Nutrition Flashcards
(107 cards)
1
Q
GA of highest growth rate
A
mid 30s with decline after 36
2
Q
growth rate MC vs DC twins
A
MC lower
3
Q
decreases with increases in GA and BW
A
TBW
EC water
Na content
Cl content
4
Q
increases with GA and BW
A
IC water
protein
fat
ca phos mg
iron
5
Q
energy source of fetus
A
2/3 glucose from mother
1/3 placental lactate
remaining = maternal AA
6
Q
fetal energy expenditure
A
35-55 kcal/kg/d
7
Q
gross energy intake =
A
energy excreted + energy expended + energy stored
8
Q
enteral vs intravenous goals for infants
A
enteral 100-130 kal/kg/d
intravenous 85 - 95 kcal/kg/d
9
Q
major protein sources in neonates
A
whey and caseine
10
Q
whey vs caseine re: cysteine and methionine content
A
whey has more cysteine and less methionine
11
Q
whey to casein ratio colostrum
A
80:20
12
Q
whey to casein ratio mature milk
A
55:45
13
Q
whey to casein ratio in formula with predominant casein vs predominant whey
A
20:80
80:20 or 60:40
14
Q
whey to casein ratio of preterm vs term
A
greater protein content and w:c in preterm
15
Q
glucose precursor AAs
A
alanine glutamate aspartate
16
Q
methylated in muscle protein AAs
A
homoscysteine
methionine
creatine
phosphatidylcholine
17
Q
essential AA
A
branched chain: valine, isoleucine, leucine
histidine, lysine, methionine, phenylalanine, threonine, trytophan
18
Q
conditionally essential
A
arginine
cysteine
glutamine
glycine
proline
taurine
tyrosine
19
Q
non essential
A
alanine
asparagine
aspartate
glutamate
serine
20
Q
kcal/g of protein
A
4
21
Q
AA solutions have decreased ___ because ____
A
tyrosine and cysteine
decreased solubility
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
23
Q
enteral protein goals
A
3.5 - 4.5 g /kg/d = 3.2 - 4.1 per 100kcal
24
Q
essential FAs
A
linoleic acid and alpha linoleic acid
25
a:b (n-c) e.i 18:3 (n-3)
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
26
most prevalent fatty acids in human milk
1. oleic acid
2. palmitic acid
27
SCHAD #C
< 6
28
MCHAD #C
6-12
29
LCHAD
12-20
30
VLCFA
>22
31
what does linoleic acid give rise to and which pathway?
arachidonic acid in the n-6 pathway
32
what does alpha linoleic acid give rise to and which pathway?
eiscosapentaenoic acid
docosahexaenoic acid
n-3 pathway
33
how long of a delay in essential fatty acids can lead to EFAD
3-7 days
34
symptoms of EFAD
scaly dematitis
alopecia
thrombocytopenia
FTT
infections
35
how much IL is needed to prevent EFAD
0.5-1g/kg/d
36
how to diagnose EFAD
increased Holman index = triene:tretrene ratio
refers to mead acid:arachidonic
> 0.2
bc increased mead acid is from omega9 metabolism increasing T:T
37
kcal/1g fat
9
38
fats should provide ___% of total daily calories
30-50 (not more than 60%)
39
differences between 20% and 10% solutions of fat
10% has:
lower triglycerides
lower calories
higher phospholipid:triglyceride
--> may impair lipase in preterm so 10% not recommended
40
which lipid is 100% fish oil
omegaven
41
enteral goals of fat
4.8-6.6 g/kg/d
4.4 - 6.6g/100 kcal
42
kcal/1g carb
3.4
43
for positive nitrogen balance how much glucose do you need per gram of protein
6g
44
how much total calories should be from carbs?
35-65%
45
glucose utilization of preterm and term?
