NFS143 Nutrition in the Life Cycle
NFS143 Nutrition in the Life Cycle NFS143
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Date Created: 02/15/16
Article Assignment #1 Emily Dickinson How the First Nine Months Shape the Rest of Your Life Everyone is aware that nature and nurture affect how one grows as an individual and how it shapes who we become. But rarely do people take into account the first 9 months before we’re actually tangible human beings. What our mothers ate, drank, stressed about, smoked, or other countless things all also played a role. It’s said all of these things we’re exposed to in utero affect how easily we get diseases, can affect our appetite and metabolism, our intelligence and temperament. An example of how mother’s nutrition can affect fetuses was seen in the earlier years when England and Wales had some of the highest rates of heart disease. When further looked into, a physician found that many of those children had low birth weights. He then came to the conclusion that they had poor prenatal nutrition and instead of fully developing all the organs to their prime their bodies focused on the brain and other organs and neglected the heart. New studies include women who gained weight during pregnancy, the higher the chance they would have of their child being overweight by age 3. Heredity in some cultures has doomed them and made them have a predisposition for disease, such as in Pima Indians in Arizona. They have the highest levels of diabetes in the world. This can be accounted for and noticed through their prenatal experiences. Mothers who had diabetes and high blood sugar seemed to alter the developing fetuses metabolism and make them more likely to have diabetes as an adult or be obese. So while heredity and what you eat plays a role in certain areas, air does also. A doctor in New York City was doing a study to see if there were effects on babies just out of the womb from the local polluted air. Upon analyzing samples from the new babies she was shocked to see that they were already contaminated. This is proof that even air borne pollutants can affect fetuses while in the womb. Stress is another component to fetus development. The mothers stress levels, hormone levels due to stress, heart rate and blood pressure could affect the fetus over the course o the 9 months and in return shape its development. Studies show that offspring raised by a parent with a mental illness and in return more likely to contract that mental illness. New studies that are occurring now are going to determine whether or not there will become prenatal pills that mothers will take to help prevent cancer in their children. This is the kind of direction we are headed in when it comes to determining what happens to children while in the womb based upon what their mothers do. Possibly to our children the study of fetal origins won’t be so strange at all. LACTATION Breast Feeding Benefits of Breast Feeding Benefits Provides immunity for some diseases No preparation needed – free of bacteria Fosters maternal bonding Benefits Promotes correct development of jaws and teeth Infant not likely to be overfed Speeds physiological recovery from pregnancy Less likely to develop breast cancer and osteoporosis Several nutrients are better absorbed than formula Colostrum first fluid secreted Yellow in color rich in immune factors high carotene and vitamin A transitional milk that ultimately changes to mature milk fat and carb content starts to change around 21 day changes to mature milk Mature Milk Watery in appearance Energy content of breast milk is 20kilocals per ounce Many cells and compounds that protect baby from infection ^^ these compounds are resistant to stomach acids so aren’t destroyed enteropathogenic factors – bacteria likely to prevent disease in intestinal tract Protective Factors Supplies important non nutritional benefits not available in breast milk substitutes Cant be added to formula or found in formula (real milk stuff) Protective Factors Lactobacillus Bifidus Factor unique to human milk encourages growth of beneficial bacteria Limits growth of potentially harmful bacteria Protective Factors Lactoferrin assists iron absorption inhibits growth of some bacteria by making iron unavailable to them Protective Factors Antibodies (Immunoglobulins) Secretory IgA – predominant one Antibodies targeted against pathogens in immediate surroundings Oligiosaccharides Protective Factors Immune Cells Neutrophils and macrophages Lymphocytes Lysozymes Antimicrobial enzyme Secreted from macrophages Destroys bacterial cell membranes Milk Production Volume dependent on demand Can increase to meet demand of twins, triplets Maternal Illness Colds or ordinary infections have no effect on breast feeding Maternal Illness Breast milk transmission of HIV is well documented Mature Milk Carbohydrate Dominant carbohydrate is lactose not influenced by mothers diet Lactose levels fairly constant Mature Milk Protein Amino acid content is ideal for human infant Contains whey and casein proteins Mature Milk Protein Alpha –lactalbumin largest single amount of protein infant can easily digest Mature Milk Lipids Lipids packaged in globule membrane Allows emulsification in milk Mature Milk Fat Varies in fat content during single feeding average fat content is 3.53.8% Single Feeding Foremilk released initially low fat; high nutrients Hindmilk High in fat Fat provides 5055% of Kcal in breast milk Mature Milk Fat Total fat is not affected by the