Chapter 6-7 Notes and Lecture Comments
Chapter 6-7 Notes and Lecture Comments 30123
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This 11 page Class Notes was uploaded by Megan stookey on Tuesday February 16, 2016. The Class Notes belongs to 30123 at Texas Christian University taught by Dr. Stevenson in Winter 2016. Since its upload, it has received 17 views. For similar materials see Nutrition Throughout the Lifecycle in Nutrition and Food Sciences at Texas Christian University.
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Lifecycle Notes Section 2 Chapter 6: Nutrition During Lactation Lactation Physiology Mammary Gland => source of milk for offspring, the breast Functional Units of the Mammary Glands Alveoli in mammary glands are the functional units Each is composed of secretory cells with a duct in the center Myoepithelial, that line the alveoli, contract during letdown causing milk ejection Mammary Gland Development During puberty, the ovaries mature with increase in estrogen and progesterone Stages of development = tanner stages Primary hormones contributing to breast development are: o Estrogen => contributes to ductal growth during mammary gland differentiation with menstruation o Human growth hormone => alveolar development after the onset of menses and during pregnancy o Human placental lactogen => development of terminal end buds during mammary gland development o Progesterone => Alveolar development during pregnancy o Prolactin => alveolar development and milk secretion during pregnancy and breast feeding (from the 3 rd trimester to weaning o Oxytocin => letdown: ejection of milk from the Myoepithelial cells from the onset of milk secretion to weaning. Alveoli => rounded or oblong shaped cavity present in breast Secretory Cells => cells in acinus (milk gland) that are responsible for secreting milk components into duct Myoepithelial Cells => line the alveoli and can contract to cause milk to be secreted into ducts Oxytocin => hormone produced during letdown that causes milk to eject into ducts Lobes => rounded structures of mammary glands Lactogenesis => term for human milk production Stages: I => birth to 2-5 days, milk formation begins II => begins 2-5 days after birth, increased bloods flow to breast; milk “comes in” III => begins at ~ 10 days after birth, milk composition is stable Prolactin => a hormone necessary for milk production Hormonal Control Of Lactation Prolactin: Stimulates milk production Released in response to suckling, stress, sleep, and sex Inhibits ovulation post-pregnancy Oxytocin Stimulates letdown Tingling of the breast may occur corresponding to contractions in milk duct Causes uterus to contract, seal blood vessels, and shrink in size. Human Milk Consumption Human milk is the only food needed by the majority of healthy infants for ~ 6 months It nurtures and protects infants from infectious disease The composition changes over a single feeding, over a day, based on the age of the infant, presence of infection in the breast, with menses, and maternal nutrition status Breast milk is a living thing First milk that comes out is the fore-milk, which is watery and less calorie dense than the hind milk that comes in after. High concentrations of vitamins and minerals change the color of the milk Colostrum => the first milk secreted during the first few days postpartum Very high in proteins such as secretory IgA and Lactoferrin Some call it the baby’s first vaccine, because it is so high in antibodies from the mother Nutritional Composition in Human Milk Water: Major component in human milk, this is why babies don’t need extra water Isotonic with maternal plasma Energy => ~ 0.65 kcal/mL, 19-20 kcals/oz, but the standard deviations to this mean are large Calories may vary with fat, protein, and carbohydrate composition Lower in calories than human milk substitute (HMS) Lipids => provide ½ the calories in milk Important in developing the brain Effect of maternal diet on fat composition: Fatty acid profile reflects dietary intake of mother Very low fat diet with adequate CHO and protein, milk is higher in medium chain fatty acids. DHA (docosahoxaenoic acid) Essential for retinal development Associated with higher IQ scores Trans fatty Acids Present in human milk from maternal diet Cholesterol Higher in human milk than HMS Early composition of cholesterol through breast milk appears to be related to lower blood cholesterol levels later in life Proteins Total Proteins: Lower than in whole cow’s milk (.32 vs. .96g/fl oz) Have antiviral and antimicrobial effects Higher bioavailability in breast milk Casein: Main protein in mature human milk Facilitates calcium absorption Whey A soluble protein that precipitates by acid or enzyme Some minerals, hormones, and vitamin binding proteins are part of whey Includes lactoferrin, an iron carrier. Non-Protein Nitrogen ~ 20-25% nitrogen in human milk used to