BE 01 Flashcards
(249 cards)
0
Q
Why is human BM low in protein?
A
Baby born immature w/ kidneys and liver not yet able to process high protein feeds
1
Q
Four feeding choices for infants (in order) - WHO, UNICEF
A
- BM from mom’s breast
- Expressed BM from mom
- Donor BM
- Appropriate BM substitute
2
Q
Why is human BM high in lactose
A
Brain will triple in weight in next two years
3
Q
More than 98% of fat in BM is in the form of….
A
Triglycerides
4
Q
The medium- and long-chain fatty acids that make up the triglycerides in BM come from….
(2)
A
Maternal Circulation
Manufactured locally
5
Q
The 2 most abundant fatty acids in BM triglycerides are…
Also high in… (2/2)
A
Oleic acid & Palmitic acid
Also high in…
-Essential fatty acids (linoleic acid & linolenic acid)
-Long-chain polyunsaturated fatty acids (eg arachidonic acid & docosahexanoic acid)
6
Q
Why are long-chain fatty acids important for infant?
A
They are constituents of brain and neural tissue
Needed early in life for mental and visual development
7
Q
75% of nitrogen-containing compounds in BM come from….
A
Protein
8
Q
Two types of proteins in BM & their ratio
A
Micellar caseins & aqueous whey proteins
40:60
9
Q
Predominant casein of human milk & function
A
b-casein
Forms micelles and produces soft, flocculent curd in infant’s stomach
10
Q
4 major whey proteins in BM are
A
a-lactalbumin
lactoferrin
secretory IgA
serum albumin
11
Q
Principal carbohydrate of human milk is….
Where is it manufactured?
A
Lactose
In the mammary epithelial cell
12
Q
Ex. of antimicrobial factors in BM (12)
A
secretory IgA, IgM, IgG lactoferrin lysozyme complement C3 leucocytes bifidus factor lipids & fatty acids antiviral mucins, GAGs oligosaccharides
13
Q
Ex. of growth factors in BM (6)
A
epidermal (EGF) nerve (NGF) insulin-like (IGF) transforming (TGF) taurine polyamines
14
Q
Ex. of cytokines and anti-inflammatory factors in BM (7)
A
tumor necrosis factor interleukins interferon-g prostaglandins a1-antichymotrypsin a1-antitrypsin platelet-activating factor: acetyl hydrolase
15
Q
Ex. of digestive enzymes in BM (4)
A
amylase
bile acid-stimulating esterase
bile acid-stimulating lipases
lipoprotein lipase
16
Q
Ex. of hormones in BM (10)
A
feedback inhibitor of lactation (FIL) insulin prolactin thyroid hormones corticosteroids, ACTH oxytocin calcitonin parathyroid hormone erythropoietin
17
Q
Ex. of transporters in BM (6)
A
lactoferrin (Fe) folate binder cobalamin binder IgF binder thyroxine binder corticosteroid binder
18
Q
Ex. of potentially harmful substances in BM (10)
A
viruses (eg HIV) aflatoxins trans-fatty acids nicotine, caffeine food allergens PCBs, DDT, dioxins radioisotopes drugs
19
Q
Ex. of other things in BM (5)
A
casomorphins
d-sleep peptides
nucleotides
DNA, RNA
20
Q
Variation in BM concentration influenced by (6)
A
Varies on lactation period, geographic location, BF routine, parity, age, other mat charact, maternal diet, season
21
Q
4 Stages of Lactation
A
Colostral
Transitional
Mature
Involutional
22
Q
Colostrum time period
A
Birth - first 3 to 5 days after delivery
23
Q
Transitional milk time period
A
After colostrum - end of second week
24
Mature milk time period
During full lactation
25
Involutional milk time period
End of lactation
26
Colostrum is higher in (4).... and lower in (3).... than mature BM
Higher: secretory IgA, lactoferrin, vitamin A, sodium
Lower: fat, lactose, vitamin B1
27
Involutional milk is high in(3).... and low in(1)....
High: protein, fat, sodium
Low: lactose
28
Study chart on BE01: 1. Food_and_nutrition_bulletin....
Pgs. 4-8
| Human vs cow milk
29
Study table 4 in BE01: 1. food_and_nutrition_bulletin....
Pg. 9
| Typical daily intakes (g) of selected BM constituents
30
Nitrogen in human milk derived from two sources....
Protein and non-protein components
31
Protein content of human milk (appx)
9g/L, decreasing as lactation progresses
32
Function of proteins in BM (7)
Provide essential amino acids for growth (all present in BM)
Provides protective factors (eg immunoglobulins)
Carriers for hormones (eg thyroxine)
Carriers for vitamins (eg folate-binding proteins)
Provide enzymatic activity (eg amylase)
Provide other biological activities (eg IGF)
Minimal contributor to total energy provided by BM (1g provides 4 calories)
33
Casein is what 5 of total protein in BM
40%
34
Function of Casein
Mainly nutritive, providing minerals and essential amino acids to infant
Also provides peptides with multiple functions, including antimicrobial, opioid, GI functions
35
Whey proteins include (5)
```
a-lactalbumin
serum albumin
lactoferrin
immunoglobulins
lysozyme
```
36
a-lactalbumin
- is X% total protein in human milk
- is higher/lower than cow's milk
- is 10-20% of total protein in BM
| - is much higher than cow's milk
37
a-lactalbumin does.....
- in mammary gland
- in infant
- mammary gland: participates in lactose synthesis, creating osmotic "drag" to facilitate milk production and secretion
- in infant: binds Ca and Zn, may facilitate absorption of essential minerals; during digestion peptides formed have antibacterial and immunostimulatory properties & cause apoptosis of tumor cells
38
Factors that promote GI maturation in infant
Growth factors, incl EGF, IGF, TGF
39
Non-protein Nitrogen (NPN)...