mother’s diet Type of fat is affected Mature Milk Fat Primarily triglycerides High in linoleic acid High in cholesterol Mature Milk Fat Cholesterol content is not altered by diet Mature Milk Lipids Breast milk also contains linolenic acid High in DHA (omega 3) High in arachidonic acid (ARA) Mature Milk Fat DHA and ARA believed to play a role in vision and neurological development Many infant formulas in the U.S. do not contain added DHA / ARA DHA / ARA recommended in formula for premature infants Should DHA and ARA be added to all formula in the U.S.? Mature Milk Vitamins Most of the water soluble vitamins in human milk reflect maternal intake when intake is low Folate is an exception Mature Milk – Fat SolubleVitamins Mega doses of vitamin A can increase the vitamin A content of breast milk to high levels Mature Milk – Fat SolubleVitamins Breast milk is low in Vitamin D Breastfed infant needs supplement or sunlight exposure Mature Milk Minerals Minerals do not seem to correlate with maternal intake Mature Milk Minerals Lactation creates a substantial drain of body calcium Calcium concentrations in human milk remain fairly constant, even when maternal intakes are low Bone mineral content falls during lactation Dietary intake important to minimize bone loss Maternal deficiency promotes mobilization of calcium from bone Prolonged lactation, insufficient calcium intake – women at risk Mature Milk Minerals Breast milk iron content remains fairly constant regardless of maternal intake Mature Milk Minerals Level of Fluoride in breast milk is low and varies little Human milk provides sufficient fluoride for first 6 months Mature Milk Minerals Less minerals in breast milk than in cow’s milk Energy Needs of Lactating Women Energy needs are proportional to the amount of milk produced Maternal fat stores typically used up by 6 months Baboons fed 80% of usual energy intake – maintained production Baboons fed 60% of usual energy intake – reduced production Maternal Malnutrition Short term reduction or small decreases in energy intake – no decrease in milk production Energy intakes too low – reduced production Fluids Milk output is unrelated to fluid consumption Lactating mothers are encouraged to drink at least 23quarts / day Fluids Women advised to drink enough fluids to keep their urine pale yellow TASTE Flavors of some foods can pass into breast milk Flavors in breast milk can remain for up to 8 hours Occasionally foods can cause infant discomfort Taste Strong or spicy flavors may alter the flavor Mammary Gland Alveoli small, sac like milk producing areas Mammary Gland Milk produced travels into lactiferous ducts (mammary ducts) Lactiferous sinuses – store milk Stages of Lactation 1 Synthesis of milk 2 – Ejection of milk Galactagogues Substances believed to increased milk production Many cultures have their own substances believed to stimulate lactation Prolactin Stimulates milk synthesis Secreted by anterior pituitary Lactation Principal Stimulus is the suckling of the infant Lactation Oxytocin (Let down hormone) Secreted from posterior pituitary Myoepithelial Cells Triggers contraction of myoepithelial cells Rooting Reflex Induced Lactation Milk Ejection Can be inhibited by stress, anxiety, fatigue and distractions Can also become a conditioned response Lactation If milk is not regularly removed from breast, milk production stops Milk production can continue for several years if the child continues to nurse Milk Production Newborn infant typically nurses 1014 times in 24 hours Older infants need approx 6 feedings /day Weaning Should be done gradually over several weeks Minimum of two nursing times per day are needed for women to continue to make milk Wet Nurses Used as a source of human milk for infants not fed by their biological mothers Milk Banks Collect, store and distribute human milk Breast Feeding To some degree breast feeding has a contraceptive effect This effect is inconsistent Medications and Drugs Many drugs taken by mother appear in milk Some influence milk production or release Drug Use During Lactation GREEN: Safe not excreted in milk not absorbed by infant very low levels in infant with no obvious effect adverse effect minor Drug Use During Lactation YELLOW: Can be taken IF infant is monitored minor adverse effects (described or anticipated) insufficient information may suppress lactation Drug Use During Lactation RED: Unsuitable Drugs serious adverse effects (described or anticipated) Medications and Drugs Marijuana transfers and concentrates in milk absorbed by nursing infant Cocaine Can intoxicate an infant Medications and Drugs Infants can become drug addicts by way of breast milk Medicine and Drugs Medicinal herbs should be viewed as drugs Not regulated and not safety tested Alcohol and Breast Feeding Alcohol is transferred to breast milk > 2 drinks can decrease milk output Alcohol and Breast Feeding Milk levels will have similar concentrations to maternal blood Can overwhelm an infant’s immature alcohol degrading system Alcohol and Breast Feeding Occasional use, in limited amounts can be compatible with breast feeding Timing important Environmental Contaminants Some environmental pollutants, toxic metals and radioactive substances have been found in breast milk Environmental Contaminants Avoid use of pesticides Avoid exposure to solvents Avoid dry cleaners Avoid fish with high mercury Caffeine Large doses of caffeine can accumulate in the infant Moderate intake causes no problems Some babies may be