Midterm Flashcards
1
Q
Study of Nutrition
A
Study of food, nutrients and other factors that interact to impact how our bodies process food and utilize nutrients
2
Q
Benefits of food
A
Provides energy (in form of calories), nutrients, and other substances needed for growth and health
3
Q
Calorie
A
Measure of the amount of energy transferred from food to energy
4
Q
Nutrients
A
Chemical substances in food that are used by the body
5
Q
Diet
A
Consumption of foods and thoughts that go in to what we consume on a daily basis
- tells us about one’s culture and traditions
6
Q
Carbohydrates
A
Organic compounds consisting of C, H and O
7
Q
Proteins
A
Organic compounds consisting of amino acids
8
Q
Fats (lipids)
A
Organic compounds that consist of a glycerol molecule bound to three fatty acids
9
Q
Vitamins
A
A group of organic compounds essential for proper nutrition and growth and required in limited amount in diet
10
Q
Minerals
A
A group of inorganic compounds essential for proper nutrition and growth, and required in limited amounts in diet
11
Q
Water
A
Essential component of our diet
- helps transport nutrients to cells
- lubricates us
12
Q
Essential Nutrients
A
Nutrients we cannot make on our own but only obtain from our diet
- carbohydrates
- certain amino acids (9 essential)
- essential fatty acids
- vitamins and minerals
- water (can’t manufacture enough on our own)
13
Q
Nonessential Nutrients
A
Present in foods and used by the body but not required in the diet since we can also synthesize them ourselves
- cholesterol
- glucose
14
Q
Malnutriton
A
Lack of nutrition over extended period of time
- undernutrition
- over-nutrition
15
Q
Deficiency
A
Inadequate nutrient intake - depletion of tissue reserves - decreased blood nutrient level - insufficient nutrient available to cells - impaired cellular functions - physical signs/symptoms of deficiency - long term impairment of health
16
Q
Toxicity
A
Excessive nutrient intake - saturation of tissue reserves - increased blood nutrient level - excessive nutrient available to cells - impaired cellular function - physical signs/symptoms of toxicity - long term impairment of health
17
Q
Dietary reference intakes
A
Nutrient intake standards for healthy members of population
- established jointly by scientists
- continually updated
- different categories exist for certain nutrients
- Specific to life stage/ages
18
Q
RDA
A
Recommended dietary allowance
- Levels of essential nutrients adequate for ~98% of population
19
Q
AI
A
Adequate intakes
- Tentative RDA’s used when scientific information is less conclusive
20
Q
EAR
A
Estimated average requirements
- Estimated values to met requirements of half of healthy individuals in a population group
21
Q
UL
A
Tolerable upper intake levels
- Upper limits of nutrients compatible with health (should not be exceeded)
22
Q
Daily Values
A
Standards for daily intakes of nutrients
- based on needs for 2000 cal/day diet or eating pattern
- typically used on nutrition labels of foods
23
Q
Factors that impact nutrient needs
A
- age
- body size
- gender
- genetic traits
- growth
- illness
- lifestyle habits
- medication
- pregnant (lactating)
24
Q
Life cycle approach to nutrition and health
A
For certain population groups and life stages different people are more susceptible to deficiencies and diseases
25
WHO definition of health and extended definition
"Health is a state of complete physical, social and mental well being and not merely the absence of disease or infirmity."
"...the extent to which an individual or group are able to realize aspirations and satisfy needs, and to change or cope with environment."
26
Health promotion
Process of enabling people to increase control over determinants of health
27
Fundamental conditions and resources for health are:
- peace
- shelter
- education
- food
- income
- a stable eco-system
- sustainable resources
- social justice
- equity
28
Population/Public Health Approach
Our health and health behaviours are the result of numerous determinants from various sectors
- to improve health, action must be taken of the full range of health determinants and involve numerous sectors
29
Q: Define the term essential nutrients. Identify two essential nutrients and representative examples of foods that contain them
Nutrients that our body can't make so you have to get them from food
- Carbohydrates (e.g. bread)
- Calcium (e.g. milk)
30
3 levels of prevention
1. Primary (ALL)
- reduce new cases of problem behaviour
2. Secondary (SOME)
- improve health of people that already have problematic behaviour
3. Tertiary (FEW)
- help people with chronic or infections conditions manage their symptoms
31
Primary prevention
Health promotion activities aimed at a specific illness or disease
- precedes disease and is applied to generally healthy individuals
EX: immunizations, breast cancer screening, session on healthy eating to prevent cancer
32
Secondary prevention
Activities focused on early identification of health problems (identify and treat people who have asymptomatic/preclinical disease)
- people who pose risk factors for certain diseases
EX: breast self exam, screenings for genetic cancers, screening for specific illness
33
Tertiary prevention
Educating of an individual with a disease with the goal of returning them to optimum level of functioning
- targeting people that already have a certain condition
EX: referring a person who has stroke to rehab centre, educating person with type 2 diabetes how to identify and prevent complications
34
Health promotion (in CA) at federal level
- Public Health Agency of Canada
- Health Canada
- Canadian Food Inspection Agency
35
Health promotion (in ON) at provincial level
- Ministry of Health and Long Term Care
| - Public Health Units
36
Health Canada
- Health care
- Education, food guide
- Development of food regulations (food labeling, the Food and Drugs Act, health claims)
37
Public Health Agency of Canada
- Health promotion
- Prevention and control of disease
- Disease Surveillance
- Public health emergencies (food borne illness outbreaks)
