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
2
Q
Health benefits of long-term breastfeeding
A
- increased child spacing secondary to lactational amenorrhea
- Increased weight loss
- Decreased risk of developing T2DM
3
Q
AAP/WHO breastfeeding recommendation
A
- minimum 6 months
- continuation for 1 year or longer as mutually desired by mother and infant
4
Q
Breastfed infants see a decrease in what illnesses?
A
- Lower respiratory tract illnesses
- Otitis media
- Diarrheal diseases
- pneumonia
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
6
Q
What are medication-related contraindications to breastfeeding?
A
- Amphetimenes
- Chemo
- Ergotamines
- Statins
- Psychotropics
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
8
Q
Pacifiers can be used when
A
- breastfeeding is well established
- (reduce risk of SIDS)
9
Q
Vitamin D supplement for infants
A
Daily supplement of 400 IU for breastfed infants
10
Q
First complimentary foods should be rich in
A
iron
- Meat
- Meat alternatives
- iron-fortified cereal
11
Q
Human milk is
A
species specific,
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.
13
Q
How many components are in human milk?
A
Over 200
14
Q
HUman milk is secreted by
A
the mammary gland
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”
16
Q
A well-nourished woman’s milk is
A
perfectly adapted to meetthe nutritional needs of her infant
17
Q
How does a mother’s body respond to premature birth?
A
by increasing the amounts of protective factors in her milk
18
Q
What is the ratio of total soilds to fluids?
A
12:88
19
Q
The well-nourished breastfed infants recieves all the nutrients it needs, as well as
A
all the water
20
Q
Breastmilk contains a unique blend of
A
- fats
- carbohydrates
- proteins
- vitamins
- minerals
All easily utilized by infants
21
Q
Besides nutrition and water, breastmilk contains
A
Antibodies that actively protect infants from infections
22
Q
Proteins account for how much of the total composition of human milk?
A
0.9%
23
Q
Protein is essential for
A
growth
24
Q
What are the two types of prteins in human milk?
A
Casein proteins and whey proteins such as:
- serum albumin
- lactalbumin
- immunoglobulins
25
What is the ratio of whey:casein in human milk?
60%:40%
26
When acidified in the stomach, the proteins in human milk form
soft curds that are easily digested
27
what is the ratio of when:casein in cow's milk?
18:82%
28
In the stomach, casein proteins form
a tough, less digestible curd that requires an increased amount of energy to digest
29
What are the Four major components of **whey milk proteins**
* alpha-lactalbumin
* lactoferrin
* lysozyme
* immunoglobulins
30
What is alpha lactalbumin?
* breast milk whey protein
* facilitates the **synthesis of lactose.**
**LACTalbumin** makes **LACT**ose
31
What is lactoferrin?
a whey protein found in human milk.
32
Lactoferrin has what potent capacity?
* Potent bacteriostatic iron-binding capacity
* inhibits the growth of certain iron-dependent bacteria
33
How does lactogerrin stop the spread of certain pathogens?
* By making iron unavailable
* stops the spread of pathogens that thrive on iron
34
Lactoferrin is especially effective against what bacteria?
* *Staphylococcus aureus*
* *E. coli*
* *Salmonella*
35
In addition to its protective role, lactoferrin also
aids in enteric iron absorption.
36
What is lysozyme
* whey protein
* enzyme
* bactericidal
37
Lysozyme is an enzyme that can destroy what bacteria?
* *E. Coli*
* *Salmonella*
38
Lysozyme activity increases as
lactation progresses
39
How long after delivery do lysozyme levels continue to increase in breastmilk?
starting 6 months after delivery
40
High levels of lysozyme may safeguard infants against what?
Pathogens commonly introduced to solid foods around 6 months
41
What are immunoglobulins?
proteins produced by plasma cells
42
What are antibodies?
immunoglobulins that recognize and act on specific antigens
43
What is the major immunoglobulin?
Secretory immunoglobulin A (SIgA)
44
What is the purpose of SIgA?
**supplements immunoglobulins** passed on to the fetus through the placenta in utero
45
SIgA is synthesized and stored where?
in the breast
46
What type of milk has the highest levels of SIgA?
