FDNS Final Exam Study Guide
FDNS Final Exam Study Guide FDNS 4050
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This 112 page Study Guide was uploaded by Bridget Ochuko on Saturday December 12, 2015. The Study Guide belongs to FDNS 4050 at University of Georgia taught by Alex K. Anderson in Fall 2015. Since its upload, it has received 162 views.
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Date Created: 12/12/15
FDNS 4600 Final Exam Notes 12/13/2015 ▯ 100 total questions on exam: 40% from test 1-5 and 60% from new material. Pay attention to different health conditions covered and their management from infancy from previous material and to nutrition in older adults and the changes that ensue for the new material. Material in red from previous material is important! ▯ ▯ Introduction to Nutrition and the Life Span Nutrient- something your body needs to function, without this the body cannot function o Example: water, protein, carbohydrates A balanced diet can prevent chronic diseases and improve energy levels and overall health and wellness o 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: o Availability of immunizations- prevents children from catching common diseases that can kill a young child o 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 o Increases in the availability and quality of the food supply 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 ▯ What is Nutrition? The study of foods, their nutrients and other chemical constituents, and the effects of food constituents on health o A source of materials to nourish the body o 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 management/treatment/prevention to improve quality of life Two types of iron: o 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 field of human nutrition ▯ Principle #1: Food is a basic need of humans Food security- acquiring food in a socially acceptable way, always having nutritious food available at an affordable cost Food insecurity- not knowing where you’re next meal is coming from, not having access to nutritious food in an affordable way o 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 o Nutrient needs: Energy/calories Macronutrients Micronutrients Water o Essential nutrients: Carbohydrates Certain amino acids Linoleic acid and alpha-linoleic acid Vitamins Minerals Water o 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 Dietary Intake Standards o Dietary Reference Intakes (DRIs) 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 o Simple carbohydrates Monosaccharaides Disaccharides o Complex carbohydrates Starches Glycogen Fiber o Alcohol sugars o Alcohol (ethanol) o Glycemic Index of Carbohydrate Glycemic index- extent to which carbohydrate- containing foods increase blood glucose levels Foods with high glycemic index raise blood glucose levels higher 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, GL of 11-19 is considered medium, GL of 10 or less is considered low o Recommended intake level: 45-65% of calories added sugar: 25% or less of total calories 21-35 g fiber/day for females 30-38 g fiber/day for males o 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 o 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 o High quality proteins provide all essential amino acids o Recommended intake: 10-35% of calories o Food sources o Each gram of protein produces 4 calories o Main functions of protein: Chemical messengers (hormones, neurotransmitters) Enzymes Acts as a source of energy Transport Immune response Regulation of fluid and acid-base balance Growth- building blocks for construction and replacement of all cells and tissue Fats (Lipids) o Essential fatty acids Linoleic acid (omega-6) Alpha-linoleic acid (omega-3) o 4 or less omega-6 to 1 omega-3 is recommended o Food sources o Each gram of fat produces 9 calories o Saturated- try to stay away from these fats o Unsaturated Monounsaturated Polyunsaturated o Trans fats: extremely unhealthy, making an ingredient stronger than it is Hydrogenation Cis versus trans structure o Cholesterol: non essential, our bodies make them There is no cholesterol in any plant food o Recommended intakes: 20-35% pf calories from fat, limiting unhealthy fats Vitamins o Water-soluble vitamins: easily excreted from the body through urine Must make an effort everyday to obtain these because we cannot see if there is a deficiency Destroyed by excessive heat Thiamin, riboflavin, niacin, B6, folate, B12, biotin, panthothenic acid, C o Fat-soluble vitamins: A, D, E, K o Functions Coenzymes Antioxidants o Recommended intakes: deficiencies, toxicities o Other substances in food: phytochemicals Minerals o Essential minerals: Calcium, phosphorus, magnesium, iron, zinc, fluoride, iodine, selenium, copper, manganese, chromium, molybdenum, sodium, potassium, chloride