Midterm Study Guide
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Date Created: 10/02/15
FDNS 4600 Midterm Review 10022015 Test 1 Review Chapters 12 Introduction to Nutrition and the Life Span Nutrient something your body needs to function without this the body cannot function 0 Example water protein carbohydrates Nutrition is a vital component to overall wellness and health Diet affects energy well being and many disease states There is a connection between lifetime nutritional habits and the risks of many chronic diseases A balanced diet can prevent chronic diseases and improve energy levels and overall health and wellness 0 There are a set of principles that will guide us on how to consume a balanced diet in moderation Increase in Life Expectancy The increase in life expectancy is primarily from decreases in infant mortality and in deaths from infectious diseases because infants are the ones who will grow to be a part of the population Other factors 0 Availability of immunizations prevents children from catching common diseases that can kill a young child 0 Improved healthcare and sanitation in countries with low life expectancy ratings the facilities are not as advanced as those where people are expected to live longer 0 Increases in the availability and quality of the food supply Reasons why we are ranked lower than 41 other countries given the amount spent on healthcare About half of the gap between US life expectancy and countries with higher life expectancy is due to heartdisease rates in the US Smoking among women appears to account for lower life expectancy relative to other countries The type of services our healthcare system provides is more treatment than prevention Teenage pregnancy the children of these teens are dying Obesity rates contributes 15 to 13 of the shortfall in the US life expectancy Portion sizes What is Nutrition o The study of foods their nutrients and other chemical constituents and the effects of food constituents on health 0 A source of materials to nourish the body 0 The processes by which an organism assimilates food and uses it for growth and maintenance What is Dietetics The application of nutrition knowledge in disease managementtreatmentprevention to improve quality of life 0 Two types of iron 0 Heme meat source and non heme plant source Foundation of Nutrition there are 10 sets of principles that govern and provide the foundation for knowledge in the eld of human nutrition Principle 1 Food is a basic need of humans 0 Food security acquiring food in a socially acceptable way always having nutritious food available at an affordable cost 0 Food insecurity not knowing where you re next meal is coming from not having access to nutritious food in an affordable way 0 About 14 of the households in American are insecure Principle 2 Food provides energy calories nutrients and other substances needed for growth and health Calorie a measure of the amount of energy transferred from food to the body Nutrients chemical substances in food that are used by the body 0 Nutrient needs Energycalories Macronutrients Micronutrients Water 0 Essential nutrients Carbohydrates Certain amino acids Linoleic acid and alphalinoleic acid Vitamins Minerals Water 0 Nonessential nutrients the human body is able to synthesize or manufacture these nutrients and do not necessarily have to be present in one s diet Cholesterol Glucose Creatine and certain types of amino acids 0 Dietary Intake Standards 0 Dietary Reference Intakes DRls Recommended Dietary Allowances Adequate Intakes not any evidence to give a set amount to consume Estimated Average Requirements Tolerable Upper Levels of Intake Daily Values standards for daily intakes of nutrients used on nutrition label of food Carbohydrates 0 Simple carbohydrates Monosaccharaides Disaccharides 0 Complex carbohydrates Starches Glycogen Fiber 0 Alcohol sugars 0 Alcohol ethanol o Glycemic Index of Carbohydrate Glycemic index extent to which carbohydrate containing foods increase blood glucose levels a Foods with high glycemic index raise blood glucose levels higher a Foods with low glycemic index improve blood glucose control in diabetes Glycemic Load GI x grams of carbs in food 100 glycemic load of a serving of food can be calculated as its carbohydrate content measured in grams g multiplied by the food s GI and divided by 100 GL greater than 20 is considered high CL of 1119 is considered medium CL of 10 or less is considered low 0 Recommended intake level 4565 of calories Added sugar 25 or less of total calories 2135 g berday for females 3038 g berday for males 0 Food sources Protein primary function is development and growth we only depend on protein for energy when our body runs out of carbohydrates to use gluconeogenesis therefore our body needs a much smaller percentage of protein in our meals as opposed to carbohydrates 0 Amino acids building blocks of proteins Non essential can be synthesized by the body Conditionally essential can be synthesized by the human body except in conditions Essential cannot be synthesized by the body must be supplied through nutrition High quality proteins provide all essential amino acids Recommended intake 1035 of calories Food sources Each gram of protein produces 4 calories Main functions of protein Chemical messengers hormones neurotransmitters Enzymes OOOOO Acts as a source of energy Transport Immune response Regulation of uid and acidbase balance Growth building blocks for construction and replacement of all cells and tissue 0 Fats Lipids 0 00000 O 0 Essential fatty acids Linoleic acid omega6 Alphalinoleic acid omega3 4 or less omega6 to 1 omega3 is recommended Food sources Each gram of fat produces 9 calories Saturated try to stay away from these fats Unsaturated Monounsaturated Polyunsaturated Trans fats extremely unhealthy making an ingredient stronger than it is Hydrogenation Cis versus trans structure Cholesterol non essential our bodies make them There is no cholesterol in any plant food Recommended intakes 2035 pf calories from fat limiting unhealthy fats o Vitamins O Watersoluble vitamins easily excreted from the body through urine Must make an effort everyday to obtain these because we cannot see if there is a de ciency Destroyed by excessive heat Thiamin ribo avin niacin B6 folate 812 biotin panthothenic acid C o Fatsoluble vitamins A D E K 0 Functions Coenzymes Antioxidants 0 Recommended intakes de ciencies toxicities o Other substances in food phytochemicals Minerals 0 Essential minerals Calcium phosphorus magnesium iron zinc uoride iodine selenium copper manganese chromium molybdenum sodium potassium chloride 0 Water 0 Adults are 6070 water 0 Recommended intakes 1516 cupsday for males 11 cupsday for females 75 from uids 25 from foods 0 Dietary sources Best are water and nonalcoholic beverages Alcoholic beverages increase water loss through urine 0 Why is water important Maintain body temperature Metabolize body fat Aids in digestion Lubricates and cushions organs Transports nutrients Flushes toxins from your body 0 Factors that In uence Nutrient Needs Age Gender Growth Pregnancylactation Body compositionbody type Body size Genetic traits Illnessdisease state Lifestyle habits Medication use Principle 3 Health problems related to nutrition originate within cells Homeostasis Principle 4 Poor nutrition can result from both inadequate and excessive Ie vels of nutrient intake 0 Micronutrients low Deficiencies begins with inadequate nutrient intake Toxicities begins with excessive nutrient intake 0 The quotripple effectquot dietary changes introduced to improve intake of one nutrient may affect intake level of other nutrients Principle 5 Humans have adaptive mechanisms for managing uctuations in food intake 0 Regulation of absorption or appetite 0 000000000 0 Nutrient storage Principle 6 Malnutrition can result from poor diets and from disease states genetic factors or combinations of these causes 0 Primary malnutrition dietary in origin 0 Secondary malnutrition precipitated by a disease state surgical procedure or medication ex Someone who has down syndrome 0 NutrientGene Interactions Single gene defects Interaction of genetic environmental factors including nutrition n Ex Alcohol intake during pregnancy Principle 7 Some groups of people are at higher risk of becoming inadequately nourished than others Pregnantbreastfeeding women 0 Infants and children 0 People who are ill frail elderly persons Principle 8 Poor nutrition can in uence the development of certain chronic diseases 0 Heart disease hypertension cancer stroke osteoporosis type 2 diabetes obesity Principle 9 Adequacy and balance are key characteristic of a healthy diet 0 Variety Nutrient density 0 Limiting quotemptycalorie foods Principle 10 There are no good or bad foods 0 All things in nutriment are good or bad relatively based on o If nutrient needs are met 0 If calorie intake maintains healthy body weight Nutrient Labeling 0 Nutrition facts panel mustlist fat saturated fat trans fat cholesterol sodium total carbohydrates ber sugars protein vitamins A and C calcium and iron also daily values 0 Nutrient content and health claims 0 Ingredient label Other Labeling Concerns Enrichmentreplacing what was lost during processing into the food adding nutrients back 0 Re ned grain products have added thiamin niacin ribo avin and iron 0 Forti cation adding a nutrient to a food that might not naturally be present in the food substance 0 Done in order