HNF260-Exam3StudyGuide.pdf HNF 260
Popular in Principles of Human Nutrition
Popular in Nursing and Health Sciences
verified elite notetaker
This 26 page Study Guide was uploaded by Brittany Ballog on Sunday September 27, 2015. The Study Guide belongs to HNF 260 at Michigan State University taught by j. ekstrom in Spring 2014. Since its upload, it has received 56 views. For similar materials see Principles of Human Nutrition in Nursing and Health Sciences at Michigan State University.
Reviews for HNF260-Exam3StudyGuide.pdf
Report this Material
What is Karma?
Karma is the currency of StudySoup.
You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!
Date Created: 09/27/15
PreExam Review Chapter 15 Trace minerals Iron Fe Foods Heme iron meats D wellabsorbed Nonheme iron leafy greens l less bioavailable than heme iron Iron is added to forti ed grains RDA menstruating women need more than men Women39s needs drop to equal men39s needs after menopause De ciency Iron is the most common trace mineral de ciency Iron de ciency anemia At risk premature infants young children females of childbearing age vegetarians Toxicity Children can get toxicity due to overconsumption of chewable vitamins Toxicity from frequent blood transfusions iron accumulates 0 Hard to get rid of excess iron from the bloodstream Iron Absorption Ef ciency of absorption depends on the body s needs for iron size of iron stores quotmucosal blockquot mechanism that prevents absorption of excess iron Intestinal absorptive cells produce ferritin More ferritin produced when blood iron levels are high Ferritin binds iron traps the iron in the absorptive cells of the SI Remember absorptive cells have rapid turnover Every 4 or so days cells die D dead cells and the Ferritin trapped Fe are shed into GI tract and go out in the feces If iron is needed by the body Iron is transferred to bloodstream where it binds to the transport protein transferrin Cells in body have receptors that bind transferrin endocytosis brings Fe into the target cell Factors Affecting Iron Absorption Factors that reduce absorption of nonheme iron Phytic acidphytates in whole grains legumes Oxalic acid in leafy greens polyphenols in coffeetea high ber Factors that enhance absorption of nonheme iron Meat protein factor MPF eating meat sh or poultry in the same meal as leafy greens increases iron absorption 0 Vitamin C Acidity stomach acid or acidity in food 0 Functions of Iron Part of Hemoglobin and Myoglobin oxygen transport Redox oxidationreduction reactions Ironcontaining enzymes Zinc Zn Meat and seafood best source in wheat and nuts too Absorption Transportation Storage and Excretion Mucosal block similar to Iron Metallothionine binds Zn in intestinal cells High amounts of iron intake can reduce Zn absorption Functions Many different enzymes require zinc as a cofactor CopperCu In variety of foods liver shell sh nuts seeds lentils 0 Transport protein ceruloplasmin brings Cu to cells Toxicity Risk of liver damage neurological damage Functions Component of several Cucontaining metaloenzymes 0 Needed for Connective tissue formation Manganese Mn In plantbased foods Whole grain foods nuts legumes leafy greens tea Very little in meat and dairy Binds to alpha2macroglobulin for transport to the liver then transported to other tissues by one of several carrier proteins Functions Cofactor for several enzymes 0 Toxicity neurological impairment Parkinsonslike symptoms muscle stiffness tremors Iodine I Has only one function Synthesis of Thyroid hormones T4 circulating form of the hormone T3 active form of the hormone in cells Selenium is also needed to produce T3 Iodine accumulates in the thyroid gland excess excreted in urine Foods Saltwater seafood seaweed iodized salt and dairy products 12 tsp iodized salt meets RDA Processed foods often use uniodized salt sea and specialty salts are usually uniodized o Bioavailability Goitrogens compounds in raw veggies and some other foods decrease uptake of iodine and also inhibit iodine use by thyroid gland Cooking destroys goitrogen activity 0 De ciency and Toxicity Both de ciency and excess result in enlargement of thyroid decreased hormone synthesis De ciency Iodine De ciency Disorders IDD Endemic goiter enlargement of thyroid gland TSH thyroidstimulating hormone stimulates thyroid enlargement in attempt to more ef ciently trap lodine With longterm de ciency metabolism slows serious complications Endemic cretinism abnormalities to offspring during development that affect brain development and physical growth Toxicity Occasionally hyperthyroidism autoimmune thyroid issues thyroid cancer Selenium Se Seafood meats grains and cereals 0 Absorption Most comes in through amino acids protein Selenomethionine selenocysteine 0 Functions Component of over 25 different enzymes and proteins Antioxidant defense network Glutathione peroxidases contain selenium prevents cell membrane damage Thyroid metabolism conversion of T4 