- % of total nitrogen
- roles
- 20-25% total nitrogen
| - still studying roles, current known include essential vitamins, stimulation of beneficial bacteria....
40
A diet deficient in free amino acid taurine results in...
impaired fat absorption, bile acid secretion, retinal function and hepatic function
41
Where does most protein synthesis occur?
| Add'l milk proteins (eg albumin, immunoglobulins) derived from....
Lactocyte of mammary gland
| add'l proteins derived from mother's extracellular fluid
42
Carbohydrates in BM:
- primary
- 1.2% of milk made up of....
- these 4 present in sm quantities
- lactose (disaccharide)
- over 130 different oligosaccharides (short chains of monosaccharides) (varies w/ many factors)
- glucose, frutose, glycoconjugates glycoprotein and glycolipid in sm Q's
43
Lactose....
- stable?
- [Avg]
- % energy requirements provided (and measure)
- most table component of mature BM
- [avg] = 68g/L
- provides up to 40% of energy req's (each gram of carbs provides 4 calories)
44
Where is lactose synthesized?
in breast by lactocytes
45
What are the lactocytes?
Single layer of secretory cells that comprise the spherical alveolus
46
Lactose is a disaccharide. Prior to absorption what happens?
Prior to infant absorption broken down by enzyme lactase, to glucose and galactose
47
Where is lactase prodiced and when is it secreted in infant?
Lactase enzyme produced in brush border of small intestine.
| Secreted in fetus from about 24 weeks gestational age
48
Functions of lactose (4)
1. rapid increase of lactose at SA (Lact II) causes osmotic drawing of water into breast secretion - result: copious BM production
2. enhances absorption of Ca and Fe
3. Glucose and galactose provide energy to body, esp rapidly growing infant brain.
4. Galactose essential for develop of CNS
49
Likelihood of seeing primary lactose intolerance
HIGHLY unlikely. If happens is usually after weaning!
50
Most variable constituent of human milk is
FAT
51
Milk fat is inversely related to
Degree of breast fullness
52
98-99% of milk fats are....
triglycerides (triacylglycerols)
53
Each gram of fat provides X calories
| Fats provide what % energy in BM
Each g of fat provides 9 calories
| Fats provide about half of energy in BM
54
Function of fats in BM (3)
Essential for synthesis and develop of retinal and neural tissue and support develop of human immune system
55
Human milk contains these fatty acids....
Medium chain
Long chain
-inclu long chain polyunstaurated fatty acids (LCUPFA)
56
BM is rick source of these 2 essential fatty acids and their derivatives
linoleic acid --> arachidonic acid (AA)
| alpha-linolenic acid --> docosahexaenoic acid (DHA)
57
LCPUFA status of brain of AF infant provides possible explanation of...
decreases in neurological function and later cognitive ability found in AF infants
(AF has significantly lower LCPUFAs)
58
Remaining 1-2% fat not composed of triglycerides include (6)...
```
Di- and monoglycerides
Nonesterified fatty acids
Phospholipids
Cholesterol
Cholesterol esters
```
59
Chemical form of triglycerides
Three fatty acids bound to glycerol molecule
60
Where are triglycerides synthesized?
In lactocytes from free fatty acids and glycerol
| Fatty acids may be manufactured in lactocyte or originate from bloodstream
61
Maternal diet and protein....
- Total amount?
- Types of fats?
Mat diet does NOT affect total amount of fat in human milk.
| Types of fat in mon's diet influence composition of fatty acids in her BM.
62
When mothers ingest typical western diet, what % of fatty acids synthesized in mammary gland?
What does that mean about those not produced in mammary gland?
20% from mammary gland, rest from bloodstream.
| Therefore, composition of the 80% reflects composition of dietary intake or adipose deposited fatty acids
63
Fats synthesized in mammary gland are XX fatty acids, while those synthesized in adipose tissue are XX.
Mammary: medium-chain fatty acids
| Adipose tissues: long-chain fatty acids
64
When mothers eat high-carb, low fat diet, as much as XX% of fatty acids may be synthesized in mammary gland.
40%
65
BF women should aim to return to pre-preg weight by...
6 mos PP
66
Level of cholesterol in BM? Consistent?
Remains constant at 100-200 mg/L despire dietary change
67
Function of cholesterol in BM
Necessary for formation of stale cell membrane structure.
68
Role of phospholipids
Vital role in myelinization of CNS and develop of retina
| Most important growth during critical period is occurring in the brain which will double in size during first year.
69
Mean concentration of fat in BM
4%, but subject to large sampling errors.
| Remember, lots of variability in fat content by breast fullness (1-18%)
70
What breaks triglycerides down in to free fatty acdis and glycerol
LIPASES
71
Which lipases break down triglycerides into free fatty acids and glycerol in BM, and how (4)?
1. Bile salt-stimulated lipase (in BM, aiding baby's digestive enzymes)
2. Lingual lipase (initiates digestion process in infant's mouth)
3. Gastric lipase (continues digestion in infant's stomach)
4. Pancreatic lipase (completes digestion in the small intestine)
72
Which 2 lipases markedly aid digestion of lipids in BF infant?
Gastric and bile-salt stimulated lipase
73
Why might expressed & stored BM have a soapy smell/taste, potentially refused by infant?
How to fix if baby refuses?
This is caused by BM lipase beginning the digestion process
Fine for baby to drink, if he will take it.
If refuses, scald BM (see other card on how)
74
How to scald BM
1. In heavy-based pan over low heat, bring milk to just below boiling point.
2. As soon as she sees some steam rising and bubbles forming around inside edges of pan, remove fr heat. Stir occasionally while heating to prevent a skin from forming on top.