to prevent de ciencies Herbal remedies considered dietary supplements by FDA 0 Some act like drugs and have side effects 0 Vary in safety and effectiveness 0 Particularly be careful if trying to become pregnant 0 Functional food foods that have health promoting effects beyond their nutritional effects 0 Prebiotics example ber microorganisms use that for survival 0 Probiotics contain live organisms fermented foods example yogurt LifeCourse Approach whatever we eat today affects our health later on in life we must focus on long term health Nutritional Assessment Communitylevel assessment 0 Statistics data surveys observations 0 Used to develop communitywide nutrition programs Individuallevel assessment 0 Clinicalphysical assessment doctor Inspection for features that may be related to malnutrition 0 Dietary assessment nutritionist dietician 24 hour dietary recalls and record O O Dietary history Food frequency questionnaires Anthropometric assessment taking your weight height Biochemical assessment blood samples urine samples genetic testing nutrient and enzyme levels Nutrition Needs and In uences during Preconception Overview 0 O 0 15 of couples are infertile 44 diagnosed infertile will eventually conceive without use of technology Healthy couples have 2025 chance of becoming pregnant within a given menstrual cycle Miscarriage Most happen because of defects in fetus Maternal infection Structural abnormalities of uterus Endocrine or immunological disturbances Subfertility woman with 2 miscarriages reduced level of fertility characterized by unusually long time for conception 18 of couples are subfertile Multiple miscarriages sperm abnormalities infrequent ovulation o Preconception Health the provision of biomedical and behavioral interventions prior to conception in order to optimize women s wellness and subsequent pregnancy outcomes 0 Preconception Care an organized comprehensive programs that identi es and reduces women s medical psychological social and lifestyle reproductive risks before conception Objective related to Preconception 0 Make sure you are within the weight limit before pregnancy 0 Reduce or avoid drinking alcohol 0 Type of environment advised o Underlying physical environment having access to resources 0 Intermediate family environment 0 Immediate biomedical and lifestyle risk factors avoid substances that could negatively affect the baby Reproductive Physiology Key terms Puberty period in which humans become biologically capable or reproduction Ova eggs females produce and store within the ovaries o Menstrual Cycle 4 week interval in which hormones direct buildup of blood and nutrient stores within uterus ovum matures and is released 0 Development of female and male reproductive systems 0 Begins during rst months after conception 0 Continue to grow and develop through puberty 0 Females have been hitting puberty very early because of our changing environments Capacity for reproduction establishes during puberty when hormonal changes stimulate Hormonal Effects During the Menstrual Cycle 0 Gonadotropin releasing hormone GnRH o Stimulates pituitary to release FSH and LH o Folliclestimulating hormone FSH o Stimulates maturation of ovum and sperm production of estrogen o Luteinizing hormone LH o Stimulates secretion of progesterone and testosterone o Estrogen o Stimulates release of GnRH in follicular phase and follicle growth and maturation of follicle o Stimulates vascularity and storage of glycogen and other nutrients within uterus 0 Stores nutrients 0 Progesterone o Prepares uterus for fertilized ovum increases vascularity of endometrium and stimulates cell division of fertilized ova o If pregnancy doesn t occur estrogen and progesterone levels decrease and vice versa for pregnancy 0 Progesterone helps with nutrient mobilization vascularity of endometrium Two Phases of Menstrual Cycle 0 Follicular Phase rst half of menstrual cycle 0 Follicle growth and maturation 0 Main hormones GnRH FSH estrogen and progesterone Luteal Phase last half of menstrual cycle 0 Begins with ovulation by the 14th day in the 28day cycle Not all women ovulate athletes or females with very low body fat Temperature rising halfway through the cycle indicates ovulation 0 Formation of corpus luteum Male Reproductive System 0 The male reproductive system is more ongoing than females every 75 days 0 Interactions among hypothalamus pituitary gland and testes 0 Androgens testosterone stimulate sperm maturation Sperm are stored in the epididymis and released in semen Sources of Disruption in Fertility o Adverse nutritional exposures de ciencies excesses 0 Contraceptive use provides hormones to let the body think you are pregnant in order to avoid pregnancy Severe stress 0 infection 0 Tubal damage an abortion that doesn t go completely right Chromosomal damage Undernutrition and Fertility Undernutrition in women previously wellnourished is associated with a dramatic decline in fertility that recovers when food intake does Food shortages in countries have been accompanied by dramatic declines in birth rates Chronic undernutrition the body adapts to an undernourished mother that can result in a baby born with a birth defect 0 Primary effect birth of small and frail infants with likelihood of death in the rst year of life Acute undernutrition associated with a dramatic decline in fertility that recovers when food intake does Weight loss and Fertility Decreased fertility seen with low or high body fat due to alterations in hormones Estrogen and leptin levels increase with high body fat and reduce with low body fat 0 Both extremes lower fertility Body fat to support pregnancy should be between 2030 because a doctor uses the fat to monitor hormones Weight loss greater than 1015 of usual weight decreases estrogen LH FSH 0 Results in amenorrhea lack of menses anovulatory cycles and short or absent luteal phases Weight loss in men can result in sperm not being able to move easily or it could change the shape Antioxidant nutrients can counteract this stuff Oxidative Stress Decreases sperm mobility Reduces ability of sperm to fuse with an egg Harm egg and follicular development Interfere with corpus luteum function Interfere with implantation of the egg Antioxidants protect the cells from damageoxidation o Vitamins E and C Betacarotene Selenium 0 Found in vegetables and fruits 0 Protect cells of the reproductive system including eggs and sperm 0 Phytochemicals also have antioxidant properties 0 Zinc in men plays a role in the reduction of oxidative stress in sperm mutation and in testosterone synthesis Fertility and 0 Plant Foods lowfat high ber linked to irregular menstrual cycles 0 lso avones from soy decrease levels of estradiol progesterone LH Caffeine study results are mixed on effects of caffeine 0 Alcohol may decrease estrogen and testosterone levels or disrupt menstrual cycles HeavyMetal Exposure high lead levels decreased sperm production abnormal motility and shape buildup of cadmium molybdenum manganese boron and other metals also affect male fertility Exercise adverse affects of intense physical activity 0 Delayed age at puberty 0 Lack of menstrual cycles Periconceptual Period 4 weeks to conception Life Course Perspective maintaining nutrition throughout your life so that each point in your life you are able to meet your nutrient needs 0 Iron status is extremely important about 12 of females enter pregnancy anemic Folate status important prior to conception to avoid neural tube defects Nutrition Care Process 0 Nutrition care standards developed by the Academy of Nutrition and Dietetics The Nutrition Care Process 0 Step 1 Nutrition assessment 0 Step 2 Nutrition diagnosis 0 Step 3 Nutrition intervention 0 Step 4 Nutrition monitoring and evaluation Test 2 Review Chapters 3 4 and 6 Nutrition Management for Preconception Conditions Premenstrual syndrome could interfere with fertility Characterized by lifedisrupting physiological and psychological changes that begin in the luteal phase and end with menses Symptoms occur in 1525 of menstruating women o If you know you have this you can seek treatment previous to conceonn Some studies suggest that reducing caffeine intake could reduce PMS also Vitamin D and Magnesium but there is not much evidence for this 0 Cause of PMS not yet clear 0 Thought to be related to abnormal serotonin activity following ovulation o Treatments 0 Antidepressants containing serotonin uptake inhibitors 0 Calcium B6 chaste berry supplements o Premenstrual Dysphoric Disorder 0 Severe form of PMS o Characterized by marked mood swings depressed mood irritability and anxiety 0 Symptoms breast tenderness headache joint and muscle pain Obesity Body Fat Distribution and Fertility Central obesity interferes with reproduction in women and men 0 Treatment of rst choice for obese people should be weight loss this can reduce or eliminate fertility problems 0 Weight reduction methods 0 Focus on lifestyle changes 0 Decrease calorie intake 0 Increase physical activity levels 0 Weight loss surgery if efforts fail bariatric surgery Fertility may return after surgery Increases the risk for multiple de ciencies Pregnancy not recommended during rst year after surgery Metabolic syndrome can be well managed by diet and physical activity Characterized by a cluster of abnormal metabolic and health indicators 0 If not well managed it can lead to CVD and diabetes Prevalent in about 32 of US adults 0 Therapy dietary modi cation weight