Nutrition - infancy/childhood, micronutrient requirements Flashcards
Fiber
complex carb
soluble/insoluble form
reduce cholesterol levels, protect against heart disease, cancer, GI problems
Soluble fiber sources
oatmeal dried beans peas fruits apples strawberries citrus
insoluble fibre sources
cereal
whole grain
rice
vegetables
Protein energy
4 kcal/g
Saturated fat
raises cholesterol
increases heart disease risk
butter, fat from red meat, tropical oils (coconut oil)
Trans fat
main source: partially hydrogenated vegetable oils
may elevate LDL and lower HDL
may also independently increase risk of CAD
Omega 3 fatty acid
linolenic acid
can be converted to DHA/EPA in body
fish oil, flaxseed oil, canola, soybean oil
Omega 6 fatty acid
linoleic acid
can be converted to ARA in body
plant oils, vegetable oils
Breastfeeding recommendations
exclusive up to 6 mo
continued to 2 y +
Breastfeeding benefits for infant
species-specific nutrition
nutritional (fat, digestible)
Anti-infective: antibodies, proteins, imune cells
Breast milk composition changes over time to meet needs of growing child (colostrum –> transitional –> mature)
promotes jaw development and tooth alignment
skin-to-skin contact
Breastfeeding protective effects for mother
oxytocin = less postpartum bleeding, quicker uterine involution
lactation amenorrhea, delayed ovulation, improved child spacing
improved bone remineralization postpartum
reduced premenopausal breast and ovarian ca
convenient, sterile, correct temperature & free
Folate source
vit B9 green leafy vegetables organ meats dried yeast dried beans legumes citrus fortified grains
Folate deficiency signs
macrocytic anemia diarrhea glossitis lethargy stomatitis very rare in Canada due to fortification of bread
Signs of folate toxicity
none known from foods
seizures
Cyanobalamin source
Vit B12 organ meats beef pork milk cheese fish
vitamin B12 deficiency
Common in vegans megaloblastic anemia glossitis leukopenia weakness peripheral neuropathy (esp foot drop)
niacin sources
vit B3 dairy products eggs enriched breads/cereals fish lean meats legumes nuts poultry
Nicin deficiency
Pellagra (digestive problems, inflamed skin, mental impairment)
Signs of niacin toxicity
increased blood glucose
liver damage
peptic ulcers
skin rashes
Vitamin C sources
citrus tomatoes ptoatoes red berries peppers
Vitamin C deficiency
required for collagen formation/crosslinking scurvy keratosis of hair follicles impaired wound healing anemia depression lethargy bleeding
Vitamin C toxicity
osmotic diarrhea
nausea/vomiting
oxalate kidney stones
interference with anticoagulant therapy
Vitamin A sources
fish liver oils
egg yolk
dairy products
green leafy or orange/yellow vegetables and fruit
Vitamin A deficiency
vitamin A stimulates collage ndeposition dermatitis night blindness keratomalacia xerophthalmia
Vitamin A toxicity
N/V headache dizziness deep bone pain peeling skin gingivitis alopecia hepatotoxicity
Vitamin D sources
fish fish liver oils fortified milk egg yolk sunlight
Vitamin D deficiency
osteoporosis osteomalacia muscle weakness bone pain hypophosphatemia hypocalcemia
Vitamin D toxicity
excess bone/soft tissue calcification kidney stones hypercalcemia anorexia renal failure
Vitamin E sources
Polyunsaturated vegetable poils nuts eggs wheat germ whole grains
Vitamin E deficiency
rare hemolysis
anemia
neuronal axonopathy
myopathy
Vitamin E toxicity
prolonged clotting time
impaired neutrophil function
Vitamin K sources
green leafy vegetables
liver
vegetable oils
intestinal flora
Vitamin K deficiency
bleeding
purpura
bruising
prolonged clotting time
Vitamin K toxicity
jaundice
Calcium sources
Dairy
dark, green, leafy vegetables
fortified soy
fortified orange juice
Calcium deficiency
Tetany arrhythmias CHF altered nerve conduction osteomalacia
Calcium toxicity
metastatic calcification
weakness
renal failure
psychosis
Magnesium sources
soy clams wheat germ almonds dairy green leaves nuts cereal seafood
Mg deficiency
weakness
convulsions
neuromuscular irritability and dysfunction
failure to thrive
Magnesium toxicity
hypotension
cardiac disturbances
respiratory failure
K sources
Meat milk bananas prunes raisins oranges grapefruits potatoes legumes
K deficiency
polyuria impaired muscle contraction ECG changes (prolonged QT interval, prominent U waves) peritoneal distension dyspnea paralysis cardiac disturbances