Colostrum
47
SIgA is found in what part of the body?
The intestine
48
How does SIgA provide protection against infections?
by keeping viruses and bacteria from penetrating the intestinal mucosa.
49
Are all milk proteins synthesized in the breast?
No
50
SIgA is secreted into breastmilk by
acinar cells
51
Other proteins in breast milk are synthesized by
amino aids
52
How are proteins synthesized by amino acids transferred to breast milk?
picked up from the circulation by the epithelial cells of the mammary gland.
53
what factors influence the content and amounts of specific proteins in milk?
* Stage of lactation
* Gestational length
54
What are nucleotides?
* part of the non-protein nitrogen content of breastmilk
* important for infant’s i**ntestinal development**
55
Nucleotides are higher in what type of milk?
* Preterm milk
* 20% higher
56
How do nucleotides impact intestinal flora?
* lower the pH of the bowel
* this suppresses growth of acid-intolerant pathogens.
57
Nucleotides enhance the utilization of what?
* **Protein**
* which could explain why breastfed infants grow so well despite their relatively low protein intake.
58
What is the most variable component of human milk?
Lipids
59
Lipids are the
second largest constituent in milk by concentration
60
What is the range of fat content in human milk?
3.5% - 4.5%
61
Lipids make up how much of breastmilk's total calories?
Half
62
What are the main constituents of human milk fat?
* Triglycerides
* followed by fatty acids
* and fat soluble vitamins
63
What are fat soluble vitamins found in breast milk?
A, D, E, and K
64
As the baby's needs change, fat content in milk
gradually decreases
65
What breaks down triglycerides in to free fatty acids?
Lipases
66
when can the fat content of a mother's breastmilk vary in concentration?
* During a feeding
* From breast to breast
* From one time of day to another
* in accordance with the efficiency of the infant's sucking
67
Breastmilk's fat content is mediated by
* **time since last feeding**
* The longer the gap, the lower the fat content.
* **efficient milk removal**
* greater efficiency= greater fat content consumed
68
Fat content is usually lower at what time of day?
morning
69
When does fat content peak?
early afternoon
70
What percentage of an infant's brain development and nervous tissue forms after birth?
50%
71
What fatty acids found in breastmilk are responsible for brain development?
Long-chain polyunsaturated fatty acids
72
What other fatty acids aid in brain maturation?
* docosohexaenoic acid (DHA)
* arachidonic acid (AA)
73
What is lipase?
enzyme in breastmilk that aids the digestion of fats.
74
Milk lipases facilitate
the emulsion of milk lipids, producing a soft curd that is easily digested by the infant.
75
Milk fats are derived fropm
plasma
76
milk fats are sythesized by the breast from
carbohydrates
77
What does the breast synthesize that is a major source of energy for the infant?
fatty acids
78
Fat synthesis
* Idroplets of fat collect in the acinar cell
* Fat globules are extruded from the cell membrane into the acinar lumen
79
What promotes the secretion of fat into breastmilk?
Contraction of the myoepithelial cells during the milk-ejection reflex
80
What is foremilk?
* watery first milk drawn by an infant when feeding
* lower fat content
81
what is hindmilk?
Richer, higher fat milk that follows foremilk
82
Why is it important that the infant drain the entire breast?
To receive the crucial hindmlik
83
Carbohydrates in breast milk are derived from
blood glucose
84
Carbohydrates provide
the main source of energy in breastmilk
85
The carbohydrate level of breastmilk
remains at a constant level during different phases of lactation
86
POstpartum maternal intake of glucose should increase by
30%
87
Why should breastfeeding mothers increase glucose intake?
Lactose, the main carbohydrate in breast milk, is syhthesized from maternal glucose
88
What is the lactose content in mature breast milk?
7.3 g per 100 ml
89
what is the primary carbohydrate in breastmilk?
lactose
90
What does lactose metabolize to?
glucose and galactose
91
Why does lactose metabolize to glucose and galactose?
o provide energy to the infant’s developing brain
92
Lactose is an osmotic agent that regulates what?
milk volume
93
Lactose aids in the absorption of what?