reduction exercise Diabetes 0 Diabetes mellitus intolerance to carbohydrate with fasting glucose gt 126 mgdL 0 Prior to pregnancy High blood glucose levels during the rst 2 months of pregnancy are teratogenic Associated with a 23 fold increase in congenital abnormalities n newborns n Malformations of pelvis CNS and heart seen in newborns higher rates of miscarriage Types 0 Gestational diabetes only seen in females during pregnancy If it is well managed it can go away If not it could lead to Type 2 diabetes 0 73pe 1 diabetes autoimmune the patient is not secreting insulin previously called juvenile diabetes Results from destruction of insulin producing cells 10 of cases Management a Main goals blood glucose control resolution of coexisting health problems health maintenance a Diets controlled in carbohydrate content carbohydrate control 0 Replace sugars with reasonable amounts of arti cial sweeteners Choose food low in glycemic index and high in ber 0 Encourage brightly colored fruits and vegetables 0 Low fat meat and dairy products sh dried beans and nuts and seed U Need insulin shots to enhance transport of glucose in blood to the cells a Physical activity 73pe 2 diabetes the body may be secreting adequate or excess insulin but the problem is that the insulin is insensitive 0 Body unable to use insulin normally to produce enough insulin or both 90 of cases 0 Without insulin the sugar is unable to move from the blood to the cells 0 Need medication to sensitize the insulin to transport the sugar into the mitochondria for energy metformin Can enhance weight loss 0 Management Diet and exercise and oral medication to increase insulin production and insulin sensitivity Polycystic Ovary Syndrome lnsulin is not sensitive enough for glucose transport 0 510 of women of childbearing age 0 Leading cause of female infertility o Tends to be in women who are overweight who have fatty ovaries Cause is uncertain o lnsulin o Genetics could play a part in this 0 Management 0 Primary goal to increase insulin sensitivity 0 Weight loss and exercise improve prognosis 0 Important to limit fat in the diet to help with this weight loss recommended Phenylketonuria Elevated blood phenylalanine due to lack of phenylalanine hydroxylase If this accumulates in the blood it could affect the mental state of the fetus intellectual disability 0 Monitor the amount of phenylalanine make sure it is able to be synthesized Celiac Disease Autoimmune disease characterized by chronic in ammation of small intestine o Inherited sensitivity to gluten in wheat rye barley which causes malabsorption and attening of intestinal lining o 133 in the US have this 0 Linked to infertility in some women and men 0 Management 0 Important to avoid gluten in diet 0 Correction of vitamin and mineral de ciencies Nutrition Needs and In uences During Pregnancy Infant mortality is a great indication of a nation s health Decreases in mortality related to improvements in social circumstances safe and nutritious food availability and infectious disease control 0 Strong correlation between infant mortality and life expectancy 0 Infant mortality higher in males male fetus much more vulnerable There is a lot of focus on the rst 1000 days of life pregnancy2 years if the child is healthy the child will grow up and go on to be healthy throughout their lives 0 Low birth weight or preterm infants at higher risk of dying in 1st year of life 0 Reducing infant mortality 0 Improve birth weight of newborns desirable birth weight 7 lb 12 oz 10 lb 0 Infants born with desirable weightless likely to develop heart and lung diseases diabetes and hypertension Health Objectives for 2020 o The Health Objectives for 2020 in relation to pregnant women and newborns focus on o The reduction of low birth weight 0 Preterm delivery 0 Infant mortality 0 A number of the objectives are related to improvements in nutritional status 0 Reducing teenage pregnancy is important 0 Teenagers are still growing themselves so they need more of every source she gets normally give birth to preterm babies because when eating they consume most of the nutrients they absorb leaving little for the baby 0 Tend to hide the pregnancy in the beginning which is the most important time of pregnancy early prenatal care Physiology of Pregnancy Gestational age assessed from date of conception average pregnancy is 38 weeks Menstrual age assessed from onset of last menstrual period average pregnancy is 40 weeks 0 A lot of dilution in the rst weeks of pregnancy 0 Hemodilution Most weight gain occurs between 35 and 40 weeks 0 Two phases of changes 0 Anabolic phase rst 20 weeks Blood volume expansion increased cardiac output buildup of fat nutrient and lover glycogen stores Growth of some maternal organs increased appetite and food intake Decreased exercise tolerance increased levels of anabolic hormones o Cataboic phase last 20 weeks Mobilization of fat and nutrient stores increased production and blood levels of glucose triglycerides and fatty acids decreased liver glycogen stores Accelerated fat metabolism Increased appetite and food intake decline somewhat near term increased levels of anabolic hormones Glucose provides an energy source for the baby through glycogen and fat Body Water Changes 0 Body water increases from 7 L to 10L results from increased blood and body tissues and extracellular volume and amniotic uid Edema swelling due to accumulation of extracellular uid Metabolism Carbohydrate Metabolism o Glucose is preferred fuel for fetus 0 Early pregnancy high estrogen and progesterone stimulate insulin which increases glucose and consequently glycogen and fat 0 Late pregnancy human chronic somatotropin hCS and prolactin inhibit conversion of glucose to glycogen and fat 0 Protein Metabolism 0 About 92 g of protein accumulate during pregnancy 0 Protein and amino acids conserved during pregnancy 0 Needs must be met by mother s intake of protein 0 Fat Metabolism 0 Fat stores accumulated in rst half of pregnancy enhanced fat mobilization in last half 0 Blood lipid levels increase 0 Increased cholesterol is substrate for steroid hormone synthesis 0 Mineral Metabolism 0 Calcium increased bone turnover and reformation 0 Sodium accumulation in mother placenta and fetus restriction of sodium potentially harmful The Placenta 0 Nutrient factors 0 Size and charge of molecules 0 Small molecules pass through most easily o Lipid solubility of particles 0 Concentration of nutrients in maternal and fetal blood 0 The fetus is not a parasite Nutrients rst used for maternal needs then for placenta and last for fetal need 0 The fetus is harmed more than the mother by poor maternal nutrition 0 Types of transport 0 Passive diffusion o Facilitated diffusion 0 Active transport 0 Endocytosis Embryonic and Fetal Growth and Development 0 Growth and development is at the highest level during the 9 months of gestation o If weight gain continued at this level at 1 years old the infant would be 160 lbs 0 Critical Periods o Differentiation cellular acquisition of one or more characteristics or functions different from that of the original cell 0 Critical Periods preprogrammed time periods during embryonic and fetal development when speci c cells organs and tissues are formed and integrated or functional levels established Fetal Body Composition 0 In the second half of pregnancy body fat composition occurs where nutrients are extremely critical 0 Small for gestational age 0 Disproportional the baby s body is disproportional the legs arms and head are of normal range but the weight is extremely low less than 10th The malnutrition within the mother occurs at the end of the pregnancy 0 Proportional the child is all around small each part of the baby is small Side effect of chronic malnutrition in the mother There is a de cit in the babies cells because the mother doesn t eat enough nutrients 0 Variations in fetal growth if the mother eats too much protein it results in a high risk for the baby to be overweight later on in life 0 Linked to Energy nutrient and oxygen availability Genetically programmed growth and development Insulinlike growth factor IGFl is main fetal growth stimulator 0 Nutrition Miscarriages and Preterm delivery 0 Miscarriages thought to be caused by chromosome abnormalities thyroid disorders hormone imbalances infections Underweight increases risk Elevated blood cholesterol or triglycerides increase risk Multivitamin use reduces risk 0 Preterm Delivery infants born preterm are at risk for death neurological problems congenital malformations and chronic health problems Developmental Programming of Later Disease Risk every chronic disease has the origin from the mother s womb Process by which exposures to adverse nutritional and other conditions during critical periods of growth and development modify gene function fetal origins hypothesis 0 Changes may predispose individuals to chronic diseases 0 As long as there is weight gain in the child periodically the child is ok not every child will gain weight at the same rate 0 Many chronic diseases begin in the womb with whatever the mother is eating during pregnancy could relate to changes in genes 0 Related to genes and environmental exposure through the uterus Environmental exposures epigenetic alterations in gene activity that do not change the structure of DNA but only affected by environmental factors Energy and Nutrient Needs During Pregnancy 0 Energy requirements 300 additional calday 340day