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NUTCORE > Nutrition through the Lifecycle - Lactation > Flashcards

Nutrition through the Lifecycle - Lactation Flashcards

1
Q

At which stage during pregnancy does the breast tissue change to accommodate milk production?

A

third trimester

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2
Q

describe the basic anatomy of the breast

A

nipples and areola

  • smooth muscle
  • contain Montgomery’s tubercules

each breast has 15-20 lobes
each lobe contains a lactiferous duct

lactiferous sinuses lie at the nipple end of the lactiferous duct

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3
Q

where is the site of milk production in the breast?

How is milk produced?

A

alveolar cells

layer of epithelial cells that line the alveolar lumen
milk is produced here and drains into the lactiferous duct

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4
Q

Describe colostrum and explain it’s function in infant development

how much is produced per day?

A
  • immature milk produced for the first 2-3 days after birth
  • thick, sticky, yellow fluid
  • small in quantity - 100ml/day

minimises risk of infection and maturation of the gut

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5
Q

what are the components of colostrum?

A

high in protein, lactoferrin, immunoglobin A and vitamin A

low in lactose and fat

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6
Q

describe transitional milk.

A
  • produced from days 3-7 postpartum
  • produced in larger volume
  • lower protein content, higher lactose and fat content
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7
Q

When is mature milk produced?

What is its nutritional content?

A

from 14 days postpartum

similar nutrient content to transitional milk

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8
Q

at the peak of lactation, roughly how much milk is produced per day?

A

750-800ml milk

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9
Q

what percentage of total energy does fat constitute in mature human milk?

What is the primary form of fat in mature milk?

A

50% energy comes from fat - primary form is trigylcerides

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10
Q

what percentage of total energy do carbohydrates constitute in mature human milk?

what is the primary form of CHO in human milk?

A

40% of energy comes from carbohydrates - lactose is the primary form

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11
Q

which proteins are primarily found in human milk?

A

casein and whey

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12
Q

describe the term ‘let down’

A

the release of milk fro the breast

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13
Q

describe ‘foremilk’.

A

the first milk to be released from the breast when feeding is initiated.
more watery than hindmilk - aims to quench thirst
less calorie dense as contains more lactose than fat

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14
Q

describe ‘hindmilk’.

A

hindmilk is the milk released after ‘let down’ occurs.

richer and more nutrient dense than foremilk.

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15
Q

describe how the composition of human milk varies throughout the day.

A

breast milk generally contains more fat in the evenings

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16
Q

describe the carbohydrate content of breast milk:

what % is lactose?
what is the remaining % made of?

A

80% lactose

remaining 20% are oligosaccharides

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17
Q

describe the fat content of breast milk

A
  • 98% triglycerides - remaining 2% are diglycerides, monoglycerides, FFA’s, cholesterol, phospholipids
  • fat is suspended in emulsified droplets
18
Q

describe the protein content of breast milk

A
  • major proteins are whey and casein

- whey proteins are primarily lactoferrin and a-lactalbumin

19
Q

which two hormones are produced during breast feeding?

describe their roles.

A
  • prolactin and oxytocin

prolactin initiates milk secretion
triggered by infant suckling

oxytocin triggers milk ejection
‘let down’ reflex
milk released from mammary glands to nipple to infant

20
Q

Why can’t you give water to a breastfeeding baby before 6 months?

A
  • risk of diarrhoea/infection due to un-pure water
  • risk of malnutrition as baby may drink less breastmilk and mother will produce less milk over time.
  • breastmilk contains adequate water, especially in foremilk.
21
Q

How does maternal nutrient requirements change during lactation/breastfeeding?

How many kcal per day does breastfeeding cost?

How many extra kcal/day does mother need if breastfeeding?

A

Same as or increased from pregnancy

around 650kcal per day

330kcal per day

22
Q

How much weight roughly can a women lose per month whilst breastfeeding?

A

0.8kg per month

23
Q

how many extra calories per day does a breastfeeding woman need?
how is it calculated?

A

approximately 330kcal

calorie content of breast milk = 0.67kcal/g
approx 750-850ml breast milk produced every day

24
Q

Which vitamins/mineral requirements increase during lactation and why?

A

all but vitamin D which stays the same (10 micrograms)

zinc - plays an important role in over 300 enzymes in breastmilk and plays a role in macronutrient metabolism

25
Q

What is the vitamin D requirement for both mother and baby?

A

mother - 10 micrograms

baby - supplemented with 8.5-10 micrograms from birth to 1 year old

26
Q

what are some advantages of breastfeeding for the mother?