K toxicity
mental confusion hypotension weakness ECG changes (flattened P waves, wide QRS, peaked T waves) paralysis arddiac disturbances
Iron sources
meat fish poltry organ meats eggs prunes peas beans lentils soy raisins fortified grain products
Iron deficiency
glossitis fatigue tachycardia microcytic hypochromic anemia koilonychias enteropathy
Fe toxicity
nutritional hemosiderosis
organ damage
Assessing vit B12 status
serum B12
transcobalamin (transporter)
homocysteine
MMA
Vitamin B12 absorption
requires IF - synthesized by parietal cells in stomach
B12 bound to protein in food, HCl hydrolyzes so it can bind to IF
B12/IF absorbed in distal ileum
Pernicious anemia = autoimmune condition where parietal cells are destroyed, no IF = no absorption of B12
Vitamin D supplementation
10 ug/d (400IU/d) for breastfed infants from birth up until one year or when infant's diet contains 10 ug/d of vitamin D breast milk naturally low in vitamin D infants get little sun exposure
Risk for poor vitamin D status
breastfed infants
darker skin tone
obesity
Vitamin D assessment
quantify circulating 25-OHD3
Function of vitamin D
calcium absorption and balance
immunity
cell proliferation
binds VDR to regulate gene expression
Rickets
Bone deformities due to low vitamin D clinical chemistry: - low 25-OHD - elevated PTH low serum phosphate and calcium
Vitamin K deficiency risk
rare
but most common in newborns - little transfer from mom, and newborn gut doesn’t have a lot of bacteria
Dietary forms of iron
Heme: animal products; better absorbed
Non-heme: vegetables, fortified products
Iron status assessment
serum iron
ferritin - best, storage protein to estimate stores
transferrin: increases with poor status
Iron deficiency in young children SSx
fatigue/weakness pale eyes irritability lack of appetite apathy pale skin
Folate types
folic acid: supplements, fortified food Polyglutamylated folates (natural form): attached to glutamate residues; absorption more elaborate
Folate status assessment
RBC folate (long-term): indicator of sources plasma/serum folate: short term plasma total homocysteine
Folate functions
DNA synthesis
methylation reactions
Metabolically linked to: B12, B6, aa
Can mask hematological signs of B12 deficiency
Zinc function
cofactor for enzymes involved in protein/collage synthesis immune system cell division cell growth wound healing Carb breakdown sense of smell/taste
Zinc sources
high protein foods (beef, pork, lamb, dark meat) nuts whole grains legumes yeast
Zinc deficiency SSx
frequent infections hypogonadism in males losso f hair poor appetite problems with taste/smell skin sores slow growth trouble seeing in the dark long time healing wounds
Zinc toxicity
diarrhea
abdominal cramps
vomiting
Phosphorus function
formation of boens and teeth
ATP!!!
work with B vitamins
Phosphorous sources
Protein food groups of meet/milk
phytin (storage form) in whole grain breads and cereals
Phosphorous deficiency
generally no deficiency since abundant in food
Phosphorous toxicity
rare
can combine + Ca in blood to form deposits in soft tissues
–> occur in people with severe kidney disease or severe dysfunction of calcium regulation
Iodine function
normal metabolism
normal thyroid function
Iodine sources
iodized salt seafood naturally rich (cod, sea bass, haddock, perch) kelp dairy plants grown in iodine-rich soil
Iodine deficiency SSx
goiter
hypothyroidism
cretinism
Iodine toxicity
rare in NA - iodized salt
can reduce function of thyroid
Consequences of anemia on development
Impaired intellectual/motor functions that can occur early in Fe deficiency before anemia develops , may not be completely reversible
Pica
Pagophagia
Pica
desire to ingest non-nutritive substances
happens in Fe deficiency
can lead to ingestion of lead-containing substances –> concomitant plumbism (chronic lead poisoning)
Pagophagia
desire to eat ice
Sodium requirement
Up until 1 y:
Sodium sources
88% not naturally present
77% due to processed foods
6% from table salt; 5% cooking
Caffeine effects
Positive: alertness, ability to concentration
Adverse: insomnia, irritability, nervousness, inhibit Ca absorption
Children /women of reproductive age may be particularly sensitive
Caffeine recommendations
Health Canada max intake
healthy adults: 400 mg/day (~3 x 8oz brewed coffee)
Children
Magnesium function
enzymes required for protein/collagen synthesis