in 2nCI trimester 452 calday in 3rel trimester Calorie intake assessed by pregnancy weight gain Carbohydrates Arti cial Sweeteners and Alcohol Carb intake 4565 minimum of 175 g 0 Basic foods such as vegetables fruits and whole grains with bers 0 Arti cial sweeteners are ok Strongly advised to avoid alcohol ingestion during pregnancy Fiber 0 Very important of pregnancy diet although fetus development does not depend on it Adequate ber intake increases the comfort of pregnant women helps reduce constipation 28 gday Protein 0 Requirement 25 gday or 71 g 0 Average intake of typical female 78 g Fat 0 Pregnant women consume 33 of total calories from fat 0 Fat consumed in food is used as an energy source for fetal growth and development 0 Fat serves as a source of fatsoluble vitamins Fat provides essential fatty acids 0 Adequate intake liked to higher intelligence optimal development better vision and more mature CNS 0 Do not exceed 3 gdays Vitamins Folate associated with anemia and reduced fetal growth 0 Increase in folate extensive organ and tissue growth 0 Functions metabolic reaction de ciencies lead to abnormal cell division and tissue formation 0 Congenital abnormalities Neural Tube Defects Malformations of spinal cord and brain spinal bi da anencephaly encephalocele 0 Status has improved with forti ed cereals and supplements 0 Recommended intake 600 mcg o Choline fetal brain growth intellectual development 0 Vitamin A needed for cell differentiation growth of fetus protein synthesis 0 In US more concerned with toxicity 0 Vitamin D supports fetal growth and bonesskeleton supports immune system prevents autoimmune diseases and other chronic diseases 0 812 also very important when pregnant Minerals 0 Calcium needed for fetal skeletal mineralization and maintain maternal bones 0 Needs can be met with 3 cups of milk or calcium forti ed soy rice and almond milk 0 Fluoride teeth begin to develop in utero limited amount transferred from mother supplementation not recommended 0 Iron 0 Iron de ciency a condition marked by depleted iron stores with weakness fatigue short attention span poor appetite increased susceptibility to infection and irritability 0 Iron de ciency anemia a condition marked by low hemoglobin with signs of iron de ciency plus paleness exhaustion and rapid heart rate Risk of preterm delivery f late in pregnancy associated with lower intelligence 0 Iron supplementation Absorbed better from supplements containing iron ony than when mixed with other minerals Excess intake can create other problems it can impair the absorption of zinc a Make sure not to exceed the amount of zinc needed as well 0 Magnesium only occurs if not eating healthy 0 De ciencies associated with increased risk of miscarriage fetal growth retardation and preterm delivery 0 Some studies show de ciencies can create gestational diabetes 0 Zinc extremely important during the rst trimester when organs are formed and may play a role in assisting in immune system development 0 Iodine required for thyroid function and energy production and for fetal brain development 0 Absence can lead to many deformities in the baby sti birth premature delivery Cretinism affects the intellectual ability of the individual Abundant in seafood Need minute amounts of iodine Sodium plays a critical role in maintaining body s water balance restriction not indicated in normal pregnancy or for control of edema or high blood pressure Bioactive food components that s have health bene ts besides nutritional bene ts Include phytochemicals and antioxidant pigments Are not considered essential nutrients but in uence health Water helps with amniotic uid in mother s womb protects the baby from serious trauma while in the stomach Met by increased levels of thirst Diet During Pregnancy Effect of taste and smell changes during pregnancy on intake This will in uence the baby s taste preferences Pica eating disorder where pregnant women eat nonfood substance Dietary supplements during pregnancy 0 Pregnant women do not need supplements as long as they are eating healthy except for iron Food Safety Issues 0 Foodborne illness 0 Avoid foods with mercury in them Exercise No evidence that moderate or vigorous exercise undertaken by healthy women is harmful Studies show women who exercise during pregnancy have an easier time during labor Recommendation 35 times each week for 2030 minutes at 60 70 V02 max Common Health Problems During Pregnancy Nausea and vomiting O O O O Separating uids from food will give the food sometime to settle in your stomach reducing the frequency of vomiting Eating dry foods helps reduce Certain dietary supplements Ginger Heartburn O Ingest small meals frequently do not go to bed with a full stomach avoid foods that make heartburn worse Constipation O Consume daily ber drink water along with ber laxatives are not recommended Nutrition Needs and In uences during Lactation Physiology 0 Mammary gland source of milk for offspring the breast O O Alveoli functional units Rounded or oblong shaped cavity present in breast Composed of secretory cell with a duct in the center Secretory cells cells in acinus that are responsible for secreting milk components in ducts Myoepithelial cells line the alveoli and can contract to cause milk to be secreted into ducts o The most important thing when breastfeeding is the nipple and areola o The baby must have the entire areola in their mouth with the O nipple center of the mouth If the baby latches on to only the nipple it will be painful for the mother Mammary Gland Development Estrogen progesterone and human growth hormone help with the development of the breasts 0 0 Levels of both hormones increase dramatically to prepare mammary glands for lactation f progesterone levels do not decrease after pregnancy it will affect prolactin 0 Primary hormones contributing to breast development 0 Human placental lactogen is released during pregnancy to prepare the breasts for lactation o Prolactin synthesizes the milk Secreted towards the end of pregnancy 0 Oxytocin is the enzyme that enables the milk to ow Also known as the Letdown Hormone Secreted after birth when there is any type of stimulation to the breasts Without oxytocin the mother can become engorged Helps with contraction of the uterus Stages of Lactogenisis Stage 1 birth to 25 days the mother does not need stimulation of the breasts 0 Milk colostrum Helps the babies immune system mature faster yellowish in color 0 Stage 2 begins 25 days after birth 0 Stimulation needed 0 Milk transitional milk Much lighter milk 0 Stage 3 begins 10 days after birth 0 Stimulation needed 0 Milk mature milk coming in Slightly thicker than transitional milk but lighter than colostrum For each breastfeeding episode the baby gets foremilk and hindmilk o Foremilk lighter very high in lactose o Hindmilk much thicker very high in fat and protein and nutrients o The mother must empty one breast completely before going to the next breast so the baby gets the foremilk and hindmilk If the baby only gets foremilk the baby will get diarrhea Only foremilk also can result in the baby not gaining weight As the baby suckles on the breasts it sends signals to the brain to release prolactin and oxytocin 0 Both hormones cause inhibition of ovulation 98 protection from pregnancy during the period of breastfeeding Milk composition Human milk is the only food needed by the majority of healthy infants for 6 months The composition changes over a single feeding over a day based on the age of the infant presence of infection in the breasts with menses and maternal nutritional status The fat content in the morning is lower than in the evening because the baby is sleeping 0 At each feeding the foremilk has more water than the feeding before The carb and protein composition remain the same throughout the day Protein in Human Milk At the beginning of breastfeeding 90 whey 10 casein o Whey a soluble protein that contains some minerals hormones and vitamin binding proteins includes lactoferrin which is an iron carrier 0 Casein main protein in mature human milk which facilitates calcium absorption After 6 months 50 whey 50 casein The protein content in human milk decreases as the baby gets older 0 Formula is an indication of childhood obesity because it has a high protein concentration the entire time the baby drinks it DHA Trans Fatty Acids and Cholesterol in Human Milk DHA 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 human milk substitute early consumption of cholesterol through breast milk appears to be related to lower blood cholesterol levels later in life Minerals in Human Milk Minerals contribute to osmolality 0 Content related to growth of infant 0 Concentration decreases over rst 4 months except for magnesium Bioavailability most have high bioavailability Exclusively breastfed infants have very low risk of anemia despite low iron content of human milk Zinc bound to protein and highly available rare defect in mammary gland uptake of zinc may cause zinc de ciency that appears as diaper rash Trace minerals copper selenium chromium manganese molybdenum nickel uoride 0 Not altered by mother s diet Bene ts of Breastfeeding Breastfeeding worldwide is known universally as the method of feeding the baby No formula can be an exact replacement of breast milk because it contains active compounds Hormonal bene ts increased oxytocin stimulates uterus to return to prepregnancy status Physical bene ts delay in monthly