T3 0 De ciency Thyroid issues increased risk of certain cancers Chromium Cr May enhance insulin action and help normalize blood sugar levels Fluoride F Added to tap municipal water in many but not all communities helpful in preventing dental caries Stored in teeth and skeleton Promotes remineralization of tooth enamel Ca and P Fluoride toxicity rare but lifethreatening Molybdenum Mo and Ultra Trace Minerals Don39t worry about these Chapter 10 Energy Balance Weight control Eating disorders Energy Balance Energy intake vs Energy expenditure 0 Identify conditions of positive energy balance gain weight vs negative energy balance lose weight 0 De nition of kcal the amount of energy to raise the temperature of 1 kg water 1 degree C bomb calorimeter for measuring energy content of food understand principle 0 measured gross energy values are higher than the physiological fuel values 4497 Gross Energy Values Protein 56 kcalg Carbs 42 kcalg Lipids 93 kcalg Physiological Fuel Values Protein 4 kcalg Carbs 4 kcalg Lipids 9 kcalg Alcohol 7 kcalg Why Absorptiondigestion not 100 ef cient ie urea is excreted when metabolizing protein Obesity 0 BMI weight in kgheight in metersquot2 o Overweight BMI gt 25 o Obese BMI gt 30 0 About 23 of adults are overweight g obese 0 Michigan over 30 obesity now huge upward trend over the last 20 years 0 Table 102 obesityrelated health concerns be able to recognize Energy Expenditure Basal metabolism energy expended at rest in fasting state basic body processes 0 6070 of total energy use 0 Basal Metabolic Rate in uenced by lean body mass body surface area nutritional state pregnancy caffeine and tobacco o BMR goes down when losing weight D metabolism becomes more efficient 0 Physical activity 0 2035 of total energy use 0 Thermic effect of food TEF 0 510 of total energy use 0 Energy cost of digesting absorbing and metabolizing food 0 Adaptive thermogenesis Nonexercise activity thermogenesis NEAT o Calorie expenditure that accompanies physical activity other than volitional exercise Fidgeting shivering etc 0 Response to cold temperature conditions 0 Related to quotBrown fatquot fat cells that are rich in mitochondria and burn energy to create heat Measuring Personal Energy Expenditures Direct Calorimetry measures heat released from the body 0 Indirect Calorimetry measures oxygen consumption and carbon dioxide release 0 Food 02 C02 H20 heat 0 Respiration measurements D Measure 02 or C02 during experiment Estimation of Energy BMR amount of energy at rest in a fasting state 0 For women 09 kcalkg body weight hour 0 For men 10 kcalkg body weight hour 0 Physical activity contribution o Sedentary add 2040 of BMR 0 moderate activity add 5565 of BMR 0 heavy activity add 80100 of BMR TEF thermic effect of food 10 of BMR PA 0 Total energy estimate BMR physical activity contribution thermic effect offood Estimated Energy Requirements EERs Based on calculation using age weight height physical activity level 0 Different equations for men and women 0 This is what was used in SuperTracker our diet assessment calculations Hunger Hunger is the phvsiolooical drive to nd and eat food 0 Controlled in part by interactions of the gut liver and central nervous system 0 Hypothalamus integrates regulation of food intake 0 Understand difference between hunger physiological and appetite psychological Hunger signals 0 Blood glucose is one signal to regulate feeding o Hormones involved in hunger stimulating hunger and feeding Neuropeptide Y agoutirelated peptide endorphins ghrelin and glucocorticoids inhibiting hunger and feeding CCK secreted by intestinal cells 0 Slows gastric emptying increases pancreatic secretions contracts gall bladder and helps you feel satiated Insulin responsible for glucose regulation but also helps you feel satiated o Leptin produced by fat cells 0 Larger fat cells produce more leptin o Leptin travels via blood to hypothalamus to decrease food intake 0 People with larger fat cells often become resistant to the food decreasing actions of leptin and insulin Body Mass Index BMI Weight in kgheight in meters2 0 BMI does not directly measure body fat 0 Healthy People 2020 Physicians instructed to calculate and track BMI on patients Healthy weight l BMI of 185249 Overweight l 25299 BMI Obese D BMI over 30 Obesity Health Risks Risk factor for type 2 diabetes 10 of adults have diabetes 0 About a third of the obese population is type II diabetic Increased risk for CVD stroke hypertension 0 Type II diabetes increases risk of CVD amp stroke 34x Increased risk forjoint problems surgical risk some cancers Measurement of Body Fat Underwater weighing measures body density from which fat is calculated Bioelectrical impedance 0 Low voltage current run through body Skinfold measurements 0 Estimate of subcutaneous fat DEXA xray scan measures bone density Desirable fat ranges women 2135 0 Too low not enough leptin produced reproductive hormone release diminished menstrual