38
Canadian Food Inspection Agency
- Enforcement of food regulations set by Health Canada
- Inspection of facilities
- Identification and oversight of food recalls
39
Federal Minister of Health
Jane Philpott
40
PHAC Healthy Living Strategy targets
1. Healthy eating, physical activity, and theirrelationsaip to health weights
2. Tobacco, diabetes, chronic disease prevention, etc.
3. Mental Health
4. Injury prevention
41
Sodium reduction strategy for Canada
```
Particular strategy initiated in 2007:
Reduction task force
- researchers, industry, medical community, professional organizations, government
Risks
- elevated blood pressure
- CVD
- stroke
- kidney disease
Avg. intake among CA (3400 mg/day)
Recommended intake (1500 mg/day)
UL (2300 mg/day)
```
42
Who has highest intake of sodium?
Male teenagers
- sports drinks
- processed foods
- fast food availability
43
High sodium in common processed foods
- Kraft dinner
- Frozen pizza
- Pizza pockets
- Soy sauce
- Ketchup
- Pickles
44
Provincial Minister of Health
Dr. Eric Hoskins
45
Ministry of Health and Long Term Care
Healthy Eating and Active Living Action Plan
- access to healthy food for children
- help Ontarians access dieticians
- Active 2010
Healthy Change Ontario's Action Plan
- provides action plan for Health Care
- keeping ontario healthy, faster access to stronger family health care, right care, right time, right place
46
What do Dietitians do in Public Health?
- Preparation of kits, educational material
- Liaise with policy makers to work on nutrition policy implementation and guidelines
- Public level screening
- Public level education
- Nutrition counselling (in person, telephone)
47
Define social determinant of health
Economic and social circumstances within which people live
- processes/mechanisms by which members of different socio-economic groups come to experience varying degrees of health and illness
48
12 Core Determinants of Health
- health services
- education
- physical environments
- social support networks
- health child development
- gender
- social environments
- personal health practices and coping skills
- culture
- biology and genetic endowment
- employment and working conditions
- income and social status
49
Socio-ecological Model
Individual - Interpersonal - Organizational - Community - Public Policy
50
SeM - INDIVIDUAL
Personal level factors
51
SeM - INTERPERSONAL
Factors relating to the influence of families, peers and partners, culture
52
SeM - ORGANIZATIONAL (institutional)
Practices and physical environment of an organization
53
SeM - COMMUNITY
Cultural values or norms unique to urban, rural and remote settings
54
SeM - PUBLIC POLICY
Broader guidelines at various levels of government
55
Where do food and nutrition fit into the SeM?
Individual: lactose intolerance impacting calcium status in individuals
Interpersonal: meal-time practices in the home – eating meals together
Organizational/institutional: time and space available to eat lunch at your workplace
Community: living in a food desert – few locations nearby to purchase healthy fresh foods
Public Policy: The former Conservative government replacing the federal Food Mail program which subsidized foods being shipped to the North, with Nutrition North, another federal program which subsidizes food retailers – none have been successful in establishing food security in remote northern regions of Canada!
56
Food security
All people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life
57
Food insecurity
The inability to acquire nutritionally adequate foods in culturally acceptable ways
58
Food availability
Daily energy, macronutrient, and micronutrient needs must be met
- food can be available for individuals or families living in a city or rural area
- sources of food locally such as farmer's markets, grocery stores etc.
59
Food access
Individuals or households may not have access to available foods due to circumstances such as insufficient income or lack of transportation
60
Food supply and systems
Environmental impacts can lead to droughts, floods, sharp price increases
61
Traditional foods
Plants and animals harvested from the local environment
62
Tradition food systems
Include preferences at individual level
| - physical, social and cultural environments
63
Determinants of traditional food choice
- no time to prepare
- lack of knowledge
- unhealthy
- no land access
- expensive
- no availability
64
Food as a social determinant of health
To achieve sustainable food systems, community members of all ages must identify a shared vision of food security and translate it into a locally controlled food system in order to ensure a vibrant healthy community
65
Emerging adult
Phase of the life span between adolescence and adulthood
- a period of time to explore possibilities and define one's self
- not necessarily settled on career, house, partner
- theory coined by Jeffrey Arnett
66
Transitional period leading to adulthood
- moving from home
- paying bills
- own place to live
- buying/cooking food
- responsible for yourself (making appointments)
- completing education
- life partner
- starting family
67
How has this stage evolved?