ovulation resulting in longer intervals between pregnancies Psychological bene ts increased selfcon dence and bonding with infant Bene ts for mother 0 Reduced risk of cancer breast and ovarian 0 Reduced risk of diabetes 0 Reduced risk of postpartum depression Bene ts for infants 0 Many nutritional bene ts 0 Immunological bene ts lower infant mortality in developing countries and fewer acute illnesses 0 Reduced risk of SIDS Sudden Infant Death Syndrome infants dying for no apparent reason Normally suffocation Reduces risk because when breastfeeding mothers wake up more often to feed the baby and consequently are able to check on the baby and make sure he is still breathing Babies that drink formula won t wake up as often and therefore the mother won t wake up as much 0 Reduction in chronic illness 0 Reduction in possibility of baby being overweight Weight wise babies at 1 year are leaner than formula fed babies I They have more body fat which assists in brain development and growth spurts Signi cant cognitive difference in premature babies Analgesic effects reduction of infant pain signi cantly milder when it comes to circumcision in breast fed babies Socioeconomic bene ts decreased need for medical care 0 Countries save on formula exchange 0 Employers bene t because parents don t need to stay home and take care of sick children Breast Milk Supply and Demand 0 Milk synthesis is related to o How vigorously an infant nurses 0 How much time the infant is at the breast o How many times per day the infant nurses 0 Having larger breasts doesn t mean you make more milk but it means it contains more fat 0 Baby milk demand 0 Nutritive feeding if the child is feeding and removing nutrients from the breasts You can hear a faint noise indicating that the baby is still feeding o Nonnutritive feeding if the child is sucking on the breasts as a paci er Feeding frequency depending on how much the baby feeds the breasts will send a signal to the brain to either inhibit or enhance milk production 0 One breast always produces more than the other 0 There are several different methods for pumping or expressing milk manual and electric The type of breast reductionaugmentation determines the ability to breastfeed but it is possible 0 There is no evidence that silicone from breast implants produces toxicities in breast milk The Breastfeeding lnfant 0 Identifying hunger and satiety o Hunger is signaled by infant bringing hands to mouth sucking on them and moving head from side to side 0 Crying is a late sign of hunger 0 Allow infant to nurse on one breast as long as they want to ensure they get hindmilk with its high fat content that provides satiety Identifying Breastfeeding Malnutrition Losing 7 in the rst week is normal because the baby is full of uids when born some babies also have stool that they will pass 0 Weight loss of 10 needs evaluation by lactation consultant Malnourished infants become sleepy nonresponsive have a weak cry and wet few diapers o By day 5 to 7 infants should have 6 wet diapers and 34 soiled diapers Energy and Nutrient Needs for Lactation 0 RDA for macronutrients during lactation is similar to that for pregnant women 0 Energy needs vary by activity level DRl is 500 kcalday for the rst 6 months and 400 kcalday afterward The additional energy needs is to come from increase in intake and fat stores Exercise Water and Breastfeeding Modest energy restriction combined with increased activity may help women lose weight and body fat 0 Exercise does not inhibit milk production or infant growth Lactating mothers should consume 38 liters or 128 ounces of water perday Micronutrients The RDA for micronutrients remain the same as those set for pregnancy except iron 0 Water soluble vitamins dependent on mother s intake because they are not stored in the body as well as zinc selenium and iodine 0 During breastfeeding iron RDA moves from 27 during pregnancy back to 18 0 Vitamin and mineral supplements not needed in wellnourished women 0 Functional foods show no adverse effects Factors in uencing Breastfeeding Initiation and Duration Obese women tend to have dif culty with breastfeeding due to higher levels of estrogen and progesterone Lowincome and more af uent mothers need breastfeeding support due to socioeconomic status Barriers to Breastfeeding Initiation Embarrassment Time and social constraints Lack of support from family and friends Lack of con dence Concerns about diet and health Fear of pain Healthy People 2020 Objectives Increase proportion of infants breastfed Increase duration of breastfeeding Increase worksite lactation programs Reduce formula supplementation in rst 2 days of life Increase births in facilities providing recommended care for breastfeeding mothers Breastfeeding Promotion Facilitation and Support The healthcare system plays an in uential role in breastfeeding Lactation support in hospitals and birthing centers Lactation support after discharge essential in the rst few weeks after delivery 0 Any knowledgeable healthcare practitioner should see all breastfed infants at 24 days of age 0 Breastfeeding Peer Counseling 0 Le Leche League The work place provides barriers making it dif cult for mothers to breast feed o The community must establish a multidisciplinary breastfeeding task force with representatives from the healthcare system and others knowledgeable in the eld 0 Community attitudes and obstacles to breastfeeding need to be assessed 0 Model Breastfeeding Promotion Programs 0 WIC national Breastfeeding Promotion Project 0 Office of Women s Health 0 Wellstart International New Material Chapters 811 Nutrition Needs and Requirements During Infancy 0 Nutrition is an important contributor to the complex development of infants 0 Birth weight and infant mortality 0 Energy and nutrient needs 0 Physical growth assessment 0 Infant feeding skills 0 Remember gestational age is the number of weeks the baby was in the mother s stomach Assessing Newborn Health 0 When a baby is born the gestational weight and birth weight are the indicators of the nutrients the baby will need 0 We determine if a baby is well by frequently assessing the baby s growth 0 Birth weight as an outcome 0 Fullterm infant 37 to 42 weeks Typical weight 25003800 g 55 to 85 lbs Typical length 4754 cm 185 to 215 in 88 of US infants are born fullterm Standard Newborn Growth Assessment O O 0 Appropriate for gestational age AGA Small for gestational age SGA and intrauterine growth retardation IUGR mean newborn was lt10th wtage Large for gestational age LGAO means newborn was gt90th wtage Physical Growth Assessment 0 O O O Newborns grow faster than any other time of life Growth re ects nutritional adequacy health status economic and environmental adequacy There is a wide range of growth normal Calibrated scales and recumbent length measurement board required for accurate measures Interpretation of Growth Data Measures over time identify change in growth rate and need for intervention Warning signs a Lack of weight or length gain a Plateau in weight length or head circumference for gt 1 month a Drop in weight without regain in a few weeks Infant Development 0 Digestive System Development 0 Fetus swallows amniotic uid which stimulates intestinal maturation and growth 0 At birth the healthy newborn can digest fats protein and 0 simple sugars Common problems include gastroesophageal re ux GER diarrhea and constipation Infancy is the beginning of our food habits 0 Parenting 0 New parents must learn Infant s cues of hunger and satiety Temperament of infant How to respond to infant cues o Responsive feeding the mother looks out for the child s cues to see if they are hungry o Forced feeding the mother is on her own schedule and must force feed the baby even if the child isn t hungry or a parent forcing a baby to nish a bottle of formula Also known as complimentary feeding Not healthy for the baby 0 Temperament of infant this can indicate if the parent is overfeeding the child Developmental Hypothesis Energy and Nutrient needs 0 Energy Calories 108 kcalkgday from birth to 6 months range from 80 to 120 0 Infants tend to have higher metabolic weight because they have a high percent of muscle mass which is metabolically ache 0 Their energy needs decrease at about 6 months because the growth rate decreases 0 Factors that in uence calorie needs Weight and growth rate Sleepwake cycle Temperature and climate Physical activity Metabolic response to food Health statusrecovery from illness 0 In one year infants are expected to triple their birth rate 0 Never compare a female s growth rate to a male s growth rate because males always tend to have a slightly higher growth rate Protein Needs 0 22 gkgday from birth to 6 months 0 16 gkgday from 6 to 12 months 0 How much is that o Newborn weighing 4 kg 88 lbs needs 22 X 4 88 g protein 0 6 month old weighing 8 kg 176 lbs needs 16 X 8 128 g protein 0 protein needs are similar to that of energy but are also in uenced by body composition 0 With growth rate decreasing we don t need much protein Fat Needs 0 No speci c recommended intake level for infants 0 Breast milk contains about 55 calories from fat 0 Infants need cholesterol for gonad and brain development 0 Breast milk contains shortchain and mediumchain fatty acids in addition to the longchain o Easier to digest and utilize than longchain fatty acids Metabolic Rate 0 Metabolic rate of infants is highest of any time after birth 0 The higher rate is related to rapid