cycle will stop 0 men 8 24 Body Fat Distribution 0 Upper body android obesity related to more health risk 0 Waist circumference gt 40 inches for men and gt35 inches for women increase health risk 0 Lower body obesity hips legs rear D less health risk 0 After menopause fat distribution shifts towards belly fat in women Genetics of obesity Overweight parents D increased chance of obesity in offspring Environment also plays an important role in obesity Treatment of Obesity 0 focus on active lifestyle over dieting Body resists weight loss basal metabolism drops as weight goes down 0 Only 5 of people who follow commercial weight loss programs lose weight and maintain the weight loss after 5 years o If overweight or obese weight loss ofjust 10 may reduce disease risks 0 Prediabetic state blood lipids blood pressure can all improve 0 Increased physical activity without any weight loss may also reduce disease risks Results in shift in body composition toward more lean body mass 0 First concern should be to PREVENT further weight gain Energetics of Body Fat Loss 0 One pound of adipose tissue contains 3500 kcal o A de cit of 500 kcalday is necessary to lose onepound adipose tissue per week 0 Decrease food intake by 250 kcal AND 0 Increase energy expenditure by 250 kcal Control of Energy lntake Weight Loss 0 control intake to prevent further weight gain 0 Plan to lose no more than 1 pound of body fat per week 0 This will require a reduction of 500 kcalday 0 Do not try to consume lt1000 kcalday o Emphasize nutrientdense foods Regular Physical Activity 0 Recommend both sustained aerobic exercise and weight training 0 energy expenditure 0 lean body mass preservation o Maintains basal metabolic rate Professional Assistance 0 For candidates with BMI gt30 or health risk and BMI gt27 hypertension diabetes 0 Pharmaceuticals not effective by themselves amphetamines lipase inhibitors 0 Very low calorie diets under medical supervision 0 Surgery 0 Gastric bypass LAPBand 0 only for people with a BMI of at least 40 for 5 years 0 effective for weight loss in severe cases 0 creates longterm nutrition absorption problems BlZintrinsic factor Fad Diets 0 Promote quick weight loss not effective longterm o a quick 510 lb drop won39t be loss of fat more typically water and glycogen Disordered Eating o distorted body image 0 Dieting to become thin may lead to an eating disorder 0 genetic connection to eating disorders runs in families Eating disorders 0 Disordered eating 0 Experienced by most of the population from time to time 0 Usually no longterm physiological effects 0 Holidays an occasional binge Occasional stressinduced or emotional eating or other unhealthy foodrelated behaviors 0 Eating disorders Genetic connection 0 More than 50 percent of the risk for developing a disorder is because of genetic risk factors 0 Eating disorders up to 5 of the population 0 Anorexia nervosa psychological denial of appetite The most serious eating disorder Anorexics likely to develop heart problems High suicide rate Depression common Characterized by an intense fear of obesity and weight gain Depletion of nutrients including potassium damaging to heart function Diagnostic Criteria Denial of hunger and underweight Irrational intense fear of gaining weight 0 Excessive loss of body weight 0 lt 85 of expected weight or BMI lt 175 0 Loss of menstrual cycle amenorrhea for 3 consecutive months Pro le of anorexia nervosa Occurs in 1 out of every 200 adolescent girls in North America 510 times more common in females Typically develops in adolescence puberty False body perception view themselves as much larger than they actually are High family expectations Finds security in control tends to be obsessive competitive Preoccupied with food Lack of menses for girls amenorrhea Warning signs Abnormal eating habits eating very little food Hiding and storing food Preparing large meals for others but not eating them Withdrawal from friends and family Selfcritical Sleep disturbances and depression Physical changes quotSkin and bonesquot appearance Lowering of body temperature Lower basal metabolic rate Appearance of lanugo ne downy body hair Iron de ciency anemia and other nutrient de ciencies weakened immune system amenorrhea o Leads to bone metabolism problems 0 Destined for osteoporosis Treatment Prevent further weight loss lncrease food intake try to raise the BMR Restore appropriate food habits Hospitalization if under 75 of expected weight Psychological 0 Cognitive behavioral therapy 0 Determine underlying emotional problems 0 Reject the sense of accomplishment associated with weight loss 0 Family therapy support groups Recovery Many never fully recover from anorexia nervosa May return to a normal body weight but still have anorexic tendencies o Bulimia nervosa bingeing and purging 0 Diagnosis binge at least 2 times a week for at least 3 successive months 50 have major depression Feelings of guilt depression low selfesteem