Nutrition Through The Life Cycle Flashcards
Nutrition role in epigenetics
. Fetal origins hypothesis: retain genes in fetus may or may not be activated depending on environment exposed to in utero
Main goals of nutrition-related care
. Identify women who are at nutritional risk
. Provide appropriate nutritional management
. Attention should be paid to patient’s weight status, dietary practices, and use of harmful substances
What maternal factors decrease fetal birth weight?
. Under 5 yrs since 1st period . Under 90% standard weight . Excessive work or exercise . 50% decrease in calories while pregnant . Over 20 cigarettes/day . Chronic cocaine use . Social alcohol use
Milieu
. Causes complex series of adjustments in carbs, protein, and fat metabolism during gestation so fetus gets continuous fuel supply
Main fuel for fetus
. Glucose
. Has low glycogen stores and low rate of gluconeogenesis so it depends on mom’s glucose
. Early pregnancy the carb intake matches fetal requirement
. As pregnancy progresses the glucose need inc. and maternal sensitivty to insulin dec. to high glucose in blood can go to fetus
. Late pregnancy mom uses alternative fuels so fetus can have glucose
Fluctuations in glucose and hormone levels during pregnancy
. After meal women enters starved state rapidly from inc. fuel use for fetus
. Causes rapid decline in insulin and rise in counter regulatory hormones to inc. lipolysis
. Maternal hyperglycemia inc. glucose transfer to fetus since glucose transporters don’t require insulin
Gestational diabetes
. Occurs in women w/ no prior history of DM
. Resolves after pregnancy
. Inc. risk of preeclampsia and future risk of DM
. Universal screening accords btw 24 and 28 weeks gestation
. Treatment: involves diet regulation, adequate distribution of calories btw carbs, at and protein and sometimes insulin
What determines Energy requirements during pregnancy
. Change in mother’s usual physical activity
. Inc. in her BMR to support the work required for growth of fetus and accessory tissues
. Total energy needed: 40,000-70,000 calorie
Additional calorie recommendations for pregnancy from institute of medicine
. No extra in 1st trimester
. 340 extra per day in second
. 450 extra per day in 3rd
Protein requirement during pregnancy
. 15% total energy intake should be from protein
. Higher in 2nd and 3rd trimester
Lipid requirement in pregnancy
20-35% total calories
. Adequate amounts of omega-3s
Carb requirement during pregnancy
. Pre-pregnancy requirement
Micronutrient requirement during pregnancy
. Inc. in quantity
Vit. A in pregnancy
. Cross placenta and fetal storage account for recommendation of extra 1000 IU of it daily
. Can cause toxicity in mega doses
Iron during pregnancy
. Placenta has transferrin receptors
. Needed to manufacture Hb in both maternal and fetal RBCs
. Fetus accumulates most of its iron (80%) in the last trimester
. Most common cause of iron deficiency anemia in infant is prematurity due to lack of time to acquire sufficient iron
Ca in pregnancy
. Fetus acquires most of Ca in last trimester when skeletal growth is maximal and teeth are formed
. Hormonal factors are responsible for extensive adjustments in Ca metabolism that takes place in pregnant woman
zinc in pregnancy
. Active constituent in enzymes or cofactor
. Supplementation found to improve maternal reproductive outcome
Mg deficiency in pregnancy
. Assoc. w/ inc. risk of miscarriage, fetal growth retardation and preterm delivery
Tissue effects from fetal malnourishment
. Reduced size and number of cells in placenta
. Reduces number brain cells and head size
. Proportional reduction in size of other organs
. Alterations in normal cell constituents
. In protein malnutrition the rapidly dividing cells suffer the most
Influencing factors on fetus with maternal malnutrition
. Fetal consequences of malnutrition depend on timing, severity, and duration of maternal dietary restriction
. Consequences can be reversible if restriction primarily affects growth in cell size
Fetal alcohol syndrome
. Most severe form of fetal alcohol spectrum disorder
. Leading cause of non-genetic based intellectual disabilities
. Facial abnormalities, growth deficiency, and CNS dysfunction
