11:709:255: Nutrition & Health - Study Guide
11:709:255: Nutrition & Health - Study Guide 11:709:255
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This 45 page Study Guide was uploaded by Madison Notetaker on Thursday October 16, 2014. The Study Guide belongs to 11:709:255 at Drexel University taught by Sherman in Fall. Since its upload, it has received 143 views. For similar materials see Nutrition & Health in Nutrition and Food Sciences at Drexel University.
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Date Created: 10/16/14
10162014 Calcium Func ons 1 teeth amp bones in bone Ca is embedded in a crystal matrix form of calcium called hydrocyapetite 2 of the major types of calcium in bone osteoblasts osteoclasts 2 cell metabolism the 1 of Ca not found in boneteeth the entry of Ca into a cell influenced by hormones This triggers cells to perform very specific functions it acts as a cellular mediator of hormone activity blood calcium levels independent from dietary calcium levels 3 muscle contraction 4 nerve transmission 5 blood clotting blood calcium levels are never indicative of dietary calcium intake if blood ca levels are out of normal reange it is a hormonal problem Calcium Homeostasis When blood ca levels are on high side this is sensed by the thyroid gland which produces a few hormones including thyroid hormone and calcitonin Calcitonin travels thru the blood Calcitonin sends msg to 2 main target organs The small intestine Calcitonin tells small intestine to reduce the amount of calcium it is absorbing The bone The bone will decrease the amount of breakdown of bone thereby reducing the amt of cal released into the blood The kidney Will increase the excretion of calcium into the urine If blood ca levels are lower than normal this is sensed by the parathyroid gland They release parathyroid hormone PTH PTH travels to the kidney In the kidney pth stimulates final activation of vit d and the conversion of 25OHD2 to 125OH2D3 or calcitriol Calcitriol and the PTH together go to the small intestine and tell it to increase the absorption of calcium tell bone to increase bone breakdown and decrease calcium excretion in the urine Blood levels of calcium then return to normal Calcium Requirements Folate RDA 400mg Calcium RDA 918 yrs 1300mg men and women 1950 1000 mg women gt51 1200mg men gt70 1200 mg UL at 50 yrs 2500g UL gt51 2000 mg Calcium Absorption Calcium absorption is unpredictable 2040 absorbed from diet Factors enhancing absorption 1 Adequate vitamin D the amt of ca absorbed in intesetinal track is influenced by amt of calcitriol type vit d 2 Acidity of digestive mass as people get older hcl production tends to decrease a bit which works against ca absorption 3 Presence of lactose in food 4 Need for calcium during growth ca absorption is higher than in adulthood Factors hindering absorption 1 Alkaline digestive mass 2 Dietary fiber 3 Increased GI motility when products move thru gi track quickly less time for absorption 4 Phytic acid oxalic acid present in whole grains and some foliage 5 Excess FA can result from a diet very high in fat when theres a high level of fat in the si the calcium ions are bound to the fat 6 Vitamin D deficiency Bone Growth and Maintenance In the body bone is living tissue Constantly under metabolic change The cells that make up the bone are very active and the bone is constantly going through turnover Osteoblasts Bone forming cells Osteoclasts Breakdown bone resorption is the process of breaking down bone to release minerals into blood circulation Osteoblasts and osteoclasts work together to maintain healthy bone a process called bone remodeling aka turnover Peak bone mass From childhood up until puberty there is some difference in bone mass bw men and women Up until early 30 s your are still depositing bone and building up your bone mass Men consistently have higher bone mass then women and maintain that higher bone mass longer than women there is an abrupt decline of bone mass in women assoc with menopause Estrogen levels protect this but menopause diminishes estrogen levels there is a threshold of bone mass below which we consider the individual to have osteoporosis women more likely to have this than men porous bones that can easily lead to bone fracture the higher peak bone mass is the longer we can prolong desention into that threshold area osteopenia means that bone mass is lower than optimal and the person is at a higher risk for dvlping osteoporosis and its important to identify this and try to prevent bone mass loss from dimishing any further into osteoporatic range osteoporosis results from activity of osteoclasts the cells that are resorbing bone exceeding the activity of the osteoblasts Over a number of years then the bone mass begins to decline Osteoporotic bone is less dense or more porous and more prone to fracture Essentially there are larger holes in the bone matrix Consequences is loss of height the upper vertebrae become compacted and wedged lower vertebrae becomes crushed Loss of height and stooped over stature No