3. Cool and store as usual.
75
Only difference between foremilk and hindmilk
Fat content is much higher in hindmilk AT A GIVEN BF
| but changes at different rates between BFs
76
What is lactoengineering? What is it currently used for?
Altering milk composition for a particular purpose. Currently used to provide high-fat BM to VLBW preemies.
77
Vitamin A:
- fat or water soluble?
- Two categories
-FAT SOLUBLE
-Two categories:
-Retinol from animal sources (liver, whole milk, eggs)
-Carotenoid, a provitamin fr yellow and green vegetables and fruit
which is converted to retinol in body
78
Function of Vit A
Deficiency causes
Deficiency caused by
Necessary for vision, immune system, maint of epithelial structures.
Deficiency causes blindness and death.
Deficiency caused by early weaning, insufficient intake of foods rich in vit A, low-fat diets, chronic exposure to cigarette smoke.
79
Vit A in BM
- good source?
- which type?
- effect of supplementation?
- BM excellent source of vit A
- BM vit A mainly retinol, influenced by maternal serum levels of retinol
- Suppl including vit A and beta-carotene significantly increase [BM]
80
When are vitA levels highest?
Early lactation, gradually decline
81
Vit D
- fat or water soluble?
- functions
-FAT SOLUBLE
-Functions:
-Bone health: Ca and phosphorous homeostasis (prevents rickets
and osteoporosis)
-Cell proliferation
-Role in prevent hypertension, autoimmune disorders, cancer
82
Sources of Vit D
Main source: sunlight reacting on skin - produces lg amounts, eg 10,000-20,000 IU in 10-12 mins for person in swimsuit in Boston
Found naturally in very few foods, incl: fatty fish, egg yolks, some wild mushrooms, fortified foods
83
BM levels of vit D & depletion
```
Low usually (20-<100IU/L)
Stores of Vit D laid down during preg in normal moms may be depleted in 2 mos in absence of exposure to sunlight.
```
84
Adequate level of Vit D?
No consensus
Current recommend is 400 IU/day, beginning soon after birth.
Admin as medicine to prevent rickets.
85
Supplement mom's Vit D?
Yes, usually they are low. Mat vit D3 suppl of 6400 IU/day meets needs of lactating woman, raising level to upper normal range, also maintaining normal [vit D] in EBF infant
86
Vit E
- fat or water soluble
- function
- what is it?
- FAT SOLUBLE
- Function: antioxidant that protects cell membranes from oxidation
- Vit E describes collection of tocopherols of which alpha-tocopherol is most significant
87
Vit E:
- Good source (colostrum, mature milk)?
- Supplement?
- Fx of smoking and infant formula
- Colostrum rich source of Vit E, as with mature milk. Since fat-soluble, higher levels found in hind-milk.
- Suppl not recommend for healthy babies and moms
- Smoking causes oxidative stress, reduces vit E in BM. Smoking & formula cause deleterious pro-oxidant fx in infants
88
Vit K
- fat or water soluble?
- where produced
- good sources
- FAT SOLUBLE
- produced by bacteria in human intestines (menaquinone, vit K2)
- sources include leafy greens, avocado, kiwi: phylloquinone and vit K1 are the plant sources
89
Which components of blood are vit K-dependent?
Prothrombin, coagulation factors VII and IX, some plasma proteins.
^all = blood clotting factors
90
Maternal intake of X mg/day provides [BM] that meet infant's daily requirement.
5 mg/day
91
Adequacy of maternal diet for meeting infant vitamin K needs?
Inadequate. Vit K xfer across placenta is poor and [BM] varies considerably by maternal diet.
92
Supplement recommend Vit K
Single IM injection of Vit K1 recommended for all healthy term infants at birth, with no further supplementation recommended.
93
Early onset Vitamin K deficiency bleeding (VKDB)...
-presents when, how
Late onset VKDB
-presents when, how
EARLY: presents between 1-7 days of age, usually as hemorrhage at umbilical cord site, GI tract or circumcision site
LATE: between 2-12 weeks with intracranial, GI, cutaneous bleeding.
-Late onset results in serious morbidity or mortality and occurs almost exclusively in BF infants who did not receive parenteral (IMI) prophylactic vit K soon after birth
94
Vit C
- fat or water soluble?
- sources
- deficiency causes
- WATER SOLUBLE
- humans dependent on vit C from external sources (body cannot make own) - found in fruits and veggies
- deficiency causes scurvy
95
Supplement vit C?
NO. Intake of vit C in mat diet, but not as suppl, determines [vit c] in BM. Supplementation does not raise BM levels above normal in well-nourished women.
96
B-complex vitamins
- name all 4 listed here (there are 8 total)
- function
- sources
- Thiamin (B1), riboflavin (B2), B6 (pyridoxine), B12 (cobalamin)
- play role in cell metabolism
- found in potatoes, bananas, lentils, tempeh, turkey, liver, tuna, brewer's yeast
97
Thiamin (vit B1)
- suppl?
- [BM] influenced by...
- [thiamin] of BM in well-nourished moms meets infants needs, not signif affected by suppl.
- influenced by maternal thiamin intake. Suppl during preg and lat only for women w low serum thiamin
98
Riboflavin (vit B2)
- suppl?
- [BM] influenced by
- No need to supplement in well nourished moms
| - influenced by mat intake of riboflavin
99
Vitamin B6 (pyridoxine)
- suppl?
- RDA
- [BM] ifluenced by
- compl foods
- not needed if well nourished
- RDA: 2 mg/day for infant
- influenced by mat intake, mat supplementation in deficiency beneficial to mom & baby
- compl foods at 6 mos should be rich in vit B6 to meet increasing needs for vitamin at this age
100
Vit b12 (cobalamin)
- use
- sources
- suppl?
