Nutritional Requirements Flashcards
Human Milk and Infant formula components per 100ml:
- Calories: breast milk: 20 cal/oz, formula: 19-20 cal/oz.
- Carb source: breast milk: Lactose 7.2, oligosaccharides. Formula: Lactose, GOS 7.6, glucose, corn syrup solids, rice starch, maltodextrin.
- Protein source: Human milk 1.1, alpha lactalbumin 99%, albumin, lactoferrin, lysozyme, IgA. Formula: nonfat milk and whey concentrate (1.4), Whet:Beta lactoglobulin (65%), alpha lactablumin (25%), albumin (6%)
-Whey/casein ratio: Breast milk: 60/40-70/30. Formula: 18/82-100/0. - Fat source: Human milk 3.9, triglyceride >98%, oleic and palmitic acids most abundant. ARA and DHA +. Formula: High oleic safflower, soy and coconut oils (0.14% DNA, 0.4% ARA) (3.7)
-Na/K Breast milk: 0.78/1.34. Formula: 0.71/1.82. - Ca/Phos: breast milk: 28/14. Formula: 53/28.
- Fe: 0.3 (very bioavailable). Formula: 1.2.
-Zinc: 0.1-0.3. Formula 0.5-0.7
Vitamins D and K: breast milk: inadequate. Formula: adequate.
mOsmol/kg water: breast milk: 290. Formula: 310.
Other: Breast milk: lower mineral and protein content but higher bioavailability. faster gastric emptying, digestive enzymes, immune factors, growth factors, hormones, microbiome, protection against diarrhea, OM, UTI, NEC, botulism, hospitalization, infant mortality, IDDM, Crohn’s disease, lymphoma, leukemia, allergy, obesity.
Other: formula: supplemented with prebiotics: ARA and DHA.
Human Milk and Infant formula: Carbohydrates
- Carb source: breast milk: Lactose 7.2, oligosaccharides. Formula: Lactose, GOS 7.6, glucose, corn syrup solids, rice starch, maltodextrin.
Human Milk and Infant Formula: Protein
- Protein source: Human milk 1.1, alpha lactalbumin 99%, albumin, lactoferrin, lysozyme, IgA. Formula: nonfat milk and whey concentrate (1.4), Whet:Beta lactoglobulin (65%), alpha lactablumin (25%), albumin (6%)
Human Milk and Infant Formula: Whey/Casein
-Whey/casein ratio: Breast milk: 60/40-70/30. Formula: 18/82-100/0.
Human Milk and Infant Formula: Fat
- Fat source: Human milk 3.9, triglyceride >98%, oleic and palmitic acids most abundant. ARA and DHA +. Formula: High oleic safflower, soy and coconut oils (0.14% DNA, 0.4% ARA) (3.7)
Human Milk and Infant Formula: Electrolytes
-Na/K Breast milk: 0.78/1.34. Formula: 0.71/1.82.
- Ca/Phos: breast milk: 28/14. Formula: 53/28.
- Fe: breast milk 0.3 (very bioavailable). Formula: 1.2.
-Zinc: breast milk 0.1-0.3. Formula 0.5-0.7
- mOsmol/kg water: breast milk: 290. Formula: 310.
Human Milk and Infant Formula: Vitamins:
Vitamins D and K: breast milk: inadequate. Formula: adequate.
Human Milk and Infant Formula: Other
- Breast milk: lower mineral and protein content but higher bioavailability. faster gastric emptying, digestive enzymes, immune factors, growth factors, hormones, microbiome, protection against diarrhea, OM, UTI, NEC, botulism, hospitalization, infant mortality, IDDM, Crohn’s disease, lymphoma, leukemia, allergy, obesity.
- Formula: supplemented with prebiotics: ARA and DHA.
Nutritional Requirements vary depending on age, activity, level and disease state
highest needs in infancy, decrease with age, needs are high during periods of growth, parental needs are lower than enteral needs because of thermic effects of growth.
Recommended Dietary Allowance (RDA)
Average daily dietary level that is sufficient to meet the nutrient requirement of nearly all healthy individuals in a particular life stage and gender group. Should be the goal for daily intake by individuals.
Estimated Average Requirement (EAR)
Daily intake value that is estimated to meet the requirement in half of the healthy individuals in a life stage or gender group
Adequate Intake (AI)
Used if sufficient scientific evidence is not available to calculate an EAR and used instead of the RDA. Based on experimentally derived intake levels or approximations of observed mean nutrient intakes by a group of healthy people.
