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BF Course > Section 2: Composition of Human Milk > Flashcards

Section 2: Composition of Human Milk Flashcards

1
Q

Health benefits of breastfeeding mothers

A
  • decreased postpartum blood loss
  • more rapid involution of the uterus
  • Decrease in postpartum depression
  • decrease in child abuse/neglect
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2
Q

Health benefits of long-term breastfeeding

A
  • increased child spacing secondary to lactational amenorrhea
  • Increased weight loss
  • Decreased risk of developing T2DM
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3
Q

AAP/WHO breastfeeding recommendation

A
  • minimum 6 months
  • continuation for 1 year or longer as mutually desired by mother and infant
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4
Q

Breastfed infants see a decrease in what illnesses?

A
  • Lower respiratory tract illnesses
  • Otitis media
  • Diarrheal diseases
  • pneumonia
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5
Q

When is breastfeeding contraindicated?

A

Infants with galactosemia

Mothers with:

  • Human T-Cell lymptotropic virus
  • Brucellosis
  • Untreated TB
  • Active herpes lesions on breast
  • HIV positive (in western world)
    • in developing world, breastfeeding may outweight risk of HIV
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6
Q

What are medication-related contraindications to breastfeeding?

A
  • Amphetimenes
  • Chemo
  • Ergotamines
  • Statins
  • Psychotropics
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7
Q

Pacifier use in neonatal period should be limited to what situations?

A
  • pain relief
  • Calming
  • Part of structured program for enhancing oral motor function
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8
Q

Pacifiers can be used when

A
  • breastfeeding is well established
  • (reduce risk of SIDS)
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9
Q

Vitamin D supplement for infants

A

Daily supplement of 400 IU for breastfed infants

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10
Q

First complimentary foods should be rich in

A

iron

  • Meat
  • Meat alternatives
  • iron-fortified cereal
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11
Q

Human milk is

A

species specific,

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12
Q

Species specific means that human milk is

A

designed to provide all the essential nutrients the human infant requires for optimal growth and development.

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13
Q

How many components are in human milk?

A

Over 200

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14
Q

HUman milk is secreted by

A

the mammary gland

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15
Q

Does human milk change over time or stay the same?

A

changes continually over time in order to meet the nutritional needs of the maturing infant

A “living fluid”

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16
Q

A well-nourished woman’s milk is

A

perfectly adapted to meetthe nutritional needs of her infant

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17
Q

How does a mother’s body respond to premature birth?

A

by increasing the amounts of protective factors in her milk

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18
Q

What is the ratio of total soilds to fluids?

A

12:88

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19
Q

The well-nourished breastfed infants recieves all the nutrients it needs, as well as

A

all the water

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20
Q

Breastmilk contains a unique blend of

A
  • fats
  • carbohydrates
  • proteins
  • vitamins
  • minerals

All easily utilized by infants

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21
Q

Besides nutrition and water, breastmilk contains

A

Antibodies that actively protect infants from infections

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22
Q

Proteins account for how much of the total composition of human milk?

A

0.9%

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23
Q

Protein is essential for

A

growth

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24
Q

What are the two types of prteins in human milk?

A

Casein proteins and whey proteins such as:

  • serum albumin
  • lactalbumin
  • immunoglobulins
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25
Q

What is the ratio of whey:casein in human milk?

A

60%:40%

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26
Q

When acidified in the stomach, the proteins in human milk form

A

soft curds that are easily digested

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27
Q

what is the ratio of when:casein in cow’s milk?

A

18:82%

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28
Q

In the stomach, casein proteins form

A

a tough, less digestible curd that requires an increased amount of energy to digest

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29
Q

What are the Four major components of whey milk proteins

A
  • alpha-lactalbumin
  • lactoferrin
  • lysozyme
  • immunoglobulins
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30
Q

What is alpha lactalbumin?

A
  • breast milk whey protein
  • facilitates the synthesis of lactose.

LACTalbumin makes LACTose

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31
Q

What is lactoferrin?

A

a whey protein found in human milk.

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32
Q

Lactoferrin has what potent capacity?

A
  • Potent bacteriostatic iron-binding capacity
  • inhibits the growth of certain iron-dependent bacteria
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33
Q

How does lactogerrin stop the spread of certain pathogens?

A
  • By making iron unavailable
  • stops the spread of pathogens that thrive on iron
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34
Q

Lactoferrin is especially effective against what bacteria?

A
  • Staphylococcus aureus
  • E. coli
  • Salmonella
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35
Q

In addition to its protective role, lactoferrin also

A

aids in enteric iron absorption.

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36
Q

What is lysozyme

A
  • whey protein
  • enzyme
  • bactericidal
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37
Q

Lysozyme is an enzyme that can destroy what bacteria?

A
  • E. Coli
  • Salmonella
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38
Q

Lysozyme activity increases as

A

lactation progresses

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39
Q

How long after delivery do lysozyme levels continue to increase in breastmilk?

A

starting 6 months after delivery

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40
Q

High levels of lysozyme may safeguard infants against what?

A

Pathogens commonly introduced to solid foods around 6 months

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41
Q

What are immunoglobulins?

A

proteins produced by plasma cells

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42
Q

What are antibodies?

A

immunoglobulins that recognize and act on specific antigens

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43
Q

What is the major immunoglobulin?