Water o Adults are 60-70% water o Recommended intakes: 15-16 cups/day for males 11 cups/day for females 75% from fluids; 25% from foods o Dietary sources Best are water and nonalcoholic beverages Alcoholic beverages increase water loss through urine o Why is water important? Maintain body temperature Metabolize body fat Aids in digestion Lubricates and cushions organs Transports nutrients Flushes toxins from your body Factors that Influence Nutrient Needs o Age o Gender o Growth o Pregnancy/lactation o Body composition/body type o Body size o Genetic traits o Illness/disease state o Lifestyle habits o Medication use ▯ Principle #3: Health problems related to nutrition originate within cells Homeostasis ▯ Principle #4: Poor nutrition can result from both inadequate and excessive levels of nutrient intake Micronutrients low Deficiencies- begins with inadequate nutrient intake Toxicities- begins with excessive nutrient intake The “ripple effect”- dietary changes introduced to improve intake of one nutrient may affect intake level of other nutrients ▯ Principle #5: Humans have adaptive mechanisms for managing fluctuations in food intake Regulation of absorption or appetite Nutrient storage ▯ Principle #6: Malnutrition can result from poor diets and from disease states, genetic factors, or combinations of these causes Primary malnutrition- dietary in origin Secondary malnutrition- precipitated by a disease state, surgical procedure, or medication (ex. Someone who has down syndrome) o Nutrient-Gene Interactions Single gene defects Interaction of genetic environmental factors, including nutrition Ex. Alcohol intake during pregnancy ▯ Principle #7: Some groups of people are at higher risk of becoming inadequately nourished than others Pregnant/breastfeeding women Infants and children People who are ill, frail elderly persons ▯ Principle #8: Poor nutrition can influence the development of certain chronic diseases Heart disease, hypertension, cancer, stroke, osteoporosis, type 2 diabetes, obesity ▯ Principle #9: Adequacy and balance are key characteristic of a healthy diet Variety Nutrient density Limiting “empty-calorie” foods ▯ Principle #10: There are no “good” or “bad” foods All things in nutriment are good or bad relatively based on: o If nutrient needs are met o If calorie intake maintains healthy body weight ▯ Nutrient Labeling Nutrition facts panel must list fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, fiber, sugars, protein, vitamins A and C, calcium, and iron; also % daily values Nutrient content and health claims Ingredient label ▯ Other Labeling Concerns Enrichment-replacing what was lost during processing into the food, adding nutrients back o Refined grain products have added thiamin, niacin, riboflavin, and iron Fortification- adding a nutrient to a food that might not naturally be present in the food substance o Done in order to prevent deficiencies Herbal remedies- considered dietary supplements by FDA o Some act like drugs and have side effects o Vary in safety and effectiveness o Particularly be careful if trying to become pregnant Functional food- foods that have health promoting effects beyond their nutritional effects o Prebiotics- example: fiber; microorganisms use that for survival o Probiotics- contain live organisms, fermented foods; example: yogurt ▯ Life-Course Approach: whatever we eat today affects our health later on in life, we must focus on long term health ▯ Nutritional Assessment Community-level assessment o Statistics data, surveys, observations o Used to develop community-wide nutrition programs Individual-level assessment o Clinical/physical assessment: doctor Inspection for features that may be related to malnutrition o Dietary assessment: nutritionist, dietician 24 hour dietary recalls and record Dietary history Food frequency questionnaires o Anthropometric assessment: taking your weight, height o Biochemical assessment: blood samples urine samples, genetic testing, nutrient and enzyme levels ▯ ▯ Nutritional Needs and Influences during Preconception Does caffeine intake play any role in human fertility? o Anything in excess is harmful, studies show too much coffee can affect fertility Health and nutrition are very important for successful reproduction The most important thing to do is build your nutrient storage if you are sexually active incase of pregnancy o Improve your health o Boost your energy o Greatly improve your fertility Folic acid is vital in first 3-4 weeks of pregnancy to avoid neural tube defects Overview: o ~15% of couples are infertile o Miscarriage: Most happen because of defects in fetus Maternal infection Structural abnormalities of uterus Endocrine or immunological disturbances o Subfertility: woman with 