Generally speaking...
- leaving home at older ages
- leaving school at older ages
- age of marriage is increasing
- age of parenthood increasing
68
Average age of first marriage in 1972 vs. today for men and women
Men: 25 vs. 31
Women: 22 vs. 29
69
Characteristics of emerging adult
- Don't see themselves as adults
- Time of identity exploration
(work, love, worldview, lifestyle)
- Experimentation
- High level of transition
(residential status, school attendance)
70
Human brain does not reach full maturity until?
Mid 20's
71
Brain development in emerging adulthood
Frontal lobe
- largest of brain's structures
- "prefrontal cortex" changes
72
Prefrontal cortex
Termed "Executive Suite" - Involves processing of tasks such as:
- calibration of risk and reward
- problem solving
- prioritizing
- long term planning
- self evaluation (awareness being less critical)
- regulation of emotion (not being so dramatic)
73
Changes to prefrontal cortex during emerging adult stage
"Melting of teenage brain"
Myelination
- more extensive myelination of nerves in this area of rain
Synaptic pruning
- nerve connections are pruned back = more efficient signal transmission among remaining nerves
74
Result of changes to prefrontal cortex
- More sophisticated learning and emotion regulation
| - Executive suite functions are more efficient
75
Changes by the end of emerging adulthood
- More complex thinking (consider both present and future)
- Appreciation of diverse views
- Emotional regulation (weigh immediate rewards with future consequences)
- Risk taking and decision making (increased ability to modulate risk taking and make decisions about future)
76
Overall health and well-being of emerging adult
- self reported health is good to excellent
- rates of disease and stability are low
- peak in substance use, STI
- psychiatric disorders also peak (anxiety increases but depression decreases)
77
Window of opportunity for public health
Time of identity exploration during emerging adult stage
- incorporating health related behaviours is part of self-identity
- important indicator of lasting health-related behaviours
78
Nutrition in emerging adulthood
- Support active lifestyle
- Maintain physical status (healthy body weight, prevent type 2 diabetes)
- Special requirements for reproduction
- Otherwise nutrient requirements for adulthood
79
Trends in general dietary intake emerging adult
- Fast food intake is highest
- High consumption of sugar-sweetened and caffeinated beverages
- High salty snack foods
- Low intake of fruit and vegetables (only 13% of uni/college students have 5 or more servings per day)
- Low milk intake
80
Lifestyle influences emerging adult diet
Eating on the run is common
- sugar sweetened beverage
- fast food
- total fat and saturated fat
- fruits and veggies
81
True or false - students who live on campus have better diets than those who live off campus?
True - Compared to students living on campus those that lived with parents or in rented houses/apartments had:
- increased fast food intake
- decreased fruit, vegetable, and whole grain intake
82
Obesity and weight gain in emerging adults
- Large increase in prevalence of obesity among 18-29 year olds
- Transition to university (freshman 15)
83
BMI
Measure of obesity - weight relative to height (not a direct measure of body fat)
BMI = kg/m2
NOT ACCURATE FOR EVERYONE
84
BMI underweight
less than 18.5
85
BMI normal
18.5-24.9
86
BMI overweight
25.0 - 29.9
87
BMI obese I
30-34.9
88
BMI obese II
35.0 - 39.9
89
BMI obese III
greater than 40.0
90
Key considerations for using BMI
- 18+
- based on population level data
- only part of an individual's risk assessment
- does not take into account bone density
- not to be used with pregnant/lactating women
- does not capture risk with weight change
91
Results of BMI less accurate for who?
- emerging or young adults
- muscular/lean individuals
- certain population groups
- adults older than 65
- dehydrated individuals
92
Q: BMI measure don't accurately represent healthy weights for:
```
A. athletes with larger percentage of muscle
B. individuals with little muscle mass
C. individuals with large, dense bones
D. dehydrated individuals
E. all of the above
```
ALL OF THE ABOVE
93
Fertility
Ability to bear children
94
Infertility
Inability to bear children
95
(In)Fecundity
Biologic ability (inability) to bear children (uterus, ovaries - basically having proper parts)
96
Subfertility
Reduced level of fertility or early pregnancy losses
97
Infertility rates
- About 18% of couples are sub fertile (44% able to conceive with no intervention in 3 years)
- Healthy couples have a 20-25% chance of diagnosed pregnancy within a single menstrual cycle
98
Puberty
Period in which human become biologically capable of reproduction
99
Ova
Female reproductive cells that are produced and stored in ovaries
100
Follicle
Cellular structure in ovary where ova matures
101
Sperm
Male reproductive cells
102
Reproductive system develops...
within first months after conception and continue to grow and develop through puberty (course of 3-5 years)
103
Women born with how many ova?