A

Secretory immunoglobulin A (SIgA)

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44
Q

What is the purpose of SIgA?

A

supplements immunoglobulins passed on to the fetus through the placenta in utero

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45
Q

SIgA is synthesized and stored where?

A

in the breast

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46
Q

What type of milk has the highest levels of SIgA?

A

Colostrum

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47
Q

SIgA is found in what part of the body?

A

The intestine

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48
Q

How does SIgA provide protection against infections?

A

by keeping viruses and bacteria from penetrating the intestinal mucosa.

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49
Q

Are all milk proteins synthesized in the breast?

A

No

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50
Q

SIgA is secreted into breastmilk by

A

acinar cells

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51
Q

Other proteins in breast milk are synthesized by

A

amino aids

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52
Q

How are proteins synthesized by amino acids transferred to breast milk?

A

picked up from the circulation by the epithelial cells of the mammary gland.

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53
Q

what factors influence the content and amounts of specific proteins in milk?

A
  • Stage of lactation
  • Gestational length
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54
Q

What are nucleotides?

A
  • part of the non-protein nitrogen content of breastmilk
  • important for infant’s intestinal development
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55
Q

Nucleotides are higher in what type of milk?

A
  • Preterm milk
  • 20% higher
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56
Q

How do nucleotides impact intestinal flora?

A
  • lower the pH of the bowel
  • this suppresses growth of acid-intolerant pathogens.
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57
Q

Nucleotides enhance the utilization of what?

A
  • Protein
  • which could explain why breastfed infants grow so well despite their relatively low protein intake.
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58
Q

What is the most variable component of human milk?

A

Lipids

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59
Q

Lipids are the

A

second largest constituent in milk by concentration

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60
Q

What is the range of fat content in human milk?

A

3.5% - 4.5%

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61
Q

Lipids make up how much of breastmilk’s total calories?

A

Half

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62
Q

What are the main constituents of human milk fat?

A
  • Triglycerides
  • followed by fatty acids
  • and fat soluble vitamins
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63
Q

What are fat soluble vitamins found in breast milk?

A

A, D, E, and K

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64
Q

As the baby’s needs change, fat content in milk

A

gradually decreases

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65
Q

What breaks down triglycerides in to free fatty acids?

A

Lipases

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66
Q

when can the fat content of a mother’s breastmilk vary in concentration?

A
  • During a feeding
  • From breast to breast
  • From one time of day to another
  • in accordance with the efficiency of the infant’s sucking
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67
Q

Breastmilk’s fat content is mediated by

A
  • time since last feeding
    • The longer the gap, the lower the fat content.
  • efficient milk removal
    • greater efficiency= greater fat content consumed
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68
Q

Fat content is usually lower at what time of day?

A

morning

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69
Q

When does fat content peak?

A

early afternoon

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70
Q

What percentage of an infant’s brain development and nervous tissue forms after birth?

A

50%

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71
Q

What fatty acids found in breastmilk are responsible for brain development?

A

Long-chain polyunsaturated fatty acids

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72
Q

What other fatty acids aid in brain maturation?

A
  • docosohexaenoic acid (DHA)
  • arachidonic acid (AA)
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73
Q

What is lipase?

A

enzyme in breastmilk that aids the digestion of fats.

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74
Q

Milk lipases facilitate

A

the emulsion of milk lipids, producing a soft curd that is easily digested by the infant.

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75
Q

Milk fats are derived fropm

A

plasma

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76
Q

milk fats are sythesized by the breast from

A

carbohydrates

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77
Q

What does the breast synthesize that is a major source of energy for the infant?

A

fatty acids

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78
Q

Fat synthesis

A
  • Idroplets of fat collect in the acinar cell
  • Fat globules are extruded from the cell membrane into the acinar lumen
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79
Q

What promotes the secretion of fat into breastmilk?

A

Contraction of the myoepithelial cells during the milk-ejection reflex

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80
Q

What is foremilk?

A
  • watery first milk drawn by an infant when feeding
  • lower fat content
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81
Q

what is hindmilk?

A

Richer, higher fat milk that follows foremilk

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82
Q

Why is it important that the infant drain the entire breast?

A

To receive the crucial hindmlik

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83
Q

Carbohydrates in breast milk are derived from

A

blood glucose

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84
Q

Carbohydrates provide

A

the main source of energy in breastmilk

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85
Q

The carbohydrate level of breastmilk

A

remains at a constant level during different phases of lactation

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86
Q

POstpartum maternal intake of glucose should increase by

A

30%

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87
Q

Why should breastfeeding mothers increase glucose intake?

A

Lactose, the main carbohydrate in breast milk, is syhthesized from maternal glucose

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88
Q

What is the lactose content in mature breast milk?

A

7.3 g per 100 ml

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89
Q

what is the primary carbohydrate in breastmilk?

A

lactose

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90
Q

What does lactose metabolize to?

A

glucose and galactose

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91
Q

Why does lactose metabolize to glucose and galactose?

A

o provide energy to the infant’s developing brain

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92
Q

Lactose is an osmotic agent that regulates what?

A

milk volume

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93
Q

Lactose aids in the absorption of what?

A

Calcium and iron

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94
Q

What stimulates the growth of lactobacillus bifidus?

