Nutrition in the LifeCycle Flashcards
(89 cards)
1
Q
Fetal Origins Hypothesis (Developmental Origins of Disease)?
A
- events in utero, which reduce fetal growth, permanently alter the structure and physiology of the offspring such that the risk of certain chronic diseases (heart disease and diabetes) in later life is increased
- the theory that exposures to adverse nutritional and other conditions during a critical or sensitive period of growth and development can permanently effect body structures and functions and such changes may predispose individuals to disease later in life
2
Q
Thrifty Phenotype Hypothesis?
A
- the fetus responds to an adverse environment by reducing growth and making developmental adaptions that are appropriate to an anticipated deprived (in nutrition terms) postnatal environment
- fetus responses to poor nutrition in utero adapts in utero so that when it is born it can adapt to limited nutrition however, the outside environment is plentiful and the change in the expression of genes causes disease later in life
3
Q
Epigenetics
A
- changing DNA expression without changing DNA sequences
- Environment changes DNA expression
- Modifications to our Phenotype
4
Q
DNA Methylation
Micronutrients that affect methyl groups
A
- methylation a methyl groups are added to nucleotides on the DNA when a gene is methylated it can change a gene expression it is not good or bad it can affect genes by turning it off increase or decrease gene expression and timing
- B12, Choline, Folate affect methyl groups
5
Q
Dutch Winter Famine
A
- During the Nazi regime, there was a blockade that prevented good reaching Holland, leading to a famine-the famine was well documented, especially amount of calories that were consumed
- example of thrifty phenotype hypothesis
- Mother’s who were in their first trimester during the famine did not have LBW babies, however, these babies had a greater incidence of CHD and obesity
- Mother’s who were in 2nd and 3rd trimester during the famine had LBW babies, but these babies DID NOT have a greater incidence of disease
6
Q
Nutrition Research Study Designs
A
- Randomized Control Trial
- Cohort Studies
- Case Control
- Case Series
7
Q
Challenges in Nutrition Research
A
- Choice of Study Design
*longitudinal/observational studies cannot assume cause and effect/loss ot follow-up
*Clinical Trials use smaller populations, expensive, require volunteers - Choice of Research Subject
- Generalizability
- Complexities of diets and lifestyles
*manipulate one vitamin/supplement but we eat real food - Ethics of research in “vulnerable populations”
Pregnant women are vulnerable population -it is not ethical to due research on them
8
Q
Critical Windows
A
- Different regions of the brain develop at different times and are associated with different functions
- Neural tube formation, Cell Migration, Myelination Birth
- After Birth Visual/Auditory Cortex, Angular Gyrus (receptive language area) Broca’s Area (speech production), Prefrontal Cortex (Higher Cognitive Functioning
9
Q
Nutrients that are critical to brain development
A
- Protein: cognition, negative effects on IQ, processing speed, math and vocabulary
- Iron: reduced recognition memory, speed of processing, reduced affect, motor ability, and attention
- Zinc: reduced autonomic stability, recognition memory, reduced abstract reasoning, spatial memory
- iodine: deficiency in utero is irreversible, deficiency after birth reduced verbal IQ, hypomyelination, reduced recognition memory,
10
Q
How is the young brain different than the old brain in terms of susceptibility to nutritional interventions?**
A
Deficiencies in utero cause global sometimes irreversible damage.
Deficiencies after birth cause less severe global damage-affect brain structures developing at that time.