. High rate of prenatal mortality, but those that survive are irritable and hyperactive after birth
. Total brain weight positively correlated w/ peak alcohol blood concentration
. High alcohol conc. Reduces or displaces transfer of nutrients through placenta
. Significant if alcohol use is in 1st trimester
Infant physical growth
. From rite to 1 y/o infants triple their weight and inc. length by 50%
. Birth weight determined by mother’s pre-pregnancy weight and her weight gain during pregnancy
. Weight loss occurs at first due to loss off fluid and some catabolism of tissue (ang. 6% but can exceed 10%) but returns to birth weight by 10th day
Factors contributing to inc. needs to daily requirements in infants
. High resting metabolic rate
. Growth and development
. Inefficient absorption
Nutrient requirements in infants
. Carbs and fats necessary
. Protein greater than adults bc AAs needed
. Fe from prenatal reserves and food sources
Renal solute load
. For each g of protein ingested, 4 mOsm of solute are produced in form of urea
. Makes infants vulnerable to water imbalance
Advantages of breast feeding
. Easily digested
. Allows for maternal weight loss
. Fewer infections
Major non-immune components of breast milk
. Carbs: lactose is 40% calories bc giestion and absorption is less efficient than other sugars but is important for generation of acid environment in distal bowel
. Human milk oligosaccharides: indigestible but is prebiotic, aids in GI bifidobacteria growth, prevents infections by mimicking glycine receptors
. Fat: 50% calories, difficult to digest so less is absorbed than consumed
. 0.2% DHA
. Proteins: 10% calories, casein and whey
Transient lactose intolerance in infants is seen in ___
. Premature infants (50% lactase activity)
. Infants following acute viral or bacterial gastroenteritis
Whey contents in breast milk
. Igs
. Enzyme (alpha-amylase, lipase) hormones
. Nucleotides and other N-containing compounds
. AAs like taurine and essential AA binding proteins
. Alpha-lactalbumin used in lactose synthesis
. Lactoferrin that binds to Fe inhibiting bacterial multiplication
Macrophages in breast milk
. Produce lysozyme
. Breakdown bacterial cell wall and destroy it
T/F infants don’t make Igs for weeks or months after birth
T
Maternal IgA
. Antibody that is protected from digestion in guts of infants
. Specific for the antigens in her environment and work on specific pathogens
. Useful so gut bacteria can grow while preventing harmful bacteria from taking over
. Doe sno cause inflammatory response
Bifidus factor
. Stimulates growth of bifidus bacteria
. Antagonizes The survival of enterobacteria
Infant formula
. Made from cow’s milk by removing butter fat, adding veggie oil, carbs, and dec. protein
. Can’t reproduce immunological properties, digestibility, and tropic effects of human milk
Disadvantages of cow’s milk
. Poorly digested fat
. Low con. Vit. C
. Excessive Na and PO4 that can result in high renal solute load inc. risk of dehydration w/ vomiting, diarrhea, or heat exposure
. GI bleeding
. Risk of milk protein allergy
. No recommended before 6-12 months of age
Solid foods for infants
. Have extrusion reflex that prevents solid food intake before 4-5 months old
. Solid food starts 4-6 months after the learn oral and gross motor skills
Ca, Fe, and Zn in adolescents
. Ca: 45% skeletal mass is formed during adolescence
. Women usually don’t achieve genetically determined bone mass
. Fe: losses w/ periods
. Zn: important for growth and sexual maturation
Body composition changes when aging
. Dec. in lean body mass and inc. in total body fat
. Energy requirements dec. over lifespan due to decline in physical activity and metabolic activity of lean body mass (recommended energy intake reduction each year after 30)
Sarcopenia
. Loss of muscle mass and strength
. Assoc. w/ functional impairment
. More commonly seen in men than in women
Nutrient requirements with aging
. Protein needs do not decline, may need more if frail or chronically ill to maintain nitrogen balance
. Vit. D: inc. from 400 to 600 IU/day due to dec. GFR
.Vit. B6 needs inc. w/ age
. Dec. Fe requirement in women w/ age as period stops