real symptoms and current practice is to only really measure bone density in women once they get to their 60s Risk factors for osteoporosis 1female more common but are cases in men 2 Age 3 Body size smaller people that are a little more fragile in appearance have a higher risk 4 Ethnicity very common among caucasions less common among af Am 5 Genetics 6 Smoking 7 Medications include some diretics cortisone and thyroid hormone 8 Estrogen 9 Eating disorders 10 Alcohol prevalent among alcoholics 11 Weight bearing exercise you should est a lifelong weight bearing exercise program bycicling and swimming the only noneffective ones 12 nutrition Ca P Mg amp Protein vitamins C D K Phosphorus Func ons 1 Part of ATP 2 Component of enzymes 3 Cell membranes phospholipid bilayer 4Bones Phosphorus Balance Very well absorbed 6090 absorbed from diet Also partly regulated by calcitriol vit D Excess is excreted by way of the urine Deficiency or Depletion Virtually unheard up Would have to result from some unusual and rare metabolic problem Excess phosphorus Excess circulating in the blood can alter kidney function Excess dietary P can interfere with calcium It can reduce Ca absorption and can weaken the bones Food sources of Phosphorus Meat cheese dairy products Avg American diet 2030 consumed comes from food additives Added to processed meats and leading source of P as a food additive is soda P RDA 700 mg for adults typical intake is 10001500 mg UL4g Esp when combined with high protein intake this tends to lower body s calcium levels Magnesium Mg Plantsgtanimals higher in plant foods than in animal food sources 50 of Mg is stored in the bone elsewhere in the body the majority of Mg is found intracellularly functions 1 Activates gt300 enzymes in the body 2 activates ATP phosphorylation od ADP 3 Inhibits muscle contraction Works in opposition to calcium 4 Negative effect on blood clot mechanism 5 Needed for normal transmission of nerve impulses Mg Absorption 3040 is absorbed can go up to 75 gtdietary calcium ltMg absorption Mg RDA DO NOT STUDY THIS 420 mg males 320 mg females Deficiency or Depletion Related to disease processes not really dietary deficiency Alcoholism endocrine malfunction renal disease GI malabsorption Renal excretion of excess the kidney Electrolytes Maintain water balance in the body Water Body composition 5070 of body weight is water 73 weight of muscle 35 weight of adipose males have larger muscle mass so have greater percentage of water Fluid Compartments of the Body 55 of the total amt of water in the body is found inside cells inside of the cells the main minerals associated with that water are potassium and phosphate we refer to this as intracellular fluid the water found outside of cells in the lymph and the blood stream is called interstitial fluid 45 of water is outside of the cells This is associated with sodium and chloride Functions of water in the body 1 Transportation nutrients waste etc the blood is 90 water 2 protection lubricates the eyes tears saliva mucus etc 3 Temperature regulation helps maintain normal body temp we lose water in sweat production which helps cool the body 4 Chemical reactions water is the active component in every hydrolysis reaction 5 Solvent has a positive charge from he hydrogen and a negative charge from the oxygen This polarity attracts the electrolyte minerals positive H attracts negative chloride negative oxygen attracts positive sodium ion Water Balance outputinput Average daily water output Sweat 500 ml Lungs 400 ml Feces 150 ml Urine 1300 ml We lose this we need to replace this Average daily water input Beverages 1000 ml Foods 1000 ml Metabolism 350 ml Regulation of Blood Pressure and Blood Volume Dehydration can contribute to low blood volume Low blood volume is detected by pituitary gland in the head and the then secrete the hormone antidiuretic hormone ADH aka vasopressin This circulates in blood and goes to kidney Tells kidney to excrete less water in the urine ADH decreases water excretion by the kidneys and causes blood vessels to constrict The low blood pressure caused by low blood volume stimulates the adrenal glands they sit on the kidney and they respond by secreting hormone aldosterone Aldosterone increases sodium and chloride resorption by the kidneys thus maintaining it in the blood Net effect of these 2 hormones is that blood volume is increased bc less water is in urine and more in the blood which serves to increase the amt of pressure Blood volume and pressure restored to normal During this process your brain also tells you to drink Dehydration Causes Diarrhea Fever Excess sweat heat vigorous exercise Abuse of laxatives or diuretics Alcohol Symptoms thirst loss of appetite reduces water intake thru foods decreased urine impaired performance nausea impaired temperature regulation muscle spasm increased pulse amp respiration sometimes hallucinations sensory perception of thirst tends to decline in the elderly reason why dehydration is a common reason for elderly ER visits Loss of Body Weight lt2 thirst 4 decreased