11
Q
Nutrition-Related Disruptions in Fertility
A
- Undernutrition
- Weight loss
- Obesity
- High Exercise levels
- Intake of specific foods & food components
12
Q
How does undernutrition affect fertility
A
- acute undernutrition affects fertility profoundly than chronic undernutrition
- chronic undernutrition can greatly effect neonatal outcomes
- critical BM I>20 needed for menstrual cycles
- 10-15% loss of usual weight also affects menstrual cycle
13
Q
How does overweight affect fertility
A
- rates of infertility are high overweight and obese women and men
- can be due to hormonal imbalances or oxidative stress leading to damage in gametes
- obese women have higher rates of PCOS-leading to anovulatory cycles and irregular periods
- high BMI is best addressed before pregnancy because weight loss during pregnancy is not recommended
14
Q
How does intense physical activity affect fertility and female athlete triad
A
- delayed age at puberty
- lack of menstrual cycles
- appear to be related to hormonal and metabolic changes
- related to caloric deficits
- reduced levels of estrogen
- low levels of body fat
- decreased bone density
Female athlete triad: disordered eating amenorrhea osteoporsis
15
Q
Fertility
A
the production of children (not necessarily the ability to bear children), most often referring to vital statistics rates
*depends on multiple factors, many that can be disrupted by abnormal body composition and dietary factors
16
Q
What is oxidative stress
A
- an imbalance between anti-oxidants and pro-oxidants
- free radicals get into our body via the environment and metabolism
- body has ways of neutralizing free radicals by producing different enzymes
- can also increase anti-oxidant status by eating foods high in anti-oxidants
- oxidative stress is when you have more free radicals than you have enzymes to counteract them
17
Q
How does oxidative stress affect fertility?
A
In men *decrease sperm motility *reduces ability of sperm to fuse with an egg In women *harm egg and follicular development *interfere with corpus luteum function *interfere with implantation of the egg
18
Q
Name some anti-oxidants
A
Vitamin E Vitamin C Beta-Carotene Selenium Found in vegetables and fruits protect cells of the reproductive system including eggs and sperm
19
Q
Female Hypothalamic Pituitary Gonadal Axis
A
- The hypothalamus is in the brain it produced two hormones LHRH (leutinizing hormone releasing hormone) & gNRH gonadatropin releasing hormone
- signal the pituitary to release LH (leutinizing hormones) and FSH (follicile stimulating hormone)
- signals the ovaries to release progeterone and estrogen
- progesterone and estrone signal the pituitary and signal the hypothalamus
- hormones work on a negative feedback loop
20
Q
Hormonal Changes during the menstrual cycle
A
- FSH-relatively stable spikes slightly during ovulation
- Estradiol-slightly increases during follicular phase, peaks right before ovulation, levels in luteal phase are higher than follicular
- LH- huge spike during ovulation
- Progesterone- increases during ovulation and remains high during luteal phase
21
Q
What are the important micronutrients in pregnancy
A
- Folate
- Iron
- Vitamin D
- Iodine
- Vitamin A
22
Q
Why is folate important during pregnancy? Food Sources?
A
- food sources: dairy, poultry, meat (liver and kidney esp), seafood, fruits, veg, nuts, grain, cereal products. Highest in yeast, spinach, liver, peanuts, lima, and kidney beans, brussels sprouts, and broccoli.
- remethylation of homocysteine, a key chemical reaction for SAM production
- neural tube closure begins at day 21 and is finished at day 28
23
Q
Why is Vitamin A important during pregnancy? food sources?
A
- retinoid form in meat betacarotene in sweet potatoes and carrots and leafy greens
- important for cell differentiation
- teratogen in high amounts(causes birth defects)
24
Q
Why is Vitamin D important during pregnancy? food sources
A
- milk, sunlight
- fetus is depended on mother for 1,25(OH)2D
- involved in fetal skeletal development and deficiency during pregnancy increases the chance of rickets in infants
25
Why is iron important during pregnancy? food sources?
* heme: meat
* non heme: lima beans, kidneys, chickpeas
* increased maternal RBC mass
* fetal iron requirements
* compensation for iron losses (blood loss at delivery)
26
What are the effects of iron deficiency in pregnancy?