A

Lactose and oligosaccharides

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95
Q

What is lactobacillus bifidus?

A
  • intestinal bacterial flora
  • protects infants from intestinal infections.
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96
Q

What is amylase?

A

a polysaccharide-digesting enzyme

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97
Q

How long is mammary amylase present in breastmilk?

A

Throughout lactation

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98
Q

What type of milk has the highest level of amylase?

A

Colostrum

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99
Q

Why is amylase important to the infant?

A

it’s own pancreatic amylase activity is still at low levels until about 6 months of age.

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100
Q

Most milk amylase activity occurs in what part of the infant’s digestive tract?

A

the duodenum

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101
Q

What are do oligosaccharides stimulate in the infant’s gut?

A

Lactobacillus bifidus

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102
Q

The vitamins present in human milk vary

A

between mothers

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103
Q

The vitamins in breastmilk can provide what?

A

Generally, breastmilk can provide a normal, healthy newborn with all the required vitamins needed for growth.

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104
Q

What type of vitamins are present in breast milk?

A

Fat or water soluble

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105
Q

The presence of fat-soluble vitamins in breastmilk is depen dent on what?

A

The maternal diet

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106
Q

Why are fat soluble vitamins in breastmilk dependent on the maternal diet?

A

because the vitamins are drawn from the mother’s body stores

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107
Q

Fat-soluble vitamins found in breastmilk include

A

A, D, E, and K

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108
Q

What is the precursor of vitamin A?

A

Beta-carotene

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109
Q

What type of milk has the most vitamin A?

A
  • Colostrum
  • contains twice as much as mature milk
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110
Q

Recent research suggests that vitamin D may play a role in

A

protecting against the development of other diseases besides rickets

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111
Q

How much vitamin D does human milk contain?

A

1-10 IU (250 mL)

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112
Q

What is the most efficient way of triggering adequate vitamin D production in a person’s skin?

A

Exposure to sunlight

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113
Q

Why do infants need a vitamin D supplement?

A

the Canadian Dermatology Association andHealth Canada advise that infants under 1 year of age should be kept out of direct sunlight due to high risk of developing skin cancer.

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114
Q

Infants older than 6 months who are exposed to sunlight should

A

use suncreen

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115
Q

Sunscreen can reduce infant’s Vitamin D production by how much?

A

97.5%

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116
Q

What children are at the greatest risk for vitamin D deficiency?

A
  • children with dark skin
  • infants whose mothers have subclinical vitamin D deficiency
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117
Q

Why are dark skinned infants at higher risk for developing rickets?

A

because they require increased exposure to sunlight to produce the same amount of vitamin D compared with light- skinned infants.

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118
Q

If a mother has subclinical Vitamin D deficiency

A

her infant will be born with limited vitamin D stores.

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119
Q

What can cause subclinical vitamin D deficiency in women?

A

a combination of factors, including:

  • avoidance of milk
  • lack of vitamin D supplementation
  • limited sun exposure.
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120
Q

What type of vitamin D supplementation is recommended for all breastfed full-term infants by the Canadian Pediatric Society?

A

Daily dietary supplementation of 400 IU

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121
Q

Why is 400 IU of vitamin D supplementation recommended?

A

to correct for the lack of exposure to ultraviolet light

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122
Q

What is the duration of Vitamin D supplementation?

A
  • Should begin at birth and should continue until:
    • the infant’s diet includes at least 400 IU perday of vitamin D from other dietary sources
    • or until the breastfed infant reaches 1 year of age
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123
Q

Vitamin E is abundant in

A

colostrum

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124
Q

Vitamin E is higher in breastmilk than

A

cow’s milk

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125
Q

Vitamin E deficiency can result in

A

Hemolytic anemia (especially in the premature infant)

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126
Q

Vitamin E protects

A

cell membranes in the lungs and retina

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127
Q

Vitamin K is needed for

A

the synthesis of blood-clotting factors

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128
Q

Vitamin K is found in

A

small amounts in breast milk

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129
Q

Within a few days after birth, vitamin K is produced by

A

the infant’s enteric bacteria

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130
Q

Breastmilk promotes gastrointestinal bacteria that increase levels of what vitamin?

A

vitamin K

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131
Q

Low levels of vitamin K in the newborn can cause

A

vitamin K-responsive hemorrhagic disease

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132
Q

Vitamin K is routinely given

A

intramuscularly to newborns to prevent hemorrhage.

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133
Q

Water-soluble vitamin levels in breastmilk are influenced by

A

the maternal diet

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134
Q

If supplementary vitamins are taken

A

their levels in breastmilk change.

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135
Q

Do all mothers require vitamin supplements?

A
  • NO
  • Lactating women who eat a nutritious diet do not require vitamin supplements
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136
Q

Water soluble vitamins include:

A
  • vitamin C
  • vitamin B6
  • vitamin B12
  • niacin
  • folate
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137
Q

Vitamin C function

A

Important for:

  • enzyme and hormone systems
  • essential for collagensynthesis
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138
Q

Vitamin C levels in human milk are strongly influenced by

A

the mother’s dietary intake.

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139
Q

Vitamin B6 (Pyroxidine) function

A
  • vital to DNA synthesis
  • involved in the myelination of the central nervous system
140
Q

Why can B6 often be deficient?