make non-essential amino acids Carbohydrates Lactose Dominant CHO Enhances calcium absorption Babies utilize and absorb lactose well Oligosaccharides A medium-length CHO Prevent binding of pathogenic microorganisms to gut, which prevents infection and diarrhea Fat-Soluble Vitamins Vitamin A Content in colostrum is ~ double that of mature milk Yellow color from beta-carotene Vitamin D Most as 25-OH vi2amin D and D 3 Content reflective of mother’s exposure to sun Vitamin E Level linked to milk’s fat content Level not adequate to meet needs of preterm infants, so supplementation needs to be use Vitamin K ~ 5% of breastfed infants at risk for K deficiency based on clotting factors Infants who did not receive K injection at birth may be deficient After birth all babies should receive a vitamin K injection Water-Soluble Vitamins Water soluble in general Content reflective of mother’s diet or supplements Vitamin most likely to be deficient in is B6 Vitamin B12 and Folate Bound to whey proteins Low B12 seen in women who: o Have hypothyroidism or latent pernicious anemia o Are vegans or malnourished, realy need to make sure mom is getting enough B12, because deficiency in the infant is very detrimental o Have had a gastric bypass Minerals: Minerals contribute to osmolality Content related to growth of the infant 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. Mom’s breast milk changes with the needs of the baby 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. In general, trace minerals are not altered by mother’s diet, except fluoride. Taste of Human Milk Flavor of foods in mother’s diet influences taste of breast milk Infants seem more interested in mother’s milk if flavors are new Exposure to a variety of flavors may contribute to infant’s interest and acceptance of new flavors in solid foods When infants are exposed in the breast milk it can help avoid picky eaters, because they have already experienced a variety. Benefits of Breastfeeding for Women 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 of Breastfeeding for Infants Nutritional: Widely recognized HMS (Human Milk Subs) use human milk as a standard Nutrients are balanced Human milk is isosmotic (just the right amount for it to digest well) Meets infants’ protein needs without overloading the kidneys Contains soft, easily digestible curd (noticeable changes in stool) (formula fed babies are more prone to constipation) Provides generous amounts of the right lipids Minerals more bioavailable Immunological Benefits: Lower infant mortality in developing countries Fewer acute illnesses Reductions in Chronic Illnesses Reduced risk of celiac disease, IBS, leukemia Reduced risk of allergies and asthmatic disease Breastfeeding & Childhood Overweight => typically breastfed infants are leaner at 1 year of age. Cognitive benefits => studies show an increase in cognitive ability even after adjusting for family environment Analgesic Effects => reduction of infant pain Socioeconomic Benefits => decreased need for medical care Breast milk Supply and Demand Can women make enough milk? => Adequacy is assessed by if they poop or pee. Milk Synthesis is related to: Supply and Demand How vigorously an infant nurses How much time the infant is at the breast How many times per day and infant nurses The size of the breast does not limit a woman’s ability to nurse Is feeding frequency related to the amount of milk a woman makes? => rate of milk synthesis is variable between breasts and between feedings Several different methods are available for pumping or expressing milk: Manually Hand pumps Commercial electric pumps Hospital grade electric pumps To stimulate adequate milk it may require 8-12 expressions a day Can women breastfeed after breast reduction of augmentation? The type of surgery determines the ability to breastfeed Does silicone from breast implants leach into the milk? There is no evidence of direct harm to the infant Breastfeeding Positions: Lay back hold Football or clutch hold Cross-cuddle hold Breastfeeding the Infant Reflexes: Gag reflex => prevents infant from taking food and fluids into lungs Oral Search Reflex => infant opens mouth wide when close to breast and thrusting tongue forward Rooting Reflex => infant turns to side when stimulated on that cheek Also requires appropriate positioning, adequate letdown and milk production. Identifying Hunger and Satiety: Hunger is signaled by infant bringing hands to mouth, sucking on them, and moving head from side to side Crying is a late sign of hunger Allow infant to nurse on one breast as long as they want to ensure they get the hind milk with its high fat content and high energy content that promotes satiety. Note: high lactose content of foremilk may cause diarrhea, so be aware of switching breasts too soon Feeding can occur on one side only or both, but if you feed on both feed long enough on each. Feeding Frequency: 10-12 