* association with higher maternal mortality
* lower birth weight
* preterm delivery
* lower apgar scores
* increased risk of birth asphyxia
* adverse impact on postpartum maternal iron status
* low iron stores in infant subsequent impact on development
27
Iron deficiency Spectrum***
1. iron stores (ferritin) are depleted
2. transport form (transferrin) becomes low-still ID
3. iron stores are completely low and hemoglobin low-IDA
* Hematocrit: the proportion of your total blood volume made up of red blood cells
28
What are the effects of iodine deficiency
* trace element required by thyroid gland to make thyroid hormone
* required by both pregnant mother and fetus for proper thyroid function and energy production and for fetal brain development
* continuum of effects ranging from lowered IQ to severe MR
* deficiency increasing in developed countries because of processed food
29
Study Pregnancy Weight Gain Chart
*rule of thumb 1-2 lbs until 36 weeks; 25-35 lbs
*underweight
total weight gain 28-40lbs
rate 1lb per week
*normal
total weight gain 25-35lbs
rate 1 lb/week
*overweight
total 15-25 lbs
rate .6lbs/week
*obese
total 11-20 lbs
rates .5lbs/week
30
Why is Omega-3 fatty acid consumption controversial during pregnancy?
* alpha-linolenic acid is essential
* EPA important for heart, immune system, inflammation
* DHA brain, eyes, CNS
* EPA and DHA are selectively used by the fetus and are depleted with each subsequent pregnancy
* omega 3 are found in fish and some fish have high mercury content which is dangerous for the fetus
* some eggs are not fortified with omega-3, also can take supplements, choose fish that have a lower mercury content
31
Caffeine during pregnancy
* readily absorbed from GI tract and crosses the placenta to fetus
* concentrations in fetus are similar to that in maternal plasma
* inconclusive evidence
* recommendation is <300mg per day
32
Alcohol during pregnancy
* enzyme EtOH easily crosses the placenta
* fetus lacks enzyme to break it down
* recommendation is to abstain
* can cause fetal alcohol spectrum disorders
33
Hyperemesis Gravidarum
severe nausea and vomiting during pregnancy that can cause:
* dehydration
* weight loss
* electrolyte imbalance
* headache
* jaundice
* may require hospitalization for IV rehydration, nutrition therapy (tube feeding or TPN)
34
What not to eat during pregnancy
* raw meat and seafood (coliforms, toxoplasmosis, salmonella)
* Smoked Seafood, Soft Cheeses, Unpasteurized Milk, Pate, Unwashed Veggies (listeria-linked to MC and still birth)
* fish with high levels of mercury
* raw eggs
* raw milk
35
Obesity complications during pregnancy
* higher risk of congenital abnormalities
* risk factor for preterm birth
* higher risk of blood pressure disorders (mother)
* adverse perinatal outcomes
* still birth
* macrosomia
* neonatal hypoglycemia
* reduced rates of breastfeeding
36
Maternal underweight complications during pregnancy
* inadequate weight gain
| * risk of preterm delivery
37
Consequences, Risk Factors, and Recommendations for GDM
elevated glucose from mother risk for: *spontaneous abortion, stillbirth, neonatal death, congenital abnormalities
*increase insulin leads to increase glucose uptake & triglyceride formation in fetus
*insulin resistance and or type II diabetes later in life
*increase risk of hbp and obesity later in life
risk factors
* multiple inherited predisposition
*chronic hypertension
* excess body fat, low PA, obesity
*Regular aerobic exercise decreases insulin resistance & blood glucose in gestational diabetes
*Exercise should approximate 50-60% of VO2 max, 3 times per week
38
Gestational Diabetes Mellitus
* CHO intolerance with first onset during pregnancy
* women who develop GDM appear to be predisposed to insulin resistance & type II diabetes
* associated with increased levels of blood glucose, triglycerides, fatty acids, & blood pressure
39
Hypertensive Disorders of Pregnancy
