NTR 454/554 Exam 2 jaja

A protein in milk that binds iron and inhibits bacterial growth and is also involved in bone formation and increases bone mineral density is ___

Select one:

a.Lactose synthase

b.IgA

c. Lactoferrin

d.ethylene-diaminetetracetic acid (EDTA)

c. Lactoferrin

Pick the TOP THREE populations with the highest prevalence of lactose intolerance (referred to in the book as low lactose digestion capability).

Select one or more:

a. Spanish

b. Eskimo

c. Apapche

d. Thai

e. Czech

f. Irish

d. Thai

b. Eskimo

c. Apapche

Milk may be digested into bioactive peptides that react with opioid receptors, but similar peptides can be derived from digestion of the protein in...

Select one:

a. Rice

b. Wheat

c. Eastern North Carolina barbeque

d. Asparagus

b. Wheat

Factors that have been proposed as possible mechanisms for higher intake of dairy product reducing the risk of cancer include ALL of the following EXCEPT:

Select one:

a. Conjugated linoleic acids (vaccenic or rumenic acid) induce apoptosis or cell death in cancer cells.

b. Vitamin D from fortified milk may protect against colorectal neoplasia by reducing epithelial cell proliferation and inducing differentiation in target tissues.

c. binding of secondary bile acids and free fatty acids to calcium in the colon to reduce their toxic effects.

d. high intakes of milk induce cardiovascular disease, the leading cause of death in the US, so milk consumers die of other causes before cancer has time to develop.

d. high intakes of milk induce cardiovascular disease, the leading cause of death in the US, so milk consumers die of other causes before cancer has time to develop.

Higher dairy product intake is linked is linked to lower incidence of high blood pressure through its increasing the intake of all of the following nutrients EXCEPT

Select one:

a. bioactive peptides.

b. potassium.

c. vitamin E.

d. calcium.

c. vitamin E.

The proper order of dairy processing equipment acting on milk from a dairy farm is

Select one:

a. storage silo, fortification and fat balancing, homogenizer/pasteurizer, clarifier/separator, packaging

b. storage silo, clarifier/separator, fortification, homogenizer/pasteurizer, packaging

c. fortification and fat balancing, homogenizer/pasteurizer, clarifier/separator, packaging, storage silo

d. storage silo, homogenizer/pasteurizer, clarifier/separator, fortification, packaging

b. storage silo, clarifier/separator, fortification, homogenizer/pasteurizer, packaging

Sanitation of milking equipment and storage units on a dairy farm...

Select one:

a. requires disassembly and autoclaving of all parts and milk lines between milking, just like in the dairy processing plant.

b. makes all surfaces that contact milk totally sterile.

c. is important to keep bacterial counts within the levels needed to sell Grade A milk.

d. is not important because the milk will be pasteurized later.

c. is important to keep bacterial counts within the levels needed to sell Grade A milk.

The strongest evidence for a protective effect of higher intake of dairy products against cancer risk is related to cancer of the...

Select one:

a. lung.

b. brain.

c. colon.

d. breast.

C. colon

When the first Pasteurized Milk Ordinance was published in 1924, milk products accounted for approximately 25% of all foodborne illness, whereas today milk products account for less than 1% of all foodborne illnesses.

Select one:

True

False

True

Why would donor milk be used to feed a preterm infant?

Select one:

a. Because the milk from the mothers of preterm infants is considered "too rich" for the sensitive digestive systems of these babies.

b. If a mother's own milk may be not available for her preterm infant or in adequate amounts.

c. Because federal regulations require the use of human milk.

d. If the infant's family cannot afford formula.

b. If a mother's own milk may be not available for her preterm infant or in adequate amounts.

The new Milk Bank at WakeMed Cary hospital features ALL of the following benefits EXCEPT

Select one:

a. surfaces that are easy to sanitize, and a clean air working surface.

b. temperature-controlled shaking water baths.

c. a walk-in freezer for milk storage.

d. instruments for high pressure processing and irradiation of breast milk.

d. instruments for high pressure processing and irradiation of breast milk.