more sensitive Smoking Associated with… decreased milk volume inhibition of milk ejection Exercise and Breast Feeding Exercise does not hurt milk quantity SIGNS BREASTFEEDING IS GOING WELL Some Barriers to Breastfeeding Lack of: Support, confidence, freedom embarrassment Misinformation Job Social concerns Medical conditions Baby Friendly Hospitals NFS 143 Nut in Life Cycle 08/26/2014 ▯ 8/26/14 ▯ ▯ cell turnover cells turnover and replace themselves. Some do it faster than others (RBC do it faster) ▯ ▯ what are the energy nutrients? Carbs, fats, proteins These ^^ are known as macronutrients (body needs large amounts) ▯ ▯ AMDR = acceptable macronutrient distribution range Set with lower and upper boundary Each nutrient group the AMDR represents a % of the total energy intake This % is thought to – o allow for adequate intake of other nutrients o reduce the risk of chronic diseases recommendations for adults are o carbs 45-65% o fats 20-35% o proteins 10-35% (>10 is a bad idea, but unsure of 35) ▯ ▯ George wants to consume 60% of his dietary intake from carbs. He eats 2400kcal a day. How many grams of carbs would George be eating? 2400kcal x .6 = 1440 kcal from carbs 1440 kcal / 4kcal/g = 360 grams of carbs ▯ ▯ in a 1600kcal diet, if someone ate 50% of kcal from carbs, how many grams of carbs is that? 1600 kcal x .5 = 800 800 kcal / 4kcal/g = 200 grams of carbs ▯ ▯ RDA = recommended dietary allowance ▯ AI = adequate intake ▯ UL = tolerable upper intakes ▯ EAR = estimated average intakes ▯ ▯ Different categories based upon your gender, age, pregnancy and lactation ▯ ▯ RDA = have to take a minimum of 3 days and take the average. One day doesn’t cut it. Established due to o Poor nutrition of recruits (WWII) o Food shortages o Prisoners of war Old RDAs was to prevent deficiency diseases (scurvy, blah etc) New RDAs are the best estimate of nutrient intake levels that promote optimal health For most people the RDA is higher than their real needs o Only way they can be inclusive in a population group Estimates the avg nutrient intake sufficient to meet the needs of 97- 98% of healthy individuals of a particular life stage and gender Not a straight line between dangerous and safe. There is marginal. If you need 60g per day, 59 or 61 will not harm you Reference point for individual clients o Essentially, planning diets for large groups ▯ ▯ EAR = Not used for guideline ▯ ▯ ▯ AI = ‘tentative RDAs’ used then RDAs cannot be determined based on less data estimated based on observations of the average nutrient intake that appears to maintain nutritional health by a group of apparently healthy people ▯ ▯ UL – tolerable upper limits Highest average daily intake level that can be tolerated without the possibility of causing ill effects o A level that is likely to pose no risk of adverse health effects to almost all individuals in a particular life style Applies to chronic daily use Based on total food intake: food, water, and supplements If you go over, pretty good chance you will have an adverse effect ▯ ▯ ▯ When Kate was 7, she drank 2 glasses of milk a day plus yogurt and consumed about 950 mg of calcium a day. She has continued that practice and she is now 14. Is Kate consuming a good amount? (4-8 100mg: 14-18 1300mg) not enough ▯ 25 year old John consumes lots of fruits and veggies during the summer as he works on a farm and gets free produce. His dietary intake shows vitamin A intake at 3835mcg. UL for vitamin A is 3000mg Not concerned bc he’s not taking supplements, its all natural. If it were supplements, might cause issues. ▯ 52 y/o Julia eats a varied diet but lots of chicken and peanut butter. Her diet shows intake of niacin is 47mg. is this a safe level? UL for niacin is 35mg. She’s ok. Not concerned. Only concerning if it’s coming from supplements. Since it’s coming from food she’s ok. ▯ Heidi, 27 y/o vegan. Her diet shows her folate intake is 985mcg. is this an acceptable level? RDA 400mcg : UL 1000mcg Vegan keep in mind. Why is it a problem if she has high levels of folate? Anemia can happen in vegans with high folate levels, and hides the early symptoms because B12 keeps those levels down. B12 only comes from animals so therefor she doesn’t have any. ▯ ▯ ▯ Nutrigenomics for disease prevention and intervention Genes affect how nutrients are metabolized Nutrients affect how genes are expressed and regulated GOAL o To understand how diet can be used …. ▯ ▯ Effects of Pre-Pregnancy Nutrition Poor nutrition can.. o Impair fertility o Acute under nutrition (normal weight women) Reduced fertility Holland 1943-1944- Famine o <1000kcal/day o 30-40 g protein o ½ of women stopped menstrual cycle o after about 1 year of famine, for most women fertility returned to normal once diet returned to normal o nutritional factors exert a temporary influence on fertility menstrual cycle is necessary for ovulation to occur no menstrual cycle = no ovulation = no babies o body fat also plays a role in reproduction plays a role in the fact that it secretes leptin & also estrogen and even a little testosterone leptin is an appetite hormone, also plays a role in reproduction low body fat means hormones change and high amounts mean the same thing. This affects reproduction o excessive weight loss and intense exercise cause often induce amenorrhea (loss of your period) commonly seen in intense athletes if you lose 10-15% very quickly it happens o Why does nature do this? (make your period stop due to certain circumstances) You don’t have enough