performance gt10 decreased blood pressure increase in heart rate gt20 death Al for water Designed to prevent dehydration Females 91 oz 27 L Males 125 oz 37 L 80 of water requirement comes from beverages 20 from foods No UL set Cases seen mostly in athletes around a race that drink a lot of water without electrolytes Increased need with exercise and hot climate Chronic lower levels of water Shriveled skin muscle cramping constipation Drinking a full glass of water before you eat a meal correlates w weight loss Functions of Sodium Na Func ons 1 Maintains water distribution in extracellular compartment 2 Involved in nerve conduction 3 Involved in acidbase balance 4 Assists in nutrient absorption Sodium Balance Losses Absorbed in Small intestine Excess Via kidney kidney maintains sodium excretion as well as fluid balance and blood pressure Urine and sweat Typical American intake is so high that they excrete 8090 they consume in the diet How Blood Sodium is Regulated sodium Homeostasis When blood Na levels too high adrenal glands respond by decreasing the amt of aldosterone they secrete Low aldosterone levels then favor an increases in the sodium excretion in urine bringing back levels to normal range If levels are too low adrenal glands will increase the secretion of aldosterone Low blood sodium and low blood pressure stimulates the alsosterone section Aldosterone goes to kidney so kidney reduce amt of sodium secreted in the urine Sodium Deficiency or Depletion Very rare because the skeleton has sodium reserves Would need to have a veryyyy low sodium diet and that associated with excessive sweating Sources of sodium Processed foods Look in textbook for more Sodium amp Hypertension Hypertension An abnormally high blood pressure Typ is 14090 About 1725 of Americans have high bp Symptoms of high blood pressure None you generally don39t have any Silent killer High salt intake does not cause hbp but may incrs the risk along w genetic predisposition Dietary Nagtkidney excretion of Na Results in high blood Na which draws in like a sponge more water into the blood This leads to an increase in blood volume and causes the blood pressure to incrs this increases the cardiac load putting pressure on the heart lncrs risk of heart attack stroke blood vessles in brain under so much pressure they may burst or kidney failure DRI to replace losses in sweat Na 15 g CLz3g 38g of salt or half a tsp UL 58 g of salt gt95 men and 75 women consume gtUL of salt about 75 of salt in American diet comes from processed foods Dietary Guidelines lt23OO mg Na I tsp salt per day hypertension lt15OO mg Na Dietary Approaches to Stop Hypertension DASH Diet Basics based on a 2000 kcal diet Vegetables 45 servings Fruits 45 servings More in the textbook Functions of Potassium K 1 Maintains water distribution in intracellular compartment 2 Nerve conduction 3 Acidbase balance 4 Insulin release from pancreas 5 Muscle relaxation 6 cofactor in metabolism K Balance Very well absorbed about 90 absorbed Absorbed primarily in colon Excess is excreted in urine K Deficiency or Depletion Seldom due to diet Secondary to other diseases Can occur as a result of diarrhea diuretics vomit or protein energy malnutrition When it does happen symptoms are general weakness poor respiration poor muscle control and abdominal bloating Treating this is very challenging best strategy is to do it thru foods instead of IV or supplements Its difficult because there is a situation called hyperkalemia that is an excess of potassium in the body Hyperkalemia is seen when kidney is malfunctioning Imbalance in these minerals can be life or death Super caution against electrolyte fluids like gateorade they put stress on the kidneys Sources of potassium Look in textbook Al for K A47g Most adults consume 50 recommended K No UL for K Chloride Functions Cl 88 of CI in body is found outside of cells it is an extracellular ion and usually associated with Na because they are both outside of cells Together they counterbalance and their charge becomes neutral 1 Electrolyte 2 HCL 3 Acid base balance 4 RBC chloride shift enables chloride to move in an out of red blood cells maintaining neutrality of charge in the blood cell This facilitates the oxygen delivery from the red blood cell to the body cells and enabling CO2 removal of ells onto hemoglobin so can be exhaled in the lungs Trace Minerals Minerals required in relatively small amts and are present in the body in relatively small amounts The intake is typically lt1OO mgday Food Sources Amt present in food is reflective of the amt present in the soil of which the food is grown Listings in books etc are an approximation Found in all food groups Whole grain pproducts tend to contain more than milled cereal products Amt not influenced by cooking Digestions Very little needed Absorption Occurs mostly in Sl but also some in stomach Bioavailability often influenced by form nutritional status and interactions w other dietary components Circulation Via blood Func ons Most are cofactors for enzymes some of which are involved in