preterm: 5-8 mg/kg/min
term: 3-5 mg/kg/min
46
importance of b12
*(cobalamin)*
folate, CHO and fat metabolizm
47
importance of folate
coenzyme for amino acid and nucleic acid metabolism
48
risk factors for b12 deficiency
breastfed babies with vegetarian moms
methylmalonic acidemia
homocystinuria
49
risk factors for folate deficiency
evaporated milk
goats milk
iron deficiency
50
b12 or folate deficiency blood smear
megaloblastic macrocytic anemia
hypersegmented neutrophils
51
importance of vitamin e
antioxidant
protects again iron induced hemolysis
52
importance of vitamin k
carboxylation of prothrombin into active form
coagulation
53
maternal meds that decrease neonatal vit k
anticonvulsants
warfarin
antiTB
54
features of vit A deficiency
- pulmonary epithelial growth and differenciation
- photophobia, conjunctivitis,
- abnormal epiphyseal bone formation and tooth enamel
- generalized scaling
- FTT
55
features of vitamin B1 deficiency
*(thiamine)*
beriberi: fatigue, irritability, constipation and cardiac failure
a/w pyruvate dehydrogenase complex deficiency and MSUD
56
features of vitamin B2 deficiency
*(riboflavin)*
FTT, photophobia, blurred vision, dermatitis, mucosititis
a.w glutaric aciduria type 1
57
features of vitamin B6 deficiency
*(pyridoxine)*
dermatitis, mucositis, hypochromic anemia, possible seizures
a.w homocystinuria
58
features of b7 deficiency
*(biotin)*
alopecia dermatitis, scaling, seborrhea
a.w:
biotinidase deficiency
betamethylcortonyl glycinuria
propionic acidemia
pyruvate dehydrogenase complex deficiency
59
features of vit c deficiency
poor wound healing and bleeding gums
a.w transient tyrosinemia
60
features of vit d deficiency
rickets
ftt
tetany
61
function of chromium
regulates glucose - insulin metabolism
62
function of copper
- RBC and Hgb formation
- absorption of iron
63
function of iron
Hgb and myoglobin component
transport o2 and co2
absorbed in duodenum and prox jejunum
vit c enhances absoprtion
64
function of manganese
enzyme activation
normal bone structure
CHO metabolism
65
function of selenium
cofactor for glutamine peroxidase
can lead cardiomyopathy without it
66
function of zinc
- component of enzymes like carbonic anhydrase and carboxypeptidase
- growth
67
hormones in breast milk
cortisol
epidermal growth factor
68
enzymes in breast milk
bile salt dependent lipase
69
importance of inositol
- membrane synthesis
- reduces retinal damage
- enhance surfactant
- greater in BM than formula
70
importance of choline
CNS development
component of ACh and phosphatidylcholine
low in milk
71
hind milk in comparison to foremilk
higher fat
low glucose
equal protein
72
premature vs mature milk
increased protein initially but decrease
increased electrolytes
inadequate ca phos, vit d
73
drugs that are contraindications to breastfeeding
cocaine
cyclosporine
methotrexate
phencyclidine
radioactive agents
74
what is reduced by storing at 0-4degC BM
bactericidal activity after 72 hours of storage
75
what is reduced with freezing at - 20 deg C BM
pH by 3%
lactoperoxidase
cellular activity # and function
76
what is reduced by pasturization at 56 degC BM
water soluble vitamins
lipase amylase lactoperoxidase
antioxidants
adiponectin, insulin
cellular activity
bacterial growth
ifng, tnfa, il1b il10 hgf
77
what is reduced by pasteurization at 62 degC BM
watersoluble vitamins
lipase amylase lactoperoxidase
antioxidants
adiponectin, insulin
cellular activity
bacterial growth
ifng,tnfa, il1b il10 hgf
**igA lactoferrin and lysozyme
protein denaturalization**
78
what is reduced by microwaving BM
iga
lysozyme
vit C
79
which formula has higher lactose? preterm or term
term
80
which formula has higher fat content preterm or term
preterm
81
which formula has higher MCT? preterm or term
preterm
82
which formula has higher protein? preterm or term
preterm
83
which formula has higher Ca, phos, iron? preterm or term
preterm
84
which formula has higher vitamins and trace elements? preterm or term
preterm
85
which elements should you decrease in TPN cholestasis?
manganese and copper
86
which elements should you increase in TPN cholestasis
zinc
87
which elements should you decrease in renal insufficiency
chromium and selenium
88
after how many days does risk of cholestasis become independent of weight?
90
89
what is biggest culprit in pn cholestasis?
phytosterols
90
nitrogen balance =
nitrogen intake - nitrogen lost =
protein intake in g/d x 0.16 - (urine losses by urinary urea concentration+ estimate stool loss = 4g)
91
GIR =
(rate X dex%)/(weight x 6)
92
tissues richest in LCPUFAs
retina (photoreceptors) and brain
especially docosahexanoic acid
93
basal ganglia deposition from PN can lead to neurotoxicity if excess ______
manganese
94
synthesis of glutathione requires which AA?
cysteine
95
vit D measurement
25 OH vit D
96
copper requirement enterally
120 mcg/kg/d
97
predominant storage site for zinc
bone
98
zinc requirement
350 mcg/kg/d
99
component of milk that protects against NEC
platelet activating factor acetylhydrolase
100
rate of sucking:swallowing
6-8:1
101
MoA lactoferrin in antimicrobial effects
lactoferrin converted to lactoferricin by pepsin
lactoferricin directly destroys microbes
102
typical manifestation of zinc deficiency?
rash
103
zinc absorption is enhance by enteral intake of ____
protein
104
copper absorption is impaired by enteral intake of ____
ascorbic acid
105
lipoprotein lipase location
adipose
106
free water deficit =
4 x wt(kg) x desired change in Na
107
ketogenic AAs (don't form glucose)
leucine and lysine