reserves to feed and carry an infant. It disables you from becoming pregnant. Is this an adaptation response? THE ABOVE IS FOR UNDERWEIGHT WOMEN ▯ ▯ Obese women also have problems. They don’t release certain hormones that release the egg. Body fat whether high or low causes problems with fertility ▯ ▯ ▯ How does this effect males <20 million per milliliter is considered questionable sperm viability can decrease if o decreased motility o reduced numbers o reduced life span o impaired maturation o abnormal sperm (morphology) if someone were to lose 10-15% in short time, probably have decreased fertility rates because some of the issues above will happen very lean athletes often have reduced sperm production one factor in agglutination may be subclinical vitamin C o they all stick together and cant break apart o vitamin C is an antioxidant, so is vitamin E, selenium, beta carotene, zinc o zinc also plays a role in males with testosterone men who are very obese seem to be at risk for infertility o lower quality of semen o decreased count and decreased motility alcohol consumption effects sperm 9/2 primary deficiency intake related, don’t have nutrient in your diet secondary deficiency it might be in your diet, but you cant absorb it or utilize it Anemia 7-8% body weight is just from your blood about 5 liters of blood in the body (12 pints for men, 9 for women) 45% of blood is RBC o 25 trillion RBC in your body o where are RBC made? Bone marrow o You make approx. 2 million RBC every second o 1% of RBC replaced everyday RBC o No nucleus o Cant repair itself o Life span about 120 days o Unique shape allows to flow through capillaries o Hemoglobin = 1 molecule can carry 4 molecules oxygen 1 RBC has about 150 mil hemoglobin molecules hemoglobin o protein in RBC o gives pigment to RBC o carries 02 and co2 o when carrying oxygen, called oxyhemoglobin o contains iron in structure ▯ many forms of anemia no matter what type of anemia occurs, less oxygen and less co2 being removed classified based upon their appearance (size and color) o size for ex. macro and micro o color for ex. pale in color means less iron bc iron gives it color which nutrients when deficient can cause anemia? o **Iron, vitamin b12, folate (THREE BIG ONES) o vitamin c, vitamin b6, copper, protein (not huge conerns but they do) iron deficiency is the most common cause of anemia worldwide you can be iron deficient but not be anemic anemia occurs when there has already been a long stage of an iron deficiency iron gives RBC color, so the RBC will be more pale in color o iron also necessary to create hemoglobin o hemoglobin necessary for oxygen transport microcytic hypochromic anemia (comes from iron) blood is not sufficiently equipped to carry oxygen causes o low intake o insufficient abruption (harder for non-heme eaters) o increased requirements (during growth periods, pregnancy, etc) o increased excretion o insufficient release from storage o increased destruction o increased blood loss effects o PICA often seen with those who are iron deficient (eating ice) o Decreased growth o Decreased immune function o In childhood a deficiency can be very damaging o Shortness of breath or heart palpitations Transferrin transfers iron around the body Ferritin stores iron in the body Goal of treatments o Replenish iron stores o Understand and treat cause o Dietary changes to increase dietary absorbable iron o Supplements (never take single doses of iron supplement) o Eat red meat Heme iron vs non heme Heme comes from meat, best absorbed About 15% absorbed from heme 3-8% absorbed from non-heme eating vitamin C or absorbic acid increases amount of non heme you can absorb o some things can inhibit the absorption of iron oxalic acid, phytic acid, coffee and tea (tannins) ▯ ▯ Macrocytes are large cells in relations to RBC. ▯ Megaloblasts are immature RBC or cells ▯ ▯ Megaloblastic anemia – still has nucleus, no ability to carry O2 Large RBC, presence of immature cells, insufficient # of cells o Causes Lack of folate Lack of vitamin b12 Presence of inhibitors of DNA Normal body stores of folate can be depleted in 2-4 months when person has a folate deficiency diet o Folate REQUIRED for DNA replication o Symptoms pale skin irritable smooth and tender tongue diarrhea o supplements high levels in fruits and green leafy vegetables o Vitamin B12 Body can store large amounts of b12, 3-5 years can be stored Same anemia as a person with a folate deficiency Maintains the myelin sheath around your nerves ▯ Pernicious Anemia Symptoms (comes from b12 deficiency) o Numbness and tingling o Poor muscle coordination o Weakness o Nerve damage can be permanent o Untreated results in death o Requires intrinsic factor from the stomach to be absorbed properly Absolutely necessary in cases of b12 o Best way to get it is animal products but if you’re lacking intrinsic factor you need injections ▯ ** folate deficiency or b12 deficiency can produce a megaloblastic anemia ▯ ▯ ▯ ▯ ▯ PREGNANCY 10% of fetal growth in 1 half : 90% fetal growth in 2 ndhalf changes in 1 half of pregnancy o meet the demands of the placenta o build up mothers body (anabolic changes) building tissues and nutrient stores to help prepare for later in pregnancy nd changes in 2 half of pregnancy o meet fetal requirements (catabolic changes – broken down) o help prepare for labor, birth and lactation plasma volume increases 45-50% (increase known as Hemodilution) o begins about sixth week of pregnancy to prepare the increase needs of