redox reactions Some are components of nonenzymatic proteins Some have structural roles such as mineralization Toxicity Rare assoc with excess supplement intake or environmental exposure Iron Trace mineral Influences on Iron Absorption Heme iron is absorbed at a much higher rate than non heme iron Heme gt Non heme Heme is the molecule found as part of a larger protein called hemoglobin Heme is a series of ring molecules and in the center is an iron atom Heme iron is found I foods of animal origin Can be found in other chem forms non heme iron for plant foods for this reason animal foods are an excellent source of iron Body iron stores When iron consumption is low iron absorption is upregulated We absorb only 1020 of iron in the diet Ferrousgtferric Ferrous has a plus 2 charge and ferric iron has a plus 3 charge Iron in the ferrous form is absorbed much better than iron in ferric form Vitamin c helps to convert ferric iron to ferrous iron Vitamin C enhances Good to eat vit c with iron to help conversion If you are taking iron supplement take it w a glass of oj for ex Meat factor Something unidentified about meat that enhances absorption of iron from meat beyond heme effect Chelator A chem compound present in food that binds the iron very tightly and reduces the absorption of iron in the SI 2 categories phytates compounds present in a lot of unprocessed grains means that you are a vegetarian and whole grains are the richest source of iron in your diet you should be concerned about that polyphenols present in tea coffee red wine spinach effects somewhat ameliorated by simultaneous consumption of vit c Absorption helps maintain Fe homeostasis Its an essential mineral and possibly toxic Reason we have very controlled absorption of iron Heme Fe absorbed without modification Nonheme Fe reduced Fe The ferrous state Involves Fe transport proteins ferritin transferrin in enterocyte Iron Absorption Presence of iron in the intestinal lumen which is transported across brush border membrane via iron transport protein and again into enterocyte Iron can either be bound ferritin Once it passes into the enterocyte it is bound to transferrin When someone has iron deficiency there is twice as many transport proteins than in a healthy individual Also fewer molecules of ferritin so the solo iron is free to be taked up into cell Also fewer transferrin molecules that bind the iron In iron toxicity there are fewer iron transport proteins available In the enterocyte there are many more molecules of ferritin so iron that is absorbed soesnt make it to transport protein on other side of membrane to cross into the body Intestinal enterocytes live for 3 days It is very active constantly renewing itself so every 3 days the enterocytes are scruffed off excreted via feces and new cells take their place Basically ferritin is iron storage molecule holds onto iron when the enterocyte dies the ferritin is storing iron and its all excreted Transferrin transports iron into the body Transferrin transports Fe in blood Transferrin receptors regulate Fe uptake by cells When a cell needs a large amt of iron there are a greater amt of transferrin receptors on the cell membrane Iron storage liver spleen bone marrow Very little atomic form iron in the body almost all of it is bound to proteins to pretect it from becoming an oxidative damaging compound Stored with storage proteins ferritin and hemosiderin Functions of Fe As part of hemoglobin O2 and CO2 transport Myoglobin in muscle 02 reservoir Cellular energy metabolism part of cytochromes involved on oxidative phosphorylation Cytochrome 450 removed toxins from metabolism metabolize drugs Cofactor for enzymes antioxidant enzymes DNA synthsis many others Role in learning and immunity Iron RDA Women 18 mgday gtpregnancylactation That s a level almost impossible to get from foods so if preg or lactating iron supplement recommended Men 8 mgday UL45 mgday Average American diet 6 mg1000 kcal iron deficiency very prevalent of women of reproductive age Add on that monthly loss of blood your losing iron every month Iron Deficiency Mild Fe Deficiency Affect about 30 of women No symptoms signs you just cant tell No routine blood test to identify this Severe Fe deficiency anemia Tired pale poor temp regulation Microcytichypochromic Microcytic very small cells ad very pale cells Can be identified by routine blood test Ferritin levels count Concentration of transferrin receptors the best indicator of iron status can help id more mild cases At risk Infants Preschool Child bearing age Pregnancy Fe Toxicity rarely from food Hereditary hemochromatosis Manifest in middle age more common in men can result in a greyish skin tone cardiac failure diabetes liver failure and can ultimately lead to death if not diagnosed Frequent blood donation can help Zinc Dietary Influences on Zinc Absorption Animal foodsgtpIant foods Acid foodsgtnon acidic foods Phytates chelate Zn make it unavailable High intake Fe or Ca Of concern since esp for women Fe and Ca supps are common and high levels can reduce zinc