Preoccupied with food Cycle of rigid food intake and binges Involves episodes of bingeing followed by attempts to purge Purging behavior involves vomiting excessive exercise or use of laxaUves Individuals recognize this behavior is abnormal Many are not diagnosed secretive easy to hide this behavior Pro le of a bulimic Young usually female adults May be predisposed to becoming overweight Usually at or above normal weight Tried frequent weightreduction diets Impulsive and thinks of food constantly Allor none thinking quotIf I eat one cookie I m a failurequot l followed by binge Usually from disengaged or detached families Binge consists of convenient high sugar high fat foods Purge by vomiting in hopes that food does not get absorbed Health problems with bulimia nervosa Vomiting causes many problems Demineralization of teeth dental caries Drop in blood potassium Swelling of the salivary glands Ulceration of the stomach and esophagus Constipation due to lack of ber Treatment of bulimia nervosa Establish healthy normal eating habits Decrease episodes of binging and purging Psychotherapy to improve selfacceptance Group therapy Possible antidepressant drugs Bingeeating disorder binges followed by guilty feelings no purging Orthorexia nervosa extreme focus on healthy eating 0 an obsession with healthy eating Be aware of 2012 National College Health Assessment for MSU students 0 1 percent of MSU students diagnosed with anorexia nervosa 0 About 08 percent of MSU students are diagnosed with bulimia nervosa o 25 percent of students suffer from some form of eating disorder and three times that many have a distorted relationship with food 0 About 70 percent of students are at or below the recommended body mass index yet about 50 percent stiIare trying to lose weight Chapter 11 Sports Nutrition Female athlete triad Prevalent in gymnasts dancers and some other sports Energy de cit disordered eating andor overtraining Amenorrhea due to low body fat Irreversible Bone loss osteoporosis due to amenorrhea o Leptin and estrogen are needed for normal bone mineral density 0 Many are destined for osteoporosis later in life due to a low peak in O O O 0 bone mineral density 0 Bone density similar to that of 5060 year olds increased risk of fractures Treatment for female athlete triad OOOOOO Reduce preoccupation with food weight and body fat Increase meals and snacks gradually Rebuild body to healthy weight at least 25 increase Establish regular menses Decrease training by 1020 Calcium supplementation for bones Sports Nutrition 0 Healthy People 2020 Objectives include focus on physical activity 0 0 Objective increase proportion of adults meeting the 2008 quotPhysical Activity Guidelines for Americansquot 2008 Physical Activity Guidelines for adults 150 minutesweek of moderate activity g 75 minutes week of vigorous activity Strength training 2 timesweek 0 Bene ts of Physical Activity O 0000 0 Lower risk of early death CV diseases diabetes hypertension colon and breast cancers Prevent weight gain and facilitate weight loss when combined with diet Prevent falls reduce depression and better cognitive function with aging Weight maintenance after weight loss Lower risk of hip fracture Increased bone mineral density Improved sleep quality Lower risk of lung and endometrial cancers Energy Sources for Intense Exercise 0 ATP in muscles is sufficient for only 24 seconds of muscle contraction o Phosphocreatine 10 seconds to a minute of muscle contraction o Allows some more ATP to be generated 0 Anaerobic shortterm energy hard exercise without oxygen 0 Glucose is only energy source to supply ATP o Glycolysis to pyruvate converted to lactate o 2 ATP generated per glucose 0 Glycogen stores 0 Aerobic Pathway with oxygen 0 Glucose metabolism to C02 H20 36 ATP 0 Can be sustained for hours 0 Muscle glycogen can last for 2hr after depletion can work at 50 of max quotHitting the wallquot 0 Depletion of muscle glycogen over time causes fatigue Fat Main fuel for prolonged lo W intensity exercise Fat metabolism provides more energy than carbohydrates but is less ef cient Training affects muscle use of fatty acids Know how exercise intensity relates to use of fats vs carbs as energy source for muscles 0000 Protein 0 A minor fuel source during exercise 5 15 in endurance exercise 0 Energy comes from the branched chain amino acids 0 Directly or via gluconeogenesis 0 Eating more protein than what the body needs will not increase muscle mass Endurance training metabolic results changes to cells 0 Increased ability to store glycogen 0 Increased triglyceride storage in muscle 0 Mitochondria Increased size and number 0 Increased myoglobin in muscle Effects of Aerobic Exercise and Training Increases red blood cell production to deliver oxygen Increases total blood volume Increases the number of capillaries in muscle tissue Strengthens the heart muscle Increases the number and size of mitochondria Increases muscle leCOden