the fetus and the organs that need to help prepare it o increases rapidly in the second trimester o why is this increase needed? Extra blood flow to extra organs like uterus and kidneys Increase need for oxygen, volume increases to meet these needs The catch with the increase is that the increase in RBC volume is not as high. Just the plasma. RBC is about 20-30% Those who don’t have increase are often known to have still births Hemodilution o Increase in the plasma volume and a dilution in the other components o Also helps protect during childbirth because of excess blood loss Cardiac output o MUST be increased the assist in the circulation of increased blood volume o Heart size during pregnancy increases about 10-12% GI tract motility o Decreases (b/c more stuff is absorbed) o Slows passage of food (to absorb more stuff) o Increased absorption of some nutrients o Increased h20 absorption (when you have too much you have constipation) Increase fiber intake to help prevent constipation Increase fluids (when you increase fiber, you increase fluids, they’re hand in hand) Exercise can also help Consequence of pushing harder to go to the bathroom results in hemorrhoids Kidney function o Rate at which it filters blood is increased o Removal metabolic waste of fetus Other changes o Uterus expands – expands 150 folds o Breasts enlarge in preparation for lactation o Respiratory rate – increases Hormones o hCG = human chorionic gonatropin (hormone of pregnancy) o stimulates growth of placenta and fetus Nausea o 2/3 of pregnant women experience o 0-20% experience the whole pregnancy o may be a reaction to the hormone surge increase in hCG, increase in progesterone, increase in estrogen o can result in weight loss weight loss during early pregnancy needs to be avoided when you stop eating you have the issues with.. depletion of glycogen stores second fat and proteins reliance on breakdown fat products start to build up because they cant be metabolized fast enough body combines all of these to produce ketones HUGE issue with someone with nausea, cant keep any food down and you have problems with too many ketones in the body and that’s dangerous b/c it can causes issues with the fetus High ketones damage neurological development of fetus Woman will be hospitalized if she has significant dehydration, if she loses more than 5% of her pre-pregnant weight, high ketones o can be made less problematic with diet tricks are to eat smaller more frequent meals keep stomach full eating dry crackers before getting out of bed avoid highly seasoned foods and avoid greasy foods bland cold foods are better tolerated high carb foods and low fat foods are tolerated better Sever Nausea o “hyperemesis gravidarium” o 1-2% pregnant women have this o not easily managed cant keep anything down at all Edema o Accumulation of fluid, especially in lower limbs Happens a lot in the feet o Normal pregnancy – accumulation is gradual o Healthier women have a better chance of avoiding than those who aren’t healthy Metabolism o BMR increases by about 15-20% o Reflects increased energy costs of pregnancy o FAT is the primary maternal fuel o GLUCOSE is the primary fetal fuel o 1 half pregnancy insulin increases, therefor there’s an increase inversion of glucose to fat nd o 2 half pregnancy insulin resistance increases decrease conversion to fat decrease maternal utilization of glucose uses less glucose and more fat for HER energy source increase of fat mobilization for mother to use as energy Placenta o Temporary organ Complex network of tissue and blood vessels Made from tissue from both mother and embryo Placenta comes before fetus No placenta, no fetus o Completely separate blood supplies are maintained o Maternal and fetal blood NEVER mix o Produces hormones Manufactures hCG o Can weigh about 1.1-1.4 lbs at birth o Nutrients enter the fetal blood from the maternal blood o Exchange of 02 and c02 o Removal of the fetal waste products o Somewhat of a protective barrier Not perfect Cannot cross Maternal RBC Most bacteria (listeria and syphilis can cross) Whole proteins exception Immuunoglobins (IgC) Quite a few viruses can cross HIV herpes alcohol & drugs o size of placenta determines amount of nutrition available to fetus placenta size or numbers are 15-20% less than normal, infants experience intrauterine growth restrictions (IUGR) o mothers nutrient needs, fetal needs, placental needs order of priority : mothers come first, than placental, than fetal (b/c you need mom to make placenta than placenta to have fetus) Terms to know o Trimester = 3 month of pregnancy o Embryo = week 2 to end of 8 weekth o Fetus = end of week 8 to birth o Pregravid = weight before pregnancy o Gestation = pregnancy o Organogenesis = week 2-8 of gestation o Neonatal = 1 to 28 days after birth o Perinatal = 20 week of gestation to 28 days after birth Potential impact of nutrition o Greater at this time than during any other stage of life o It is genetically programmed how the fetus will grow and develop Organogenesis o Each developing organ depends on a supply of nutrients during its intensive growth Critical period (week 2-8) o Period when specific development occurs o If development of an organ is limited during the critical period, recovery is impossible o A vulnerable time for a developing embryo o Teratogen = substance that can interfere with the embryonic development causing birth defects Can be chemical, biological, physical, bacteria, virsues o Thalidomide (was given to help with