Lifetime supply of approximately 7 million
| - during fertile years about 400-500 ova will mature and be released
104
Menstrual cycle
4 week interval in which hormones direct buildup of blood and nutrient stores within uterus
- ova matures and is released
105
Follicular phase
First 14 days of cycle
| - helping egg mature to eventually be released through ovulation
106
Luteal phase
Last 14 days of cycle
- lining of uterus build up (blood and nutrients)
- egg released
- ovulation occurs
- menstruation and fertilization takes place
107
Gonadotropin-releasing hormone
Released by hypothalamus
| - stimulates the anterior pituitary gland to release FSH and LH
108
Follicle-stimulating hormone
- stimulates maturation of ovum (&sperm in men)
| - stimulates production of estrogen
109
Lutenizing hormone
- stimulates secretion of progesterone
| - surge in LH causes release of ovum
110
Estrogen
- stimulates further growth and maturation of follicle
- stimulates vascularity and storage of glycogen and other nutrients within uterus
- decrease in estrogen at the end of menstrual cycle stimulates release of GnRH
111
Progesterone
- prepares uterus for fertilized ovum
| - increases vascularity of endometrium
112
Sperm production
Men are born with sperm-producing capability
| - sperm production begins during puberty and decreases somewhat after age 30 with production continuing to old age
113
Ongoing vs. cyclic
- Men continually produce sperm
| - Menstruation is cyclic
114
Sperm production hormones
- GnRH signal release of FSH and LH
- FSH and LH stimulate production of testosterone by testes
- Testosterone stimulate maturation of sperm (takes 70-80 days)
- Sperm are stored in epididymis and released in semen
115
Main fertility disruptions
- contraceptive use
- severe stress
- infection
- tubal damage
- chromosomal damage
116
Nutrition and lifestyle factors affecting fertility
- energy status and nutrient adequacy
- obesity
- weight loss
- undernutrition
- high intensity training
- low intake of specific foods and food components
117
Estrogen and leptin levels increase with...
high body fat
118
Obese women tend to have higher/lower levels of estrogen, androgens and leptin?
HIGHER
| - fertility compromised in women with BMI greater than 30 (disruption of hormones)
119
Hormonal differences result in?
Irregularity of menstrual cycle, ovulatory failure and amenorrhea
120
Obesity and hormonal affect on men
- lower levels of testosterone
| - increased estrogen and leptin levels
121
Reducing fertility problems
Weight loss
- 7 to 22 pounds in overweight women
- 100 pounds in very obese men
- reduces insulin resistance and can ameliorate hormonal imbalances
122
Weight reduction strategy should:
- focus on lifestyle changes
- improve overall diet quality
- decrease caloric intake
- increase physical activity
123
Weight loss in non-overweight women
- loss of over 10-15% of usual weight decreases estrogen, LH, and FSH
- results in amenorrhea, anovulatory cycles
- athletes
- eating disorders that result in very low weight and fat stores
- fertility compromised in women with BMI less than 20
124
Weight loss in non-overweight men
- loss of 10-15% normal weight leads to decreased sperm viability and motility
- loss of over 25% normal weight stops sperm production
125
Acute undernutrition
Associated with dramatic decline in food energy and nutrients that recovers with normal food intake or eating behaviour (definite problems in terms of fertility)
126
Chronic undernutrition
Primary effect = birth of small/underweight infants with high likelihood of death in first year of life
- reduced fertility
- huge problems in terms of birth outcomes
127
Adverse effects of intense physical activity over long term
As a result of hormonal and metabolic changes
- delayed age at puberty
- lack of regular menstrual cycles
- reduced levels of estrogen
- low levels of body fat
- decreased bone mass (stress fractures)
128
Female Athletic Triad consists of:
- amenorrhea
- eating disorder (restricting)
- osteoporosis
129
Female athletic triad triggered when
energy intake is substantially below requirement
130
Female athletic triad results in:
- decreased LH and FSH levels
- lack of estrogen
- no menstruation
131
Plant based diet (or low fat, high fiber) linked to?
Reduced estrogen and irregular periods
| - less than 20% total calories from fat seems to negatively influence fertility
132
Isoflavones (from soy)
- may influence levels of gonadotropins, estrogen and progesterone
- also associated with reduced sperm count in men
133
Soy consumption
In increased amounts soy can mimic hormones in body and tends to disrupt hormone and menstrual cycles
134
Low iron linked to:
- premature delivery
| - low iron status of baby
135
Iron and fertility
About 50% of women enter pregnancy with inadequate iron stores and supplements usually recommended
136
Caffeine and fertility
No evidence for linkage
| - in some studies chance of conception decreased
137
Alcohol and fertility
- may decrease estrogen and testosterone levels
138
Folate and fertility
Folate intake related to increased fertility in women and healthy development of embryo following conception
139
Periconceptional period
After conception but before pregnancy is diagnosed
140
Which nutrient is very important in the periconceptional period?