stores 000000 For activity lasting longer than 2030 minutes 0 Blood glucose is an important source of fuel 0 Intake of 07 g of carbs per kg per hour is helpful during strenuous endurance activity 0 Delays fatigue Energy Needs For Athletes 0 Desirable body fat for male athletes 5 18 o Desirable body fat for female athletes 1728 o If weight falls increase calorie intake o If body fat increases cut back intake and maintain activity Carbohydrates 0 Main fuel for many types of activity 0 Need to consume a diet moderate to high in CHO 60 of total kcal o For aerobic and endurance activity recommend 610 gm CHOkg body weight 0 Marathon runners on high end of that range Carbohydrate Loading 0 Bene cial for performance In events lasting longer than 6090 minutes 0 Maximizes muscle glycogen stores 0 Look up protocol D Multiple days of tapering off exercise intensity while increasing CHO intake 0 Water is incorporated with glycogen Fat Needs 0 25 of total kcal from fat 0 Aim for fats rich in monounsaturated fatty acids such as olive oil 0 Limit saturated and trans fatty acids Proteins 0 Recommend 12 14 gm proteinkg body weight 0 Higher for highintensity endurance athletes or muscle mass gaining body building 0 Should not exceed 35 of total kcals or 2 gkg body weight Vitamins and Minerals 0 Slightly higher needs for vitamin E and C antioxidant properties 0 Calcium can be an issue for females Female Athletic Triad 0 Iron Needs 0 A true Iron de ciency will noticeably detract from performance regimen can affect iron serum levels in blood tests not a true anemia True anemia in athletes 15 of males 30 of females Women at additional risk of anemia because of menstruation Depleted iron stores can take months to replenish 0 Also Hemodilution or sports anemia not true anemia lexpansion of blood volume at the start of training Makes blood iron level and RBC look low on tests but not harmful o Other vitamins and minerals may be needed at higher amounts role in metabolism or sweatThiamin ribo avin vitamin B6 potassium magnesium iron zinc copper and chromium Fluid needs for Endurance Exercise 0 Fluids lost through sweat need to be replaced 0 Otherwise Dehydration Heat exhaustion heat cramps heatstroke o Fluid Intake 0 Goal is to lose no more than 2 of body weight 0 Thirst a sign you are already becoming dehydrated 0 Replace uid before during and after exercise 0 Sports drinks recommended for activity gt 60 minutes in duration Replace CHO and electrolytes For events gt 60 min sports drinks can help maintain blood glucose level and blood volume 0 Water Intoxication overhydration electrolytes need to be replenished at rate water is being consumed otherwise there is an imbalance Food Intake Before During and After Exercise 0 Preexercise meal 24 hours before event 0 High carbohydrate nongreasy nongas producing easily digested 0 Low ber less than 25 fat moderate in protein Fueling during Exercise 0 Carbohydrate replenishment during events longer than 60 minutes improves performance Recovery meals 0 From 30 minutes to 2 hours after exercise 0 115g carbohydrate per kgbody weight Ergogenic Supplements 0 Substances intended to improve exercise performance directly 0 Creatine caffeine glucosamine Anabolic steroids growth hormone blood doping Chapter 16 Nutrition for Pregnancy and Breastfeeding Stages of Gestation be familiar with chart in text going over zygote embryo fetus timing and development stages Three trimesters of 1314 weeks Normal gestation is 3842 weeks First trimester Ovum egg and sperm form a zygote zygote divides about 30 hours after fertilization 4th day the zygote has divided multiple times and arrives in uterus Implants by day 10 Called an embryo after 14 days 2 weeks postconception Embryonic phase weeks 38 is most critical period for geneticdevelopmental alterations Formation of organ systems Highest sensitivity to nutritional de ciencies toxins alcohol etc Fetus from eighth week of gestation to birth Fetal stage a time of rapid growth in size Diet quality is critical in rst trimester Even before women are aware they are pregnant Second and Third Trimesters Fetus continues to grow Organs continue to grow Mother deposits fat to support lactation By 26 weeks of age fetus has a good chance of surviving if born But if premature Will be de cient in iron and bone calcium Lungs may not be fully developed Fatsoluble vitamins and n3 fatty acids not stored at high enough amounts Successful healthy pregnancy Gestation period should be gt37 weeks 3842 weeks 0 Birth weight gt 55 pounds Lowbirthweight lt55 pounds usually these are preterm babies or multiple births 0 Preterm Born before 37 weeks gestation 0 SmallforGestational Age A baby that is born less than the expected weight for length of the gestation period Weight gain during Pregnancy Goal of 2535 pounds gained for a woman with a Normal BMI 0 Slightly more weight gain recommended if ow BMI 0 Less weight gain recommended if overweight to obese but