- if deficient, and sx in baby
- who is deficient, how to treat?
- necessary for synthesis of red bood cells and maint of CNS
- sources: animal foods, eg fish, meat, poultry, egg and dairy products
- no need to suppl mother who has sufficient amounts of b12
- if mom is deficient, BM will not meet baby's needs: baby may have failure to thrive, lethargy, hypotonia, develop delay or regression, megaloblastic anemia --> if untreated, cerebral atrophy and death
- Vegans and women who recently had bariatric surgery may be deficient and should eat vit B12 fortified foods or eat supplements
101
Some research found that mothers taking mega-doses of B6 may suppress secretion of this hormone
Prolactin
102
Minerals in human milk
- concentration
- bioavailability
- relationship with other nutrients fx...
- low concentration but
- high bioavailability
- absorption, metabolism, excretion
103
The [BM] of these three minerals doe snot correspond with maternal serum values
Calcium
Phosphorous
Magnesium
104
Calcium in BF infants
- function
- variation
- correlation btwn BM volume and [Ca]?
- bone growth and regulating muscle and heart function
- wide variations in [BM Ca] between regions, even may be 2-fold variation in same community
- BM volume and [Ca] are NOT correlated.
105
Infant Ca requirement for first year of life
200 mg/day avg
106
BM Ca output averages....
200 mg/day (infant needs) but varies considerably and decreases in later lactation
107
Relationship between Ca intake and infant length velocity or bone mineral content in first month of life?
NO
108
Supplement Ca?
- lactating women
- pregnant women
- NO for lactating - no change in [BM]
| - suppl during preg may influence BM levels PP
109
What primarily influences sodium levels?
Degree of closure of tight junctions between lactocytes of alveoli
*lactocytes are milk producing cells
110
When are tight junctions open?
| 3
- Early lactation, close by 4 days PP
* sodium levels 1/2 to 1/3 less in mature milk than colostrum
- Mastittis
* Na, Cl levels increase, giving milk salty taste
- Poor establishment of lactation causes tight junctions to fail to close
* can cause hypernatremic dehydration d/t poor lactation management
111
These minerals not influenced by maternal intake (3)
The levels of these minerals in infancy strongly influenced by fetal liver stores accumulated during last trimester of preg
Copper, Iron, Zinc
112
Iron
- bioavail - high or low?, vs bovine milk
- does heat tx alter?
- presence of these components aid absorption
- suppl?
- very high bioavail: 5x more efficient absorption human vs bovine milk
- heat tx does not alter rate of Fe absorption by infant
- high lactose and Vit C aid absorption
- unnecessary to suppl in first 6 mos if EBF
113
Zinc
- active or passive transport to BM?
- function
- fx of Zn deficiency
- active transport
- necessary for enzyme activity, immune function, protein synthesis, wound healing, DNA synthesis, cell division, supports normal growth & developo during preg, childhood, adolescence
- deficiency: growth retardation, loss of appetite, impaired immune function
114
Selenium
- high/low at initiation of lactation initiation
- mean values stable across pop?
- mat [selenium] influences [BM]? Infant plasma content?
- HIGH at initiation
- mean values vary by pop and follow geog distrib
- mat selenium status closely related to milk selenium values, which is positively related to infant plasma content
115
Iodine
- richest sources
- function
- fx of deficiency
- from ocean, eg seaweed, fish, and from iodized salt
- required for synthesis of thyroid hormones necessary for brain develop during fetal and early postnatal life
- deficiency is leading cause of brain damage in adults
116
Iodine
- suppl?
- BM level vary widely on (2 things)
- dietary intake influence [BM]?
- YES, if needed!
- varies on geographic region and mat intake
- iodine in BM responds quickly to dietary iodine intake, either supplemented or consumed in natural foods
117
Recommend if women living in iodine deficient region?
Recommend all pregnant and lactating women consume up to 5g of iodized salt per day.
118
Fluoride
- BM levels related to mat nutrition?
- suppl (pre- and post-6 mos)
- reports of fluorosis when...
- BM levels independent of mat nutrition
- no suppl fluoride during first 6 mos; from 6 mos - 3 yrs, decision to supplement should be made on basis of [fluoride] of water supply and in other food, fluid sources, toothpaste.
* suppl not usually needed unless [drinking water] is <0.3 ppm)
- fluorosis in infants receiving formula reconstituted with fluoridated water
119
Define Secretory Differentiation (Lactogenesis I)
Colostrum begins to be synthesized in breast from about mid-pregnancy. Risk in serum prolactin most closely assoc w this functional develop. Progression to full lactation held in check by high levels of serum progesterone.
120
Much change in [milk components] until birth of infant?
NO
121
Define Secretory Activation (Lactogenesis II)
Following birth, presence of high serum prolactin and rapid withdrawal or progesterone. SA results in ransition from colostrum to mature milk over period of 72-96 hours.
122
Milk components relatively stable by Day X in lactating mother
Day 4
123
The majority of mature milk is made of.... (%)
| The effect of this is...
Water (87.5%)
Water drawn into lactocyte to maintain osmotic equilibrium in response to synthesis of lactose. As lactose expelled into milk secretion, water moves with it. Lactose, therefore, exerts major control over milk yield.
124
Milk Yield at:
First 24 hours PP
Day 3
Day 14
First 24: 37.1 g (7-122.5)
Day 3: 408 g (98.3-775)
Day 14: 1156 g
125
24 hour milk volume remains stable for indiv mom and baby from X age until X age while EBF.