FOLATE - healthy development of embryo
| - many women not following recommendation to take folate supplements
141
Where is folate found?
Many dark leafy greens
142
Who is most vulnerable to be lacking in folate consumption?
- single women
- unplanned pregnancy
- low education
143
Folate after fertilization
Insufficient amounts affect embryonic development especially neural tube defects
144
Neural tube defects
- occur in first 2-3 weeks after conception before mother knows she is pregnant
- anywhere in spine (most commonly lower)
- paralysis, exposed meninges, hydrocephalus
145
Folate recommendation
400 micrograms/day recommended in supplemental form to all women who are sexually active and at risk of becoming pregnant
146
Naturally occurring folate
- green leafy veggies (asparagus, broccoli, brussels sprouts)
- avocado
- corn, beets
- fruits
- whole grains
- dried beans, lentils and peas
- beef liver
- yeast preparations
147
Bioavailability of nutrients
Efficiency of absorption, utilization and or retention of nutrients present in food
148
Bioavailability affected by:
- nutrient content of food
- food processing
- physical state of person
- ability to digest and absorb nutrients is compromised
- interactions among components of diet
149
Bioavailability can be improved by?
- Fortification
| - Enrichment
150
Fortification
Addition of nutrients not originally present in particular food
- almond milk
- rice milk
151
Enrichment
Addition of nutrients that were lost during food processing
| - addition of vitamins to processed white flour
152
Folic acid
Synthetic form of natural folate
- highly bioavailable
- found in supplements and supplemented food
153
Folic acid fortified foods in CA
- flour, white, enriched
- enriched pasta
- enriched corn meal
- infant formula
- formulated liquid diets
- meal replacements
- stimulated meat/poultry products and extenders
- simulated egg
154
Voluntarily fortified foods
- breakfast cereals
- pre cooked rice
- fruit flavoured drinks
- evaporated goat's milk
- beverages from legumes, nuts
155
Q: Which is high folate breakfast?
1. 2 slices of 7-grain toast, 1tbsp jam, cup skim milk, medium banana, coffee with cream
2. 1.5 cups of cooked oatmeal, 1tbsp brown sugar, 1 cup rice milk, 1c apple juice
BREAKFAST 2
156
Diabetes Mellitus
Intolerance to carbohydrate with fasting glucose greater than 126 mg/dL
157
Type 1 diabetes
Results from destruction of insulin-producing cells (10% of cases)
158
Type 2 diabetes
Body unable to use insulin normally or to produce enough insulin or both (90% of cases)
159
Gestational diabetes
Onset during pregnancy (3-7%)
- often times type 2 and younger women
- poorly controlled blood glucose levels increases risk of fetal and maternal health problems
- increased risk of miscarriage
- fetal size diminished
- macro semantic birth
- increased risk of mother and infant
- developing type 2 diabetes late in life
160
Diabetes prior to pregnancy
High blood glucose levels during first 2 months of pregnancy are associated with 2-3 fold increase in congenital abnormalities in newborn and higher rates of miscarriage
161
Prevention of GDM
- weight loss
- exercise
- healthful dietary pattern
- increased fiber intake
- intake of low GI carbohydrate sources
- increased vegetable and fruit consumption
162
Q: Three components of female athlete triad are?
Amenorrhea, disordered eating, and osteoporosis
163
Gestational age
Assessed from date of conception
164
Gestational age for average pregnancy
38 weeks
165
Menstrual age
Assessed from onset of last menstrual period
166
Menstrual age for average pregnancy
40 weeks
167
Embryo
First trimester
168
Fetus
Second trimester
169
Before 20 weeks
Miscarriage or spontaneous abortion
170
After 20 weeks
Fetal death/still birth
171
Preterm
Born less than 37 week
172
Post term
Born after 42 weeks
173
Real critical period?
Between second and third trimester
174
Baby born anytime before 26 weeks
- not likely to survive on their own
| - lungs not properly developed
175
Maternal anabolic phase
Weeks 1-20
- focus is building mother's capacity
- approximately 10% of fetal growth occurs
176
Maternal catabolic phase
Weeks 20-40
- stored energy and nutrients to fetus
- approximately 90% of fetal growth occurs
177
Maternal physiology
Changes in maternal body composition and functions occur in specific sequence
178
Specific sequence of maternal physiology
1. maternal plasma volume expands
2. maternal nutrient stores increase
3. placental weight increases
4. uterine blood flow increases
5. fetal weight finally really starts to increase
179
Body water changes during pregnancy
Women's body water increases between 7 and 10L
- results from increased plasma and extracellular volume and amniotic fluid
- begins first few weeks after conception
- necessary in relation to nutrients that need to be delivered (expand overall blood volume to increase capacity to deliver nutrients_
180
Preferred fuel for fetus?