some weight gain is necessary Average baby is 78le 2022 inches Large babies of 1215 lbs D can occur when mother has gestational diabetes Nutrition Needs to Support Pregnancy Energy No signi cant increase in rst trimester 350 kcalday additional in 2 cl trimester about 20 increase over prepregnancy diet 450 kcalday in 3rel trimester Appropriate weight gain of 24 pounds in 1st trimester and 0751 pound each week in second and third trimesters Total weight gain of around 2535 pounds Protein Increased by 2025 gday 50 above standard RDA Carbohydrate 175 gday 35 above standard RDA Vitamins need to focus on diet quality Nutrient density to achieve vitamin needs Vitamin needs increased more than calorie needs folate needs increased by 50 D de ciency in early pregnancy can cause neural tube defects spina bi da Forti ed breakfast cereals provide many vitamins Do not exceed RDA for vitamin A Minerals Iron needs are increased signi cantly Fetus needs to store iron breast milk is low in iron fetus needs to accumulate a 46 month supply of stored iron Women often enter pregnancy with poor iron stores 0 In pregnancy maternal iron absorption up to 3x higher and menstruation ceases But still iron is very commonly de cient Often need an iron supplement zinc and copper usually given too due to interference of highdose iron with zinc and copper absorption N3 fatty acids Longchain DHA accounts for 40 of fatty acids in eye and central nervous system Fish good source but beware of mercury contamination avoid large predatory sh Prenatal supplements Specially tailored to needs during pregnancy Health Issues During Pregnancy Heartburn constipation and hemorrhoids Pressure from expanding uterus on GI tract makes these more likely during pregnancy Smaller more frequent meals adequate ber Edema swelling water retention Often associated with hypertension Morning sickness nausea and vomiting Eat smaller more frequent meals avoid nausea triggers Anemia low iron Gestational diabetes diabetes that starts or is rst diagnosed during pregnancy More of an issue with overweight mothers or a family history of diabetes Pregnancy induced hypertension Preeclampsiaeclampsia high blood pressure plus protein in the urine dangerous to kidneys of mother and fetus treatment drugs bed rest to keep blood pressure down Alcohol Consumption During Pregnancy and Breastfeeding Most severe damage occurs in the rst 1216 weeks of pregnancy No safe amount has been established D avoid during pregnancy Fetal alcohol syndrome Mental retardation and other effects Breastfeeding Alcohol is transmitted to the baby through breast milk Birth Bacterial colonization of newborn39s gut starts during vaginal birth Cesarean birth hinders this What to feed the newborn baby Mammary glands develop during puberty further maturation of milk producing cells and ducts occurs during pregnancy After birth Prolactin pituitary hormone that stimulates milk production Oxytocin pituitary hormone that causes release letdown of milk Breastfeeding 70 of mothers now nurse in the hospital and this decreases to 33 at 4 mo and 20 at 6 mo Healthy People 2020 goal is to have 80 of mothers nursing in hospital 60 at 6 mo and still 34 at 1 year 0 Healthy People 2020 Increase proportion of employers with worksite lactation support programs Reduce breastfed newborns who get formula supplementation within rst 2 days of life Increase of hospitals with lactation support Ability to breastfeed Learned skill must be initiated at birth of baby letdown re ex releasing of milk Possible for almost all women Exceptions PKU other metabolic diseases requiring a specialized diet mother with HIVAIDS undergoing chemotherapy Stress can interfere with the letdown re ex need relaxed comfortable environment Colostrum First uid secreted by the breast during late pregnancy and the rst few days after birth Richer in protein minerals and vitamin A than milk expressed later in infancy Contains antibodies and immune system cells Small intestine of newborn permits absorption of these immune proteins without digestion Laxatives in the colostrum facilitates passage of the baby s rst stool Mature Milk replaces colostrum after 1 week or so Composition changed thin watery slightly bluish Colostrum is thicker more viscous Breast milk is rich in factors to promote health and development Lipase in milk helps triglyceride digestion Breast milk 50 of energy comes from fat Lipase production helpful as the baby s pancreas is not fully developed at birth 0 Folatebinding protein helps deliver folate to baby s intestine folate is needed for DNA synthesis 0 Haptocorrin Blzbinding protein Helps B12 absorption the complex 312 absorption pathway with intrinsic factor Rprotein etc is not fully developed in infants 0 Lactoferrin Iron binding protein makes the small amount of iron in milk bioavailable 0 Secretory lgA Antibodies that the mother can pass to the baby through breast milk lgA Gut is permeable in the rst