Calcium and iron
94
What stimulates the growth of lactobacillus bifidus?
Lactose and oligosaccharides
95
What is lactobacillus bifidus?
* intestinal bacterial flora
* protects infants from intestinal infections.
96
What is amylase?
a polysaccharide-digesting enzyme
97
How long is mammary amylase present in breastmilk?
Throughout lactation
98
What type of milk has the highest level of amylase?
Colostrum
99
Why is amylase important to the infant?
it's own pancreatic amylase activity is still at low levels until about 6 months of age.
100
Most milk amylase activity occurs in what part of the infant's digestive tract?
the duodenum
101
What are do oligosaccharides stimulate in the infant's gut?
Lactobacillus bifidus
102
The vitamins present in human milk vary
between mothers
103
The vitamins in breastmilk can provide what?
Generally, breastmilk can provide a normal, healthy newborn with all the required vitamins needed for growth.
104
What type of vitamins are present in breast milk?
Fat or water soluble
105
The presence of fat-soluble vitamins in breastmilk is depen dent on what?
The maternal diet
106
Why are fat soluble vitamins in breastmilk dependent on the maternal diet?
because the vitamins are drawn from the mother’s body stores
107
Fat-soluble vitamins found in breastmilk include
A, D, E, and K
108
What is the precursor of vitamin A?
Beta-carotene
109
What type of milk has the most vitamin A?
* Colostrum
* contains twice as much as mature milk
110
Recent research suggests that vitamin D may play a role in
protecting against the development of other diseases besides rickets
111
How much vitamin D does human milk contain?
1-10 IU (250 mL)
112
What is the most efficient way of triggering adequate vitamin D production in a person's skin?
Exposure to sunlight
113
Why do infants need a vitamin D supplement?
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.
114
Infants older than 6 months who are exposed to sunlight should
use suncreen
115
Sunscreen can reduce infant's Vitamin D production by how much?
97.5%
116
What children are at the greatest risk for vitamin D deficiency?
* children with dark skin
* infants whose mothers have subclinical vitamin D deficiency
117
Why are dark skinned infants at higher risk for developing rickets?
because they require increased exposure to sunlight to produce the same amount of vitamin D compared with light- skinned infants.
118
If a mother has subclinical Vitamin D deficiency
her infant will be born with limited vitamin D stores.
119
What can cause subclinical vitamin D deficiency in women?
a combination of factors, including:
* avoidance of milk
* lack of vitamin D supplementation
* limited sun exposure.
120
What type of vitamin D supplementation is recommended for all breastfed full-term infants by the Canadian Pediatric Society?
Daily dietary supplementation of 400 IU
121
Why is 400 IU of vitamin D supplementation recommended?
to correct for the lack of exposure to ultraviolet light
122
What is the duration of Vitamin D supplementation?
* 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
123
Vitamin E is abundant in
colostrum
124
Vitamin E is higher in breastmilk than
cow's milk
125
Vitamin E deficiency can result in
Hemolytic anemia (especially in the premature infant)
126
Vitamin E protects
cell membranes in the lungs and retina
127
Vitamin K is needed for
the synthesis of blood-clotting factors
128
Vitamin K is found in
small amounts in breast milk
129
Within a few days after birth, vitamin K is produced by
the infant’s enteric bacteria
130
Breastmilk promotes gastrointestinal bacteria that increase levels of what vitamin?
vitamin K
131
Low levels of vitamin K in the newborn can cause
vitamin K-responsive hemorrhagic disease
132
Vitamin K is routinely given
intramuscularly to newborns to prevent hemorrhage.
133
Water-soluble vitamin levels in breastmilk are influenced by
the maternal diet
134
If supplementary vitamins are taken
their levels in breastmilk change.
135
Do all mothers require vitamin supplements?
* NO
* Lactating women who eat a nutritious diet do not require vitamin supplements
136
Water soluble vitamins include:
* vitamin C
* vitamin B6
* vitamin B12
* niacin
* folate
137
Vitamin C function
Important for:
* enzyme and hormone systems
* essential for collagensynthesis
138
Vitamin C levels in human milk are strongly influenced by
the mother’s dietary intake.