Tolerable Upper Intake Level (UL)
Highest level of daily nutrient intake that is likely to pose no risk of adverse health effects in almost all individuals in the specified life stage group
Vitamin A Deficiency
- Eye findings: night blindness, xerophthalmia, keratomalacia
- Follicular hyperkeratosis,
- Poor bone growth,
- Impaired resistance to infection (measles)
Vitamin D Deficiency
- Rickets
- Osteomalacia
- Hypocalcemia
Vitamin K Deficiency
- Bleeding
- Bruising
- Bone Health
Thiamine Deficiency
Beriberi
- Dry Beriberi: neurological: progressive symmetrical peripheral neuropathy–> weakness, wasting, ataxia, paresthesias, loss of DTR.
-Wet Beriberi: cardiac failure and edema.
-Infantile: breast fed child, mom had subclinical thiamine deficiency: sudden onset of shock in a previously well fed child between 2-3 months of age, preceding by hoarse, weak cry, poor feeding, and vomiting.
-Wernicke encephalopathy: ophthalmoplegia, nystagmus, ataxia, altererd consciousness, hoarseness, anorexia, restlessness, and aphonia.
-Acute: refeeding syndrome, vitamin free PN and in alcoholics.
Riboflavin Deficiency
- Angular stomatitis, cheilosis, glossitis, or magenta tongue
- Seborrheic dermatitis in nasolabial folds, flexures of extremities and genital areas
- Photophobia, corneal vascularization
- Poor growth
Niacin Deficiency
Pellagra: Dermatitis, Diarrhea, Dementia
- Hartnup disease: malabsorption of tryptophan
Pyridoxine Deficiency
Infants: irritability, convulsions, microcytic anemia. Pyridoxine dependent seizures. Depression, dermatitis, glossitis, angular stomatitis, cheilosis, peripheral neuritis
Vitamin C Deficiency
Scurvy: capillary hemorrhage of gingiva, skin, bone, and poor wound healing.
Cobalamin Deficiency
Megalobastic anemia
Folate Deficiency
Macrocytic anemia, neutral tube defects
Biotin deficiency
Seen in children given biotin free TPN: dermatitis, paresthesias, alopecia
Pantothenic acid deficiency
Headache, fatigue, insomnia, paresthesias,
Calcium deficiency
cramping, tetany, osteomalacia, muscle weakness/spasms
Phosphorus deficiency
Rickets, neuropathy
Magnesium deficiency
cardiac arrhythmias, tremor, weakness, resistant hypocalcemia, hypokalemia and seizures
Iron Deficiency
anemia, exercise intolerance, poor concentration, glossitis, nail change
Essential fatty acid deficiency: Linoleic acid n-6 and alpha-linoleic acid n-3
hair loss, hematologic disturbances, poor growth, poor wound healing,
Carnitine deficiency
Hypertriglyceridemia
Zinc deficiency
Anorexia, impaired wound healing, skin lesions, hair loss, increased susceptibility to infections.
Copper Deficiency
hypochromic anemia, retarded growth, osteoporosis, neutropenia, neuropathy, depigmentation of hair and skin, Menkes syndrome: soon after birth: pallor, anemia, steely hair and progressive neurological deterioration
Manganese Deficiency
Rare: done demineralization, impaired growth, skin rash, hypocholesterolemia
Selenium Deficiency
Keshan cardiomyopathy, macrocytic anemia, loss of hair and skin pigmentation, yositis
Iodine Deficiency
Goiter, hypothyroidism, short stature
Chromium Deficiency
Impairment of glucose utilization, weight loss and confusion
Nutritional Requirements with illness and trauma
Overall energy expenditure is not necessarily increased during critical illness, protein needs do not usually change unless the illness causes increased protein losses. Excessive carbohydrate intake can result in hyperglycemia which can be deleterious.
Enteral route preferred
Trauma
Feed early: start post trauma day 1-day 3. Do not over feed.
Protein goals:
- 2-3gm/kg/day for infants and kids <2
-1.5-3gm/kg/day for kids 2-13
-1.5gm/kg/day for adolescents.
Malnutrition can affect a drug’s half life
Example: Vitamin K
Drug nutrient interactions:
Example Phenytoin and tube feeds.
Indirect drug/nutrient interactions
PPI decreased gastric acid and leads to decrease vitamin B12 absorption
PPI can block absorption of:
Vitamin B12, Zinc, and Copper
Medications can inhibit enzymes:
Cimetidine: Vitamin D
Methotrexate: Folate
Medications can enhance enzyme activity
Phenobarbital and Vitamin D
Medications can damage mucosa:
NSAIDS result in Fe deficiency
Medications can bind nutrients in gut lumen
Cholestyramine, mineral oil, antacids.
Medications can alter gastric pH
PPI
Medications can affect electrolyte balance
Thiazides and renal wasting of potassium
Medications can decrease appetite
Metronidazole
Medications can affect weight loss
ADHD Medications