2+ miscarriages, reduced level of fertility characterized by unusually long time for conception ~18% of couples are sub-fertile Multiple miscarriages, sperm abnormalities, infrequent ovulation Preconception Health: the provision of biomedical and behavioral interventions prior to conception in order to optimize women’s wellness and subsequent pregnancy outcomes Preconception Care: an organized, comprehensive programs that identifies and reduces women’s medical, psychological, social, and life-style reproductive risks before conception ▯ Healthy People 2020 Objectives Optimum folic acid levels (one a day) Low red blood-cell folate concentrations Preconception care services and behaviors Impaired fecundity ▯ Objective related to Preconception: Make sure you are within the weight limit before pregnancy Reduce or avoid drinking alcohol Type of environment advised: o Underlying- physical environment, having access to resources o Intermediate- family environment o 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 Menstrual Cycle- ~4 week interval in which hormones direct buildup of blood and nutrient stores within uterus; ovum matures and is released Development of female and male reproductive systems: o Begins during first months after conception o Continue to grow and develop through puberty o 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 Gonadotropin- releasing hormone (GnRH) o Stimulates pituitary to release FSH and LH Follicle-stimulating hormone (FSH) o Stimulates maturation of ovum and sperm, production of estrogen Luteinizing hormone (LH) o Stimulates secretion of progesterone and testosterone 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 o Stores nutrients 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 o Progesterone helps with nutrient mobilization (vascularity of endometrium) ▯ Two Phases of Menstrual Cycle Follicular Phase (first half of menstrual cycle) o Follicle growth and maturation o Main hormones: GnRH, FSH, estrogen, and progesterone Luteal Phase (last half of menstrual cycle) th o Begins with ovulation (by the 14 day in the 28-day cycle) Not all women ovulate- athletes or females with very low body fat Temperature rising half-way through the cycle indicates ovulation o Formation of corpus luteum ▯ Male Reproductive System The male reproductive system is more ongoing than females (every 75 days) Interactions among hypothalamus, pituitary gland, and testes Androgens- testosterone stimulate sperm maturation Sperm are stored in the epididymis and released in semes ▯ Sources of Disruption in Fertility Adverse nutritional exposures: deficiencies, excesses Contraceptive use provides hormones to let the body think you are pregnant, in order to avoid pregnancy Severe stress infection Tubal damage- an abortion that doesn’t go completely right Chromosomal damage ▯ Undernutrition and Fertility Undernutrition in women previously well-nourished 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 o Primary effect = birth of small and frail infants with likelihood of death in the first 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 o Both extremes lower fertility Body fat to support pregnancy should be between 20-30% because a doctor uses the fat to monitor hormones Weight loss greater than 10-15% of usual weight decreases estrogen, LH, FSH o 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 damage/oxidation o Vitamins E and C, Beta-carotene, Selenium o Found in vegetables and fruits o Protect cells of the reproductive system, including eggs and sperm o Phytochemicals also have antioxidant properties Zinc in men plays a role in the reduction of oxidative stress, in sperm mutation, and in testosterone synthesis ▯ Fertility and… Plant Foods: low-fat, high fiber linked to irregular menstrual cycles o Isoflavones (from soy) decrease levels of estradiol, progesterone, LH Caffeine: study results are mixed on effects of caffeine Alcohol: may decrease estrogen and testosterone levels or disrupt menstrual cycles Heavy-Metal Exposure: high lead levels- decreased sperm production, abnormal motility, and shape; build-up of cadmium, molybdenum, manganese, boron, and other metals also affect male fertility Exercise: adverse affects of intense physical activity o Delayed age at puberty o 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 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 Nutrition care standards developed by the Academy of Nutrition and Dietetics The Nutrition Care Process o Step 1: Nutrition assessment o Step 2: Nutrition diagnosis o Step 3: Nutrition intervention o Step 4: Nutrition monitoring and evaluation ▯ ▯ Nutrition Management for Preconception Conditions Folic acid- most important prenatal vitamin for women Premenstrual syndrome could interfere with