morning sickness) Maternal chicken pox At least 10,000 birth defects and countless deaths 8 week old fetus at the end of organogenesis (barely over an inch, 0.2 oz) o complete CNS o beating heart o fully formed digestive system o beginning of facial features o beginning of development of major organs o fingers and toes 9/9 <5.5 lb increase heart disease as an adult small abdomen increase cholesterol as adult skinny at birth children increase risk of diabetes as adult high birth weight may lead to breast cancer as an adult Thrifty Genotype low quality fetal and infant growth followed by diabetes mellitus type 2 and metabolic syndrome caused by poor nutrition during early childhood Deficiencies in later stages increase in cell numbers then increase in the size of the cells impact can be much greater when its affecting cell numbers because it cant catch up, they cant be produced later congenital malformations present at birth Fetal consequences o Timing o Duration o Severity LBW (low birth weight) infants weighing <5.5 lbs (2500g) o U.S approx. 7.6% infants born each year o 64% all infant deaths o can occur 2 different ways premature birth , too soon and too small born on time but too small Premature o Infants born prior to 37 weeks o Comprise about 2/3 of LBW infants o LBW infants 30-40x increased risk of death during neonatal period (compared to normal birth weight infants) o LBW birth size closely related to mortality Factors affecting fetal growth o Cigarette smoking o Poor diet during gestation o Low weight gain o Low pre-pregnancy weight o Teen pregnancy (moms are still growing) o Closely spaced births o Multiple births (twins & triplets) o Drug and alcohol use SGA (small for gestational age) o 2 ways to classify dSGA disproportionally SGA weight <10 % normal length and head circumference approx. 2/3 of SGA in US catch up in growth is possible this means issues happened later in pregnancy skinny and very little subcutaneous fat pSGA proportionally SGA weight, length and head circumference <10% well proportioned – just very small experienced malnutrition through majority of pregnancy catch up growth is poor and not promising Maternal Weight Gain o Satisfactory measure of adequacy prenatal nutrition o Early 1900’s Eat everything and anything, and they did o 1950’s DON’T GAIN WEIGHT. Barely gain 10-15 lbs. restrict your diet. o Current recommendations Strongest predictors of infant birth weight are: Maternal weight at conception Gestational weight gain Underweight women: BMI < 18.5 Premature delivery IUGR Obese Women : BMI >30 Complications during pregnancy Newborns with excessive body fat Macrosomia (baby with excess body fat) o Weighing more than 8.13 lb LGA (large for gestational age) o Weight, length and head circumference are all greater than the 90% Recommended weight gains Normal BMI 18.5-24.9 … 25-35 lbs Low BMI < 18.5 …. 28-40 lbs High BMI >25-29.9 … 15-25 lbs Distribution of weight gain 1 trimester – mainly maternal tissue nd 2 trimester – both maternal and fetal tissues 3 trimester – fetal tissue Nutritional needs Women most likely to be poorly nourished often have other risk factors Socioeconomic Lifestyle factors Energy needs Increased BMR Changes in physical activity More calories needed, dependent on woman Protein Forms structural basis for all new cells and tissues st 1 trimester – fetal protein needs small, mothers higher 2 nd& 3 trimester – fetal demands accelerate RDA 1.1 g/kg First 20 weeks All amino acids for protein synthesis come from mothers diet Remaining 20 weeks Fetal liver able to synthesize some non essential amino acids Severe protein restriction Decrease in number of cells in infants tissues Can be severe in brain – irreversibly stunted Omega 3 o Linolenic Omega 6 o Linoleic Pregnant mothers should eat fish Cravings / aversions o Powerful urges towards or away from foods o Cravings Not due to nutritional deficiencies May be due to: Changes in taste and smell Metabolic changes Commonly craved Sweets and dairy products Avoided Coffee, tea, seasoned foods, fried foods, meats o PICA Ingestion of non food substances Poorly understood Sometimes associated with nutritional deficiencies Common PICA substances Dirt, clay, starch, ice Clay eating practiced daily by > 200 cultures worldwide PICA concerns Displacement of essential nutrients or Kcal Reduced absorption of nutrients Dental injury Constipation Infection Minerals o Calcium Mother transfers about 30 grams to fetus Most transfer occurs in last trimester – fetal skeletal bone development and teeth are forming Absorption of calcium increases and is highest in last trimester If mother doesn’t have enough for child then it’s withdrawn from her bones Most comes from her diet, but much comes from mothers reserves in her bones Appears to be replaced after pregnancy however if adequate calcium and vitamin D is consumed o Lead Bone holds lead Released when bone demineralize Can stay in body for decades Lead can cross placenta Fetal exposure can lead to LBW or premature birth or developmental delays o Iron Iron deficient can cause LBW and birth deficiencies No loss of Fe to menstruation Fe absorption increases One of new instances where fetus comes before mother Infants born with 3-6 months of iron stores Mothers breast milk is low in iron so baby doesn’t get much from them that’s why their reserve are so high Mother transfuses about 200-270 mg of iron to fetus during gestation If mother doesn’t have enough, fetal iron stores decrease This