Avg volume during this time:
From 1-6 mos of age
Avg vol: 780 ml (26 oz) (range: >478 to 1356: >16-45 oz)
126
Do BF babies ever need extra water (under 6 mos)?
NO, BM provides all - encourage on demand BF even in hottest weather
127
These 4 factors increase from colostrum to mature milk
Energy, Lactose, Glucose, Fat
128
These 5 factors decrease from colostrum to mature milk
pH, Sodium, Chloride, Total protein, Secretory IgA
129
In first few days after birth, infant at far greater need for...
Which is why colostrum is higher in...
Immunological protection
| Higher in sIgA
130
Colostrum acts as a... on the lower bowel, helping to..., reducing infant risk of....due to....
Laxative, helping to clear meconium quickly, reducing risk of hyperbilirubinaemia due to reabsorption of unconjugated bilirubin from bowel
131
Define Involution
Occurs as result of distention of alveoli by retained milk. Milk composition reverts to be similar to that of colostrum.
132
At birth the baby's skin and gut are.... but quickly.... of those whom he....
sterile, colonized by bacterial flora, comes in contact with.
133
Harmless bacteria that colonize gut are almost exclusively....
anaerobic (live without oxygen)
134
Newborn gut initially colonized with...., but then...
| *this is an important defense mechanism to protect the infant
aerobic bacteria, but then as nutrients and oxygen used it is crowded out by anaerobic bacteria exposed to
135
Main source of bacteria for colonizing newborn gut at and after vaginal birth
Maternal intestinal flora
136
Bifidobacteria are natural part of bacteria fora in human body and have symbiotic bacteria-host relationship with humans.
They... (4 things they do)
- promote good digestion
- boost the immune system
- control intestinal pH
- inhibit growth of Candida albicans, E. coli, and other potentially pathogenic bacteria.
137
Bacteria commonly found in artificially fed infant guts
bifidobacteria +
predominance of enterococci and enterobacteria.
Development of bifidus flora is unusual.
Clostridia, Enterococci, Klebsiella, E. Coli and Bacteroides are common in gut of artificially fed infants
138
Protective factors in BM (5)
```
Proteins
Carbohydrates
Fats
Cellular components
Other BM components
```
139
Protective factors in BM (5)
```
Proteins
Carbohydrates
Fats
Cellular Components
Other BM constituents
```
140
Secretory IgA (SIgA)
- function
- dose in BM
- dose in colostrum
Fn: main immunoglobulin, provides protection against bacteria colonizing newborn's gut
Dose BM: 0.5-1 g/L for the duration of lactation
Dose in Colost: up t o12 g/L
141
Study graphic on BE 01 p. 39
Mucosal Defense System
142
Role of sIgA (3)
1. sIgA antibodies bind micro-orgs they are specifically directed against, preventing them from attaching to infant's mucosal membranes
2. Support develop of infant's own immune system
3. Inflamm. reactivity NOT activated by this defense system
143
sIgA content in milk of mothers of preemies
is significantly higher in sIgA
144
Lactoferrin
- what is it?
- dose in mature BM (colostrum?)
- is a glycoprotein that binds iron
| - dose mature: 1-3 g/L (much more concentrated in colostrum)
145
Lactoferrin function (5)
1. bactericidal to many Gram-negative and -positive bacteria, including E. coli
2. Reacts with the cell membrane of bacteria it comes in contact with
3. Has antiviral effects
4. Is antifungal against Candida albicans
5. Inflammatory reactivity prevented by lactoferrin
146
alpha-Lactalbumin function
Forms complex that induces apoptosis (cell death) of all malignant cells, but not normal cells (complex name: HAMLET: human alpha-lactalbumin made lethal to tumor cells)
^may explain why children AF have higher rates of leukemia and lymphomas, and may explain why premenopausal breast cancer risk in women who BF is reduced
147
Lysozyme function
enzyme that effectively attacks E. coli in concert with lactoferrin and sIgA
148
Anti-secretory factor function (2)
1. protects mother against acute mastitis
| 2. protects infant against diarrhea
149
Proteins that protect infant in BM (5)
```
sIgA
lactoferrin
alpha-Lactalbumin
lysozyme
anti-secretory factor
```
150
Carbohydrates that protect infant in BM (1)
Oligosaccharides
151
Oligosaccharides
- how they work
- how they present in BM
- are prebiotics, not digested in small intestine, but enter colon as intact, large carbohydrates that are then fermented by the resident bacteria
- present in BM by creating increased proliferation of bifidobacteria and lactobacilli (probiotics)
152
Oligosaccharides fact/function (4)
- pass through gut unchanged, also found in urine
- act as blocking analogues to receptors on epithelial surfaces by resembling binding sites for bacteria, sweeping the bacteria from teh gut with them as they are eliminated.
- influence microflora composition of BF baby
- defend infants against pathogens causing otitis media, respiratory tract infections, UTIs, diarrhea
153
Which lipids and fat globules protect BF infant and how
fatty acids and monoglycerides PROTECT by ATTACKING/NEUTRALIZING G. lamblia, entamoeba, E. coli, and Shiga-like toxins
154
2 cellular components in BM that most likely protect maternal breasts
neutrophils
| macrophages
155
lymphocytes in BM - how work, what do
Work: absorbed
Do: may confer immunological information to the baby
156
Other protective factors in BM (6)
```
nucleotides
defensins
cytokines
hormones & growth factors
anti-inflammatory components
soluble CD14 and soluble Toll-like receptor
```
157
Without defenses from BM, infants will experience (6)
```
inflammation
tissue damage
clinical symptoms
high energy cost
---> RESULTS IN GROWTH FALTERING
```
158
Exclusive BF definition (IGAB Consortium)
No other liquid or solid from any other source enters the infant's mouth
159
Almost exclusive BF def (IGAB Consortium)
Allows occasional tastes of other liquids, traditional foods, vitamins, medicines, etc.