A

it is dependent upon maternal nutrition

141
Q

Vitamin B12 (cobalmin) function

A

Vital to infant’s CNS development

142
Q

Which has a higher level of B12, breast milk or cow’s milk?

A

Cow’s milk

However, cow’s milk has little binding capacity for B12, whereas human milk has substantial binding capacity

143
Q

Why does greater binding capacity of B12 enhance the protective quality of human milk?

A

Due to greater binding capacity, less B12 is available to organisms such as E. coli

144
Q

vitamin B12 affects the metabolism of what?

A

Folic acid

145
Q

What type of anemia is due to Vitamin B12 deficiency?

A

Megaloblastic

146
Q

Vitamin B12 occurs exclusively in what foods?

A

Meats

ABSENT from vegetable protein

147
Q

What type of mother could be deficient in B12?

A

A vegetarian mother

148
Q

What is Niacin?

A

an essential part of the pyridine nucleotide coenzymes and the intracellular respiratory mechanisms.

149
Q

Niacin levels are elated to what?

A

Dietary intake

150
Q

Folate is essential for

A

the normal maturation of red blood cells.

151
Q

When is the presence of minerals highest in breast milk?

A

The first few days following delivery

152
Q

The presence of minerals in breastmilk is highest in the first few days following delivery, with the exception of

A

magnesium

153
Q

Human milk provides sufficient minerals to

A

support infant growth

154
Q

The concentration of electrolytes in human milk is not influenced by

A

maternal nutrition

155
Q

Important minerals in breastmilk include

A
  • potassium
  • sodium
  • chloride
  • magnesium
  • calcium
  • zinc iron
156
Q

Colostrum contains high amounts of what minerals?

A

Potassium

Sodium

157
Q

Potassium is present in lower quantities in

A

mature milk

158
Q

High potassiun in Cow’s milk can be hard on

A

infant kidneys

159
Q

Sodium content of colostrum declines by what day following delivery?

A

3rd day

160
Q

Elevated sodium levels in human milk are present during

A
  • mastitis
  • weaning
  • in the first trimester of pregnancy
161
Q

Which mineral in human milk is the most variable in concentration?

A

Sodium

162
Q

Chloride deficiency has been associated with

A

infants experiencing failure to thrive.

163
Q

Magnesium is available as

A

a free ion

164
Q

Cow’s milk contains how much more magnesium than does breastmilk

A

Three times

165
Q

Levels of magnesium in human milk increase continuously during

A

the first 3 months after birth.

166
Q

Calcium is present in what levels in human milk?

A
  • Moderate levels in colostrum
  • High levels in transitional milk
  • Lower levels in mature milk
167
Q

Calcium is four times higher in

A

cow’s milk

168
Q

Eventhough the calcium and phosphorus levels in breastmilk are comparatively low

A

infants absorb 67% of what is available.

169
Q

During lactation, maternal calcium absorption by the duodenum is

A

enhanced

170
Q

Zinc function

A
  • essential to the structure of enzymes
  • functions as an activator of enzymes

Zinc = enZymes

171
Q

Deficiencies of zinc are seen in

A
  • infants who fail to thrive
  • infants with skin lesions
172
Q

Research indicates human breastmilk has other factors that promotesuperior bioavailability of zinc to the infant over

A

cow’s milk.

173
Q

Iron is present in what amounts in human milk?

A

small amounts

174
Q

Iron is made available to the infant by action of

A

lactoferrin

175
Q

Full-term breastfed infants are rarely

A
  • iron deficient
  • have sufficient reserves
176
Q

Absorption of iron is facilitated by

A

high lactose levels and vitamin C.

177
Q

Fifty per cent of an infant’s iron intake is

A

absorbed from breastmilk

178
Q

IRON

Recommendations from 6 to 24 months recommend that if an infant is either not breastfed or is only partially breastfed

A

iron-fortified cow’s milk formula or follow-up formula is the most acceptable alternative to breastmilk from 9–12 months

179
Q

breastmilk substitutes are not recommended for ages

A

0–6 months

180
Q

what is the most substantial constituent of human milk

A

water

181
Q

all components of breastmilk are dissolved in

A

water

182
Q

Lactating women should drink to

A

to satisfy their thirst.

183
Q

What is the factor that regulates the volume of milk produced?

A

lactose

184
Q

The secretion of water into milk is regulated in part by

A

lactose synthesis

185
Q

what provides all the water that infants require?

A

breastmilk

186
Q

Human milk is not a uniform body fluid, it is a

A

dynamic secretion of the mamary gland

187
Q

Human milk changes composition

A
  • over time
  • according to the needs of the infant
188
Q

The composition of breastmilk varies according to

A
  • Stage of lactation
  • time of day
  • stage of feed
  • infections
  • gestation age at delivery
  • other factors
189
Q

Once lactation is established, the composition of major milk components

A

does not vary from day to day by more than 25%

Changes very little until weaning

190
Q

At birth and in the immediate postpartum period, what is available to the infant in small amounts.

A

colostrum

191
Q

Colostrum is present

A
  • prior to delivery
  • and is produced up to 4 days following delivery
192
Q

The newborn does not require what in the immediate postpartum period

A

significant fluid volume

193
Q

When is transitional milk produced?