growth and high proportion of muscle 0 Low carbohydrate andor energy intake results in protein catabolism impacting growth Other Nutrients and Nonnutrients Fluoride 0105 mgd depending on age too much may cause tooth discoloration 0 Vitamin D 400 IUday Sodium 120200 mgday 0 Iron 11 mg for infants 712 months 0 Fiber no recommendations 0 Lead none may be toxic Feeding in Early lnfancy 0 Breast milk and Formula 0 Recommended exclusive breast feeding for 1st 6 months and continuation to 1 year Initiate breast feeding right after birth Growth rate and health status indicate adequacy of milk vmume Standard infant formula provides 20 cal oz Preterm formula provides 2224 cal 002 Breast milk v Formula Breast milk 7 of calories from protein 38 calories from carbs 55 calories from fat Formula 912 calories from protein 4143 calories from carbs 4850 calories from fat After exclusive breast feeding important to begin supplementing especially if the baby s weight and height increase comes to a halt Cow s Milk during infancy Whole reducedfat or skim cow s milk should not be used in infancy Ironde ciency anemia linked to early introduction of cow s milk Anemia linked to GI blood loss low absorption of calcium and phosphorus displacement of ironrich foods o It is a bad thing to expose the child to food to early the rst 46 months 0 Formula is speci c for either full term babies or preterm babies 0 After 6 months must get formula that is lower in protein 0 When formula feeding people tend to over dilute or supplement the formula very early Breast milk vs Cow s milk 0 The fat and protein content in breast milk is well tolerated by infants 0 Protein is well tolerated because they whey content is high is breast milk 0 Recommendation not to feed cow s milk to an infant less than 1 year 0 o 0 It has a very low content of iron The proteins could cause bleeding in the baby also contributing to iron deficiency The milk has a low glycemic index so the baby is lled up without need of anything else Attributed allergies to infant O Commonly introduced early with minority mothers Development of Infant Feeding Skills Cues infants may give for feeding readiness include O 0000 0 Watching the food being opened in anticipation of eating Tight sts 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 0 Introduction of Solid Foods 0 0 Food offered from spoon stimulates mouth muscle development At 6 months offer small portions of semisoft food on a spoon once or twice each day Feeding with a spoon could also possibly help with speech development Recommendations Infant should not be overly tired or hungry Use small spoon with shallow bowl Allow infant to open mouth and extend tongue Place spoon on front of tongue with gentle pressure Avoid scraping spoon on infant s gums Pace feeding to allow infant to swallow Limit added sugars as much as possible 0 The importance of infant feeding position 0 O Improper positioning may cause choking discomfort and ear infections Position young bottlefed infants in a semiupright position O O Spoonfeeding should be with infant seated with back and feet supported Adults feeding infants should be directly in front of infant making eye contact 0 Preparing for drinking from a cup 0 O 0 Offer water or juice from cup after 6 months Wean to a cup at 12 to 24 months Early weaning may result in plateau in weight due tor educed calories andor constipation from low uid intake 0 Food Texture and Development 0 O O 0 Can swallow pureed foods at 6 months Early introduction of lumpy foods may cause choking Can swallow very soft lumpy foods at 68 months By 810 months can eat soft mashed foods 0 First Foods 0 6 months iron forti ed baby cereal Rice cereal is hypoallergenic 6 months fruits and vegetables Only one new food over 23 days Commercial baby foods are not necessary but do provide sanitary and convenient choices 912 months soft table foods Inappropriate and Unsafe Food Choices Foods that choke infants hot dogs popcorn potato chips peanuts chunks of peanut butter raisins whole grapes stringy meats gum and gummy textured candy hard candy orjelly beans hard fruits or vegetables 0 How infants learn food preferences lnfants learn food preferences based on experiences with foods 0 O 0 Flavor of breast milk in uenced by mother s diet Genetic predisposition to sweet taste Food preference from infancy sets stage for lifelong food habts Water 0 Breast milk or formula provide adequate water for healthy infants up to 6 months 0 All forms of uids contribute to water intake 0 Additional plan water needed in hot humid climates Dehydration is common in infants 0 As soon as supplementation with food starts water needs to be supplemented as well to help breakdown food Pedialyte or sports drinks provide electrolytes but lower in calories than formula or breast milk 0 Limit juice AAP recommends juice is not needed to meet the uid needs before the age of 6 months 0 Avoid colas and tea Nutrition Guidance Supplements for infants 0 Fluoride for breastfed infants after 6 months or if in any area with no uoridated water 0 Iron after 4 months if breastfed 0 Vitamin 812 for vegans 0 Vitamin D needed if exclusively breastfed Common Nutritional Problems and Concerns 0 Failure to thrive FTI39 inadequate weight or height gain energy de cit is suspected 0 Inorganic F39IT results directly from malnutrition 0 Organic F39IT result of some underlying condition 0 Intervention for F39IT may be complex and involve a team approach including the registered dietitian social worker Ironde ciency anemia prevalence very low among infants because the breast milk and formula contain plenty of iron 0 Iron stores in the infant re ect the iron stores of the mother 0 More common in lowincome families 0 Increased risk begins to be seen when supplemental feeding starts o Breastfed infants may be given iron supplements and iron forti ed cereals at 6 months 0 Ironforti ed vs1 quotlowiron formula Diarrhea and Constipation infants typically have 26 stools per day 0 Causes of diarrhea and constipation Viral and bacterial infections Food intolerance Changes in uid intake 0 To avoid constipation assure adequate uids 0 Continue to feed the usual diet during diarrhea 0 Prevention of Baby Bottle Caries and Ear Infections are linked to feeding practices 0 Feeding techniques to reduce caries and ear infections Limit use of bedtime bottle Offerjuice in cup Only give water bottles at bedtime Examine and clean emerging teeth Allergies vs Intolerance allergy is immune response and intolerance is the inability to secrete a certain enzyme needed to metabolize a nutrient 0 About 68 of children lt 4 years have allergies Absorption of intact proteins causes allergic reaction Common symptoms are wheezing or skin rashes Treatment may consist of formula with hydrolyzed proteins We can outgrow intolerances but not allergies Allergies can be deadly unlike intolerances Get the baby tested rst to see if they have an allergy for that food or not because infants cannot express when they are feeling uncomfortable Lactose intolerance can be outgrown by infant OOOOOO o Inability to digest the disaccharide lactose o Characterized by cramps nausea and pain and alternating diarrhea and constipation o Uncommon and tends to be overestimated Vegetarian Diets 0 Infants receiving wellplanned vegetarian diets grow normally Breastfed vegan infants need supplements Vitamin D Vitamin 812 possibly iron and zinc Nutrition Intervention for Risk Reduction 0 Early Head Start Program works with families at risk such as drug abuse infants with disabilities or teenage mothers 0 Model program newborn screening for PKU galactosemia hypothyroidism or sickle cell disease Conditions of Infancy and Their Nutrition Management Infants at Risk New challenge we now have a greater number of children with certain conditions surviving because of advances in health care therefore more infants need specialized care 0 A lot of times the care is achieved by trial and error Key questions regarding infants 0 How is the baby growing o Is the diet providing all required nutrients o How is the infant being fed 0 Any child who is growing there is some degree of nutrient adequacy 0 Remember that preterm infants have lower requirements of nutrients than normal healthy babies Energy and Nutrient Needs 0 A typical infant s DRI for energy is 108 calkg 0 Based on the condition of the baby the infant will need more or less energy 0 Increased calories required for difficulty breathing infections temperature regulation fever and recovery from surgery For preterm infants their energy need is higher because they have catching up to do Children with spina bi da or down syndrome have a lower metabolic weight therefore they need less calories 0 Children with down syndrome tend to be overweight because parents tend to feed them the same amount as a healthy baby because they have weak bones and muscles Energy needs 0 AAP suggests 120 calkg for preterm infants oThe European Society for Gastroenterology and Nutrition gives a caloric range of 110135 calkg o Recovering infants may need as much as 180 calkg Babies between 3437 weeks are healthy preterm babies their energy needs tend to be very similar to that of full term healthy babies The more preterm the baby the higher the energy needed for the baby When using a chart made for a healthy baby for a preterm baby must adjust with age subtract 15 months from baby s age that s their quotnew agequot and you must feed the