* blood pressure >140mm Hg systolic or >90 mm Hg diastolic
* related to inflammation, oxidative stress, damage to endothelium (cells lining the inside of blood vessels)
* chronic hypertension diagnosed 20 weeks (tends to occur on overweight/obese women with excess central body fat
40
Consequences and Risk Factors of Hypertension during pergnancy
*Contributes to stillbirths, fetal & newborn deaths, & other adverse conditions
*endothelia dysfunction causes impaired blood flow, increased tendency to clot, and plaque formation
* blood pressure >160/110 mm Hg increased risk of fetal death, preterm delivery, fetal growth, mental retardation
risk factors
*AA, obese, >35 age, HTN with previous pregnancy
41
Pre-ecamplsia v. Eclampsia
* a pregnancy-specific hypertensive syndrome occurring >20 weeks gestation accompanied by proteinuria
* proteinuria is a urinary excretion >.3g protein in a 24-hour urine sample (or >30 mg/dL protein or ≥2 on dipstick reading)
* symptoms decreased plasma volume expansion, low urine output, persistent and severe headaches, sensitvity of the eyes to bright light, blurred vision, abdominal pain, nausea
* Eclampsia is proteinuria and occurrence of seizures not attributed to other causes
42
Risk factors and Outcomes of pre-eclampsia/eclampsia
```
mother
* early delivery by c-section
*acute renal dysfunction
*increased risk of GDM, HTN, and NIDDM
*placenta rupture
newborn
*growth restriction
*respiratory distress syndrome
risk factors
* first pregnancy
*obesity or underweight, preexisting Diabetes, insulin resistance, high blood triglycerides
*AA, American Indian, >35
```
43
Maternal Morbidity/Mortality
morbidity: sign of disease
mortality: death
44
Miscarraige
when pregnancy terminates unexpectedly in the first trimester
45
Perinatal Morbidity/Morality
perinatal-around birth refers to a baby 20 weeks gestational age to 7 days after birth
46
Stillbirth
baby never had a heartbeat, never took a breath usually born over 20 weeks gestational age
47
Neonatal
newborn delivery to 28 days after birth
48
Infant
birth to 1 year
49
LBW
low birth weight
| birth weight under 2500g/2.5kg
50
VLBW
very low birthweight
| under 1500g/1.5kg
51
LGA/Macrosomia
large for gestation age >4000g 4kg
52
LMP
last menstrual period
53
Preterm
<37 weeks
54
Postterm
>42 weeks
55
Standard newborn Growth assessment
| AGA, SGA, IUGR, LGA
AGA: appropriate for gestational age
SGA: small for gestational age: 90% wt/age
56
What are the hormonal changes during pregnancy
```
Human Chorionic gonadotropin (hCG)
Progesterone
Estrogen
Human chorionic somatotropin
Leptin
Relaxin
```
57
What are the hormonal changes in Human Chorionic gonadotropin during pregnancy
* stimulation of corpus luteum to produce estrogen and progesterone
* stimulation of endometrium
58
What are the hormonal changes in Progesterone during pregnancy
* maintains implant
* stimulates endometrium and nutrient secretion
* relaxes smooth muscles of uterine blood vessels and GI tract
* stimulates breast tissue proliferation
* promotes fat tissue deposition
59
What are the hormonal changes in Estrogen during pregnancy
* promotes fat tissue formation and storage
* promotes protein synthesis
* promotes uterine blood flow and development
* promotes breast duct development
* promotes ligament flexibility
60
What are the hormonal changes in Human Chorionic somatotropin during pregnancy
* increases maternal insulin resistance to keep glucose available for use by fetus
* promotes protein synthesis and breakdown of fat for energy and maternal use
61
What are the hormonal changes in leptin during pregnancy
*regulation of appetite, lipid metabolism, weight gain and utilization of fat stores
62
What are the hormonal changes in relaxin during pregnancy?
* promotes angiogenesis (esp. in development of interface between uterus and placenta)
* relaxes pubic ligaments, softens and enlarges the cervix
63
Where is the distribution of weight gain in a normal term pregnancy?