139
Vitamin B6 (Pyroxidine) function
* vital to **DNA synthesis**
* involved in the **myelination of the central nervous system**
140
Why can B6 often be deficient?
it is dependent upon maternal nutrition
141
Vitamin B12 (cobalmin) function
Vital to infant's **CNS development**
142
Which has a higher level of B12, breast milk or cow's milk?
Cow's milk
However, cow's milk has little binding capacity for B12, whereas human milk has substantial binding capacity
143
Why does greater binding capacity of B12 enhance the protective quality of human milk?
Due to greater binding capacity, less B12 is available to organisms such as E. coli
144
vitamin B12 affects the metabolism of what?
Folic acid
145
What type of anemia is due to Vitamin B12 deficiency?
Megaloblastic
146
Vitamin B12 occurs exclusively in what foods?
Meats
ABSENT from vegetable protein
147
What type of mother could be deficient in B12?
A vegetarian mother
148
What is Niacin?
an essential part of the pyridine nucleotide coenzymes and the intracellular respiratory mechanisms.
149
Niacin levels are elated to what?
Dietary intake
150
Folate is essential for
the normal **maturation of red blood cells.**
151
When is the presence of minerals highest in breast milk?
The first few days following delivery
152
The presence of minerals in breastmilk is highest in the first few days following delivery, with the exception of
magnesium
153
Human milk provides sufficient minerals to
support infant growth
154
The concentration of electrolytes in human milk is **not** influenced by
maternal nutrition
155
Important minerals in breastmilk include
* potassium
* sodium
* chloride
* magnesium
* calcium
* zinc iron
156
Colostrum contains high amounts of what minerals?
Potassium
Sodium
157
Potassium is present in lower quantities in
mature milk
158
High potassiun in Cow's milk can be hard on
infant kidneys
159
Sodium content of colostrum declines by what day following delivery?
3rd day
160
Elevated sodium levels in human milk are present during
* mastitis
* weaning
* in the first trimester of pregnancy
161
Which mineral in human milk is the most variable in concentration?
Sodium
162
Chloride deficiency has been associated with
infants experiencing failure to thrive.
163
Magnesium is available as
a free ion
164
Cow’s milk contains how much more magnesium than does breastmilk
Three times
165
Levels of magnesium in human milk increase continuously during
the first 3 months after birth.
166
Calcium is present in what levels in human milk?
* Moderate levels in colostrum
* High levels in transitional milk
* Lower levels in mature milk
167
Calcium is four times higher in
cow's milk
168
Eventhough the calcium and phosphorus levels in breastmilk are comparatively low
infants absorb 67% of what is available.
169
During lactation, maternal calcium absorption by the duodenum is
enhanced
170
Zinc function
* essential to the structure of enzymes
* functions as an activator of enzymes
**Z**inc = en**Z**ymes
171
Deficiencies of zinc are seen in
* infants who fail to thrive
* infants with skin lesions
172
Research indicates human breastmilk has other factors that promotesuperior bioavailability of zinc to the infant over
cow’s milk.
173
Iron is present in what amounts in human milk?
small amounts
174
Iron is made available to the infant by action of
lactoferrin
175
Full-term breastfed infants are rarely
* iron deficient
* have sufficient reserves
176
Absorption of iron is facilitated by
high lactose levels and vitamin C.
177
Fifty per cent of an infant’s iron intake is
absorbed from breastmilk
178
IRON
Recommendations from 6 to 24 months recommend that if an infant is either not breastfed or is only partially breastfed
iron-fortified cow’s milk formula or follow-up formula is the most acceptable alternative to breastmilk from 9–12 months
179
breastmilk substitutes are not recommended for ages
0–6 months
180
what is the most substantial constituent of human milk
water
181
all components of breastmilk are dissolved in
water
182
Lactating women should drink to
to satisfy their thirst.