160
Full BF def (IGAB Consortium)
Includes exclusive and almost exclusive
161
Full BM feeding (or fully BM fed) (IGAB Consortium)
The infant receives expressed breast milk in addition to BF
162
Partial BF def (IGAB Consortium)
mixed feeding, designated at high, medium or low.
Methods for classification suggested include % of calories from BF, % feeds that are BF's, etc. Any feeding of expressed BM would fall under this category
163
Token BF def (IGAB Consortium)
minimal, occasional BFs (for comfort or with less than 10% of the nutrition thereby provided)
164
BF def (WHO)D sDSDS DS swdswd
Child has received BM direct from breast or expressed s swxx wwwwwwwwwwwwwwwwwwwwwwd
165
EBF def (WHO)ssssssssssWXssWXWsXWSwwwwwww
infant received only BM form mother or wet nurse, or expressed BM, and no other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicinesSS
166
Predominant BF def (WHO)
Infant's predominant source of nourishment has been BM, however can also have received water and water-based drinks, fruit juice, oral rehydration salts solution (ORS), drop and syrup forms of vitamins, minerals and medicines, and ritual fluids (in limited Q's). With the exception of fruit juice and sugar water, no food-based fluid allowed under this definitionSWwsxwxwSwsssswSssW
167
Full BF def (WHO)
EBF and predominant BF together constitute full BF
168
Complementary feeding def (WHO)
child has received both BM and solid or semi-solid food
169
Bottle-feeding def (WHO)
child has received liquid or semi-solid food from a bottle with a nipple/teat
170
Increased morbidity and mortality in AF infants can be attributed to which 3 things?
1. exposure to pathogens from feeding implements, formula or water used
2. absence in formula of antibacterial, antifungal, antiparasitic agents found in BM
3. Slower and weaker develop of infant's own immune system
171
GI infections cause these 5 things
```
Diarrhea
Dehydration
Loss of appetite
Resultant weight loss and
Malnutrition
```
172
3 most commonly reported causes of infectious diarrhea in infants in first 12 months include (3 + examples)
Bacteria (E. coli, Salmonella sp, Campylobater jejuni)
Viruses (esp. rotaviruses)
Parasites (Giardia lambila, Entamoeba histolytica)
173
Relative risk of developing diarrhea throughout life for AF infants as compared to BF infants
- 0-1 months
- 1-12 months
0-1 mo: 14
| 1-12 mo: 4-10
174
Necrotizing enterocolitis (NEC)
- where is this infection commonly seen?
- risk factors
- cause
- mortality rate
- most common GI emergency in NICU
- risk factors: prematurity, AF, intestinal ischemia, bacterial colonization
- due to inappropriate inflammatory response of the immature gut to some undefined insult
- mortality: 15-25%
175
NEC and formula
- how much was risk of NEC increased in preemies being fed AF?
- dose-response?
- risk of NEC 28.6
| - YES dose-response
176
Powdered infant formula contaminated with Enterobacter sakazakii has been associated with outbreaks of.... (3)
NEC
Infant sepsis
Meningitis
[in preterm, neonatal and older infants]
177
What two factors are being administered to preemies at risk for NEC?
Epidermal growth factor
| Probiotics
178
Relative risk of hospitalization d/t pneumonia in AF infants (vs BF)
17
179
Intro. of solids of artificial baby milk before the recommended 6 months of EBF results in X-times increase in pneumonia greater than X episodes of otitis media
6x increase in pneumonia
| Greater than 3 episodes of otitis media
180
RR for developing respiratory illness throughout life for AF (vs BF) infants @ 1-12 mos
3.3-4.3
181
Possible causes of process that increases incidence of otitis media in AF infants (3)
- irritation of middle ear from leakage of cow's milk into eustachian tube
- more horizontal feeding position adopted while bottle feeding
- lack of antibody T- and B- cells found in BM
182
Pneumococci middle ear infections resistant to this BM protective factor, which prevents H. influnzae colonization of the nose and mouth in BF infants
sIgA
183
RR for developing otitis media throughout life for AF infants vs BF infants
- 1-12 mos
- 1-6 yrs
- 1-12 mos: 8.6
| - 1-6 yrs: 3.3-4.3
184
UTI protected by several mechanisms (4)
- Bacteria causing infection comes from bowel, which is similarly colonized between BF mom and baby. Infant protected by mom's sIgA
- Bacterial growth in infant's gut controlled by other antimicrobial factors in BM
- Lactoferrin from BM absorbed by infant, transported into urine via kidneys, killing bacteria it comes into contact with
- Milk oligosaccharides also appear in urine, preventing attach of bacteria to urinary epithelium
185
SIDS definition
Sudden death of an infant under the age of 1 year that cannot be explained after thorough examination of all factors.
*most SIDS deaths occur between 2-4 mos of age
186
Factors protecting BF babies from SIDS (3)
- During active sleep phase infants signif more rousable that AF infants at 2-3 mos of age
- Bed-sharing moms/babies have more night feeding, which helps maintain adequate milk supply ensuring longer duration of BF and healthy baby
- Act of BF promotes optimal develop of oro-facial and jaw development. BF encourages wide palate and thus unobstructed airway. This protection from SIDS may be as much from physical act of BF as from many protective and developmental properties of BM
187
Enterobacter saskazakii def
Bacterium belonging to family Enterobacteriaceae
| A microorganism implicated in outbreaks causing meningitis or enteritis, esp. in infants
188
Three routes by which Enterobacter sakazakii can enter infant formula
- through raw material used for producing formula
- through contamination of formula or other dry ingredients after pasteurization
- through contamination of formula as it is being reconstituted by caregiver just prior to feeding.