*Breasts 1-2lbs
*Baby 6lbs
*Placenta 1-2lbs
*Uterus 1-2lbs
*Amniotic Fluid 2-3lbs
*blood 3-4lbs
*body fluid 3-4 lbs
*protein and fat storage 8-10lbs
total weight gain 25-35lbs
64
Maternal Anabolic and Catabolic
Anabolic 0-20 weeks
*blood volume expansion
*increased cardiac output
*Build up of fat, nutrient and liver glycogen stores
*growth of some maternal organs
*increased appetite, food intake (positive caloric balance)
*decreased exercise tolerance
*increases levels of anabolic hormones
Catabolic 20+ weeks
*mobilization of fat and nutrient stores
*increased production and blood levels of glucose, triglycerides, and fatty acids, decreased liver glycogen stores
*accelerated fasting metabolism
*increased appetite and food intake decline somewhat near term
*increased levels of catabolic hormones
65
What are the AAP breastfeeding recommendations?
* exclusive breastfeeding for 6months
* introduction of complementary foods at 6 months
* continuation of breastfeeding until 1 year
66
What are the Baby-Friendly Hospital Initiative?
1. Written BF promotion policies
2. BF training for all health personnel
3. Prenatal BF promotion
4. BF initiation within 30 minutes to 1 hour of birth
5. BF counseling to mothers in maternity wards (even if separated)
6. Breast milk only unless medically indicated
7. Practice "rooming in"
8. BF on demand
9. No Pacifiers or artificial nipples to breastfeeding infants
10. Community-based postnatal BF support
67
What are the stages of Lactogenesis
1. Lactogenesis I: birth to 2-5 days milk formation begins (Colostrum)
2. Lactogenesis II: begins 2-5 days after birth increased blood flow to breast, milk "comes in"
3. Lactogenesis III begins at 10 days after birth milk composition is stable
68
What is the letdown reflex
Prolactin and Oxytocin act on the mammary glands
*prolactin stimulates milk production
*oxytocin stimulates milk ejection
Both hormones at con reproductive organs
*prolactin inhibits ovulation
*oxytocin promotes uterine contractions
69
What is Colostrum
* first milk that comes in
* low volume
* higher in protein and lower in CHO then mature milk
* high in immune components (Immunoglobulins, lactoferrin, WBC)
70
Composition of Mature Milk
* 20 kcal/oz
* fat content is lower in foremilk and higher in hindmilk and varies with diet
* protein content (whey 70:casein30)
* carbohydrate source is mainly lactose
* Vit A, Vit D, Vit E, Vit K, B12, Folate
71
Benefits of Breastfeeding to Child
1. Decreased infectious disease
* acute otitis media
* infectious diarrhea
* respiratory illness
2. Decreased risk of chronic disease
* diabetes (type I and type II)
* leukemias
* obesity
3. decreased atopic disease
* asthma
* atopic dematitis (eczema)
4. Decreased risk of SIDS
72
Benefits of breastfeeding to mother
1. decreased risk of type II diabetes
2. Decreased risk of certain cancers
* breast
* ovarian
3. Promotion of bonding and attachment between mother and infant
73
Breastfeeding advantages and disadvantages
```
Advantages
*less cost
*no need for warming
*maternal and child health benefits
*easy to soothe the baby
Disadvantages
*never know the exact amount baby is getting
*partner feels lefts out
*difficult to get away from baby
*discomfort
*complications (mastitis)
*watch food and beverage intake
```
74
Mother's who should not breastfeed
* mother receiving chemo or radiation
* maternal drug or alcohol abuse
* maternal HIV
* maternal active TB
* inborn error of metabolism
* certain maternal drugs
75
How do you know how much milk the baby consumes
* diaper
* meconium (black/green stick hard poop) should happen within first 24 hours
* rule of 7, poop 7x a day or 1x every 7 days
* growth is another indicator of weight (weight baby before and after they eat)
76
Rule of thumb for infant weight gain
* double by 5 months
* triples by 1 year
* quadruples by 2 years
77
Failure to Thrive (FTT)
* condition of inadequate weight or height gain though to result from a caloric deficit, whether or not the cause can be identified from a health problem
* under 3%ile or if they cross 2 major percentile lines
* Organic: resulting from a health problem such as iron deficiency anemia or a cardiac or genetic disease
* inorganic: without an identifiable biological cause, environmental cause (child neglect) is suspected
78
Stunting
* proportional weight for length but small for age
* Stunted growth reflects a process of failure to reach linear growth potential as a result of suboptimal health and/or nutritional conditions. *associated with poor socioeconomic conditions and increased risk of frequent and early exposure to adverse conditions such as illness and/or inappropriate feeding practices.