183
What is the factor that regulates the volume of milk produced?
lactose
184
The secretion of water into milk is regulated in part by
lactose synthesis
185
what provides all the water that infants require?
breastmilk
186
Human milk is not a uniform body fluid, it is a
dynamic secretion of the mamary gland
187
Human milk changes composition
* over time
* according to the needs of the infant
188
The composition of breastmilk varies according to
* Stage of lactation
* time of day
* stage of feed
* infections
* gestation age at delivery
* other factors
189
Once lactation is established, the composition of major milk components
does not vary from day to day by more than 25%
Changes very little until weaning
190
At birth and in the immediate postpartum period, what is available to the infant in small amounts.
colostrum
191
Colostrum is present
* prior to delivery
* and is produced up to 4 days following delivery
192
The newborn does not require what in the immediate postpartum period
significant fluid volume
193
When is transitional milk produced?
between 6 and 13 days postpartum
194
What (to some extent) determines the composition and volume of milk produced?
The effectiveness of an infant's suckling
195
During weaning, what happens to milk composition?
Levels of sodium and protein increase
196
What parts of milk composition vary according to time of day?
Fat content
(lower levels in the morning, higher levels in early afternoon)
197
How does milk composition vary during stage of the feed?
* Foremilk is received during the first part of the feed
* hindmilk during the later part of the feed
198
Composition of foremilk
High in water and lactose
Provides greatest volume of feeding
199
Composition of hindmilk
Less volume than foremilk
High in fat content - causes infant to feel full and signals end of feed
200
How can mastitis alter milk composition?
Causes a decrease in milk volume while simultaneously increasing sodium and chloride
201
How does gestational age influence milk composition?
* 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
What are the types of human milk that have been identified?
* Preterm breastmilk
* Colostrum
* Transitional milk
* mature milk
* foremilk
* hindmilk
203
Preterm milk has high concentration of
* Protein
* Sodium
* Chloride
* Magnesium
* Potassium
* Iron
* Calcium
* Lipids
* Some anti-infective agents
204
In preterm milk, the whey-to-casein ratio is
higher than that of mature milk
205
What is the first fluid produced by the mammary gland?
Colostrum
206
The anti-infective properties and living cells in **preterm milk** protect the infant from
infection and necrotizing enterocolitis
207
What makes the fats in preterm milk digestible?
* Presence of acticve enzymes
* Lipase
* Bile salts
208
How does preterm milk meet the high energy needs of the premature infanT?
High concentration of calories
209
What is the mean energy value of colostrum compared to mature milk?
Colostrum:60 kcal/100 ml
Mature milk: 70 kcal/100 ml
210
Colostrum composition
* 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
Colostrum volume
Varies between 2-20 ml per feeding in first 3 days
212
Colostrum volume depends on:
* number of feedings
* effectiveness of infant's suckling
* Parity of mother
* Whether mother has nursed previously
213
Colostrum effect on gut
* Facilitates formation of bifidus flora
* Acts as a laxative to evacuate meconium
214
What is transitional milk?
Milk produced between the production of colostrum and mature milk
215
When is transitional milk produced?
Day 6 to Day 13 postpartum
216
Transitional milk composition compared to colostrum
**Decreased**
* concentration of immunoglobulins and total protein
* Fat soluble vitamins
* (decrease to mature milk levels)
**Increased**
* lactose
* fat
* water-soluble vitamins
217
When is mature milk established?
about 14 days postpartum
continues until weaning
218
Mature milk composition compared to colostrum
**Lower**
* Protein
**Higher**
* water content
* lactose
* carbohydrates
* fat
**Also rich in**
* ologosaccharides
* enzymes
* protective agents
* hormones
* (to meet needs of rapidly developing infant )
219
Mature milk solid to fluid ratio
12:88
220
221
Duration of feeds should be determined by
the infant
222
Factors affecting lipid content of breastmilk
* 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
HIndmilk is especially important for which infants?
Those with slow weight gain
224
To obtain hindmilk, the infant must have
* effective suckle
* be at breast long enough to receive available hindmilk
225
What are some significant immunological elements of breast milk
* direct-acting antimicrobial factors,
* anti-inflammatory properties, and
* bioactive compounds that are multifunctional.
226
What mechanisms and components in human milk work to protect the infant?