few months after birth selective absorption of proteins Some immune cells memory Tcells are in mother s milk and can pass to the baby s blood Cytokines in breast milk stimulate the immune system 0 Growth factors EGF IGF and TGFbeta stimulate growth of intestinal cells These help in development of gut which continues after birth 0 Nucleotides are present in high concentrations in milk l substrates for DNA and RNA synthesis We synthesize our own nucleotides from glucose but a baby39s enzyme pathways are not as developed yet Breast milk contains oligosaccharides that stimulate growth of lactobacilli and bi dobacteria bene cial bacteria that are good for colon cells 0 Fermentation by the bacteria lowers pH of the colon and discourages growth of pathogenic bacteria Oligosaccharides also seem to bind harmful bacteria which prevents them from binding to intestinal cells to cause infections Human Milk Production Mammary cells respond to prolactin produced by the pituitary Suckling increases prolactin secretion which in turn increases synthesis of milk Milk fat Some made in the breast tissue some comes to the breast from mother s blood When from blood delivered to breast tissues from lipoproteins chylomicrons and VLDL taken in to breast tissue by lipoprotein lipase 50 of energy in breast milk is from fat baby needs high energy food Milk lactose synthesized in gland Lactose is a disaccharide of glucose and galactose Glucose comes from blood glucose galactose is synthesized by mammary gland Assembled into lactose in the mammary gland How Do You Know If The Infant Had Enough Infant has 6 wet diapers a day Shows normal weight gain Passes 1 or more stools per day Softening of the breast tissue as milk is taken from it sign that feeding is working Water for Babies No Human milk allows for adequate hydration Only needs extra water if stressed by hot weather diarrhea vomiting fever No more than 4 oz of nonmilk uidsday Nutritional Needs For Lactation Milk production requires 800 kcalday EER for energy is an additional 400500 kcalday The 300 kcal difference allows a slow gradual and safe weight loss for mom Increased needs for vitamins A E C ribo avin copper chromium iodide manganese selenium and zinc Eat sh twice a week Drink plenty of uids Avoid peanuts allergens but eat a variety of foods Bene ts of Breastfeeding for the Baby Always ready quotsterilequot and meets nutritional needs for rst 46 months Few exceptions such as vitamin K injection at birth iron vit D Provides antibodies Contributes to maturation of the GI tract cytokines growth factors Reduces risk of food allergiesintolerances Reduced incidence of ovarian and breast cancers More rapid return to prepregnancy weight Boost to bone remineralization for mom potentially to levels higher than before pregnancy Quicker recovery of uterus to prepregnancy size and musculature Barriers to Breastfeeding Lack of information and role models Burden on mom Need to return to the work force Embarrassment and modesty Medical conditions Infant with galactosemia genetic inability to metabolize galactose Infant with PKU reduced ability to metabolize phenylalanine Mothers on medications chemotherapy etc Mothers with tuberculosis AIDS HV hepatitis 0 Environmental Contaminants and Breastfeeding Avoid eating sh from polluted waters Carefully wash and peel fruits and vegetables to reduce pesticide burden Remove visible fat from meats pesticides and environmental contaminants concentrate in fat Do not try to lose weight rapidly while nursing To avoid quickly releasing the contaminants that are stored in the mother39s fat tissue Lead in pipes lead paint in old homes can be a problem 0 Breastfeeding Preterm Babies Milk must usually must be expressed and fed to babies possibly through a gastric tube 0 May not have enough energystrength to suckle Forti cation of breast milk may be necessary for preterm babies with Ca P Na iron and protein Sometimes intravenous nutrition support is the only option Chapter 17 Nutrition for infancy and childhood The rst 1000 Days are the most critical pregnancy birth to 2 years of age Infant Growth and Development Rapid growth rate Weight doubles by 46 months of age Weight triples by 1 year Weight doubles again between 1 and 5 years Length increased 50 by the end of the lst year Nutrients needed to support proper growth Growth is an indicator of nutritional status Poor nutrition stunted in growth smaller in size Low weight for height sign of acute malnutrition Low height for age sign of chronic malnutrition Height The ends of bones close epiphyses fuses by age 1920 No further growth possible Assessment of Growth Growth charts Height and weight correspond to a percentile 50th percentile is considered average Be familiar with growth charts children should follow trend lines large deviations are a ag to physicians that something may be wrong 0 LengthHeight vs age Below 5th percentile possible stunted growth 0 Weight vs age 