79
Wasting
* weight is affected more disproportionately more than height
* which is often associated with acute starvation and/or severe disease
80
When and Why do you introduce solid foods?
* 4-6 months of age (4mo. supported sitting, 6mo. sitting up)
* use fingers to scrape food closer
* extrusion reflex disappears (3-4months)
* sit up
* grasp reflex needs to disapear
* iron stores diminished
81
Allergies v. Intolerance
Must differentiate between immune mediated (IG-e)
Clinical manifestations
*GI (vomiting, diarrhea, abdo pain, cramping)
*Derm (urticaria-swelling around lips and tongue, angioedema, dermatitis)
*Resp (wheeze, rhinoconjunctivitis)
*Systemic (anaphylaxis)
Nonimmune mediated (intolerance or toxic)
82
Picky Eaters
| Neophobia
* Acceptance of foods may occur only after 8-10 exposures to those foods in a non-coercive manner
* fear of new foods, evolutionary speaking its protective
83
Consequences of Iron deficiency in infants
* Microcytic, hypochromic anemia
* Dizziness/Lightheadedness
* Irritability
* Fatigue
* Behavioral Change
* Pallor
* Motor delays – gross and fine
* Cognitive deficits
* Above neurodevelopmental consequences may persist even after adequate treatment with iron
84
Preterm Infants
* Possible long-term complications include:
* Bronchopulmonary dysplasia (BPD)
* Delayed growth and development
* Mental or physical disability or delay
* Retinopathy of prematurity, vision loss, or blindness
* Breathing problems.
* Feeding difficulties.
* Cerebral palsy.
* Developmental delay.
* Vision problems.
* Hearing impairment.
85
Specific micronutrient supplementation recommendations
* Vitamin D - all breastfed infants/children should receive 400 IU/day if not drinking adequate volumes of formula/cow’s milk
* Vitamin K – all infants should receive injection at birth to prevent early vitamin K deficient bleeding
* Fluoride – after 6 months, dependent on content in water supply
86
Motor Milestones
```
0 month: fetal posture
1 month: chin up
2 months: chest up
3 months: reach and miss
4 months: sit with support
5 months: sit on lap grasp object
6 months: sit on high chair grasp dangling object
7 months: sit alone
8 months: stand with help
9 months stand holding furniture
10 months: creep
11 months: walk when led
12 months: pull to stand by furniture
13 months: climb stair steps
14 months: stand alone
15 months: walk alone
```
87
Formula Composition
```
Lactose is carbohydrate source
20kCal per ounce
Whey: 70 human milk 20 cows
Casein 30 human milk 80 cows
Calcium and casein are inhibitors of iron absorption
```
88
Difference in Macronutrient compositions of breast milk and formula
```
breast milk
7% of calories from Protein
38% calories from carbs
55% calories from fat
Formula
*9-12% calories from Protein
*41-43% calories from carbs
*48-50% calories from fat
```
89
Types of formulas
Brand name vs. Generic
Cow’s milk, Lactose-Free Soy Based, Hydrolysate
Powdered, Concentrated Liquid, Ready to Feed
Iron fortified, low iron
“enhanced” (DHA, ARA, probiotics, prebiotics)
Organic vs. Non-Organic