fertility Characterized by life-disrupting physiological and psychological changes that begin in the luteal phase and end with menses Symptoms occur in 15-25% of menstruating women If you know you have this you can seek treatment previous to conception Some studies suggest that reducing caffeine intake could reduce PMS (also Vitamin D and Magnesium)—but there is not much evidence for this Cause of PMS not yet clear o Thought to be related to abnormal serotonin activity following ovulation Treatments: o Antidepressants containing serotonin uptake inhibitors o Calcium B6, chaste berry supplements Premenstrual Dysphoric Disorder o Severe form of PMS o Characterized by marked mood swings, depressed mood, irritability, and anxiety o Symptoms: breast tenderness, headache, joint and muscle pain ▯ Obesity, Body Fat Distribution, and Fertility Central obesity interferes with reproduction in women and men o Treatment of first choice for obese people should be weight loss; this can reduce or eliminate fertility problems Weight reduction methods: o Focus on lifestyle changes o Decrease calorie intake o Increase physical activity levels o Weight loss surgery if efforts fail—bariatric surgery Fertility may return after surgery Increases the risk for multiple deficiencies Pregnancy not recommended during first year after surgery ▯ Metabolic syndrome can be well managed by diet and physical activity Characterized by a cluster of abnormal metabolic and health indicators If not well managed it can lead to CVD and diabetes Prevalent in about 32% of US adults Therapy: dietary modification, weight reduction, exercise ▯ Eating Disorders Women with eating disorders particularly anorexia, will hardly get pregnant because: o They don’t have enough body fat o Lower energy levels o Less nutrient support o They are not menstruating o If pregnancy occurs: There tends to be complications with the babies o It is easier for a bulimic to become pregnant rather than an anorexic ▯ Female Athletic Triad: Triad: o Amenorrhea o Disordered eating negatively affects bone development o Osteoporosis Triggered when energy intake in ~30% less than requirement Low hormone levels lead to reduction in bone density Supplements are important to help with pregnancy Management: o Correction of negative energy balance o Correction of eating disorders o Vitamin D and calcium supplements to facilitate bone development ▯ Diabetes Diabetes mellitus: intolerance to carbohydrate with fasting glucose > 126 mg/dL o Prior to pregnancy: High blood glucose levels during the first 2 months of pregnancy are teratogenic Associated with a 2-3 fold increase in congenital abnormalities n newborns Malformations of pelvis, CNS, and heart seen in newborns, higher rates of miscarriage Types: o 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 o Type 1 diabetes- autoimmune, the patient is not secreting insulin, previously called juvenile diabetes Results from destruction of insulin producing cells (10% of cases) Management: Main goals: blood glucose control, resolution of coexisting health problems, health maintenance Diets controlled in carbohydrate content = carbohydrate control Replace sugars with reasonable amounts of artificial sweeteners Choose food low in glycemic index and high in fiber Encourage brightly colored fruits and vegetables Low fat meat and dairy products, fish, dried beans, and nuts and seed Need insulin shots to enhance transport of glucose in blood to the cells Physical activity Type 2 diabetes- the body may be secreting adequate or excess insulin, but the problem is that the insulin is insensitive o Body unable to use insulin normally, to produce enough insulin, or both (90% of cases) o Without insulin, the sugar is unable to move from the blood to the cells o Need medication to sensitize the insulin to transport the sugar into the mitochondria for energy: metformin Can enhance weight loss o Management: Diet and exercise and oral medication to increase insulin production and insulin sensitivity ▯ Polycystic Ovary Syndrome Insulin is not sensitive enough for glucose transport 5-10% of women of childbearing age Leading cause of female infertility Tends to be in women who are overweight who have fatty ovaries Cause is uncertain o Insulin o Genetics could play a part in this Management: o Primary goal to increase insulin sensitivity o Weight loss and exercise improve prognosis o 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 Monitor the amount of phenylalanine, make sure it is able to be synthesized ▯ Celiac Disease Autoimmune disease characterized by chronic inflammation of small intestine o Inherited sensitivity to gluten in wheat, rye, barley, which causes malabsorption and flattening of intestinal lining 1:33 in the US have this Linked to