A

between 6 and 13 days postpartum

194
Q

What (to some extent) determines the composition and volume of milk produced?

A

The effectiveness of an infant’s suckling

195
Q

During weaning, what happens to milk composition?

A

Levels of sodium and protein increase

196
Q

What parts of milk composition vary according to time of day?

A

Fat content

(lower levels in the morning, higher levels in early afternoon)

197
Q

How does milk composition vary during stage of the feed?

A
  • Foremilk is received during the first part of the feed
  • hindmilk during the later part of the feed
198
Q

Composition of foremilk

A

High in water and lactose

Provides greatest volume of feeding

199
Q

Composition of hindmilk

A

Less volume than foremilk

High in fat content - causes infant to feel full and signals end of feed

200
Q

How can mastitis alter milk composition?

A

Causes a decrease in milk volume while simultaneously increasing sodium and chloride

201
Q

How does gestational age influence milk composition?

A
  • PRETERM milk is produced if an infant is born prior to 37 weeks gestation
  • Preterm milk has higher levels of energy and immune factors
202
Q

What are the types of human milk that have been identified?

A
  • Preterm breastmilk
  • Colostrum
  • Transitional milk
  • mature milk
  • foremilk
  • hindmilk
203
Q

Preterm milk has high concentration of

A
  • Protein
  • Sodium
  • Chloride
  • Magnesium
  • Potassium
  • Iron
  • Calcium
  • Lipids
  • Some anti-infective agents
204
Q

In preterm milk, the whey-to-casein ratio is

A

higher than that of mature milk

205
Q

What is the first fluid produced by the mammary gland?

A

Colostrum

206
Q

The anti-infective properties and living cells in preterm milk protect the infant from

A

infection and necrotizing enterocolitis

207
Q

What makes the fats in preterm milk digestible?

A
  • Presence of acticve enzymes
  • Lipase
  • Bile salts
208
Q

How does preterm milk meet the high energy needs of the premature infanT?

A

High concentration of calories

209
Q

What is the mean energy value of colostrum compared to mature milk?

A

Colostrum:60 kcal/100 ml

Mature milk: 70 kcal/100 ml

210
Q

Colostrum composition

A
  • Low in fat and carbohydrates, so lower in calories than mature milk
  • Yellow due to high levels of beta carotene
  • HIgh ash content (total #of minerals present)
  • High concentrations of (more so than mature milk)
    • Sodium
    • Potassium
    • Chloride
  • More proteins and fat-soluble vitamins than mature milk
  • Lower in fat and lactose
  • Rich in immunoglobulins, expecially SIgA
  • Rich in antibodies
211
Q

Colostrum volume

A

Varies between 2-20 ml per feeding in first 3 days

212
Q

Colostrum volume depends on:

A
  • number of feedings
  • effectiveness of infant’s suckling
  • Parity of mother
  • Whether mother has nursed previously
213
Q

Colostrum effect on gut

A
  • Facilitates formation of bifidus flora
  • Acts as a laxative to evacuate meconium
214
Q

What is transitional milk?

A

Milk produced between the production of colostrum and mature milk

215
Q

When is transitional milk produced?

A

Day 6 to Day 13 postpartum

216
Q

Transitional milk composition compared to colostrum

A

Decreased

  • concentration of immunoglobulins and total protein
  • Fat soluble vitamins
    • (decrease to mature milk levels)

Increased

  • lactose
  • fat
  • water-soluble vitamins
217
Q

When is mature milk established?

A

about 14 days postpartum

continues until weaning

218
Q

Mature milk composition compared to colostrum

A

Lower

  • Protein

Higher

  • water content
  • lactose
  • carbohydrates
  • fat

Also rich in

  • ologosaccharides
  • enzymes
  • protective agents
  • hormones
  • (to meet needs of rapidly developing infant )
219
Q

Mature milk solid to fluid ratio

A

12:88

220
Q
A
221
Q

Duration of feeds should be determined by

A

the infant

222
Q

Factors affecting lipid content of breastmilk

A
  • Suck–swallow pattern of the infant.
  • Efficiency of the infant’s suckle.
  • Number of letdown reflexes that occur during a feed.
  • Length of the interval between feeds.
  • Diurnal rhythm; that is, the fat content of milk is lower in morning and higher in early afternoon.
  • Gestational age at birth: Fat content in preterm breastmilk is slightly higher than it is for full-term infants.
  • Parity: Primiparous women have higher fat content in their milk than do multiparous women.
223
Q

HIndmilk is especially important for which infants?

A

Those with slow weight gain

224
Q

To obtain hindmilk, the infant must have

A
  • effective suckle
  • be at breast long enough to receive available hindmilk
225
Q

What are some significant immunological elements of breast milk

A
  • direct-acting antimicrobial factors,
  • anti-inflammatory properties, and
  • bioactive compounds that are multifunctional.
226
Q

What mechanisms and components in human milk work to protect the infant?

A
  • cellular defences
  • immunoglobulins
  • lysozyme
  • non-antibody protection
  • host-resistant factors
  • other protective factors
227
Q

What two types of white blood cells are present in breastmilk that provide cellular defenses against infection>

A
  • Phagocytes (including neutrophils)
  • Lymphocytes
228
Q

What are the dominant phagocytes found in human milk?