* cellular defences
* immunoglobulins
* lysozyme
* non-antibody protection
* host-resistant factors
* other protective factors
227
What two types of white blood cells are present in breastmilk that provide cellular defenses against infection\>
* Phagocytes (including neutrophils)
* Lymphocytes
228
What are the dominant phagocytes found in human milk?
Macrophages
They make up 90% of the leukocytes in human milk
229
Function of macrophages
* Engulf and absorb pathogens
* Produce lactoferrin and lysozymes
230
Neutrophil function in breast milk
* Less aggressive than blood-borne neutrophils
* Appear to function as **phagocytes** in the infant's gut for about 6 weeks, then disappear
231
What type of lymphocytes make up the majority in breast milk?
T-cells
232
Function of T-cells
Recognize and destroy angitens through cell-mediated immunity
destroy viruses
233
What are immunoglobulins?
* Proteins
* produced by plasma cells in response to an immunogen
234
What are antibodies?
* A form of immunoglobulin
* recognize and act against specific agents
235
What is Immunoglobulin A (IgA)
* a set of antibodies present in human milk
* protects the infant from bacteria and viruses that cause respiratory and gastrointestinal infections.
236
What is Secretory IgA (SIgA)
* 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
What type of immunity does SIgA provide?
Passive immunity (In the infant's digestive tract)
238
Where does SIgA's effect occur?
at the intestinal mucosal surface
239
What is lysozyme?
* 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
What non-antibody factors in breastmilk protect the infant against bacterial infections?
* bifidus factor
* lactoperoxidase
* oligosaccharides
* complement proteins,
241
What is lactoferrin?
* a potent bacteriostatic iron-binding **protein**
* abundant in human milk.
242
Function of lactoferrin?
**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
What is bifidus factor
* disease-resistance factor
* promotes the growth of **Lactobacillus bifidus**
244
Bifidus factor fuction
* Lowers pH of an infant’s stools
* acidic environment discourages the growth of entropathogens
* such as *_Shigella, Salmonella_**,* and *_E. coli._*
245
What is lactoperoxidase?
* enzyme
* found in the newborn’s saliva
* kills ***Streptococcus.***
246
what are oligosaccharides?
carbohydrates present in human milk
247
Function of oligosaccharides
* Help keep antigens from attaching to GI tract epithelium
248
Oligosaccharides - human milk vs cow's milk
There are about10 times as many oligosaccharides in human milk as there are in cow’s milk.
249
What are complement proteins
interact with immunoglobulins to amplify antibody activity.
250
Leukocytes are important components in the production of
igA and Interferon (which also prevent infections)
251
What is the predominant bacteria in breastfed infants?
* Bifid bacteria
* Also known as gram-positive anaerobic bacilli
* Lactobacoillus bifidus
252
Predominant bacteria in non-breastfed infants
primarily gram-negative intestinal colonization
253
Laxoperidase is particularly effective in fighting what type of infections?
strep infection
254
What is interferon?
* Protein
* produced by the **lymphocytes**
* protects against **viral infections**;
255
What is antistaphylococcal factor
* protective element in breast milk
* increases resistance to *Staphylococcus aureus*
256
The immature infant’s digestive tract mucosa is permeable to proteins, which allows
sensitization to certain antigens and allergic reactions
257
Preastmilk provides what to prevent proteins and antigens from passing into the infant's mucosa?
A supply of IgA that protects the mucosa until the infant's own IgA system becomes effective
258
Cow's milk has proteins that are known to act as
antigens
259
Modern formulas have treated cow's milk to reduce
antigens
260
Despite treatment of cow's milk formula for antigens, why is cow's milk still a common allergy?
The volume of milk consumed provides substantial exposure to antigens?
261
When does a baby's own IgA system become more effective and the mucosa less permeable to proteins?
Around 6 months of age
262
Why is it recommended to delay solids until 6 months of age?
* To minimize food allergies
* Because this is when the infant's own IgA system is more effective and matured
263
Why are proteins found in human milk unlikely to create an antibody response?
* Breastmilk provides a **protective function** that **prevents the absorption of foreign macromolecules** into the infant's immature immune system
264
in addition to nutrition, breastfed infants gain additional protection from
antibodies, proteins, and immune cells available in human milk
265
The benefits of breastfeeding for intant health include
**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
What are atopic diseases?