infertility in some women and men Management: o Important to avoid gluten in diet o Correction of vitamin and mineral deficiencies ▯ ▯ Nutrition Needs and Influences During Pregnancy When pregnant, you cannot eat and drink all you want because you have to think about the nutrient value for the baby o Everything the mother eats goes to the baby and determines the health and progression of the pregnancy o The child develops taste buds for the foods the mother eats The fetus is never a parasite because whatever the mother eats, she must satisfy her own needs first, then the placenta, and lastly the fetus benefits from what the mother eats o A parasite takes from the host whether the host likes it or not, the fetus does not do this ▯ Terms: We estimate conception based on the last menstrual cycle Periconceptional- one month before pregnancy Conceptus- when the sperm fuses with the egg o Zygote- between conception and 2 weeks o Embryo- between two weeks and 8 weeks o Fetus- between 8 weeks and delivery Very preterm- anything before 34 weeks o Premature babies ▯ 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 Strong correlation between infant mortality and life expectancy Infant mortality higher in males: male fetus much more vulnerable There is a lot of focus on the first 1000 days of life (pregnancy-2 years): if the child is healthy the child will grow up and go on to be healthy throughout their lives st Low birth weight or preterm infants at higher risk of dying in 1 year of life Reducing infant mortality: o Improve birth weight of newborns: desirable birth weight = 7 lb. 12 oz. – 10 lb.) o Infants born with desirable weight less likely to develop: heart and lung diseases, diabetes, and hypertension ▯ Health Objectives for 2020 The Health Objectives for 2020 in relation to pregnant women and newborns focus on: o The reduction of low birth weight o Preterm delivery o Infant mortality o A number of the objectives are related to improvements in nutritional status ▯ 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 A lot of dilution in the first weeks of pregnancy o Hemodilution Most weight gain occurs between 35 and 40 weeks Two phases of changes: o Anabolic phase = first 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 Catabolic 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 Body water increases from ~7 L to 10L: results from increased blood and body tissues and extracellular volume and amniotic fluid Edema: swelling due to accumulation of extracellular fluid ▯ Metabolism Carbohydrate Metabolism o Glucose is preferred fuel for fetus o Early pregnancy: high estrogen and progesterone stimulate insulin which increases glucose and consequently glycogen and fat o Late pregnancy: human chronic somatotropin (hCS) and prolactin inhibit conversion of glucose to glycogen and fat Protein Metabolism o About 92 g of protein accumulate during pregnancy o Protein and amino acids conserved during pregnancy o Needs must be met by mother’s intake of protein Fat Metabolism o Fat stores: accumulated in first half of pregnancy, enhanced fat mobilization in last half o Blood lipid levels increase o Increased cholesterol is substrate for steroid hormone synthesis Mineral Metabolism o Calcium: increased bone turnover and reformation o Sodium: accumulation in mother, placenta, and fetus; restriction of sodium potentially harmful ▯ The Placenta Nutrient factors: o Size and charge of molecules o Small molecules pass through most easily o Lipid solubility of particles o Concentration of nutrients in maternal and fetal blood The fetus is not a parasite Nutrients first used for maternal needs, then for placenta, and last for fetal need The fetus is harmed more than the mother by poor maternal nutrition Types of transport: o Passive diffusion o Facilitated diffusion o Active transport o Endocytosis ▯ Embryonic and Fetal Growth and Development 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. Critical Periods: o Differentiation: cellular acquisition of one or more characteristics or functions different from that of the original cell o Critical Periods: preprogrammed time periods during embryonic and fetal development when specific cells, organs, and tissues are formed and integrated or functional levels established ▯ Fetal Body Composition In the second half of pregnancy, body fat composition occurs, where nutrients are extremely critical Small for gestational age o Disproportional- the baby’s body is disproportional, the legs, arms, and head are of normal range, but the weight is extremely low = less than 10 % th The malnutrition within the mother occurs at the end of the pregnancy o 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 deficit in the babies’ cells because the mother doesn’t eat enough nutrients 