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Nutrition Flashcards

1
Q

GA of highest growth rate

A

mid 30s with decline after 36

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2
Q

growth rate MC vs DC twins

A

MC lower

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3
Q

decreases with increases in GA and BW

A

TBW
EC water
Na content
Cl content

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4
Q

increases with GA and BW

A

IC water
protein
fat
ca phos mg
iron

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5
Q

energy source of fetus

A

2/3 glucose from mother
1/3 placental lactate
remaining = maternal AA

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6
Q

fetal energy expenditure

A

35-55 kcal/kg/d

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7
Q

gross energy intake =

A

energy excreted + energy expended + energy stored

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8
Q

enteral vs intravenous goals for infants

A

enteral 100-130 kal/kg/d
intravenous 85 - 95 kcal/kg/d

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9
Q

major protein sources in neonates

A

whey and caseine

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10
Q

whey vs caseine re: cysteine and methionine content

A

whey has more cysteine and less methionine

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11
Q

whey to casein ratio colostrum

A

80:20

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12
Q

whey to casein ratio mature milk

A

55:45

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13
Q

whey to casein ratio in formula with predominant casein vs predominant whey

A

20:80

80:20 or 60:40

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14
Q

whey to casein ratio of preterm vs term

A

greater protein content and w:c in preterm

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15
Q

glucose precursor AAs

A

alanine glutamate aspartate

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16
Q

methylated in muscle protein AAs

A

homoscysteine
methionine
creatine
phosphatidylcholine

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17
Q

essential AA

A

branched chain: valine, isoleucine, leucine

histidine, lysine, methionine, phenylalanine, threonine, trytophan

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18
Q

conditionally essential

A

arginine
cysteine
glutamine
glycine
proline
taurine
tyrosine

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19
Q

non essential

A

alanine
asparagine
aspartate
glutamate
serine

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20
Q

kcal/g of protein

A

4

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21
Q

AA solutions have decreased ___ because ____

A

tyrosine and cysteine

decreased solubility

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22
Q

how much protein needed to avoid negative nitrogen balance in parenteral solutions

A

7-15%

1g protein = 1 g AA = 0.16 g nitrogen

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23
Q

enteral protein goals

A

3.5 - 4.5 g /kg/d = 3.2 - 4.1 per 100kcal

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24
Q

essential FAs

A

linoleic acid and alpha linoleic acid

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25
Q

a:b (n-c) e.i 18:3 (n-3)

A

a = total number of carbons
b = total number of double bonds
c = number of carbons from the terminal methyl end with the first double bond

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26
Q

most prevalent fatty acids in human milk

A
  1. oleic acid
  2. palmitic acid
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27
Q

SCHAD #C

A

< 6

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28
Q

MCHAD #C

A

6-12

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29
Q

LCHAD

A

12-20

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30
Q

VLCFA

A

> 22

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31
Q

what does linoleic acid give rise to and which pathway?

A

arachidonic acid in the n-6 pathway

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32
Q

what does alpha linoleic acid give rise to and which pathway?

A

eiscosapentaenoic acid
docosahexaenoic acid

n-3 pathway

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33
Q

how long of a delay in essential fatty acids can lead to EFAD

A

3-7 days

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34
Q

symptoms of EFAD

A

scaly dematitis
alopecia
thrombocytopenia
FTT
infections

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35
Q

how much IL is needed to prevent EFAD

A

0.5-1g/kg/d

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36
Q

how to diagnose EFAD

A

increased Holman index = triene:tretrene ratio
refers to mead acid:arachidonic

> 0.2
bc increased mead acid is from omega9 metabolism increasing T:T

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37
Q

kcal/1g fat

A

9

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38
Q

fats should provide ___% of total daily calories

A

30-50 (not more than 60%)

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39
Q

differences between 20% and 10% solutions of fat

A

10% has:
lower triglycerides
lower calories
higher phospholipid:triglyceride

–> may impair lipase in preterm so 10% not recommended

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40
Q

which lipid is 100% fish oil

A

omegaven

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41
Q

enteral goals of fat

A

4.8-6.6 g/kg/d
4.4 - 6.6g/100 kcal

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42
Q

kcal/1g carb

A

3.4

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43
Q

for positive nitrogen balance how much glucose do you need per gram of protein

A

6g

44
Q

how much total calories should be from carbs?

A

35-65%

45
Q

glucose utilization of preterm and term?

A

preterm: 5-8 mg/kg/min

term: 3-5 mg/kg/min

46
Q

importance of b12

A

(cobalamin)
folate, CHO and fat metabolizm

47
Q

importance of folate

A

coenzyme for amino acid and nucleic acid metabolism

48
Q

risk factors for b12 deficiency

A

breastfed babies with vegetarian moms
methylmalonic acidemia
homocystinuria

49
Q

risk factors for folate deficiency

A

evaporated milk
goats milk
iron deficiency

50
Q

b12 or folate deficiency blood smear

A

megaloblastic macrocytic anemia
hypersegmented neutrophils

51
Q

importance of vitamin e

A

antioxidant
protects again iron induced hemolysis

52
Q

importance of vitamin k

A

carboxylation of prothrombin into active form
coagulation

53
Q

maternal meds that decrease neonatal vit k

A

anticonvulsants
warfarin
antiTB

54
Q

features of vit A deficiency

A
  • pulmonary epithelial growth and differenciation
  • photophobia, conjunctivitis,
  • abnormal epiphyseal bone formation and tooth enamel
  • generalized scaling
  • FTT
55
Q

features of vitamin B1 deficiency

A

(thiamine)

beriberi: fatigue, irritability, constipation and cardiac failure

a/w pyruvate dehydrogenase complex deficiency and MSUD

56
Q

features of vitamin B2 deficiency

A

(riboflavin)