absorption Important to eat zinc rich foods Intestine regulates Zn homeostasis Transport protein outside enterocyte Metallothionine inside zinc binding protein that functions very similarly to ferritin with irons Functions of Zn Cofactor for hundreds of enzymes Regulate gene expression Zn fingers Zn finger fits into DNA and binds specific segments of DNA regulating the genes Cell maturation and growth Antioxidant Immunity RDA gt for vegans 11 mg men 8 mg women Avg Am Diet 6 mg per 1000 kcal Zinc Deficiency Usually occurs where there is a plant based diet high in phytates Mild Decreased appetite Increased incidence of infectious diseases Decreased growth Severe Skin irritations dermatitis diarrhea delayed sexual maturity Zinc Toxicity Use of supplements UL40 mgday Poor immunity decreased HDL impaired Cu status Energy Balance Energy balance occurs when energy intake caloric consumption equals energy expenditure caloric output Body weight tends to be stable during energy balance Positive energy balance occurs when energy intake is greater than energy expenditure Body weight tends to increase during positive energy balance Negative energy balance occurs when energy intake is less that energy expenditure Body weight tends to decrease during negative energy balance Components of Total Energy Expenditure Total energy expenditure Represented by 3 components Basal metabolism Largest component Energy needed for basic life functions Accounts for 5070 of total energy expenditure TEE Physical activity Energy required for movement Accounts for 1530 of TEE Most variable Thermic effect of food Smallest component Energy required to process food Accounts for 10 of TEE Factors which influence basal metabolism Body surface gtheat loss Need to maintain body temp at 986 and the greater body surface greater opportunity there is for heat loss energy to maintain this larger person has larger energy requirement Gender males gt LBM Males have greater requirement than females because they have greater amt of lean body mass Females genetically have more energy stored as fat Body temperature fever Fever incrs basal matab So energy requirement higher when sick Thyroid hormones Involved in metabolism regulation Underactive thyroid will reduce basal metabolism Nervous system activity Age Basal metabolism decreases starting at 30 and slowly over time Nutritional state If successful at losing weight by consuming fewer calories than you expend you will then have a lower energy requirement for basal requirement because your body is smaller so there is less to suppon Reason for diet plateaus Pregnancy lncrs in basal metab incrs in kcal requirement to support additional maternal tissues and the growing fetus Caffeine amp tobacco lncrs metabolism Determination of energy use by body 1 Measure directly or indirectly by calorimetry by very specialized research conditions whole room calorimeter specially built chamber surrounded by water Test Ss placed in room lie in resting position and the change in the water temp is measured and used to calculate the amt of energy the body expended to stay in that resting state indirect calorimeter mor commonly in some clinical sitches O2 consumes vs co2 produced is measured used to calc amt of energy expended by Ss stable isotopes can be used to calc energy expenditure 2 Estimation sum of basal metabolism phys activity thermic effect of food much more common method estimate energy required for basal metabolism men 1 kcal kg of body weight per hour women 09 kcal kg of body weight per hour body weight kg x 1 or 09 x 24 hours kcalday other formulas are avail harrisbenedict equation Physical activity take basal then add an additional of basal Select a category of physical activity Sedentary 2040 basal someone who mostly sits all day Light activity 5565 basal someone who works as a clerk in a store Moderate activity 7075 teacher who may go to the gym Heavy activity 80100 basal Active most or all day or very rigorous daily exercise These can vary from day to day numbers are very arbitrary Variable arbitrary and subjective in their defs Thermic effect of food 10 of sum basal activity Rough estimates of energy requirements from food pyramid USDA Sedentary women and older adults 1600 kcal Children teen girls active women most men 2200 kcal Teen boys active men very active women 2800 kcal Body Mass Index BMI Body weight kg height2 m Weight lb x 7031 height2 inches BMI chart lt185 underweight 185 249 healthy 25 299 overweight gt30 obese Body Mass Index and WeightRelated Mortality Ration 1 is the norm above 1 increased risk keeps going up Estimating Body Fatness Underwater weighing Used in research environment weigh individ on land and in water Adipose tissue is less dense than LBM gives an indication of body fat by comparing 2 measurements and using some formula Bioelectrical impedance Used more frequently Uses equipment that measures conduction of currents through the body DEXA Specialized xray procedure Not common bc radiation exposure Very accurate Skinfold thickness Least accurate Use a caliber