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 o Linked to: Energy, nutrient, and oxygen availability Genetically programmed growth and development Insulin-like growth factor (IGF-1) is main fetal growth stimulator Nutrition, Miscarriages, and Preterm delivery o 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 o 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) Changes may predispose individuals to chronic diseases 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 Many chronic diseases begin in the womb with whatever the mother is eating during pregnancy—could relate to changes in genes o 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 ▯ Pregnancy Weight Gain It is important for all expecting mothers to gain weight. Even if they are obese Weight gain during pregnancy is related to the weight and health status of the newborn infant o The fetus is only about 1/3 of the total weight gain o The balance of the weight gain is related to body fat changes, placenta, amniotic fluid, increase of extracellular fluids, and blood supply of the mother As long as the mother is continually gaining weight, it shows a healthy intake of macronutrients Even though there is a baby in the womb, the mother isn’t actually eating for two; she just must increase her nutrient intake When a mother breastfeeds, she tends to lose the weight faster Undernutrition puts the mother as well as the baby at risk Normal amount of calories needed a day = 1650 o Energy requirements in pregnancy require a gradual increase of caloric intake ▯ Energy and Nutrient Needs During Pregnancy Energy requirements: ~300 additional cal/day; +340/day in 2 nd trimester, +452 cal/day in 3 trimester Calorie intake assessed by pregnancy weight gain ▯ Carbohydrates, Artificial Sweeteners, and Alcohol Carb intake (45%-65%): minimum of 175 g Basic foods such as vegetables, fruits, and whole grains with fibers Artificial sweeteners are ok Strongly advised to avoid alcohol ingestion during pregnancy ▯ Fiber Very important of pregnancy diet, although fetus development does not depend on it Adequate fiber intake increases the comfort of pregnant women, helps reduce constipation, 28 g//day ▯ Protein Requirement = +25 g/day or ~71 g Average intake of typical female = ~78 g ▯ Fat Pregnant women consume ~33% of total calories from fat Fat consumed in food is used as an energy source for fetal growth and development Fat serves as a source of fat-soluble vitamins Fat provides essential fatty acids o Adequate intake liked to higher intelligence, optimal development, better vision, and more mature CNS o Do not exceed 3 g/days ▯ Vitamins Folate: associated with anemia and reduced fetal growth o Increase in folate = extensive organ and tissue growth o Functions: metabolic reaction, deficiencies lead to abnormal cell division and tissue formation o Congenital abnormalities: Neural Tube Defects Malformations of spinal cord and brain: spinal bifida, anencephaly, encephalocele o Status has improved with fortified cereals and supplements o Recommended intake = 600 mcg Choline: fetal brain growth, intellectual development Vitamin A: needed for cell differentiation, growth of fetus, protein synthesis o In US more concerned with toxicity Vitamin D: supports fetal growth and bones/skeleton, supports immune system, prevents autoimmune diseases and other chronic diseases B12 also very important when pregnant ▯ Minerals Calcium needed for fetal skeletal mineralization and maintain maternal bones o Needs can be met with 3 cups of milk or calcium fortified soy, rice, and almond milk Fluoride: teeth begin to develop in utero, limited amount transferred from mother, supplementation not recommended Iron: o Iron deficiency- a condition marked by depleted iron stores with weakness, fatigue, short attention span, poor appetite, increased susceptibility to infection, and irritability o Iron deficiency anemia- a condition marked by low hemoglobin with signs of iron deficiency plus paleness, exhaustion, and rapid heart rate Risk of preterm delivery If late in pregnancy, associated with lower intelligence o Iron supplementation Absorbed better from supplements containing iron only than when mixed with other minerals Excess intake can create other problems: it can impair the absorption of zinc Make sure not to exceed the amount of zinc needed as well Magnesium- only occurs if not eating healthy o Deficiencies associated with increased risk of miscarriage, fetal growth retardation, and preterm delivery o Some studies show deficiencies can create gestational diabetes Zinc- extremely important during the first trimester when organs are formed and may play a role in assisting in immune system development Iodine- required for thyroid function and energy production and for fetal