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uncg nutrition major

uncg nutrition major

Description

School: University of North Carolina - Greensboro
Department: Nutrition and Food Sciences
Course: Nutrition Through the Life Cycle
Professor: Lenka shriver
Term: Fall 2016
Tags: PregnancyConditions, infantnutrition, and breastfeeding
Cost: 50
Name: Exam Study Guide
Description: These notes cover the study slides for our exam
Uploaded: 10/27/2016
16 Pages 227 Views 0 Unlocks
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NTR Exam 2 Study Guide Conditions in Pregnancy  Obesity linked to unfavorable metabolic changes-know examples; Association with hypertension and GD  Unfavorable metabolic changes:   blood glucose levels   C-reactive protein levels   blood levels of insulin & insulin resistance   blood pressure  High Total, LDL-cholesterol & Triglycerides  Low HDL-cholesterol  Obesity associated with higher rates of  Stillbirth  Large for gestational newborns  Cesarean-section delivery  May increase risk of child becoming overweight or having Type 2  diabetes later in life  Hypertension (HTN) is defined as blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic blood pressure  Affects 6 to 10% of pregnancies  Stillbirths, fetal & newborn deaths, & other adverse conditions  “Pregnancy-induced hypertension” is being replaced with  “hypertensive disorders of pregnancy”  Preclampsia-Eclampsia  A pregnancy-specific syndrome occurring >20 weeks gestation  accompanied by proteinuria  Proteinuria—urinary excretion of ≥0.3 gram protein in 24-hour urine sample  (or >30 mg/dL protein or ≥2 on dipstick reading)   Eclampsia—occurrence of seizures not attributed to other causes  Diabetes: a leading complication in pregnancy  Forms of diabetes include: Type 1 diabetes—Results from destruction of insulin-producing cells of  pancreas  Type 2 diabetes—Due to body’s inability to use insulin normally, or  produce enough insulin  Gestational—CHO intolerance with 1st onset during pregnancy  All pregnant women should be screened at first prenatal visit.   Confirm positive result for any of following for diagnosis:  Hemoglobin A1c (A1c) >6.5%  Fasting plasma glucose >126 mg/dL (7.0 mmol/L)  2-hour glucose >200 mg/dL after 75 g oral load  Classic symptoms of hyperglycemia present  Random plasma glucose >200 mg/dL  Lactation  Recommendations: Exclusive breastfeeding for 1st 6 mos, continue w/ food  introduction until 12 mos  Who is likely to breastfeed less in our population?  Obesity and breastfeeding  Overweight & obesity prior to pregnancy & excess prenatal  weight gain breastfeed for shorter duration  Socioeconomic  Both low-income & more affluent mothers need breastfeeding  support  Physiology of Lactation  Mammary glands – the breasts, growth stimulated by estrogen &  progesterone  secretory cells - Cells in milk gland that are responsible for  secreting milk components into ducts  myoepithelial cells – cells lining the alveoli that contract during  letdown to cause milk ejection  alveoli – milk-producing cells that form cavities in the breast  (milk storage), contract during letdown which causes milk  ejection  Lactogenesis-production of milk  Lactogenesis I (birth to 2-5 days)   milk formation begins  Lactogenesis II (begins 2-5 days after birth)   increased blood flow to breast; milk “comes in”  Lactogenesis III (begins at ~10 day after birth)   milk composition is stable  Moms benefit most from a home visit by a lactation consultant  5-10 days after birth of baby  Hormonal control of lactation  Estrogen – causes development of ducts in breast  Progesterone - causes development of alveoli in breast  Oxytocin - Hormone produced during letdown that causes milk  to eject into ducts Stimulates letdown  Tingling of the breast may occur   corresponding to contractions in   milk duct  Causes uterus to contract, seal blood vessels, & shrink in  size  Prolactin – stimulates the production of milk, Released in  response to:   suckling, stress, sleep,   & sexual intercourse  Letdown reflex- milk is released from the secretory cells of the aveoli &  transported from ducts to the nipple, stimulated by oxytocin  Human milk composition changes:  over a single feeding, over a day,   based on infant’s age, presence of infection in the breast, with menses, & maternal nutrition status Colostrum- The first milk secreted during the first few days  postpartum  Very high in proteins such as secretory Immunoglobulin A &  lactoferrin  Only a very small amount needed for the newborn Mature milk Water  Major component in human milk  Isotonic with maternal plasma Energy  ~0.65 kcal/mL  Calories may vary with fat, protein and carbohydrate composition  Lower in calories than human milk substitute (HMS) Lipids provide approximately 50% of the calories in human milk  Effect of maternal diet on fat composition  Fatty acid profile reflects dietary intake of mother  Very  fat diet with adequate CHO & protein, milk is  in medium-chain  fatty acids  DHA (docosahexaenoic acid)  Essential for retinal development  Associated with higher IQ scores Trans fatty acids  Present in human milk from maternal diet Cholesterol  Higher in human milk than HMS  Early consumption of cholesterol through breast milk appears to be  related to lower blood cholesterol levels later in life Total proteins  Lower than in whole cow’s milk (0.32 vs. 0.96 g/fl oz)  Have antiviral & antimicrobial effects  Casein  Main protein in mature human milk  Facilitates calcium absorption  Whey  A soluble protein that precipitates by acid or enzyme  Some minerals, hormones & vitamin binding proteins are part of whey  Includes lactoferrin, an iron carrier Carbs  Lactose  Dominant CHO in breastmilk  Enhances calcium absorption  Oligosaccharides  A medium-length CHO  Prevent binding of pathogenic microorganisms to gut, which prevents  infection & diarrhea  Comparisons between colostrum and mature milk  Colostrum  Mature Milk First few days postpartum