A

Macrophages

They make up 90% of the leukocytes in human milk

229
Q

Function of macrophages

A
  • Engulf and absorb pathogens
  • Produce lactoferrin and lysozymes
230
Q

Neutrophil function in breast milk

A
  • Less aggressive than blood-borne neutrophils
  • Appear to function as phagocytes in the infant’s gut for about 6 weeks, then disappear
231
Q

What type of lymphocytes make up the majority in breast milk?

A

T-cells

232
Q

Function of T-cells

A

Recognize and destroy angitens through cell-mediated immunity

destroy viruses

233
Q

What are immunoglobulins?

A
  • Proteins
  • produced by plasma cells in response to an immunogen
234
Q

What are antibodies?

A
  • A form of immunoglobulin
  • recognize and act against specific agents
235
Q

What is Immunoglobulin A (IgA)

A
  • a set of antibodies present in human milk
  • protects the infant from bacteria and viruses that cause respiratory and gastrointestinal infections.
236
Q

What is Secretory IgA (SIgA)

A
  • the major IgA immunoglobulin found in all human body secretions
  • The SIgA present in breastmilk augments the immunoglobulins transferred to the fetus via the placenta
  • SIgA is synthesized and stored in breast tissue; SIgA levels are high in colostrum, but are reduced in mature milk.
237
Q

What type of immunity does SIgA provide?

A

Passive immunity (In the infant’s digestive tract)

238
Q

Where does SIgA’s effect occur?

A

at the intestinal mucosal surface

239
Q

What is lysozyme?

A
  • The major constituent of whey protein in human milk
  • Acts as a bactericidal and anti-inflammatory agent
  • Targets E. Coli and Salmonella
  • As lactation progresses beyond 6 months, lysozyme activity increases
240
Q

What non-antibody factors in breastmilk protect the infant against bacterial infections?

A
  • bifidus factor
  • lactoperoxidase
  • oligosaccharides
  • complement proteins,
241
Q

What is lactoferrin?

A
  • a potent bacteriostatic iron-binding protein
  • abundant in human milk.
242
Q

Function of lactoferrin?

A

In the presence of bicarbonate and IgA:

  • absorbs enteric iron
  • thus prevents pathogens like E. coli, Candida albacans, and Salmonella from obtaining the iron they require to survive.
243
Q

What is bifidus factor

A
  • disease-resistance factor
  • promotes the growth of Lactobacillus bifidus
244
Q

Bifidus factor fuction

A
  • Lowers pH of an infant’s stools
  • acidic environment discourages the growth of entropathogens
    • such as Shigella, Salmonella**, and E. coli.
245
Q

What is lactoperoxidase?

A
  • enzyme
  • found in the newborn’s saliva
  • kills Streptococcus.
246
Q

what are oligosaccharides?

A

carbohydrates present in human milk

247
Q

Function of oligosaccharides

A
  • Help keep antigens from attaching to GI tract epithelium
248
Q

Oligosaccharides - human milk vs cow’s milk

A

There are about10 times as many oligosaccharides in human milk as there are in cow’s milk.

249
Q

What are complement proteins

A

interact with immunoglobulins to amplify antibody activity.

250
Q

Leukocytes are important components in the production of

A

igA and Interferon (which also prevent infections)

251
Q

What is the predominant bacteria in breastfed infants?

A
  • Bifid bacteria
  • Also known as gram-positive anaerobic bacilli
  • Lactobacoillus bifidus
252
Q

Predominant bacteria in non-breastfed infants

A

primarily gram-negative intestinal colonization

253
Q

Laxoperidase is particularly effective in fighting what type of infections?

A

strep infection

254
Q

What is interferon?

A
  • Protein
  • produced by the lymphocytes
  • protects against viral infections;
255
Q

What is antistaphylococcal factor

A
  • protective element in breast milk
  • increases resistance to Staphylococcus aureus
256
Q

The immature infant’s digestive tract mucosa is permeable to proteins, which allows

A

sensitization to certain antigens and allergic reactions

257
Q

Preastmilk provides what to prevent proteins and antigens from passing into the infant’s mucosa?

A

A supply of IgA that protects the mucosa until the infant’s own IgA system becomes effective

258
Q

Cow’s milk has proteins that are known to act as

A

antigens

259
Q

Modern formulas have treated cow’s milk to reduce

A

antigens

260
Q

Despite treatment of cow’s milk formula for antigens, why is cow’s milk still a common allergy?

A

The volume of milk consumed provides substantial exposure to antigens?

261
Q

When does a baby’s own IgA system become more effective and the mucosa less permeable to proteins?

A

Around 6 months of age

262
Q

Why is it recommended to delay solids until 6 months of age?

A
  • To minimize food allergies
  • Because this is when the infant’s own IgA system is more effective and matured
263
Q

Why are proteins found in human milk unlikely to create an antibody response?

A
  • Breastmilk provides a protective function that prevents the absorption of foreign macromolecules into the infant’s immature immune system
264
Q

in addition to nutrition, breastfed infants gain additional protection from

A

antibodies, proteins, and immune cells available in human milk

265
Q

The benefits of breastfeeding for intant health include

A

Decreased incidence of

  • allergies
  • asthma
  • eczema
  • cancer
  • insulin-dependent diabetes mellitus (IDDM)
  • oral health
  • otitis media
  • respiratory infections
  • sudden infant death syndrome (SIDS)
  • urinary tract infections
266
Q

What are atopic diseases?