baby according to this age 0 After about 6 months the child should have caught up to normal size Protein 0 152 gkg adequate if growth or digestion not affected 0 3035 gkg required for preterm or recovery from illness 0 4 gkg may be needed for ELBW 0 Increased protein helps catch up with weight needed for baby 0 Protein Sparing Action we can only spare protein for its primary action growth and development when there is sufficient energy from carbs and fat If there is not adequate carbs and fat the body uses protein for energy and growth is compromised Hydrolyzed protein used to help with digestion because babies GI tract development is compromised when preterm Speci c amino acid formulas such as for PKU Provide up to 55 calories from fat Lowfat diet rarely required Mediumchain triglycerides MCT bene cial to VLBW and ELBW infants because of low pancreatic and liver enzymes 0 Essential fatty acids and DHA and AA important 0 Fats also provided from breast milkformula o Vitamins and Minerals 0 May need additional vitamins and minerals to support quotcatch upquot growth or during recovering from illness 0 Humanmilk forti ers provide additional calories and nutrients o Preterm infant formulas may have higher amounts of vitamins and minerals Growth 0 Tracking growth re ects nutritional status for most infants 0 Additional methods to use if underlying conditions exist include 0 Growth charts for speci c diagnosis 0 Biochemical indicators 0 Body composition 0 Head circumference o Medications that impact growth 0 Growth in Preterm Infants 0 In the last weeks of pregnancy the most weight is gained by the baby therefore preterm babies have extremely low body fat 0 Variety of growth charts Olsen Intrauterine Growth charts specialized growth charts Fenton chart preterm charts 0 All preterm growth charts show head circumference as main indicator of healthy recovery 0 Does intrauterine growth predict outside growth 0 Depends on intrauterine environment growth restriction fetalorigin errors and unknown factors such as toxins and air poHqun 0 Interpretation of Growth 0 Rate of growth frequently used to measure improvement in preterm or sick infants o Microcephaly or macrocephaly may affect body composition and growth 0 Great variability in growth of infants Toddler Nutrition Needs and Requirements Introduction Focuses on the growth and development of toddlers o By this time some pattern of meal eating must be established Pan snacks and meals around child s activities a Snack provides a limited amount of nutrients n Meals should include a variety of nutrients Todders should eat 3 meals a day with some snacks in between UMost don t eat 3 meals a day if a toddler is eating only one meal a day don t panic make sure that one meal has all the nutrients needed Appetite of toddler changes from infancy because their rate of growth decreases re ects on how much they eat 0 Must respect the child s appetite the child shouldn t be eating at the same rate they were when they were growing at the highest rate if they continue to do so the excess calories they consume will not be used up and it will distribute as fat throughout the body Feeding skills In toddler years bottles shouldn t be used more semiswallow or swallowing foods 0 Healthy food preferences children whose growth is stunted can be a result of not reaching nutritional needs 0 Increases probability of obesity Importance of Nutrition Status 0 During toddler years adequate nutrition is required to achieve full growth and development 0 Undernutrition impairs cognitive development and ability to explore environment Tracking Toddler and Preschooler Health 0 Economic and nutrition status of the US children 0 20 live in poverty 2009 o 75 million have no health insurance o 34 live in singleparent families make them more likely to live in poverty Normal Growth and Development 0 De nitions of the Life Cycle Stage toddlers 13 years characterized by rapid increase in gross and ne motor skills 0 From birth to 1 year average infant triples birth weight Toddlers gain 8 oz and grow 04 in per month CDC Growth Charts 0 The simplest way to assess a child s growth development is through growth charts 0 Acute nutrition short term nutrition measured by weightfor age 0 Charts are Gender speci c Age speci c a set for ages birth36 months and 220 years 0 Chronic nutrition measured by Length or staturefor age a Results in stunted growth if child is below average Headcircumferencefor age n Particularly measures inadequate protein intake Weightforlength or stature n Measures wasting of child measurement of weight against height For a child s BMI must compare the raw score to the percentile children 2 years 0 Anything between 1 and 1 is considered normal anything above 2 is obese anything below 1 is underweight WHO Growth Standards 0 WHO World Health Organization published growth standards for children from birth to 5 years 0 International growth standards regardless of ethnicity or socioeconomic status 0 Measure a breastfed child s growth pattern O 0 If children grown in an environment that has less restriction on them but are still breastfed grow at the same rate The conclusion was that no matter where a child is if heshe is optimally breastfed they will grow at the same rate Development of Feeding Skills of Toddlers Gross and ne motor development improved 0 910 months weaning form bottle begins 0 1214 months completely weaned 12 months re ned pincer grasp 1824 months able to use tongue to clean lips and has developed rotary chewing Adult supervision vital to prevent choking Feeding Behaviors of Toddlers O O O O O Rituals in feeding are common May have strong preferences and dislikes Parents must make the conscious effort to transition toddlers to solid foods and to try different foods Serve new foods with familiar foods when child is hungry Food jag the child wants one food and one food only very common Toddlers imitate parents and older siblings Appetite and Food Intake of Toddlers O O O Slowing growth results in decreased appetite Toddlersized portions average 1 tablespoon per year of age Nutrientdense snacks needed but avoid grazing on sugary foods that limit appetite for basic foods at meals Preschoolers 0 May prefer familiar words 0 Serve childsized portions 0 Make foods attractive colorful foods in a brightly lit room 0 Strong avored or spicy food may not be accepted 0 Control amount eaten between meals to ensure appetite for basic foods lnnate Ability to Control Energy Intake 0 Children adjust caloric intake to meet caloric needs 0 Avoid encouraging child to clean your plate Healthful eating habits must be learned Temperament Differences Temperament the behavioral style of the child 0 Three main temperamental clusters 0 40 easy temperaments adapts to regular schedules and accepts new foods 0 10 difficult temperaments slow to adapt and may be negative to new foods 0 15 slowtowarmup slow adaptability negative to new foods but can learn to accept new foods 0 Remaining styles are intermediate low to intermediate high a mixture of behaviors Food Preference Development Appetite and Satiety Prefer sweet and slightly salty reject sour and bitter foods Eat familiar foods 0 May need 810 exposures to new foods before acceptance 0 Food intake related to parent s preferences Feeding Relationship 0 Parent or caretaker responsibilities 0 What children are offered to eat 0 the environment in which food is served including when and where foods are offered 0 Don t allow the child to graze throughout the day in other words don t let them eat too many snacks and consume excess calories or not enough nutrients 0 Child s responsibilities 0 quotChild portionsquot of foods 0 quotHow muchquot they eat it is up to the child to ask for more until they are full 0 Whether they eat a particular meal or snack Nutrient Needs Protein 0 13 years 11 gkgd or 13 gday 48 years 095 gkgd or 19gday Protein needs decline with respect to body weight as we grow because the rate of growth decreases Vitamins and Minerals 0 Most toddlers have adequate vitamin and mineral consumption except for iron calcium and zinc 0 There is a challenge with iron calcium and zinc with toddlers because although you don t need much the food they choose to eat doesn t include these vitamins and minerals There is little variety in their diet 0 As opposed to babies who get these nutrients from breast milk iron especially Common Nutritional Problems Ironde ciency anemia Dental caries Constipation Elevated blood lead levels 0 Lead and iron compete for absorption extremely important to not expose the child to lead 0 Food security 0 Food safety lrondeficien c y Anemia Prevalent problem among toddlers May cause delays in cognitive development and behavioral disturbances o Seen in toddlers because of food choices this affects growth and cognition o This is prevalent in minority children Diagnosed by hematocrit andor hemoglobin concentration If the mother has adequate stores of iron the baby will have adequate stores for 46 months With adequate breast feeding the baby can build up iron store 0 Formula with iron can do this as well Preventing ironde ciency 0 Limit milk consumption to 3 servings or less 24ozday Milk can cause children to lose iron in blood Milk has a low glycemic index which lls the child up and causes them not to be hungry 0 Repeat screening recommended for children at high risk minorities and children from lowincome houses Should be tested at 912 months 