formula to increase caloric density
- ensure supplement Na or K if on diuretics
- Ensure normal Ca2= to prevent osteopenia of prematurity
What is the best dietary advice for competitive athletes:
- eat a well balanced diet
- components depend on sport
- increase protein intake to 1.5 g/d
- vitamin d and ca2+ supp
- balanced diet
Well balanced diet!
Work north of 55th parallel. How much vitamin D for 8 month old bottle fed BB IN THE WINTER?
Goal: 800 IU from all sources.
400 IU from formula + 400 IU outside.
If BF= 800 IU supp
Use well water. What do you do about vitamins? Fluoride?
Vitamins: 400 IU if BF (none if formula and less than 55th parallel)
Fluoride:
- variable level in well water
- doesn’t matter till have teeth
- once teeth if 0.3 ppm in water= great!
- if less= brush w/ fluoride paste BID = great!
- if brush < BID then need topical fluoride
Phytoestrogen in SOY contraindicated for:
- all male
- immunodeficiency
- galactosemia
- congenital hypothyroid
Congenital hypothyroidism (interfere w/ uptake of thyroid hormone)
T or F: galactosemia is an indication for soy formula.
True
Best nutrition for short gut syndrome:
- BF
- TPN long term
- elemental formula + MCT
- soy + MCT
- whey hydrolysate
BF
If that is not option= Elemental formula with MCT!
Which part of the bowel absorbs carb/protein/iron? Which does B12?
Carb, protein, Fe= Jejunum.
B12 + Na= Ileum
3 wk old going to be formula fed. Suggest Fe-fortified one. Mother ask about anticipated problem. You counsel:
- colic
- constipation
- black stool
- no problem
No problems
Misconception about GI distress but none.
CPS contraindication to BF:
- HIV
- Active untreated TB (< 2 wk of tx)
- Untreated maternal brucellosis
- Human T-cell lymphotrophic virus type 1 or 2
T or F: SSRI is contraindicated in BF.
False.
Contraindication: antineoplastic (chemo), drugs of abuse, some anticonvulsant, infant with classic galactosemia
Note: if on high dose flagyl d/c for 12-24h after taken to allow med excretion.
Note: primaquine, quinine contraindicated unless neither mom or BB G6PD
BF preterm. What is true re: Iron supplementation:
- do not use
- start sup at 1 mo. age
- start only if non-iron fortified supplemental formula
Prem:
- supp from 1-12 mo
- total need= 2mg/kg/d
- IF VLBW (<1500g) = 2-3 mg/kg/day
- may need sup on top of formula
Term BF: okay until 4-6 mo. Sup 1mg/kg/d if no 2 iron rich food
Term non BF: Iron fortified formula and then switch to solid
What is the risk of giving honey if < 1 y.o.
Infant Clostridium Botulism
Vegan mom and want stop BF her baby. Which sup do you recommend:
- B12
- C
- folate
- irone
B12
“BM in strict can be low in B12 therefore their infants should be supplemented”
Note: if > 7 month zinc supplement if BF only from vegan mom.
What nutritional deficiency is a 12 year old vegan child at risk for?
Vitamin B12
(5ug-10ug daily sup)
Other:
- vitamin B
- iron
- folic acid
- linolenic acid
- calcium
- 5 y.o. vegetarian diet. Risk of low:
- C
- Ca2+
- Folate
- Zinc
- Iron
Iron
Goat milk to baby. What do you need to supplement?
- Ca
- Iron
- Folate
- Multivitamin
Folic Acid/ Folate
** it is deficient!
4 things that increase cholestasis incidence in BB on TPN.
- Low BW
- longer duration of tx (TPN
- complicated med course (resp distress, hypoxia, acidosis)
- short bowel syn
List 4 complication of TPN:
- high TG
- low Mg
- cholestasis (bili)
- Hypernatremia
…
- High BG
- Low K
- Low Albumin
- Low Ca
14 mo. FTT. met acidosis. pH 7.31. Bicarb 14. K 3.5. Na 140. Cl 118. Urine pH 6.3
Non AG Metab Acidosis
= R/O renal
met acidosis with urine > 5.5 = less H+ out
= Distal RTA
Versus Bartter= low K and metabolic ALKALOSIS
versus Organic= AG metab Acidosis + normla/high ammonia
T or F: by changing to WHO growth charts the formula get babies look like FTT in the first 6 months?
True
3 y.o. only gained 2 kg last year. Okay or not?
Okay. Reassure.
Increase 2kg/yr and min. 5 cm/year until puberty.
13 y.o. BMI 31. At risk for:
- T2DM
- delayed menarche
- AVN femoral head
- Pancreatitis
T2DM
early puberty, SCFE, gallbladder dx, dyslipidemia
What BMI is considered overweight?
85-95th percentile
Why BMI is considered obese?
> 95th percentile
chance of child being obese if 1 parent is? what if 2 parents are?
1 parent is= 1/2
2 parents= 2/3 (practice Quest quote 80%)
Adopted. Edema. Yellow tinged rusty hair.
- Kwashiorkor
- Marasmus
- B1 deficiency
Kwashiorkor= protein deficiency= edema
Marasmus= wasting
Thick costochondral junction in baby adopted who look malnourished. Dx? P/E?
Dx: Rickets
P/E: frontal bossing, craniotabes, delayed AF closure, rachitic rosary, protruding abdo, enlarged wrist and ankle, bowing of tibia and femur
BF. Rash around orifices. Also has glossitis, stomatitis, corneal dystrophy. Lacking:
- Vit C
- Vit A
- Vit B12
- Zinc
Zinc deficiency
Keratinization of MM and skin (dry scaly patches). Poor teeth enamel. Blind. Deficiency in?
Vitamin A
DD. Hyper pigmentation, Megaloblastic anemia. Deficiency in?
Vitamin B12
Tender swollen leg. Bleeding spongy gums. Poor wound healing. Vitamin Deficiency?
Vit C
vesicobullous and eczematous skin in perioral, anal and perineal area. Deficiency in?
Zinc
= Acrodermatitis Enteropathica
All are features of iron deficiency anemia:
- pica
- koilonychia
- angular cheilitis
- mild scleral icterus
- psychomotor retardation
Mild sclera icterus
= hemolytic!
List 3 complications of iron deficiency anemia:
- angular cheilitis
- glossitis (inflam tongue)
- koilonychia (spoon nails)
- irreversible behavioural and IQ deficiency
- breath holding spell association
Tx: < 16 oz/day of homo milk. PO sup 6 mg/kg/d x 3 mo.
Some vitamins are stored in large amt and no biochemical or clinical sign for many months. Which is that:
- Thiamine (B1)
- Vit C
- Vit B12
- Riboflavin (B2)
- Folate
B12
How can you remember Kwashiorkor and Marasmus:
Kwashiorkor results form protein deficient MEAL:
- Malnutrition
- Edema
- Anemia
- Liver (fatty)
Marasmus= Muscle wasting
T or F: triglycerides require hydrolysis to free f.a.
True
Fat absorbed in proximal jejunum.
- pancreatic enzyme and other break down TG into components
- bile salt enhance solubilization via micelles (- coated with phospholipid)
- Micelles absorbed
- Note MCT diffuse passively so don’t need the above.
New ataxia after post-kasai for biliary atresia. Vit issue:
- A
- D
- E
- K
E
Crohn’s disease. Ileal resection. Nutritional deficiency at risk:
- folic acid
- B12
- Vit k
- zinc
Vitamin B12