Nearinfrared interactance Newest method Looks at how diff areas of body absorb and transmit infrared light Estimation of Healthy Body Weight Based on weight for height amp family medical history History of diabetes stroke etc because a BMI of 26 could be ok for one person but not so much for another Hypertension Increases risk LDL cholesterol Elevated levels incrs rsk of heart disease Family history of obesity cardiovascular disease colon or breast cancer diabesity Diabesity Refers to the very close correlation btw obesity and the dvlpmt of type 2 diabetes Growing concern major public health issue Pattern of fat distribution around body upper body vs lower body fat Typically distribution of fat around the body falls into accumulation of upper or lower area Not a strict dichotomy as there are all body types Android adiposity Upper body fat distribution men apple shape considered to be most related to an increased risk of dvlping cardiovascular disease hypertension and type 2 diabetes affects liver function assoc with alcohol consumption Gynoid adiposity lower body fat sitribution women pearshape risk factors not as high before menopause then shift to android after common Health problems associated with obesity Atherosclerosis cardiovascular disease Gallbladder disease Joint pain Type 2 diabetes Cancer Gout DNA and RNA bases purines and pyrimidines not metabolized properly Surgical risk pulmonary disease sleep disorders hypertension skin disorders pregnancy risks fertility problems pharmaceuticals affected by high body fat we need to incrs the risk but we really aren39t sure how the increased body mass effects it Obesogenic environments There are environmental factors that contribute to the devlpmt of obesity Poor urban areas Unsafe Few green areas Fast food readily avail Few supermarkets TV viewing Commercial marketing of junk foods Suburban life style Sedentary occupations Ride vs walk Technology Busy families Cheap food USA food is among the lowest costing food in the world thus easy to overindulge Celebrations feasts socialization food Treatment of Obesity Control energy intake Increase physical activity Behavior modification change the behaviors that lead to obese sitches ex take the stairs over the elevator other approaches drug therapy only if very obese and other complications very low calorie diets very dangerous must be done supervised preferably in patient enviro gastroplasty section of stomach surgically tied off so stomach can only hold certain amt of food many complications with these these are considered last resorts Stages in the Human Life Span Stages of the life cycle DRI life stage group Look in text book for chart Nutrition During Pregnancy and Lactation Stages of Prenatal Development and Critical Periods of Organ Formation Penconcep onalpenod Zygote Embryonic period Specialization of cells 38 wks 89 wks placenta becomes fully dvlpd Fetal period 938 wks if a woman doesn39t know shes pregnant anything harmful may have been affecting this embryofetus Functions of the Placenta Fetus suspended in a membrane sac hat is filled with amniotic fluid Amniotic fluid Protects Uterine cavity and placenta surround sac Placenta connected to fetus via umbilical cord Tree like structure of blood vessels Fetal blood vessels transport waste products out to the mother maternal blood vessles transport oxygen nutriens hormones etc in They meet but don t mix with the maternal vlood vessels Components of Weight Gain During Pregnancy Component Approx weight gain lb at 38 weeks gestation Fetus 78 Placenta 1 12 2 Uterus amp supporting structure 2 12 3 Maternal adipose stores 78 Mammary tissue 12 Extracellular fluids blood and amniotic 67 fluid Total weight gain 2530 Recommendations for Total Weight Gain and Rate of Gain During Pregnancy Based on mother39s bmi prior to conception BMI kgm2 Recommended Total Weight Gain Range lbs lt1825 2840 185249 2535 250299 1525 gt300 1120 Physiological Changes During Pregnancy cardiovascular system must adapt to provide higher amts of oxygen thru an increased blood supply to get thru incrs mass of mother s body heart enlarges slightly hear rate increases cardiac output increases blood pressure decreases during 15 half of pregnancy and returns to nonpregnant values during second half of pregnancy high blood pressure can be very dangerous to mother and fetus plasma volume increases liquid part of blood incs by more than 13 red blood cell volume increases respiratory rate increases oxygen consumption increases Gastrointestinal Track amp Food Intake Appetite increases Altered sense of taste and smell Thirst increases GI motility decreases more time for nutrient absorption Efficiency in nutrient absorption increases Gastroesophageal reflux becomes more common heartburn Renal system Filtration rate increases Sodium retention increases Energy Metabolism amp Energy Balance Basal metabolic rate BMR increases Body temperature increases Body weight increases Fat mass increases Lean mass increases Total body water increases Needs during pregnancy vs adult woman age 