increases the risk for infant to have iron deficiency early in life because they don’t have enough stores Mother has severe anemia Increased risk of maternal mortality nd Srdplements of 30mg/day recommended in the 2 and 3 trimester Lowers risk of iron depletion for infant and making sure they have enough stores Greater than 30 mg Fe should take Zinc o Zinc Important roles in cell division and cell growth Zinc deficiency – highly teratogenic in rats 1 10-12 weeks in utero develop 1 set of teeth o iodine can impact neurological development of fetus if deficient before or after pregnancy cretinism or hyperthyroidism stunting mental development or physical growth can be found in iodized salt o sodium important role for fluid balance o vitamin A deficiency uncommon although is a problem if happens lots of important roles in body, including growth for cell differentiation excessive intake during pregnancy causes birth defects causes serious problems it rapidly goes into susceptible tissues and changes the cells. Especially the neural crest cells. UL for preg women is 3000 mcg / day Supplements > RDA should be avoided HOWEVER, if you’re pregnant in the summer eating garden fresh veggies, no worries, you’re okay o Vitamin D Deficiency results in poor fetal bone formation Vitamin D is essential for calcium absorption At risk for deficiency Little sun exposure High use of sun screen Consume little vitamin D fortified milk Raw milk Darker skin Beading along ribs (rachitic rosary) Softer tissue making up the surface area to hold the ribs together because of their lack of calcium Some studies show that high vit D supplement have decrease in infections, decrease in premature birth, decrease in pregnancy complications o Vitamin k Blood coagulation Prevents neonatal hemorrhaging Transfer from mother to fetus is minimal Therefor, newborns have low levels Low levels vitamin K in breast milk You have bacteria in your intestines that create some vitamin K that you then absorb Fetus has sterile intestines though so they cant make any vitamin K But they’re given a shot at birth to help them get it Prenatal supplements don’t seem to be effective o Vitamin C Scurvy Newborns can have scurvy if mother took supplements during pregnancy Large intakes may cause rebound scurvy in neonatal period o Folate Prior to pregnancy and during early pregnancy is essential Important for DNA Neural tube defects Affect about 3000 infants every year in US Critical period for neural tube formation is days 17-30 of pregnancy Later develops to become a neural tube defect A neural tube defect Spina bifida o Spinal cord and backbone do not develop normally o They fail to close This causes a gap, and spinal fluid appears as a sac on the outside of the body ▯ Lactation Breast feeding o Benefits of breast feeding Provides immunity for some diseases No prep needed – free of bacteria Fosters maternal bonding Promotes correct development of jaws and teeth Infant not likely to be overfed Speeds physiological recovery from pregnancy Less likely to develop breast cancer and osteoporosis Several nutrients are better absorbed than formula o Colostrum First fluid secreted from breast milk Yellow in color Rich in immune factors High carotene and vitamin A Transitional milk that ultimately changes to mature milk Fat and carb content starts to change Around 21 day changes to mature milk o Mature milk Watery in appearance Energy content of breast milk is 20 kilocals per ounce Many cells and compounds that protect baby from infection ^ these compounds are resistant to stomach acids so they aren’t so easily destroyed enteropathogenic factors – bacteria less likely to prevent disease in intestinal tract o protective factors supplies important non nutritional benefits not available in breast milk substitutes cant be added to formula or found in formula (the real milk stuff) lactobacillus bifidus factor unique to human milk encourages growth of beneficial bacteria limits growth of potentially harmful bacteria lactoferrin assists in iron absorption inhibits growth of some bacteria by making iron unavailable to them antibodies (immunoglobulins) secretory IgA – predominant one antibodies targeted against pathogens in immediate surroundings oligiosaccharids immune cells neutrophils and macrophages lymphocytes lysozymes antimicrobial enzyme secreted from macrophages destroys bacterial cell membranes o milk production volume dependent on demand can increase to meet demand of twins, triplets o maternal illness colds or ordinary infections have no effect on breast feeding breast milk transmission of HIV is well documented o mature milk – carbohydrate dominant carb is lactose not influenced by mothers diet lactose levels fairly constant o mature milk – protein amino acid content is ideal for human infant contains whey and casein proteins alpha – lactalbumin largest single amount of protein infant can easily digest taurine – very high levels in infant brain so it plays a role in brain development high in breast milk o mature milk - lipids lipids packaged in globule membrane allows emulsification of milk o mature milk – fat varies in fat content during single feeding average fat content is 3.5 – 3.8% single feeding foremilk released initially, low fat ; high nutrients hind milk – high in fat ; fat provides 50-55% kcal in breast milk is mother keeps switching back and forth between breast baby will get majority foremilk which is not great because they’re getting little to no fat and they need that