0 BMI vs age BMI is looked at relative to other children of a given age rather than as a numerical target 220 years old Below 5th percentile underweight 85th to 95th percentile considered overweight Above 95th percentile obese Brain growth fastest in infancy Head circumference Below 5th percentile or above 95th percentile risk of developmental problems 75 complete by age 2 adult size at 610 years Nutrition in infancy and early childhood will affect brain mental and intellectual development 0 Failure to Thrive Physical problems Cleft palate heart problems intestinal problems feeding problems Nutritional problems Can also be due to poor parentinfant interaction Infants need physical contact and eye contact Diet restriction is never recommended for infants under 1 year of age even for those with high BMI 0 Diet restriction may affect organ development Infant39s Nutritional Needs Human milk or formula for the rst year 0 Supplemented with solid food at 6 month of age Infant39s Nutritional Needs High energy needs 24 times that of adults for a given weight High protein needs 15 gkg body weight Higher fat needs 0 50 of calories 0 Vitamin K given at birth injection 0 Bacteria in colon that make vit K not established yet Vitamin D or sunshine Vitamin Bu if mom is a vegan Calorie Needs Don t need to know the calorie requirement for 03 46 712 months But be familiar with the idea that the caloric needs per kg of body mass are highest in early infancy 03 months and decline as the baby proceeds through childhood Formula and human milk contains 650 kcal lquart or 20kcal per ounce Breast milk or formula both satisfy calorie needs high in fat 0 High energy needs due to rapid growth and metabolism rate Protein Needs Target 15 gkg Breast milk or formula is ideal 0 Cow milk has excess nitrogen and minerals not recommended until 1 yr These exceed the infant39s immature kidnev abilities especially the nitrogen Fat Needs Should be around 50 of calorie intake for babies Need high energy density of fat to get calories to support growth Essential Fatty acids 0 needed for nervous system and membrane development Arachidonic n6 and docosahexaenoic acids n3 requirement Cold water sh provide the longchain n3 fatty acids in the mother39s diet Vitamin Needs 0 Injection of vitamin K 0 Vitamin D requirements 0 Vitamin 312 for vegan moms Mineral Needs 0 Iron stores depleted by 46 months of age bottle fed infants all formula is Ironforti ed Possible iron supplementation for breastfed infants Introduction of ironforti ed solid foods at 6 months Fluoride supplement after 6 months of age for tooth development Formula Formula is considered an adequate nutritional replacement for breast milk But Cow s milk is not tolerated by infants Formulas must follow strict guidelines Cow39s milk base or Soy base Specialty formulas are made for babies with certain metabolic disorders like PKU Feeding Technique Spit up is normal Place babies on their backs after feeding quotBack to Sleepquot info campaign since 1994 SIDS sudden infant death syndrome Monitor for signs of satiety Feeding should last about 20 minutes Initial milk foremilk lower in fat Later milk hindmilk higher in fat l 20 min feeding time to ensure baby gets hindmilk Burp every 10 minutes to release air Why Introduce Solid Foods Replete iron stores Need for vitamin D uoride and other nutrients To satisfy increasing energy needs as infant grows Readiness for solid food Nutritional needs especially iron dictate a need for solid foods Physiological readiness Maturation of pancreas allows baby to digest starch not able to digest starch in infancy no complex carbs in breast milk Permeability of gut and allergy prevention Baby39s gut is relatively permeable eating solid foods too early can cause allergic responses Physical ability Extrusion re ex that babies have makes it dif cult to take solid food strong extrusion re ex D too early for solids Ability to hold head up sit up be physically upright When ready baby can make a chewing motion First Solid Foods Ironforti ed cerealsrice cereal low allergenic potential Introduce one food at a time Wait a week before introducing a new food Strained foods and meats iron Introduce vegetable before fruit due to sweetness of fruits Do not introduce mixed food right away Because of potential reactions Limit juice No cow39s milk until 1 year of age What NOT To Feed An lnfant Allergenic foods eggs egg whites nuts peanuts chocolate Honey or corn syrup contains Costridium botuinum Foods with a high choking potential Cow s milk Excessive juice Dietary Guidelines For Infant Feeding Build to a variety of foods Pay attention to infant39s appetite to avoid overfeeding Choose fruits vegetables grains but limit high ber foods Sugar in moderation Sodium in moderation Choose foods containing iron zinc and calcium
Are you sure you want to buy this material for
You're already Subscribed!
Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'