brain development o Absence can lead to many deformities in the baby, still 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 benefits besides nutritional benefits Include phytochemicals and antioxidant pigments Are not considered essential nutrients but influence health ▯ Water: helps with amniotic fluid 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 influence the baby’s taste preferences Pica: eating disorder where pregnant women eat non-food substance o Prevalent in pregnant African American women Dietary supplements during pregnancy o Pregnant women do not need supplements as long as they are eating healthy except for iron Food Safety Issues o Foodborne illness o 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 = 3-5 times each week for 20=30 minutes at 60- 70% VO2 max ▯ Common Health Problems During Pregnancy Nausea and vomiting o Separating fluids from food will give the food sometime to settle in your stomach, reducing the frequency of vomiting o Eating dry foods helps reduce o Certain dietary supplements o 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 fiber, drink water along with fiber, laxatives are not recommended ▯ Model Nutrition Programs The Montreal Diet Dispensary (MDD) o Results in fewer low birth weight infants, lower rates of perinatal mortality WIC- help pregnant women who are at nutritional risks o Saves Medicaid a lot of money because there are fewer sick newborns ▯ ▯ Nutrition Needs and Influences during Lactation ▯ Benefits of breastfeeding: Reduced infant morbidity Cost savings to the Medicaid program Higher levels of immune function ▯ Primary function of the breasts is to feed The more we breastfeed, the more milk we produce Milk composition changes over time If breastfeeding hurts, that means the mother is doing something wrong Diet: variety and balanced meals ▯ Physiology Mammary gland: source of milk for offspring, the breast Alveoli: functional units o Rounded or oblong shaped cavity present in breast o 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 The most important thing when breastfeeding is the nipple and areola o The baby must have the entire areola in their mouth with the nipple center of the mouth o 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 o Levels of both hormones increase dramatically to prepare mammary glands for lactation o If progesterone levels do not decrease after pregnancy it will affect prolactin Primary hormones contributing to breast development: o Human placental lactogen is released during pregnancy to prepare the breasts for lactation o Prolactin synthesizes the milk Secreted towards the end of pregnancy o Oxytocin is the enzyme that enables the milk to flow 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 2-5 days): the mother does not need stimulation of the breasts o Milk = colostrum Helps the babies’ immune system mature faster; yellowish in color Stage 2 (begins 2-5 days after birth) o Stimulation needed o Milk = transitional milk Much lighter milk Stage 3 (begins ~10 days after birth) o Stimulation needed o 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 o Both hormones cause inhibition of ovulation = 98% protection from pregnancy during the period of breastfeeding ▯ Exclusive breastfeeding = all of the baby’s nourishment is coming from breastfeeding; absolutely no other food, not even water Up to 6 months After 2 months, the baby should be supplemented Vitamin D because the mother isn’t producing enough Vitamin D ▯ Optimal breastfeeding = breastfeeding 80% of the time, formula or other foods here and there ▯ Partial breastfeeding = 50/50 between breastfeeding and formula ▯ Token breastfeeding = when the baby uses the breasts as more of a snack; seen in older children Ultimately it is up to the mother and the baby on how long they breastfeed ▯ 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 o 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 o 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 o 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 o Content related to growth of infant o Concentration decreases over first 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 deficiency that appears as diaper rash Trace minerals: copper, selenium, chromium, manganese, molybdenum, nickel, fluoride o Not altered by mother’s diet ▯ Importance of Breastfeeding: Species specific Nutritional advantages Infection protection Allergy protection Psychological benefits Brain development ▯ Benefits 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 benefits: increased oxytocin stimulates uterus to return to pre-pregnancy status Physical benefits: delay in monthly ovulation resulting in longer intervals between pregnancies Psychological benefits: increased self-confidence and bonding with