2551 Kcal 15 trimester same 2 39 amp 3 trimester 300 protein increased 10g vitamins increased D E C thiamin riboflavin niacin B6 folate B12 minerals increased Fe Ca Zn F most urban areas have a fluorinated water supply anyway bold should be supplements bc difficult to get this much Fetal Alcohol Syndrome Small head circumference low nasal bridge eye folds short nose small midface thin upper lip 2 3 of pregnant women are chronic heavy drinkers leading cause of preventable birth defects in the US involves pre and post natal growth retardation mental retardation damaged immune system and craniofacial abnormalities from 6quot month of gestation to several years after birth fetuschild is creating synaptic connections in the brain During this period transient alcohol exposure can delete millions of neurons from developing brain Other factors affecting successful pregnancy greater than 55 lbs Low socioeconomic status Closely space births themother s body needs time to recover Age younger than 18 Prenatal care Lifestyle factors Smoking higher risk of lbw Alcohol Use of some medications and illegal frugs crash dieting or fasting ore than 12 h body weightweight gain caffeine consumption Maternal Nutrition during lactation Nutrient need VERY high 2 factors that influence milk production fluid intake caloric intake even in women w very poor diet the quality of milk is not drastically compromised it39s the volume of milk that decreases Efficiency of converting maternal calories to milk 8090 90 kcal for mammary glands to produce 100 ml milk 67 kcal to infant maternal fat stores built up during preg contribute 200300 kcal per day enough kcal to produce 3 months of lactation Mother39s Diet Should be maintained similar to that during pregnancy 1 additional serving of dairy product pr day will give more calcium vit d etc needed for milk production lots of fluids preferably water breast feeding is a LEARNED behavior not necessarily instinctive doesn39t come naturally to us we need the education on it to do it successfully many sources of info best if mother learns while theyre pregnant so they have time No cow s milk should be fed prior to 1 yr of age The ability to digest the proteins in it is not present until ab 1 yr Anatomy amp Physiology of the Human Breast During pregnancy the breast tissue fully matures triggered by hormonal changes Mammary tissue surrounded by adipose tissue which provides readily source of cals for milk prod Alveolus Cluster of cells that drawin into one of the mammary ducts which collect into the nipple Made up of 2 diff kind of cells w2 diff funcs Milk producing secretory cells surrounded by Myoepithelial cells When they contract milk is forces out of the aveoli and into the mammary ducts These 2 types of cells respond to 2 diff hormonal signals That stimulus is the infants sucking Neural and hormonal regulation of lactation Infant sucking stimulates the hypothalamus recommended that they can start immediately after birth rooting response Neural signals are sent to the hypothalamus The hypothalamus signals the pituitary gland to release the hormones prolactin and oxytocin Prolactin stimulates the alveolus cells secretory cells to produce milk Oxytocin stimulates myoepithelial cells to contract forcing milk into the ducts releasing it This is called milk let down reflex This process takes time there is a time lag right after birth and also when the baby starts sucking and when the milk actually starts The first couple feedings will release only very little milk The baby is getting what heshe needs most babies will lose a little weight after being born Benefits of Human Milk Colostrum The firs milk that s produced for the first 23 days Looks very different than milk like a buttery yellow rich and thick and almost oily looking Filled with immunological protection Baby receives some immunological factors at the end of preg and continues through lactation There is immunological protection throughout lactation but the most here High in fat so rich energy source Meconium elimination First feces formed from baby very black tar like consistency the way that the infant39s digestive track cleanses itself Sometimes before birth and present in amniotic fluid sometimes after birth Immunological protection Antibodies in milk very specific to environment in which mother is living Lower risk of chronic diseases later in life Like food allergies diabetes asthma obesity and cancer Nutritional aspects of human milk Easier to digest and nutrients in milk easier to absorb Ex milk contains lipase The milk contains enzymes for its own digestion Bioavailability of nutriens like zinc and iron is higher than in any other foods Lower protein than faster growing species Diff proteins than in any other species Uniquely suited to support human infant growth They form a curd in the gi track and is much softer and easier to handle than other milkformulas Naturally contains FA DHA Conditionally essential FA during infancy For eye and brain dvlpmt Contains cholesterol Needed for cell membrane synthesis