feedings a day are normal for newborns Stomach emptying occurs in about 1 ½ hours Breastfeeding moms will produce oxytocin with will help them relax, so even if they have to wake up more often they will be getting better rest. Identifying Breastfeeding Malnutrition Normal weight loss for newborns st ~7% of birth weight in the 1 week Weight loss of 10% needs evaluation by lactation consultant Malnourished infants become sleepy, non-responsive, have a weak cry and wet few diapers By day 5-7, infants should have 6 wet diapers and 3-4 soiled diapers Tooth Decay Caries can occur in children who are breastfed Risk factor is frequent nursing at night after 1 year st All children should be seen 6 months after the 1 tooth erupts or at 1 year of age Vitamin Supplements Vitamin K => all U.S. infants receive injections at birth Vitamin D => exclusively breastfed infants need supplements at 2 months No recommendations for fluoride or iron Maternal Diet MyPlate food guide has been adapted for pregnant and breastfeeding women Dietary Guidelines => moderate weight reduction can be achieved without compromising the weight gain of the infant Diets formed around MyPlate food plan for pregnant and breastfeeding women provide a healthy assortment of nutrients at specified calorie levels for each stage of breastfeeding Energy and Nutrient Needs For Lactation: Energy needs vary by activity level st DRI is +500 kcal/day for the 1 6 months and +400 kcal/day afterwards A single recommendation for energy needs could never address all of the individual variation in energy needs Maternal Energy Balance and Milk Composition: Protein-calorie malnutrition => results in reduction in milk volume but not quality Weight loss During Breastfeeding: The caloric DRI assume a loss of 0.8 kg/month Most women do not reach prepregnancy weight by 1 year after birth Modest or short-term energy reductions do not decrease milk production Extreme dieting and exercise can affect quantity of breast milk Exercising and breastfeeding; Modest energy restriction combined with increased activity may help women lose weight and body fat Exercise does not decrease milk production or infant growth Other Factors Of Maternal Diet: Vitamin and mineral supplements => not needed in well-nourished women Functional foods => no adverse effects based on studies to date Fluids => women should drink to thirst, and if mom does not drink enough it will effect her milk supply Alternative Diets => type of diet determines supplement that may be needed Infant Colic => defined as crying for 3 hours a day – no medical cause Components of maternal diet may be related to infant colic More likely with => cow’s milk, onions, cabbage, broccoli, and chocolate Factors Affecting Breastfeeding Initiation and Duration Optimal Duration for Breastfeeding AAP and Academy of Nutrition and Dietetics say 1 year or longer US Surgeon General says exclusively for 6 months and beast to breastfeed for 12 months Obesity and Breastfeeding => overweight and obesity prior to pregnancy and excess prenatal weight gain breastfeed for a shorter duration Socioeconomic => both low-income and more affluent mothers need breastfeeding support. Chapter 7: Nutrition During Lactation: Conditions and Interventions Maternal Medications: Most medications are excreted in the breast milk Variables to consider related to medications during lactation: Pharmacokinetic (how a drug moves through the blood and the body) properties of the drug Time-averaged breast milk/plasma drug concentration ratio The ratio of the concentration of a drug in milk to the concentration of the drug in maternal plasma Drug exposure index, dose, strength, duration The average infant milk intake per kilogram body weight per day X (the milk plasma ratio divided by the rate of drug clearance) X 100 Infant’s ability to absorb, detoxify, and excrete the drug Infant’s age, feeding pattern, total diet, and health Minimizing the effect of Maternal Medications: Avoid long-acting forms: accumulation in the infant is a genuine concern because the infant may have more difficulty excreting a long- acting form of a drug, which usually required detoxification in the liver. Schedule doses carefully: check usual absorption rates and peak blood levels of the drug, and schedule the doses so that the least amount possible gets into the milk. The safest time to take a drug is usually immediately after and infant nurses. Evaluate the infant: watch for any unusual signs or symptoms, such as changes in feeding pattern or sleeping habits, fussiness or rash Choose the drug that produces the least amount in the milk. Herbs Widely Used in the U.S. with Impact on Breastfeeding: Echinacea – not recommended Ginseng Root – not recommended St. John’s Wort – may reduce milk supply Fenugreek – used as a galactogogue, infants may have reactions Goat’s Rue and Milk Thistle/Blessed Thistle – potential use as galactogogues