A
  • common health problems to which an infant can be genetically predisposed
  • include eczema, food allergies, and respiratory allergies.
267
Q

Children of parents who both have an atopic disease have what likelihood of developing an atopy.

A

47%

268
Q

If only one parent has an atopic disease, the infant has what chance of developing an atopy

A

29%

269
Q

The likelihood of an infant developing an atopy if neither parent suffers from an allergy is what?

A

13%

270
Q

What is a milk allergy?

A

abnormal immune response or sensitivity to a specific substance in bovine milk.

271
Q

Milk allergy occurs as a result of

A
  • bovine milk protein crosses the infant’s digestive tract mucosa and initiates an antigen antibody response
  • eg lactoglobulin, casein, albumin, or lactoalbumin
272
Q

HOw much has the incidence of cow’s milk allergy increased in the last 20 years?

A

about 10 times

273
Q

Why might giving an infant a soy based formula not be beneficial to those with a milk allery?

A

because infants who are sensitive to cow’s milk may also be sensitive to the proteins in soy-based formulas.

274
Q

IgA in breasktmilk functions as a protective mechanism against the development of what?

A

allergies

275
Q

IgA promotes

A

gut closure

276
Q

What is gut closure

A

The tightening of the cell junctions of the GI tract

277
Q

What is the benefit of gut closure?

A

prevenst foreign milk proteins from penetrating the immune system of the infant’s gut.

278
Q

Babies can sometimes react to proteins present in dairy products that their mothers consume

Symptoms include

A
  • diarrhea
  • vomiting
  • rash
  • wheezing
  • cough
  • failure to gain weight appropriately
279
Q

What is the most common chronic disease in children?

A

asthma

280
Q

cow’smilk proteins are associated with increased risk for what type of diseases.

A

Respiratory diseases such as asthma

Cow’s milk based formulas are known to stimulate allergic reactions later in life

281
Q

breastmilk provides prophylactic protection against atopic diseases such as

A

eczema

282
Q

How can breastmilk benefit children who have a family history of allergies?

A

Provides infant with protection against these allergies, even with a family history

protection can last up to 3 years

283
Q

How can breastmilk provide protection against cancer?

A

breastfeeding for at least 4 months provides a protective effect against the development of childhood cancers.

284
Q

Breastfeeding and diabetes

A
  • Research suggests connection between cow’s milk and diabetes
  • significant reduction in diabetes is seen in exclusevly BF infants
  • Bovine serum albumin is believed to be triggger in development of DM
  • Breastmilk provides protection from early onset of T2DM in families with predisposition
285
Q

What is the most commonly identified childhood cancer?

A

lymphoma

286
Q

Breastfeeding and oral health

A
  • Suckling from the breast requires a different muscular action than sucking from a bottle
  • Breastfeeding strengthens the tongue and promotes the development of the dental arch.
  • direct relationship between the duration of breastfeeding and a lower incidence of malocclusion
287
Q

Care of an infant’s first teethwhile breastfeeding involves

A

daily brushings and examination by a dentist by 12 months of age.

288
Q

Breastfeeding and otitis media

A
  • breastfeeding reduces ear infection
  • possibly due to upright position during breastfeeding (vs supine with bottle)
  • placement of the tongue during breastfeeding or the positioning of the infant when breastfeeding may allow the Eustachian tubes to work more effectively.
289
Q

Breastfeeding and respiratory infections

A
  • Respiratory infections account for the majority of illnesses in the first year of life.
  • BF infants less likely to develop serious Resp. infection, eg RSV
  • Fewer infants in developing countries would die from RSV if breastfeed
  • Bottle-fed infants hospitalized for resp. illnesses more often than BF
290
Q

Breastfeeding and SIDS

A
  • Breastfed infants are known to rouse more easily and frequently.
  • Sleep maturation seems to coincide with peak occurrences of SIDS between the age of 2 and 3 months.
    • comparatively short sleep–wake cycles of the breastfed infant in contrast to that of bottle-fed infants.
291
Q

What protective factors in breastmilk protect the infant against UTI?

A
  • lactoferrin
  • secretory IgA
  • oligosaccharides
292
Q

How does SIgA work?

A
  • resists gastrointestinal enzymes
  • coats the intestinal epithelium, thereby blocking pathogens from reaching the mucosal surface.
293
Q

What is the major IgA immunoglobulin found in all human body secretions?

A

Secretory IgA

294
Q

WHat does the SIgA in breasmilk do?

A

augments the immunoglobulins transferred to the fetus via the placenta

295
Q

Where is SIgA synthesized and stored?

A

In breast tissue

296
Q

What are SIgA levels in colostrum versus mature milk?

A
  • high in colostrum
  • reduced in mature milk.
297
Q

What is the major constituent of whey protein in human milk

A

Lysozyme

298
Q

Lysozyme acts as

A

a bactericidal and anti-inflammatory agent

299
Q

What organisms does lysozyme target?

A

E. Coli and Salmonella

300
Q

What happens to lysozyme activity as lactation progresses beyond 6 months?

A

Increases

301
Q

Lactoferrin absorbs enteric iron in the presence of what?