infant Benefits for mother: o Reduced risk of cancer (breast and ovarian) o Reduced risk of diabetes o Reduced risk of postpartum depression Benefits for infants: o Many nutritional benefits o Immunological benefits: lower infant mortality in developing countries and fewer acute illnesses o 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 o Reduction in chronic illness o Reduction in possibility of baby being overweight Weight wise, babies at 1 year are leaner than formula fed babies They have more body fat which assists in brain development and growth spurts Significant cognitive difference in premature babies Analgesic effects: reduction of infant pain significantly milder when it comes to circumcision in breast fed babies Socioeconomic benefits: decreased need for medical care o Countries save on formula exchange o Employers benefit because parents don’t need to stay home and take care of sick children ▯ Breast Milk Supply and Demand Milk synthesis is related to: o How vigorously an infant nurses o How much time the infant is at the breast o How many times per day the infant nurses Having larger breasts doesn’t mean you make more milk, but it means it contains more fat Baby milk demand o 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 Non-nutritive feeding: if the child is sucking on the breasts as a pacifier 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 o One breast always produces more than the other There are several different methods for pumping or expressing milk (manual and electric) The type of breast reduction/augmentation determines the ability to breastfeed, but it is possible o There is no evidence that silicone from breast implants produces toxicities in breast milk ▯ Positions for Breastfeeding: Lay back hold Football or clutch hold Cross-cuddle hold ▯ The Breastfeeding Infant Identifying hunger and satiety o Hunger is signaled by infant bringing hands to mouth, sucking on them, and moving head from side to side o Crying is a late sign of hunger o 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 first week is normal because the baby is full of fluids when born, some babies also have stool that they will pass o Weight loss of 10% needs evaluation by lactation consultant Malnourished infants become sleepy, non-responsive, have a weak cry, and wet few diapers o By day 5 to 7, infants should have 6 wet diapers and 3-4 soiled diapers ▯ Energy and Nutrient Needs for Lactation RDA for macronutrients during lactation is similar to that for pregnant women Energy needs vary by activity level DRI is +500 kcal/day for the first 6 months and +400 kcal/day 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 Exercise does not inhibit milk production or infant growth Lactating mothers should consume 3.8 liters or 128 ounces of water per day ▯ Micronutrients The RDA for micronutrients remain the same as those set for pregnancy except iron Water soluble vitamins dependent on mother’s intake because they are not stored in the body as well as zinc, selenium, and iodine o During breastfeeding, iron RDA moves from 27 during pregnancy back to 18 Vitamin and mineral supplements not needed in well-nourished women Functional foods show no adverse effects ▯ Factors influencing Breastfeeding Initiation and Duration Obese women tend to have difficulty with breastfeeding due to higher levels of estrogen and progesterone Low-income and more affluent 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 confidence 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 first 2 days of life Increase births in facilities providing recommended care for breastfeeding mothers ▯ Breastfeeding Promotion, Facilitation, and Support The healthcare system plays an influential role in breastfeeding Lactation support in hospitals and birthing centers Lactation support after discharge: essential in the first few weeks after delivery o Any knowledgeable healthcare practitioner should see all breastfed infants at 2-4 days of age o Breastfeeding Peer Counseling o Le Leche League The work place provides barriers making it difficult for mothers to breast feed The community must establish a multidisciplinary breastfeeding task force with representatives from the healthcare system and others knowledgeable in the field o Community attitudes and obstacles to breastfeeding need to be assessed Model Breastfeeding Promotion Programs o WIC national Breastfeeding Promotion Project o Office of Women’s Health o Wellstart International ▯ Nutrition Needs and Requirements During Infancy Nutrition is an important contributor to the complex development of infants o Birth weight and infant mortality o Energy and nutrient needs o Physical growth assessment o Infant feeding ski
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