A
  • dont need to prep bottles/formula
  • cheaper
  • develop emotional bond between mother and baby
  • aids postpartum weight loss
  • oxytocin release from let down reduced anxiety
  • helps mother understand needs of the baby
  • delayed return of menstrual cycle (contraception and iron store)
27
Q

what happens to the bone health of women whilst breastfeeding and why?

cue questions:
how much Ca needed per day in BM?
how much Ca needed in total for 6 month feeding?

A

calcium needed for breastmilk (200-225mg/day) comes from maternal store (spine and hip usually).
approximately 35-40g calcium needed for 6 months breastfeeding

bone mineral density decreases 4-6% however is still 3-5% higher than those who have never had a baby.

BMD recovers after breastfeeding and adaptive mechanisms to preserve Ca, increase bioavailability and increase remineralisation take place.

28
Q

What are some advantages of breastfeeding for the infant?

A
  • human milk remains nutritionally adequate even if mother undernourished
  • provides immunoprotective factors e.g., antibodies
  • guarantees nutrient availability for the infant is optimal
  • reduces risk of childhood obesity
  • essential for brain development
  • promotes development of immune system
29
Q

What are some bioactive proteins in breastmilk?

A
  • iron bound to lactoferrin

- lysozyme (antimicrobial agent)

30
Q

Describe the link between breastfeeding and risk of childhood obesity.

A

childhood obesity risk is reduced by 22% in those breastfed as opposed to bottle fed

31
Q

which omega-3 fatty acid in breastmilk aids brain development?

How can breastmilk levels of this nutrient be maintained?

A

DHA (Docosahexanoic acid) is a omega 3 fatty acid
in human milk, DHA benefits brain growth and development

mothers can supplement with fish oils to increase DHA content in breastmilk

32
Q

What signs might indicate that an infant is getting enough milk?

A

adequate weight gain
good skin colour and tone
urinates 6-8 times a day
poos 3-4 times a day

33
Q

What does WHO recommend about the duration of breastfeeding, including feeding with colostrum?

A

feeding of colostrum should be initiated within the first hour of birth

babies should be exclusively breastfed for at least 6 months
from 6 months onwards they can have complementary foods
breastfeeding can continue up to age 2 years

34
Q

What is the breastfeeding trend in the UK?

A

very low rates of breastfeeding by age 6 months in the UK (34%)

breastfeeding especially low in young mothers and those from low socioeconomic backgrounds

35
Q

What is the WHO breastfeeding goal?

what is the current status?

A

50% babies exclusively breastfed by 6 months

currently, only 38% of babies are exclusively breastfed by 6 months

36
Q

What are the laws on breastfeeding in the UK and Scotland?

A

it is gender discrimination to treat a woman unfavourably if she is breastfeeding in public.

Scotland have implemented the issuing of fines if women are treated unfavourably.

37
Q

What are the different types of infant formula?

A

cows milk formula
soya formula
hydrolysed protein and amino acid based formulas
sheep/goats milk derived formula

38
Q

What happens to a mother’s breastmilk if alcohol is consumed?

hw long does it take to clear from milk?

A
  • consuming alcohol changes the odour and taste of breastmilk
  • maternal plasma and breastmilk alcohol levels peak at 30-60 minutes after alcohol consumption (60-90 minutes if consumed with food)
  • 1 serving of wine/beer takes about 2-3 hours to clear from the milk?
39
Q

What is recommended for breastfeeding mothers who want to consume alcohol?

A
  • express milk prior to drinking alcohol

- wait 2-3 hours to feed after alcohol consumption

40
Q

what are the effects of smoking on breast milk?

cue questions:
what happens to volume of BM?

A

smoking decreases breast milk volume

nicotine levels in breastmilk are higher than maternal plasma

41
Q

what are the effects of caffeine consumption whilst breastfeeding?

what % of maternal plasma level does infant receive?

how many caffeinated drinks are recommended per day?

A

caffeine passes into breastmilk and infant receives 1% of maternal plasma level

infant does not develop ability to metabolise caffeine until 3-4 months so infant becomes fussy and hyperactive as caffeine builds up.

1-2 cups of coffee per day is fine

42
Q

Quickfire Questions:

Does breastfeeding cost energy?

Can women produce enough milk to meet the needs of multiple births? e.g triplets?

When should breastfeeding start?

Does breastfeeding really protect against pregnancy?

Can you give unmodified cow’s milk for an infant?

Does a malnourished woman provide a lower quality of milk compared to a well-nourished woman?

Can women drink alcohol while breastfeeding?

Do you know an example of an advert for an infant formula (0-1 year)?

A

Yes
Yes
ASAP - at least 1 hour after birth
Yes - delays return of menstrual cycle
No
No - quality of milk is preserved over quantity
Yes - advised to express beforehand or wait 2-3 hours after consumption

NUTCORE (15 decks)

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