189
Increased risk for these 4 diseases assoc with AF and short-term BF
type 1 diabetes
celiac disease
some childhood cancers
IBD
190
Type 1 Diabetes Mellitus (DM)
- def
- general risk, risk w/ 1st degree relative affected, risk if both parents affected
- how does BF affect risk?
- Def: autoimmune disease determined by combo of genetic and environ factors
- Gen pop risk: 0.4%
- 1st degree rel: up to 6%
- Both parents: up to 30%
- BF is protective (if 12+ mos)
191
Hypotheses about what causes trigger which damages islet cells in infants, causing T1DM (3)
- early exposure to cow's milk protein
- intro to solid food before 3 mos
- not having protective benefits of BM
192
Mothers who have T1DM are more/less likely to BF?
LESS
193
BF also decreases risk of T2DM.
| OR of T2DM develop w/ BF
OR 0.61
194
Celiac disease def, prevalence, avg age at dx
Def: an autoimmune chronic enteropathy AKA celiac sprue. Intestinal damage and Inflamm response result in maldigestion and malabsorption caused by ingestion of gluten by susceptible individuals
Prevalence: strongly hereditary, prev of 10% w/ presence in 1st degree relative
Avg age: 8.4 years
195
Increase in risk of celiac in non-BF infants
2x
196
Current recommendation for preventing celiac:
Children to be EBF for 6 mos and BF to continue while, and for several months after, gluten introduced into diet.
197
IBD
- def
- 2 types
-IBD: idiopathic disease, probably involving immune reaction of body to own intestinal tract
-2 types:
-Ulcerative colitis - chronic inflammatory disorder limited to colon
-Crohn's disease - can involve any segment of GI tract from mouth
to anus
198
Chance of child of parent with IBD developing IBD is X%
5%
199
Possible reasons artificial infant feeding has been linked to GI illnesses (Crohn's, IBD, etc) (3)
- AF infants have more GI infections
- AF infants miss out on earlier develop and maturation of GI mucosa that BM stimulates
- infant formula is trigger for antigen response
200
How does BM help prevent obesity?
programs infant's parameters for normal metabolism and regulation of intake
201
Possible physiological reasons that AF is significantly associated with obesity (4)
- AF babies have half the normal levels of serum leptin. Leptin is hormone that regulates food intake and energy metabolism and is found in BM.
- BF fx insulin production which can have long-term effects on energy metabolism.
- Amniotic fluid and BM provide flavor exposure to fetus and infant. These exposures influence taste preference and food choices after weaning. So, maternal healthy food consumption during preg and lact may improve accept of healthy food after weaning.
- BM programs infant's parameters for normal metabolism and regulation of intake, reducing weight gain in infancy. This & the relatively low protein level in BM (vs formula) seems to normalize weight later in life. This is called the early protein hypothesis.
202
Possible behavioral reasons that AF is significantly associated with obesity (3)
- Mothers who choose to BF may select healthier foods for their children.
- Compared with parents who bottle-feed, mothers who BF allow infant to take active role in controlling intake, fostering better self-regulation of energy intake
- Children with mothers who were obese before pregnancy are at greater risk of becoming overweight. This plus AF combined represent greatest risk for obesity.
203
Possible explanations for reduction in lung function in AF babies include (3)
- Loss of factors in human milk that may favorably modify lung develop and an increase in total lung capacity
- Increased respiratory muscle strength that reduces residual volume
- loss of growth factors and cytokines found in BM that influence growth of respiratory alveoli. *Alveoli continue to develop after birth.
204
Multiple Sclerosis
- define
- discuss importance of myelin
- how to prevent (hypothesis)
- MS is idiopathic, inflammatory, demyelinating disease of CNS. Is autoimmune dz where lesions develop along nerve pathways; commonly optic nerve, white matter of cerebellum, brain stem. Neuropsych dysfunction progresses over several years.
- Myelin: Essential fatty acids necessary for normal myelin develop. Demyelination continues (once it starts) until all abnormally formed myelin is destroyed.
- D/t ^, follows that prevention of MS should be mainly dietetic measures ensuring sufficient supply of essential fatty acids, minerals and vitamins, during pregnancy and childhood (BF!!!!).
205
Two strongest dietary links to MS:
1. lack of BF and excessive consumption of cow's milk during infancy.
2. consumption of animal fats which are deficient in unsaturated fatty acids.
206
Which 4 cancers have been linked to AF include:
- lymphoblastic leukemia
- Hodgkin's lymphoma
- neuroblastoma
- Wilm's tumor
207
Possible reasons that AF could be linked to childhood cancers (3)
- Lymphomas common in children with immunodeficiencies, and AF provides none of the immunodefenses BF does
- Infection has been proposed as risk factor for both leukemia and Hodgkin's dz. AF infants may be less able to handle carcinogenic insults after infancy w/o BM protection.
- Alpha-lactalbumin, which can take the HAMLET form, killing tumor cells, not present in AF.
208
Which two hormones found in BM help explain why BF infants better able to maintain normal weight as they grow?
Leptin
| Insulin
209
Define atopy
a form of allergy in which a hypersensitivity reaction eg dermatitis or asthma may occur in a part of the body not in contact with the allergen
210
5 Predictors of childhood allergy
- Hereditary - 43% of children with one parent with hx of atopy - esp maternal
- Elevated cord blood IgE
- Maternal cigarette smoking, prenatal and postnatal
- AF
- Environmental factors (eg house dust mite, cigarette smoke, etc)
211
Examples of atopic disease manifestation (9)
- asthma
- eczema
- cholic
- failure to thrive
- anaphylaxis
- urticaria
- chronic respiratory disease
- GI disease
- rhinitis
212
How does food allergy occur??