Glucose
181
Carbohydrate metabolism during anabolic phase
Hormones promote increased insulin production
182
Carbohydrate metabolism during catabolic phase
- Increased insulin resistance in mother
- Hormones inhibit energy storing
- Women's body can't use glucose as energy source and rely on fat stores instead
183
Fetus has glucose from what 3 main sources?
- Maternal dietary sources
- Maternal storage form of glucose
- Glucose manufactured from gluconeogenesis from fat stores in earlier stage of pregnancy
184
Diabetogenic effect of pregnancy
Results from maternal insulin resistance
| - huge spikes in glucose during pregnancy
185
Protein metabolism during pregnancy
- About 925g of protein accumulated for new maternal and fetal tissue (growing hair/skin/nails, enzyme manufacturing)
- no extra protein is stored
- primarily met by mother's intake
186
Fat metabolism during pregnancy
Fat stores accumulate in first half of pregnancy and enhanced fat mobilization in last half of pregnancy
187
Blood lipid levels during pregnancy
Increase from non pregnant women to third trimester
188
What is fat used for during pregnancy?
```
Mother
- reliance on fat stores for energy
Placenta
- steroid hormone synthesis
Fetus
- nerve and cell membrane production
- energy
```
189
Mineral metabolism during pregnancy
Calcium
- increased bone turnover so more calcium absorbed from food
Sodium
- increased requirement due to elevated body water and tissue enlargement
190
Placenta (flat cake)
Disk shaped organ of nutrient and gas exchange between mom and fetus (temporary organ)
191
Functions of placenta
- hormone and enzyme production
- nutrient and gas exchange
- removal of waste from fetus
192
Factors that affect nutrient transfer between placenta
- size and charge of molecules
- small molecules with little charge pass through most easily (i.e. water)
- lipid solubility of particles (lipids pass through more easily)
- concentration of nutrients in maternal and fetal blood
193
Critical periods
Preprogrammed time periods during embryonic and fetal development when specific cells, organs and tissues are formed and integrated or functional levels established
194
Fetal development
- one way street
| - most critical development during first 2 months post conception
195
Very preterm birth
Gestational age less than 32 completed weeks
196
Perinatal mortality
Combined mortality of stillbirths and live births with death occurring up to 6 days of age as a proportion of all births
197
Low birth weight
Birth weight less than 2500 g (5.5 lbs)
198
Disproportionately Small for Gestational Age
dSGA (asymmetrical)
- short term malnutrition during 3rd trimester
- post birth complications
- small organs, normal cell #
- can catch up
- poorer academic performance, risk of heart disease, high bp, type 2 diabetes later on
199
Proportionately Small for Gestational Age
pSGA (symmetrical)
- chronic malnutrition
- fewer birth related complications
- small organs and # of cells
- minimal catch up, breastfeeding helps
- risk of obesity, high bp, type 2 diabetes later on
200
Large for Gestational Age
Greater than 90th percentile for sex and GA and birthweight greater than 4500 g (10 lbs)
- rapid weight gain of mother, untreated GDM
- complications for mother
- taller later in life
- later life risks (chronic disease)
201
Preterm birth rates in CA
- rates are going down as we are learning more about healthy pregnancy and nutriton
202
Infant mortality
Reflects general health and socioeconomic status of a population because it identifies vulnerable members of population
203
How much weight should you gain during pregnancy?
DEPENDS ON PRE-PREGNANCY WEIGHT (don't gain much during 1st trimester)
- underweight (28-40 lbs)
- normal weight (25-35 lbs)
- overweight (15-25 lbs)
- obese (11-20 lbs)
204
Where does pregnancy weight go?
```
Baby: 7-8 lbs
Maternal fat and nutrient stores: 7 lbs
Maternal blood: 4 lbs
Fluids in maternal tissue: 4 lbs
Placenta: 1-2 lbs
Amniotic fluid: 2 lbs
Uterus: 2 lbs
Maternal breast tissue: 2 lbs
```
205
Risks with too little weight gain
- preterm birth
- poor fetal growth
- small for gestational age
206
Risks with too much weight gain
- preterm birth
- large for gestational age
- caesarean birth
- weight retention mom (future risk of obesity)
* WEIGHT loss not recommended during pregnancy
207
Q: How much do energy needs increase in the first trimester?