FTT, photophobia, blurred vision, dermatitis, mucosititis

a.w glutaric aciduria type 1

57
Q

features of vitamin B6 deficiency

A

(pyridoxine)

dermatitis, mucositis, hypochromic anemia, possible seizures

a.w homocystinuria

58
Q

features of b7 deficiency

A

(biotin)

alopecia dermatitis, scaling, seborrhea

a.w:
biotinidase deficiency
betamethylcortonyl glycinuria
propionic acidemia
pyruvate dehydrogenase complex deficiency

59
Q

features of vit c deficiency

A

poor wound healing and bleeding gums
a.w transient tyrosinemia

60
Q

features of vit d deficiency

A

rickets
ftt
tetany

61
Q

function of chromium

A

regulates glucose - insulin metabolism

62
Q

function of copper

A
  • RBC and Hgb formation
  • absorption of iron
63
Q

function of iron

A

Hgb and myoglobin component
transport o2 and co2
absorbed in duodenum and prox jejunum
vit c enhances absoprtion

64
Q

function of manganese

A

enzyme activation
normal bone structure
CHO metabolism

65
Q

function of selenium

A

cofactor for glutamine peroxidase
can lead cardiomyopathy without it

66
Q

function of zinc

A
  • component of enzymes like carbonic anhydrase and carboxypeptidase
  • growth
67
Q

hormones in breast milk

A

cortisol
epidermal growth factor

68
Q

enzymes in breast milk

A

bile salt dependent lipase

69
Q

importance of inositol

A
  • membrane synthesis
  • reduces retinal damage
  • enhance surfactant
  • greater in BM than formula
70
Q

importance of choline

A

CNS development
component of ACh and phosphatidylcholine
low in milk

71
Q

hind milk in comparison to foremilk

A

higher fat
low glucose
equal protein

72
Q

premature vs mature milk

A

increased protein initially but decrease
increased electrolytes
inadequate ca phos, vit d

73
Q

drugs that are contraindications to breastfeeding

A

cocaine
cyclosporine
methotrexate
phencyclidine
radioactive agents

74
Q

what is reduced by storing at 0-4degC BM

A

bactericidal activity after 72 hours of storage

75
Q

what is reduced with freezing at - 20 deg C BM

A

pH by 3%
lactoperoxidase
cellular activity # and function

76
Q

what is reduced by pasturization at 56 degC BM

A

water soluble vitamins
lipase amylase lactoperoxidase
antioxidants
adiponectin, insulin
cellular activity
bacterial growth
ifng, tnfa, il1b il10 hgf

77
Q

what is reduced by pasteurization at 62 degC BM

A

watersoluble vitamins
lipase amylase lactoperoxidase
antioxidants
adiponectin, insulin
cellular activity
bacterial growth
ifng,tnfa, il1b il10 hgf
igA lactoferrin and lysozyme
protein denaturalization

78
Q

what is reduced by microwaving BM

A

iga
lysozyme
vit C

79
Q

which formula has higher lactose? preterm or term

A

term

80
Q

which formula has higher fat content preterm or term

A

preterm

81
Q

which formula has higher MCT? preterm or term

A

preterm

82
Q

which formula has higher protein? preterm or term

A

preterm

83
Q

which formula has higher Ca, phos, iron? preterm or term

A

preterm

84
Q

which formula has higher vitamins and trace elements? preterm or term

A

preterm

85
Q

which elements should you decrease in TPN cholestasis?

A

manganese and copper

86
Q

which elements should you increase in TPN cholestasis

A

zinc

87
Q

which elements should you decrease in renal insufficiency

A

chromium and selenium

88
Q

after how many days does risk of cholestasis become independent of weight?

A

90

89
Q

what is biggest culprit in pn cholestasis?

A

phytosterols

90
Q

nitrogen balance =

A

nitrogen intake - nitrogen lost =
protein intake in g/d x 0.16 - (urine losses by urinary urea concentration+ estimate stool loss = 4g)

91
Q

GIR =

A

(rate X dex%)/(weight x 6)

92
Q

tissues richest in LCPUFAs

A

retina (photoreceptors) and brain
especially docosahexanoic acid

93
Q

basal ganglia deposition from PN can lead to neurotoxicity if excess ______

A

manganese

94
Q

synthesis of glutathione requires which AA?

A

cysteine

95
Q

vit D measurement

A

25 OH vit D

96
Q

copper requirement enterally

A

120 mcg/kg/d

97
Q

predominant storage site for zinc

A

bone

98
Q

zinc requirement

A

350 mcg/kg/d

99
Q

component of milk that protects against NEC

A

platelet activating factor acetylhydrolase

100
Q

rate of sucking:swallowing

A

6-8:1

101
Q

MoA lactoferrin in antimicrobial effects

A

lactoferrin converted to lactoferricin by pepsin
lactoferricin directly destroys microbes

102
Q

typical manifestation of zinc deficiency?

A

rash

103
Q

zinc absorption is enhance by enteral intake of ____

A

protein

104
Q

copper absorption is impaired by enteral intake of ____

A

ascorbic acid

105
Q

lipoprotein lipase location

A

adipose

106
Q

free water deficit =

A

4 x wt(kg) x desired change in Na

107
Q

ketogenic AAs (don’t form glucose)

A

leucine and lysine

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