High in protein


 Who is likely to breastfeed less in our population?



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 Comparisons between mature milk and HMS Mature Milk HMS Less calories

Higher cholesterol More protein

 Taste of human milk  Flavor of foods in mother’s diet influences taste of breast milk  Infants seem more interested in mother’s milk if flavor is new   Exposure to a variety of flavors  contribute to infant’s interest & acceptance of new flavors in solid  foods  Benefits of breastfeeding  For mother:  Hormonal benefits  Increased oxytocin stimulates uterus to return to pre pregnancy status  Physical benefits  Less postpartum bleeding and more rapid uterine  involution  Delay in monthly ovulation resulting in longer intervals  between pregnancies  Psychological benefits  Increased self-confidence & bonding with infant  For infant:  Decreased risk for lower respiratory tract infections  Reduced incidence of otitis media Reduced incidence of GI infections  Reduced risk of SIDS  Reduced incidence of clinical asthma, atopic dermatitis and  eczema  Reduced risk of developing celiac disease in infants who were  breastfed at time of gluten exposure  Reduced risk of childhood inflammatory bowel disease  Reduced risk of obesity with each month of breastfeeding  associated with a 4% reduction in risk  Reduced incidence of Type 1 diabetes  Reduced risk of leukemia  Cognitive benefits  Studies show an increase in cognitive ability even after  adjusting for family environment  Analgesic effects  Reduction of infant pain  Socioeconomic benefits  Decreased need for medical care  Breastfeeding potentially reduces obesity risk by developing hunger &  satiety ques, & has less protein than HMS  Pumping or expressing milk  Several different methods are available  Manually  Hand pumps  Commercial electric pumps  Hospital grade electric pumps  To stimulate adequate milk   may require 8-12 expressions per day  Milk synthesis is related to:  How vigorously an infant nurses  How much time the infant is at the breast How many times per day infant nurses  Feeding frequency  10-12 feedings/day are normal for newborns  Stomach emptying occurs in ~1½ hours  The size of the breast & ability to nurse  Is feeding frequency related to the amount of milk a woman makes?  Rate of milk synthesis is variable between breasts & between feedings  Conditions necessary for successful breastfeeding: appropriate  positioning, adequate letdown and milk production  Infant reflexes and breastfeeding  Definitions-know the major reflexes  Gag reflex—prevents infant from taking food and fluids into  lungs  Oral search reflex—infant opens mouth wide when close to  breast & thrusting tongue forward  Rooting reflex—infant turns to side when stimulated on that side  Feeding frequency  Know the general amount and # feedings/day from birth to 4  months  Vitamin supplements for breastfeeding infants  Vitamin K - all U.S. infants receive injections at birth  Vitamin D - exclusively breastfed infants need supplements at 2  months  Fluoride—for breastfed infants after 6 months or if in any area  with no fluoridated water  Iron— after 4 months if breastfed  Vitamin B12—for vegans  Maternal diet  Energy needs vary by activity level  DRI is based on an “active” physical activity   330 kcal/day for the 1st 6 months 400 kcal/day-2nd 6 months  The caloric DRI assume a loss of 0.8 kg/month  A single recommendation for energy needs could never address  all of the individual variation in energy needs  Diet influence on human milk composition and volume  Weight loss appropriate during lactation?  What does the DRI assume in terms of weight loss?  Exercise and lactation? Current recommendations are….  