0 kcal
208
Energy needs trimester 2
Increase kcal by 340
209
Energy needs in trimester 3
Increase Kcal by 452
| - essentially 2-3 more servings from EWCFG
210
MINIMUM carbohydrate intake during pregnancy
175 g/day
- primary source for fetus
- definitely needs to increase
211
Alcohol ingestion during pregnancy
Not necessarily solid evidence but should be avoided
212
Artificial sweeteners during pregnancy
No evidence of causing harm but think about nutrient density
| - ensure that nutrient dense foods aren't replaced by artificial sweeteners
213
Protein during pregnancy
+25g/day (approximately 71g) particularly in second and third trimester
214
Folate recommendation during pregnancy
600 micro grams/day of dietary folate (400 micro grams/day as folic acid supplement)
215
Iron needs in pregnancy
27 mg/day
| - additional iron needed for fetus and placenta, increased red blood cells, blood loss at delivery
216
Iron status
Many women enter pregnancy with subclinical deficiency
| - for infants this could lead to low birth weight, preterm birth, and slower cognitive development
217
Iron supplementation during pregnancy
16-20 mg iron per multivitamin throughout pregnancy (lower absorption)
218
If iron deficient
Provide supplemental form only
| - side effects: nausea, cramps, gas, constipation
219
Calcium intake during pregnancy
Recommendation same as nonpregnant - 1000 mg/day
- increased need in 3rd trimester of an extra 300 mg/day - can be accounted for by increased absorption from food and release of calcium from maternal bones
220
Foods to avoid during pregnancy
- semi soft cheeses
- raw and undercooked meats, poultry and fish
- runny yolks and raw eggs
- lunch meats
- uncooked hot dogs
221
Caffeine during pregnancy
Recommended less than 300 mg/day
- 1-3 200 ml cups of coffee
- 12 200 ml cups of weak tea
- 12 oz dark chocolate
222
GDM risks for mother
- c section delivery
- risk of preeclampsia
- risk of type 2 diabetes, high bp, and obesity later on
223
GDM risks for infant
- still birth
- miscarriage
- congenital abnormalities
- large baby
- insulin resistance, type 2 diabetes, high bp, obesity later on
224
GDM management
```
3 meals and snacks
- even out carbohydrate intake across day
No energy restriction
Limit concentrated sugar
Appropriate weight gain
Regular exercise
```
225
Diet plan prescribed to manage GDM
40-50% CHO
30-40% fat
20% protein
* if nutrition therapy does not work within 2 weeks may need insulin
226
Mammary gland development
During puberty a system of dunces, lobes and alveoli develops
- estrogen and progesterone levels contribute
System remains inactive until pregnancy
During pregnancy growth proliferates with ductal branching and lobular-alveolar development proceeding at a spectacular, orderly, rate
227
Alveoli
Functional units in mammary glands
228
Secretory cells
Make up alveolus (just below nipple) and have a duct in the center
229
Myoepithelial cells
Line alveoli and contract during letdown causing milk ejection
230
Mammary glands
Milk producing cells
231
Two key hormones in lactogenesis
1. Prolactin
| 2. Oxytocin
232
Prolactin
Stimulates production of milk
| - suckling, stress, sleep and sex can produce prolactin
233
Oxytocin
Stimulates production of milk and let down of milk into ducts (also causes uterus to contract during birth)
- suckling, thinking about child, crying, sex produce oxytocin
234
Lactogenesis I
- begins during last trimester of pregnancy and lasts until 2-5 days after birth
- milk formation begins, and lactose and protein content in milk increases
- may be affected by premature delivery (mothers with premature births are usually unable to provide full milk supply)
235
Major CHO in milk?
Lactose
236
Lactogenesis II
- begins 2-5 days after birth
- characterized by increased blood flow to breasts (onset of milk secretion)
- significant changes in milk composition and quantity over first 10 days of life
237
Lactogenesis III
- begins about 10 days after birth
- milk composition is more stable
- routine schedule of breast feeding should be established
238
Human milk consumption
- only food needed by majority of healthy infants for up to 6 months
- allows for transfer of energy, nutrients and antibodies from mother to infant to protect against infections
239
Composition of human milk can change...
- over a single feeding
- over a day
- based on infant age
- presence of infection in breast
- with menses
- with maternal nutritional status
240
Colostrum
First milk secreted in Lactogenesis II
- very high in protein compared to milk once established
- high in secretory IgA and lactoferrin (involved in immune function and high in Vit A)
- lower in energy, lactose, and fat
241
Water in human milk
- major component in human milk is water
- same concentration as maternal plasma
- allows baby to be hydrated
242
Energy in human milk
Approximately 0.65 kcal/mL
| - less in calories than human milk substitutes
243
Lipids in human milk
- second largest component
- provides half calories
- foremilk lower fat compared to hind milk
- what mother eats does not affect fat content
244
Maternal diet and lipid content in milk
Affects fatty acid profile but not total fat content
245
Protein in human milk
- relatively low compared to other mammals
- mostly dependent on time since delivery
- both nutritional and non-nutritional effects
246
Casin
- main protein in mature human milk
- contributes to white appearance
- facilitates calcium absorption; increases calcium bioavailability by creating a soluble complex
247
Whey
- other water soluble protein in milk
- some mineral/hormone/vitamin binding proteins
- ex: lactoferrin (carries iron in a form that is easily absorbed)
248
Lactose
- major CHO in milk
- enhances calcium absorption
- stimulates growth of good bacteria and prevents growth of bad bacteria in developing infant gut
249
Oligosaccharides
- medium length CHO containing lactose at one end
- can be bound to proteins or lipid
- prevent binding of pathogenic microorganisms to walls of infant gut, preventing infection and diarrhea
250
Q: What fat-soluble vitamin is given to all infants at birth?