Scientific information about herb use during lactation is sparse Medicinal herbs should be viewed as drugs Many herbs are contraindicated during lactation Alcohol: Alcohol consumed quickly passes through to breast milk Level of alcohol in breast milk is the same as in maternal plasma Peak plasma levels occur at: 30-60 min. after consumption if consumed without food 60-90 min if consumed with food Alcohol decreases oxytocin and let-down Decreases volume consumed by the infant Interferes with sleep pattern of the infant Other Dugs and lactation: Nicotine => smoking cigarettes The heath risks for infants posed by a smoking mother are many: Otitis media Exacerbation of asthma Respiratory infections Gastrointestinal deregulation Levels are 1.5 to 3 times higher in breast milk than in mother’s blood. Marijuana Is transferred and concentrates in breast milk and it is metabolized by the nursing infant May change DNA/RNA formation and neurotransmitter systems needed for growth Caffeine Moderate intake causes no problem for most breastfeeding infants and mothers Level in breast milk is only 1% of that in the mother’s plasma May accumulate in infants younger that 3-4 months – varies from infant to infant May interfere with sleep or cause hyperactivity and fussiness of infant Neonatal Jaundice and Kernicterus Jaundice => a yellow color of the skin seen in: ~40% of full-term infants ~80% of preterm infants (hyperbilirubinemia) If not resolved, the elevation of Bilirubin (byproduct of the breakdown of RBCs) can cause permanent neurological and brain damage It is the most frequent cause for hospital readmission for newborns Bilirubin metabolism: Bilirubin => a pigment produced as a heme from RBC break down Usually precessed by the liver and excreted in the baby’s stool In the fetal state, high levels of hemoglobin were needed to carry oxygen delivered by the placenta At birth, infants have very high levels of hematocrit of 50% to 60% As and infant breathes on his own, high hemoglobin is not needed, so RBC begin to break down Physiological vs Pathological newborn Jaundice: Physiological: Begins after the 1 day of birth rising steadily with peak at ~6-7 days Bilirubin <12 mg/dL Condition resolves within a few days on its own Cause: normal heme breakdown Pathological: Begins within the 1 day after birth and rises rapidly and lasts longer Bilirubin >8 mg/dL in 1 dayt Medical intervention with phototherapy (UV light that converts bilirubin to a water soluble form for excretion) Cause: various pathological conditions Bilirubin Encephalopathy or Kernicterus Bilirubin is toxic to cells and may cause brain damage (brain and cells destroyed by bilirubin do not regenerate Mortality rate is 50% Usually caught before it ever gets to this level May Cause: Cerebral palsy Hearing loss Paralysis of upward gaze Intellectual and other handicaps Breast Non-Feeding Jaundice: Infants nursing infrequently or inefficiently are at risk for elevated bilirubin Have delayed and inadequate stools Usually resolves after 1-2 weeks of birth Breast-Milk Jaundice Syndrome: Onset later than physiological jaundice – typically peaks on the 7 -10h th day 1/3 of breastfed infants are jaundiced at 3 weeks Cause is unknown, thought that more bilirubin is reabsorbed due to factors in breast milk that promote its absorption Typically resolves itself but in severe cases is treated like regular physiological jaundice Treating Jaundice: The AAP guidelines recommend phototherapy using fluorescent lights Light is absorbed in bilirubin changing it to a water-soluble product that can be excreted via the kidneys AAP guidelines encourage continuation of breastfeeding Information For Parents: Inform parents that most breastfed infants will become jaundice Only a small fraction of these infants will develop extreme hyperbilirubinemia and kernicterus Infant Allergies: Exclusive Breastfeeding for >4 months protects against: Allergies Dermatitis Wheezing Development of food allergies influenced by numerous factors => genetics, duration of breastfeeding, time of introduction of other foods, maternal smoking, air pollution, and exposure to infectious disease, maternal diet and immune systems. Food Intolerance: No scientific evidence shows gassy foods in mother’s diet produce gas in infant Low-allergen maternal diet associated with reduction in distressed behavior (colic) Cow’s milk Eggs Peanuts Tree nuts Wheat Soy Fish Medical Contraindications to breastfeeding Few medical problems I the mother or baby are absolute contraindications to breastfeeding Table 7.13 Breastfeeding and HIV Infection: HIV infection may be transmitted to the infant by breast milk Transmission rates 5-20% depending on duration of breastfeeding DHHS recommends: “HIV infected women should not breastfeed or provide their breast milk for the nutrition of their own or other infants”
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