* common health problems to which an infant can be genetically predisposed
* include eczema, food allergies, and respiratory allergies.
267
Children of parents who both have an atopic disease have what likelihood of developing an atopy.
47%
268
If only one parent has an atopic disease, the infant has what chance of developing an atopy
29%
269
The likelihood of an infant developing an atopy if neither parent suffers from an allergy is what?
13%
270
What is a milk allergy?
abnormal immune response or sensitivity to a specific substance in bovine milk.
271
Milk allergy occurs as a result of
* **bovine milk protein** crosses the infant’s digestive tract mucosa and initiates an **antigen antibody response**
* eg **lactoglobulin,** **casein**, **albumin,** or **lactoalbumin**
272
HOw much has the incidence of cow's milk allergy increased in the last 20 years?
about 10 times
273
Why might giving an infant a soy based formula not be beneficial to those with a milk allery?
because infants who are sensitive to cow’s milk may also be sensitive to the proteins in soy-based formulas.
274
IgA in breasktmilk functions as a protective mechanism against the development of what?
allergies
275
IgA promotes
gut closure
276
What is gut closure
The tightening of the cell junctions of the GI tract
277
What is the benefit of gut closure?
prevenst foreign milk proteins from penetrating the immune system of the infant’s gut.
278
Babies can sometimes react to proteins present in dairy products that their mothers consume
Symptoms include
* diarrhea
* vomiting
* rash
* wheezing
* cough
* failure to gain weight appropriately
279
What is the most common chronic disease in children?
asthma
280
cow’smilk proteins are associated with increased risk for what type of diseases.
Respiratory diseases such as asthma
Cow's milk based formulas are known to stimulate allergic reactions later in life
281
breastmilk provides prophylactic protection against atopic diseases such as
eczema
282
How can breastmilk benefit children who have a family history of allergies?
Provides infant with protection against these allergies, even with a family history
protection can last up to 3 years
283
How can breastmilk provide protection against cancer?
breastfeeding for **at least 4 months** provides a protective effect against the development of childhood cancers.
284
Breastfeeding and diabetes
* 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
What is the most commonly identified childhood cancer?
lymphoma
286
Breastfeeding and oral health
* 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
Care of an infant’s first teethwhile breastfeeding involves
daily brushings and examination by a dentist by 12 months of age.
288
Breastfeeding and otitis media
* 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
Breastfeeding and respiratory infections
* 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
Breastfeeding and SIDS
* 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
What protective factors in breastmilk protect the infant against UTI?
* *lactoferrin*
* *secretory IgA*
* *oligosaccharides*
292
How does SIgA work?
* resists gastrointestinal enzymes
* coats the intestinal epithelium, thereby blocking pathogens from reaching the mucosal surface.
293
What is the major IgA immunoglobulin found in all human body secretions?
Secretory IgA
294
WHat does the SIgA in breasmilk do?
augments the immunoglobulins transferred to the fetus via the placenta
295
Where is SIgA synthesized and stored?
In breast tissue
296
What are SIgA levels in colostrum versus mature milk?
* high in colostrum
* reduced in mature milk.
297
What is the major constituent of whey protein in human milk
Lysozyme
298
Lysozyme acts as
a **bactericidal** and **anti-inflammatory** agent
299
What organisms does lysozyme target?
*E. Coli* and *Salmonella*
300
What happens to lysozyme activity as lactation progresses beyond 6 months?
Increases
301
Lactoferrin absorbs enteric iron in the presence of what?
bicarbonate and IgA
302
What iron-dependent pathogens does Lactoferrin prevent from proliferating?
* *E. coli*
* *Candida albacans,*
* *Salmonella*
303
What is the pH of an infant's stools?
5-6
304
What contributes to the low pH of an infant's stools?
Bifidus factor
305
What is the benefit of bifidus factor lowering the pH of an infant's stools?
* an acidic environment discourages the growth of entropathogens such as *Shigella, Salmonella,* and *E. coli.*
306
What promotes the growth of lactobacillus bifidus?
bifidus factor
307
Why is colostrum lower in calories than mature milk?
it is low in fat and carbohydrates
308
Why is colostrum yellow?
due to high levels of beta carotene
309
Colostrum has a high ash content
What is ash content?