VITAMIN K
251
Vitamin K
- supplemented to all children at birth
- about 5% of breastfed infants at risk for K deficiency based on clotting factors
- infants who did not receive at birth may be deficient
252
Vitamin E
- levels linked to milk's fat content
- levels adequate to meed needs for full term infants
- muscle development; prevention of red blood cell lysis
- levels are inadequate to meet needs of preterm infants
253
Vitamin A
- important for cell differentiation
- content in colostrum is about twice that of mature milk
- yellow colour of colostrum comes from Vitamin A in form of beta-carotene
254
Vitamin D
- key for fetal growth, addition of calcium to bone and tooth enamel formation
- milk content varies with mother's diet and sun exposure
- maternal sun exposure can increase levels in milk up to 10-fold
- exclusively breastfed infants need supplements
255
Minerals in human milk
- most have high bioavailability (Mg, Ca, Iron, Zinc)
| - exclusively breastfed infants have little risk of anemia despite low iron content of human milk
256
Benefits of breastfeeding for baby
- increase bioavailability
- protection from: GI, respiratory and ear infections
- decreased infant mortality
- decreased risk of allergy, asthma, eczema, inflammatory bowel disease, metabolic conditions
- special benefits for preterm infants
257
Benefits of breastfeeding for mother
- reduced postpartum bleeding
- delayed return of ovulation
- uterus decrease in size faster (flat tummy)
- decreased risk of breast and ovarian cancer and osteoporosis
- return to pre pregnancy weight
- increase self confidence and bonding with infant
- practical
258
3 main types of recommendations
- duration
- process
- maternal diet
259
Breastfeeding duration recommendations
- early initiation within one hour of birth
- exclusive for first 6 months of life
- appropriate up to 2 years of age
260
Breastfeeding process recommendations
Babies mouth needs to cover all of alveolar
- position baby
- position breast
- present breast
- proper infant latch
261
Maternal diet recommendations during breastfeeding
- energy increase (330-400 kcal)
- fluid 16 cups per day
- increased CHO, protein, vitamin C, A, E, potassium, zinc, iodine, selenium, copper, manganese, chromium, choline
- no increase in vitamin D, K, sodium, chloride, calcium, phosphoric, magnesium, fluoride
262
Q: Milk comes in during which stage of lactogenesis?
Lactogenesis II
263
Neonatal jaundice (hyperbilirubinemia)
Yellow colour of skin
- most frequent cause for hospital readmission for newborns
- 60-70% of newborns
- if not resolved elevated bilirubin levels can cause permanent damage to brain
264
Bilirubin metabolism
In fetal state high levels of hemoglobin are necessary to carry oxygen delivered by placenta
- at birth infants have very high levels of hemoglobin and hematocrit
- as infant breathes on their own high hemoglobin is not needed so red blood cells begin to break down and yellow colour results
265
Bilirubin
Pigment produced as heme from RBC break down
- usually processed by liver and excreted in stool
- newborn liver not fully mature
266
Jaundice appears where?
- first in eyes, face and upper body
- progresses down toward toes
- sever cases present in extremities
267
Non-breastfeeding jaundice
Most common type
- early onset: 2-5 days
- caused by non feeding early enough after birth, nursing irregularly or improperly, infant given water, delayed passage of first stool (meconium)
- treated by increased/supplemental feedings
268
Breastmilk jaundice Syndrome
More extreme
- late onset: after 5 days
- only about 20% of babies
- cause is unknown
- treatments is phototherapy (light used to help break down bilirubin)
269
Infant allergies
- reduced by exclusive breastfeeding for more than 4 months
270
Are breastfeeding rates in CA going up or down?
UP
| - wide range between provinces however
271
Who are less likely to initiate BF?
- younger single mothers
| - less post secondary education
272
Percent who BF exclusively for 6 months?
26% but increasing
273
Who are more likely to BF exclusively?
- married women
- over age 30
- higher levels of education
274
What influences decision to breastfeed or not?
- pain
- physical difficulty
- practicality
- diet
275
Common BF problems?
- letdown failure
- hyperactive letdown
- engorgement
- plugged ducts/mastitis
276
Factors influencing intiation?
- embarrassment
- time and work constraints
- lack of support from family and friends
- lack of milk supply
- concerns about diet and health
- fear of pain and discomfort
277
La Leche League Canada
International organization to support women individually