It is an immune system response. Occurs when body mistakes ingredient in food, usually a protein, as harmful and initiates antibody response to fight it.
First contact with the food causes body to produce IgE antibodies. Next contact causes body to release histamines and other chemicals into bloodstream, triggering allergic rxn that could be potentially life-threatening.
213
Define leaky gut
D/t immaturity of baby's gut in early months, passage of large unwanted molecules from ingested foods able to pass through the gut wall into bloodstream.
214
Most common single allergen affecting infants
Bovine milk proteins (not lactose)
215
The 7 foods that account for 90% of alergic rxns in babies and children are....
- cow's milk protein
- eggs
- peanut
- soy
- tree nut
- fish
- wheat
216
Incidence of cow milk protein allergy in infants under 12 mos
Often misdiagnosed as.... (2)
3%
Misdx: colic, gastroesophageal reflux
217
7 steps in management to control atopic disease
1. ID "at-risk" families - hx, other child with atopic dz
2. Stop smoking, preferably before preg
3. From v early in preg, exclude common food allergens, plus any known to have problems in members of that family
4. Preven post=natal sensitization - continue maternal avoidance diet
5. EBF for min 4 mos and continue BF after intro of compl foods
6. Withhold cow's milk, egg and peanuts and known family allergens for 2-3 years
7. Contron environ allergens - eg avoid animals, dust mites and molds, smokeHow l
218
How long does it take an infant to double his birthweight
6 months
219
How long does it take for infant to double his brain size?
1 year
220
Success of adding PUFA's DHA and ARA to artificial baby formula?
NO
221
Benefits of BF in dental health
Tongue mvmts of BF help spread palate and thus allow good teeth spacing
222
Bottle feeding and non-nutritive sucking associated with these dental anomalies (2)
Altered occlusion: open bite and posterior cross-bite.
223
Do BF or AF children have higher rates of dental caries
AF
224
Why does BM sugar not cause dental caries?
BM sugar is lactose - split by enzyme lactase into glucose and galactose in infant's gut, not in the mouth, so not cavity-causing. Sucrose is main sugar implicated in tooth decay.
225
Mean Hb is appx. XX g/L lower in non-lactating women compared with lactating women
50 g/L lower
226
Most significant factor in iron deficiency anemia
PP blood loss and early recommencement of menses
227
See chart on pg 69/80 of BE01
chart of iron and BF vs AF
228
Fertility rate of women EBF, amenorrheic in first 6 months after birth
2%
229
How long until fertility returns when lactation is suppressed
Within 6 weeks
230
What % of the normal weight gain in pregnancy is attributed to maternal fat stores?
25% (7 lb)
231
Estimated avg add'l nutritional burden of EBF until 6 months for RDA energy, vitA, Ca, Fe
Small: 0.1-6.0%
| *Being amenorrheic for 6 months conserves nutrients such as iron
232
Regulatory processes allowing for successful lactation involve (4)
- mobilizing fat
- increasing food intake
- reducing energy expenditure, and
- changing composition or volume of milk
233
During which trimester(s) does the most bone loss occur?
| Amount?
Second and third b/c fetal bone growth is at it's peak.
Amount: 25-30 g calcium (2-3% total body calcium content).
234
Following pregnancy, mom continues to lose further XXX-XXXmg calcium per day in BM
300-400mg
235
After BF stops, bone mineral content at most skeletal sites...
increases to similar or higher than amount measured shortly after birthing
236
PP decrease in bone mineral content does not occur in women who do not BF?
NOT recovered
237
Are either # of pregnancies or length of BF associated with low bone mineral density in post-menopausal women?
NEITHER
238
Will calcium supplements during lactation affect process of bone mineral density decrease?
No effect, several studies.
239
When a mother with T1DM BF's, what happens to her total daily insulin requirement? Why?
It decreases as a result of increased glucose uptake during lactation
240
Note that there is a dose response relationship with EBF and maternal T2DM risk.
That is all.
241
What happens to the T2DM risk for women who have had GDM?
Greatly increases later in life.
Women w GDM who suppressed lactation developed early postpartum diabetes at TWICE the rate of those who BF
242
Why do GDM women have higher risk for T2DM?
Women who AF had poorer pancreatic beta-cell function vs women who BF for 3 mos in a study
243
How do pregnancy and lactation affect breast cancer risk?
Risk of estrogen-receptor positive and progesterone-receptor positive tumors decreases by early age at first pregnancy and multiparity.
Lactation is assoc with reduced risk of both est. and progest. positive AND negative tumors, suggesting different mechanism of protection in lactation.
244
Dose-response relationship exists between EBF duration and breast cancer protection
That is all.
245
Discuss endometrial cancer risk and BF
Risk of endometrial cxr related to estrogen levels, showing increased risk with increasing endo-or exo-genous estrogen stimulation and reduced risk when opposed by progesterone.
During BF, reduction in endogenous estrogen exposure is larger than that of progesterone, suggesting that BF may possibly reduce risk of endometrial cancer.
246
What are the other 5 names for modified milk for infants?
```
infant formula
artificial baby milk (ABM)
breastmilk substitutes
artificial formula (AF)
powdered infant formula (PIF)
```
247
MAKE FLASHCARDS FOR IBCLC PRINCIPLES OF ETHICAL PRACTICE
TO DO
248
Elements of informed consent includes a discussion of the following 6 element
1. nature of client's problem or illness
2. nature and purpose of proposed procedure or tx
3. risks and benefits of proposed procedure or tx
4. alternatives to proposed intervention
5. risks and benefits of alternative tx or procedure
6. any risks related to failing to undergo a procedure or tx