Lactose The milk sugar present in the milk very easy to digest and can facilitate absorption of some minerals like Ca and Mg Oligosaccharides Polysaccharides that have immunologically protective features bc they inhibit growth of harmful bacteria in GI More than half the cals come from lipids Very concentrated source of energy Breastfeeding 52 middle class 29 lower class Barriers Lack of education Employment Constant demand Embarrassment or cultural taboos Teen moms diet would need to be extreme for growth and milk prod Infant Nutrition Nutritional requirements Per lb gt adult 1 Growth 1335 gday 46 months double birth wt 1 yr triple birth wt higher metabolic rate surface area wt ratio is 2x that of adults Infant Nutritional Requirements Kcal 13 months 4550 kcal per lb per day in adults 10 kcal per lb per day 4 months 30 kcal per lb per day Protein 20 kcal 22 g protein per kg per day adults 08 rapid growth skeleton muscles tissues water 15 ml per kcal fat 3050 kcal vitamin d 400 IU equivalent to 1530 min of sunlight breast fed infants supplement recommended vitamin k intestinal bacteria born wo intestinal bacteria little transferred from mother to fetus newborns need the adequate supply While the microbiota are typically est by 810 days theres no real way to tell so newborns are given a vit k injection enough to geth them through any possible hemorrging so their blood is able to clot Fe Born with 46 months stores after that they are depleted Once depleted their iron requirement is higher than the amt found in breast milk The first nutrient that becomes limited in an infant39s diet Introduction of Solids The introduction of a source of iron is so important it guides this 46 months body stores of iron have been depleted can usually sit up showing some signs of readiness drool swallowing 6 months Fe fortified cereals are the recommended first food 9 months gradual transition to high protein foods soft meats can be introduced 1 yr baby can feed themselves digestive system liver kidney fully dvlpd modified adult diet can eat small pieces of same food that adults are eating Ages 15 Eat 57x pday The foods they re offered should be very nutrient dense Regulate own energy intake no need for overly forced eating by the parents Snacks important Frequent exposure to new foods It might take up to 10 exposures to a new food for a child to decide if she really likes it or not Preschoolmiddle childhood middle school Growth rate slower Infancy 9month 2 yrs 1month provide nutritionfoods for optimal growth development health promote sound lifelong habits for nutrition and exercise promote habits to avoid chronic health problems later on kids are not little adults still try and avoid obesity and type 2 diabetes adolescence growth spurts secondary sex characteristics appear hormonal secretions promote this girls 913 yrs boys 1216 yrs sexual maturation of statural growth girls 1017 yrs boys 1221 yrs nutritional vulnerability geriatric care a growing field never before have we had such a large population of older generations Nutrition amp Aging Aging affect nutritional needs Nutritional status affects the aging process Changes in body composition with aging Increase in body fat percentage Decrease in lean body mass Influenced by exercise and kcal intake Over time percentage of muscle or lean body mass goes down and body fat goes up Can lead to heart disease diabetes maybe some cancers Loss of muscle mass will you have enough to carry out daily types of living enough not to fall and break something etc Things that may or may not be influenced by phys activity Nerve conduction Basal metabolism Vital capacity of lungs Cardiac Decline Signs Dvlping disease cholesterol plauque buildup Symptoms angina sharp pain in heart during excerise More severe symptoms mild heart attack Death fatal heart attack cardiac muscle deprived of 02 Energy requirement decreases with age Decline in physiological processes Decrease in resting energy expenditure needed for basal metabolism Decrease in phys activity DRls Requirements for protein vitamins and minerals remain unchanged Calcium requirement even increases Nutrient density of our diet becomes critical with age You need to eat less than when you were younger but the samemore nutrients Ca Zn Fe vitamin D folate thiamin vitamin B12 water Most commonly found to be limited in the diets of elderly Other changes with aging Impaired brain function Role of B6 B12 and folate Supplemental levels of these could be beneficial in preventing alzheimers Failing vision Cataracts antioxidants smoking incrs liklelihood of ctrcts Macular degeneration antioxidants declining immunity more succeptible to infections some cancers most aspects of diet obesity and diabetes avoid excessive kcal exercise weight loss in very old thin and frail medications most elderly use Many medications can interfere w nutrient absorption Psych and soc factors Long standing food habits Economic considerations Living alone Depression amp anxiety Nutrition quackery
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