A

bicarbonate and IgA

302
Q

What iron-dependent pathogens does Lactoferrin prevent from proliferating?

A
  • E. coli
  • Candida albacans,
  • Salmonella
303
Q

What is the pH of an infant’s stools?

A

5-6

304
Q

What contributes to the low pH of an infant’s stools?

A

Bifidus factor

305
Q

What is the benefit of bifidus factor lowering the pH of an infant’s stools?

A
  • an acidic environment discourages the growth of entropathogens such as Shigella, Salmonella, and E. coli.
306
Q

What promotes the growth of lactobacillus bifidus?

A

bifidus factor

307
Q

Why is colostrum lower in calories than mature milk?

A

it is low in fat and carbohydrates

308
Q

Why is colostrum yellow?

A

due to high levels of beta carotene

309
Q

Colostrum has a high ash content

What is ash content?

A

Total number of minerals present

310
Q

Colostrum has a higher concentration of what minerals (than mature milk)?

A
  • Sodium
  • Potassium
  • Chloride
311
Q

Colostrum protein and fat-soluble vitamin content compared to mature milk

A

More proteins and fat-soluble vitamins than mature milk

312
Q

Colostrum fat and lactose content compared to mature milk

A

Lower in fat and lactose

313
Q

Colostrum immune properties

A
  • Rich in immunoglobulins, expecially SIgA
  • Rich in antibodies
314
Q

Research suggests a connection between cow’s milk and what disease?

A

Diabetes

315
Q

In breastfed infants, a significant reduction is seen in what endocrine illness?

A

Diabetes

316
Q

What is believed to be a trigger in development of diabetes?

A

Bovine serum albumin

317
Q

Breastmilk provides protection from diabetes for what type of families?

A

provides protection from early onset of T2DM in families with predisposition

318
Q

What effect does infant feeding have on oral muscle development?

A
  • strengthens the tongue
  • promotes the development of the dental arch.
319
Q

There is a direct relationship between the duration of breastfeeding and lower incidence of what dental problem?

A

malocclusion

(misalignment between upper and lower teeth)

320
Q

Breastfeeding is beneficial for reducing what type of infections in infants?

A

ear infections

321
Q

What is believed to be a positive factor in breastfeeding that reduces the number of ear infections in infants?

A

The upright position during breastfeeding, in contrast to the supine position commonly used when bottle-feeding

322
Q

What part of breastfeeding may allow the eustachian tubes to work more effectively?

A

placement of the tongue or the positioning of the infant

323
Q

What accounts for the majority of illnesses in the first year of life?

A

Respiratory infections

324
Q

Breastfeed infants are less likely to develop

A

serious Resp. infection, eg RSV

325
Q

Fewer infants in developing countries would die from what if they were breastfed?

A

RSV

326
Q

Bottle-fed infants hospitalized for what type of illnesses more often than breastfed?

A

Respiratory illnesses

327
Q

How does breastfeeding aid in the prevention of SIDS?

A
  • Breastfed infants rouse more easily and frequently
  • comparatively short sleep–wake cycles of breastfed infants (compared to bottle fed)
328
Q

Peak occurrences of SIDS coincide with what?

A
  • Sleep maturation
  • between the age of 2 and 3 months.
329
Q

How do protective factors in breastmilk protect against UTI?

A
  • adhere to mucosal surfaces that line the urinary tract
  • provide a protective barrier against urinary tract infections
330
Q

What are the second largest constituent in milk by concentration

A

lipids

331
Q

If there is a longer gap between feedings, the breast milk fat content will be

A

Lower

332
Q

How does the infant’s efficiency at nursing affect breast milk fat content?

A

The more efficient the infant is at draining milk from the breast, the greater the fat content will be in the milk consumed.

333
Q

How does diurnal rhythm influence the fat content of breast milk?

A

the fat content of milk is lower in morning and higher in early afternoon.

334
Q

How does gestational age at birth influence the fat content of breast milk?

A

Fat content in preterm breastmilk is slightly higher than it is for full-term infants.

335
Q

How does parity influence the amount of fat in breast milk?

A

Primiparous women have higher fat content in their milk than do multiparous women.

336
Q

If a baby is reacting to dairy products in the mother’s diet, what usually causes the symptoms to end?

A

Removal of dairy products from the maternal diet

337
Q

What may be an important factor in breasmilk’s aid in preventing childhood cancers?

A

The strengthening of the immune system that breastmilk appears to achieve

338
Q

How does long-term breastfeeding influence child-spacing?

A

increased child spacing secondary to lactational amenorrhea

339
Q

In mothers who breastfeed long term, weight loss is

A

Increased

340
Q

In mothers who breastfeed long term, risk of developing T2DM is

A

decreased

341
Q

Why might an HIV positive mother in the developing world still be encouraged to breastfeed?

A

in the developing world, risk of not breastfeeding may outweight risk of HIV

342
Q

What does the enzyme lactoperoxidase kill?

A

Streptococcus

343
Q

Alpha lactalbumin facilitates the synthesis of

A

lactose

344
Q
  • serum albumin
  • lactalbumin
  • immunoglobulins

Are all what?

A

Proteins

345
Q
  • alpha-lactalbumin
  • lactoferrin
  • lysozyme
  • immunoglobulins

Are the four major components of what?

A

Whey milk proteins

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