fat total fat on affected by the mothers diet the type of fat is affected amount of fats wont vary but the types of fats will primarily triglycerides greater than 90% of content is triglycerides some phospholipids however also monoglycerides (which is one fatty acid attached to the backbone of glycerol) fatty acids high in linoleic acid omega-6 fatty acid in body is converted to arachidonic acid (ARA) high in cholesterol (actually, quite high) cholesterol content is not altered by diet not varied by how much mother eats high cholesterol might be important for nerve development and brain development, so its theorized that the high levels are important for those things to develop if exposed to high levels when they are young their body learns how to manage high levels so when they’re older the body will also know how to handle the levels and keep their body in check breast milk also contains linolenic acid omega-3 fatty acid EPA and DHA (also omega-3) high in DHA (omega-3) lots of DHA are transferred to fetus late in pregnancy high in ARA (arachidonic acid / omega-6) DHA and ARA believed to play a role in vision and neurological development Many infant formulas in the US do not contain added DHA and ARA Not a quality product if it doesn’t have it However, lots of reasons why its not added o Arguments against added it are numerous including ; 1) if you add it, it costs more – 10-15% more 2) DHA that would be used comes either form fish oil or from single celled algae or fungi from the lab [source not fully tested in infants, so cant determine its completely safe] 3) don’t really show a long-term significant difference between babies who had it and babies who don’t have it. So if no long term benefits, why add it. DHA and ARA recommended in formula for premature infants Should DHA and ARA be added to all formula in the US? Breast milk has lipase This helps baby break down products in breast milk o Mature milk – vitamins Most of the water soluble vitamins in human milk reflect maternal intake when intake is low Vitamin C thiamin riboflavin niacin vitamin b6 vitamin b12 folate – exception biotin “choline” pantothenic acid high intake will not increase that vitamin in milk Folate is an exception Folate levels in milk will be maintained no matter what the women’s intake is. It will come from her reserves. If they’re low, mom gets megaloblastic anemia and the baby is fine bc taking from moms reserves Fat soluble vitamins Mega doses of vitamin A increase the vitamin A content of breast milk to high levels Not a good thing. Don’t take supplements of vitamin A while breastfeeding. Breast milk is low in vitamin D Breastfed infant needs supplement or sunlight exposure o Vitamin D supplementation beginning at birth for breast fed infants who don’t receive enough sun exposure (due to being born in the winter, or in a naturally dark place) Maternal intake does not affect babies. Vitamin K Low levels in breast milk o Mature milk – minerals Minerals do not seem to correlate with maternal intake Lactation creates a substantial drain of body calcium Women who breastfeed have less risk of osteoporosis This is due to the fact that the bone loss for the babies needed calcium can start to be repaired and mother can actually restructure her bones where they might’ve been naturally weak before Calcium  in human milk remain fairly constant, even when maternal intakes are low Bone mineral content falls during lactation Dietary intake important to minimize bone less Maternal deficiency promotes mobilization of calcium from bone Prolonged lactation – insufficient calcium intake – women at risk Breast milk iron content remains fairly constant – regardless of maternal intake But highly absorbable Levels of fluoride in breast milk is low and varies little Human milk provides sufficient fluoride for first 6 months Less minerals in breast milk than cows milk Energy needs of lactating women o Energy needs are proportional to the amount of milk produced Mom uses her fat from pregnancy for first 6 months of lactation and for second 6 months uses her diet o Maternal fat stores typically used up by 6 months o Baboons fed 80% of usual energy intake – maintained production o Baboons fed 60% of usual energy intake – reduced production Maternal malnutrition o Short term reduction or small decreases in energy intake – no decrease in milk production o Energy intakes too low – reduced production Fluids o Milk output is unrelated to fluid consumption o Lactating mothers are encouraged to drink at least 2-3 quarts a day o Women advised to drink enough fluids to keep their urine pale yellow Taste o Flavors of some foods can pass into breast milk o Flavors in breast milk can remain for up to 8 hours o Occasionally foods can cause infant discomfort o Strong or spicy flavors may alter the flavor Mammary gland o Alveoli (little sacs like what you would find in the lungs) Small, sac-like milk producing area o milk produced travels into lactiferous ducts (mammary ducts) o lactiferous sinuses – store milk (not a separate space, just a wider area in the duct) stages of lactation o 1) synthesis of milk o 2) ejection of milk o galactagogues substances believed to increase milk production many cultures have their own substances believed to stimulate lactation fenugreek – believed to increase milk production (most common) not sufficient evidence to say whether or not it does fennel – also goats rue – same milk thistle ??
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