6 months later and annually from ages 25 Intervention for Iron De ciency 0 Iron supplements 0 Counseling with parents 0 Repeat screening Dental Caries Prevalence 1 in 3 children ages 35 Causes 0 Bedtime bottle with juice or milk 0 Streptococcus mutants o Sticky carbohydrate foods Prevention uoride supplemental amounts vary by age and uoride content of water supply Constipation 0 De nition hard dry stools associated with painful bowel movements 0 Causes quotstool holdingquot and diet 0 Prevention adequate ber and uid Elevated Blood Lead Levels Seen in 09 of children ages 15 0 Has been decreasing since NHANES 19992002 data 0 Low levels of lead exposure linked to lower IQ and behavioral problems 0 High blood lead levels may decrease growth 0 Reduce lead poisoning by eliminating sources of lead Food Safety 0 Young children especially vulnerable to food poisoning Food safety practices by FightBAC 0 Clean wash hands and surfaces often 0 Separate don t crosscontaminate 0 Cook cook to proper temperatures 0 Chill refrigerate properly Nutrition and Prevention of Cardiovascular Disease 0 Limit dietary saturated fats trans fat and cholesterol Acceptable total fat intake ranges o 2 to 3 years 30 to 35 of calories 0 4 to 18 years 25 to 35 of calories 0 for children at high risk of CVD limit saturated fat to lt7 of calories and cholesterol to lt200 mg Vitamin and Mineral Supplements o A varied diet provides all vitamins and minerals needed 0 AAP recommends supplements for certain groups of children 0 O O O From deprived families With anorexia poor appetites or poor diets F39IT or a dietary program for weight management Who consume only a few types of foods Vegetarians without dairy products Types of vegetarians n Pescatarian only eat sh n Ovolacto eggs dairy and milk a Vegans absolute no foods that come from animals n Lacto only dairy and milk a Ovo only eggs n Flexitarians vegetarians but sometimes will eat meat depending on the circumstances Dietary and Physical Activity Recommendations 0 Dietary guidelines 0 0 Offer a variety of foods limiting foods high in fat and sugar 60 minutes of vigorous physical activity each day MyPlate developed by the USDA for young children 0 Physical Activity recommendations 0 Children need active play several times a day Family walk after dinner walking the dog Riding a tricycle or bicycle Freestyle dance Playing catch Hide and seek Recommendations for Intake Iron meats forti ed cereal dried beans and peas Fiber fruits vegetable whole grains Fat follow Dietary Guidelines and MyPlate Calcium dairy canned sh with soft bones green leafy vegetable calciumforti ed beverages Fluids beverages foods and sips of water Recommended v Actual Food Intake 0 Dietary intake of children ages 25 Energy met or exceeded recommendations Consistently low mean intakes of zinc folic acid Vit D and Vit E Totale fat is 31 boys and 32 girls of calories Sodium intake is 22832331 mg recommended 2300 mg Other Concerns Crosscultural considerations 0 Build on cultural practices Reinforce positive practices Attempt change for more bene t 0 Vegetarian diets vegan and macrobiotic diet children ten to have lower growth rates but remain within normal ranges Guidelines n Several mealsday 3 meals 23 snacks n Avoid excessive bulky foods bran n Include energy dense foods cheeseavocado n Include omega3 fatty acids for fat n Sources of Vitamin B12 Vitamin D and Calcium should be included or supplemented Nutrition Intervention for Risk Reduction 0 Model Program Bright Futures Nutrition 0 Public food and nutrition programs 0 O O O WIC WIC s Farmers Market Nutrition Program Head Start and Early Head Start Supplemental Nutrition Assistance Program formerly Food Stamps Conditions and Their Nutrition Management During Toddler and Preschooler Age Introduction 0 Our focus is on toddlers and preschoolers at nutritional risk 0 Covers nutrition needs and services for children with O O Foodaergies Breathing problems 0 Developmental delays oThose needing nutrition support 0 Increasing numbers of children with developmental disabilities enter the healthcare system each year CDC reports that gt17 of the pediatric population have some type of developmental disability and require extra nutrition support Who are children with special health care needs 0 Criteria for quotchronic conditionquot or disability varies from state to state 0 Estimates range from 5 to 31 of children 0 90 of children with disabilities have a nutrition problem Eligibility for Early Intervention Services are Based on 0 Developmental delays 0 Cognitive physical language and speech psychological or selfhelp skills 0 Physical or mental condition with a high probability of delay 0 At risk medically or environmentally for substantial developmental delay without services Nutrition Need of Toddlers and Preschoolers with Chronic Conditions oGoal is to make sure that children with disabilities are meeting their needs 0 Look at the DRls and depending on the child s disability reduce or increase whatever particular nutrient will meet their needs 0 DRls are a starting point for setting protein vitamin and mineral needs 0 Speci c conditions need adjustments 0 May cause poor appetite and increased caloric needs 0 May lead to over or underweight Caloric and nutrient recommendations should be customized for each child Growth Assessment Repeated assessment is needed in order to provide the child with a disability with the highest quality of life possible for them Assessment answers the following o Is child s growth on track o Is child s food and nutrient intake adequate o Are feeding or eating skills age appropriate 0 Does diagnosis affect nutritional needs 0 When looking at the chart anything above the 5th percentile is ok as long as the child is consistently growing at that rate if below the 5th percentile there is something wrong with the child even if it is consistent Feeding Problems 0 Special health care needs cause feeding problems in young children combined with typical feeding issues of the average toddler or preschooler 0 Examples low interest in eating long mealtimes preferring liquids over solids food refusals Behavioral Feeding Problems Mealtime feeding problems are common with toddlers and preschoolers with behavioral and attention disorders Behavioral disorders that affect nutritional status 0 Autism Spectrum Disorder ASD o ADHD may be suspected in preschool years but usually treated in the school years NutritionRelated Conditions Failure to thrive F39IT Toddler diarrhea and celiac disease Autism Spectrum Disorders Muscle coordination problems and cerebral palsy Pulmonary problems Developmental delay and evaluations Failure to Thrive F77 Inadequate weight or height gain with growth declines more than 2 growth percentiles 0 Organic v inorganic May result from o Digestive problems 0 Asthma or breathing problems 0 Neurological conditions 0 Pediatric AIDS Recovery can include catchup growth All require increased energy needs When looking at the graphs If you see the child s weight plateauing or getting lower then it is important to seek medical help Todder Diarrhea and Celiac Disease quotToddler diarrheaquot typically caused by sucrose and sorbitol content of fruit juices 0 Limiting juice may be recommended 0 Excess soda can also lead to diarrhea lf changing the child s diet doesn t help then celiac disease might be the cause 0 Celiac disease results in diarrhea and caused by sensitivity to the protein gluten found in wheat and other grains 0 With celiac disease you should avoid gluten if gluten is continually fed then the diarrhea will be persistent Autism Spectrum Disorders 0 No speci c diet is recommended for prevention or treatment Glutenfree and caseinfree diets have been used by parents but not endorsed by professional societies Muscle Coordination Problems and Cerebral Palsy Cerebral Palsy 0 Group of disorders characterized by impaired muscle activity and coordination present at birth or developed during early cthhood Spastic quadriplegia a form of cerebral palsy 0 Reduced dietary intake results from child easily becoming tired while eating Meal pattern may be changed to provide small frequent meals and snacks to prevent tiredness at meals Foods recommended are easy to chew and soft Can occur at birth or later on in the child s life Triggered by not enough oxygen reaching the brain 0 The child shows symptoms of being extremely tired 0 Multiple small meals will help the child Pulmonary Problems 0 Examples of pulmonary breathing problems are brochopulmonary dysplasia and asthma 0 Breathing problems increase nutrient needs lower interest in eating and can slow growth 0 Children with these problems tend to have higher energy needs 0 Preterm infants at high risk of breathing problems 0 Recommend small frequent meals with concentrated energy Developmental Delay and Evaluation 0 Developmental delay may be suspected when 0 Speci c nutrients are inadequately or excessively consumed 0 May result from iron de ciency or lead toxicity 0 Physical growth may be impacted Food Allergies and Intolerance True food allergies seen in 2 to 8 of children 0 Common food allergies include milk eggs wheat peanuts walnuts soy shell sh Sources of Nutrition Services 0 State programs 0 Early intervention programs 0 Early childhood education programs IDEA Head Start 0 Early Head Start 0 WIC 0 Low birth weight follow up 0 Child care feeding programs
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