Total number of minerals present
310
Colostrum has a higher concentration of what minerals (than mature milk)?
* Sodium
* Potassium
* Chloride
311
Colostrum protein and fat-soluble vitamin content compared to mature milk
More proteins and fat-soluble vitamins than mature milk
312
Colostrum fat and lactose content compared to mature milk
Lower in fat and lactose
313
Colostrum immune properties
* Rich in immunoglobulins, expecially SIgA
* Rich in antibodies
314
Research suggests a connection between cow's milk and what disease?
Diabetes
315
In breastfed infants, a significant reduction is seen in what endocrine illness?
Diabetes
316
What is believed to be a trigger in development of diabetes?
Bovine serum albumin
317
Breastmilk provides protection from diabetes for what type of families?
provides protection from early onset of T2DM in families with predisposition
318
What effect does infant feeding have on oral muscle development?
* strengthens the tongue
* promotes the development of the dental arch.
319
There is a direct relationship between the duration of breastfeeding and lower incidence of what dental problem?
malocclusion
(misalignment between upper and lower teeth)
320
Breastfeeding is beneficial for reducing what type of infections in infants?
ear infections
321
What is believed to be a positive factor in breastfeeding that reduces the number of ear infections in infants?
The upright position during breastfeeding, in contrast to the supine position commonly used when bottle-feeding
322
What part of breastfeeding may allow the eustachian tubes to work more effectively?
placement of the tongue or the positioning of the infant
323
What accounts for the majority of illnesses in the first year of life?
Respiratory infections
324
Breastfeed infants are less likely to develop
serious Resp. infection, eg RSV
325
Fewer infants in developing countries would die from what if they were breastfed?
RSV
326
Bottle-fed infants hospitalized for what type of illnesses more often than breastfed?
Respiratory illnesses
327
How does breastfeeding aid in the prevention of SIDS?
* Breastfed infants rouse more easily and frequently
* comparatively short sleep–wake cycles of breastfed infants (compared to bottle fed)
328
Peak occurrences of SIDS coincide with what?
* Sleep maturation
* between the age of 2 and 3 months.
329
How do protective factors in breastmilk protect against UTI?
* adhere to mucosal surfaces that line the urinary tract
* provide a protective barrier against urinary tract infections
330
What are the second largest constituent in milk by concentration
lipids
331
If there is a longer gap between feedings, the breast milk fat content will be
Lower
332
How does the infant's efficiency at nursing affect breast milk fat content?
The more efficient the infant is at draining milk from the breast, the greater the fat content will be in the milk consumed.
333
How does diurnal rhythm influence the fat content of breast milk?
the fat content of milk is lower in morning and higher in early afternoon.
334
How does gestational age at birth influence the fat content of breast milk?
Fat content in preterm breastmilk is slightly higher than it is for full-term infants.
335
How does parity influence the amount of fat in breast milk?
Primiparous women have higher fat content in their milk than do multiparous women.
336
If a baby is reacting to dairy products in the mother's diet, what usually causes the symptoms to end?
Removal of dairy products from the maternal diet
337
What may be an important factor in breasmilk's aid in preventing childhood cancers?
The strengthening of the immune system that breastmilk appears to achieve
338
How does long-term breastfeeding influence child-spacing?
increased child spacing secondary to lactational amenorrhea
339
In mothers who breastfeed long term, weight loss is
Increased
340
In mothers who breastfeed long term, risk of developing T2DM is
decreased
341
Why might an HIV positive mother in the developing world still be encouraged to breastfeed?
in the developing world, risk of not breastfeeding may outweight risk of HIV
342
What does the enzyme lactoperoxidase kill?
Streptococcus
343
Alpha lactalbumin facilitates the synthesis of
**lactose**
344
* serum albumin
* lactalbumin
* immunoglobulins
*
Are all what?
Proteins
345
* alpha-lactalbumin
* lactoferrin
* lysozyme
* immunoglobulins
Are the four major components of what?
Whey milk proteins