What is WIC and who does it serve? What types of services does WIC offer? Conditions in lactation  Infant colic  Defined as crying for more than 3 hours a day – no medical cause  Components of maternal diet may be related to infant colic  Disappears after 3rd-4th month  More likely with  Cow’s milk, onions, cabbage, broccoli, & chocolate Infant Nutrition  Nutrition is an important contributor to the complex development of infants  Birthweight and infant mortality  Motor and cognitive development  Energy and nutrient needs  Physical growth assessment  Infant feeding skills  Birthweight as an Outcome  Full-term infant (37 to 42 wks)  Typical weight 2500-3800 g (5.5 to 8.5 lbs)   Typical length 47-54 cm (18.5 to 21.5 in)  88% of U.S. infants are born full-term Definitions:  Infant mortality  Social and economic status   Access to health care  Medical interventions  Teenage pregnancy  Availability of abortion services  Failure to prevent preterm & LBW births  Standard Newborn Growth Assessment  “Appropriate for gestational age” (AGA)  “Small for gestational age” (SGA) and “intrauterine growth retardation” (IUGR) mean newborn was <10th % wt/age  “Large for gestational age” (LGA) means newborn was >90th % wt/age  Reflex—automatic response triggered by specific stimulus   Babinski – baby’s toes fan out when sole of foot is stroked  Blink – baby’s eyes close in response to bright light/loud noise  Moro – baby throws its arm out, then inward (hugging motion)  immature CNS results in inconsistent cues for hunger and satiety ;Strong  reflexes, especially suckle and root (reflexes are protective for newborns);  Motor and muscle development  Motor development: ability to control voluntary muscles  top down, controls head first and lower legs last  Muscle development   from central to peripheral  Influences ability to feed self & the amount of energy expended  Critical periods  A fixed period of time in which certain behaviors or developments  emerge  Necessary for sequential behaviors or developments  If the critical period is missed, there may be difficulty later on Digestive System Development  Fetus swallows amniotic fluid which stimulates intestinal maturation  and growth  At birth the healthy newborn can digest fats, protein and simple sugars  Common problems include gastroesophageal reflux (GER), diarrhea,  and constipation  Identifying hunger and satiety  infant bringing hands to mouth, sucking on them, & moving head from  side to side  crying-late sign of hunger  Parenting & infant clues; temperament of the child  Energy & nutrient needs of infants: Dietary Reference Intakes (DRI), National  Academy of Medicine, AAP and ANAD  Energy (Calories):   108 kcal/kg/day from birth to 6 months (range from 80 to 120)  98 kcal/kg/day from 6 to 12 months  Factors that influence calorie needs  Weight and growth rate  Sleep/wake cycle  Temperature and climate  Physical activity  Metabolic response to food  Health status/recovery from illness  Protein and fat needs vs adults?  Protein Needs (RDA g/kg/d)  1.52 g/kg/day from birth to 6 months  1.2 g/kg/day from 6 to 12 months  How much is that?  Newborn weighing 4 kg (8.8 lbs) needs 1.52 X 4 = 6.08 g protein  6-month-old weighing 8 kg (17.6 lbs) needs 1.2 X 8 = 9.6 g protein  Protein needs are similar to that of energy but are also influenced by  body composition  Fat Needs  No specific recommended intake level for infants  Breastmilk contains about 55% kcal from fat  Cholesterol needed for gonad and brain development  Breast milk contains short-chain and medium-chain fatty acids (in  addition to the long-chain)  Easier to digest and utilize than long-chain fatty acids  allow infant to nurse on one breast as long as they want to ensure they get hindmilk   high fat content that provides satiety  high lactose content of foremilk may cause diarrhea  Metabolic rate of infants is highest of any time after birth  The higher rate is related to rapid growth and high proportion of  muscle  Low carbohydrate and/or energy intake results in protein catabolism  impacting growth  Micronutrient Needs  Fluoride—0.01 - 0.5 mg/d depending on age (too much may cause  tooth discoloration)  Vitamin D—400 IU/day (200 IU for all infants in the first 2 months of  life); 200 IU supplemental vit. D for exclusively breastfed or those who  consume less than 500 ml of formula per day   Sodium—120-200 mg/day  Iron – 11 mg for infants 7-12 months  Breastfed infants: minimal iron needs through diet from 0 to 4 or 6  months  Formula-fed infants: needs met through iron-fortified formula  Fiber—no recommendations  Lead—None—may be toxic   Growth assessments Newborns grow faster than any other time of life  Growth reflects:   Nutritional adequacy  Health status   Economic & environmental adequacy  There is a wide range of growth =normal  Calibrated scales & recumbent length measurement board required for accurate measures  Growth measures in both  Weight for age  Length for age  Weight for length  Head circumference for age  Types, differences between WHO and CDC  Cow’s milk in infancy  Whole, reduced-fat or skim cow’s milk should not be used in infancy (AAP &  ANAD’s Pediatric Practice Group)  Iron-deficiency anemia linked to early introduction of cow’s milk   Anemia linked to:  GI blood loss  Low absorption of calcium & phosphorus   Displacement of iron-rich foods  Soy protein in place of milk protein should be limited in its use  Used for vegetarian diets; lactase deficiency   The use of soy formula is not recommended  For managing infantile colic  Lactose free and hydrolyzed formulas are better for infants  unable to breastfeed or be fed cow’s milk formulas  If baby has sensitivity to proteins in cow’s milk  Feeding skills Infants born with reflexes & food intake regulatory mechanism; Inherent  preference for sweet taste  At 4-6 wks, reflexes fade; infant begins to purposely signal wants & needs  Cues infants give for feeding readiness:  Watching the food being opened in anticipation of eating  Tight fists or reaching for spoon  Irritation if feeding too slow or stops temporarily  Playing with food or spoon  Slowing intake or turning away when full  Stop eating or spit out food when full  Introduce foods slowly, while facing baby  Texture issues in infants  Can swallow pureed foods at 6 months  Early introduction of lumpy foods may cause choking  Can swallow very soft, lumpy foods at 6-8 months  By 8-10 months, can eat soft mashed foods   Offer water or juice from cup after 6 months  Wean to a cup at 12 to 24 months  First portion from cup is 1-2 oz  Early weaning may result in plateau in weight (due to reduced  calories) and/or constipation (from low fluid intake)  Changing from a bottle to a covered “sippy” cup with a small  spout is not the same developmental step as weaning to an  open cup  Open cup drinking skills also encourage speech development  Water needs of infants  Breast milk or formula provide adequate water for healthy  infants up to 6 months  Dehydration is common in infants  Pedialyte or sports drinks provide electrolytes but lower in  calories than formula or breast milk Limit juice   Failure to thrive (FTT)   Inadequate weight or height gain  Energy deficit is suspected  Intervention for FTT  May be complex and involve a team approach including the  registered dietitian, social worker Toddler & Preschool Nutrition  Under 2 years of age (WHO)  Weight-for-length measure  >95th percentile considered overweight  < 5th percentile considered underweight  Over 2 years old (CDC)  Body Mass Index-for-age percentiles used  The 85th or greater, but less than 95th percentile = overweight  >95th percentile considered obese weight status  Specific measures to focus on with this age group and why?  Temperaments & relation to feeding  Temperament—the behavioral style of the child   Three main temperamental clusters:  40% “easy” temperaments  10% “difficult” temperaments  15% “slow-to-warm-up”  Remaining styles are “intermediate-low” to “intermediate-high”  9-10 months—weaning from bottle begins  12 to 14 months—completely weaned  12 months—refined pincer grasp  18-24 months—able to use tongue to clean lips & has developed rotary  chewing  Parent vs child responsibility-Ellyn Satter philosophy Parent Child When How much Where Eating/not eating What


 What is WIC and who does it serve?




 What does the DRI assume in terms of weight loss?



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