Centrifugation, clarification and bactofugation is a process in the dairy plant that

Select one:

a. removes dirt and some bacteria at the center of the separator-clarifier while milk fat leaves from a port on the outside of the machine.

b. mixes skim milk and cream to an extent that the material leaving this machine has the appropriate or desired fat content.

c. applies high centrifugal force to the milk for the purpose of killing bacteria by high-pressure-processing.

d. removes dirt and cells at the outer wall of the separator-clarifier while milk fat leaves from a port closer to the center of the machine.

d. removes dirt and cells at the outer wall of the separator-clarifier while milk fat leaves from a port closer to the center of the machine.

The polymeric Ig receptor (pIgR) is responsible for

Select one:

a.

Transcytosis of IgG.

b.

Using IgM to initiate an immune response.

c.

Adding secretory component during the transfer of IgA.

d.

Binding IgE to start an allergic response to milk protein.

c.

Adding secretory component during the transfer of IgA.

Milk synthesis can be divided into 5 distinct pathways. Which of these is most likely to be responsible for the movement of immune cells from the blood to the milk.

Select one:

a.

The paracellular pathway.

b.

Lipid secretion pathway

c.

The secretory vesicle pathway.

d.

Transcytosis.

a.

The paracellular pathway.

Pasteurization of donor human milk may decrease bioactive factors such as lactoferrin and lysozyme.

Select one:

a. True

b. False

a. True

Match the health effects of camel milk with the mechanism through which they impart the effect.

I Insulin, IgG, and casein structure

II lysozyme, lactoferrin, lactoperoxidase, hydrogen peroxide, and immunoglobulins

III Angiotension 1-converting enzyme (ACE) inhibitory activity

IV Orotic acid, bacterial and milk peptides, and possibly small fat droplets

V Low in alpha-casein and beta-lactoglobulin

I Hypoglycemic effect

II Antimicrobial effect

III Lowers blood pressure

IV Hypocholesterolaemic

V Hypoallergenicity effect

Research indicates that bovine milk proteins can be degraded into specific peptides that, if absorbed, can have various biological effects. Some people have advised against consuming milk because it can produce which of the following peptide functions?

Select one:

a. A peptide (BCM7) that binds with the opioid receptor and may have adverse health outcomes.

b. a peptide that inhibits the angiotensin converting enzyme in the lung.

c. phosphorylated calcium binding peptides that deliver too much calcium to the bone matrix.

d. antibacterial peptides derived from milk fat globule membrane proteins that destroy the microbiome in the gut.

a. A peptide (BCM7) that binds with the opioid receptor and may have adverse health outcomes.

Human milk, both donor human milk and mother's own milk, is protective of necrotizing enterocolitis because of all of the following reasons EXCEPT:

Select one:

a. Human milk has a trophic (nutritive) effect on gut

b. Human milk decreases permeability of the gut

c. Human milk stimulates development of oligosaccharides in the stomach

d. Human milk stimulates cell proliferation

e. Human milk has a probiotic effect on the gut

c. Human milk stimulates development of oligosaccharides in the stomach

During pasteurization of donor human milk, the milk is heated to __________ degrees Celsius for ______________ minutes.

Select one:

a. 120, 1

b. 73.5, 25

c. 62.5, 30

d. 56, 60

c. 62.5, 30

IgA antibodies in milk are likely to provide more important immune protection than IgG in what types of animals?

Select one:

a.

Animals that hatch from eggs

b. Those that have an "open gut" in the first days or hours after birth for absorption of proteins from colostrum

c.Birds and reptiles

d.Those that have extensive trans-placental transport of IgG

d.Those that have extensive trans-placental transport of IgG

Which of the following is NOT a role of the donor milk bank?

Select one:

a. Feed infants who cannot survive without human milk

b. Decrease gold drain caused by purchasing formula

c. Provide human milk for mother's who are too busy to breastfeed

d. Improve outcome for preterm/sick infants

e. Promote breastfeeding

c. Provide human milk for mother's who are too busy to breastfeed

In contrast to breast pumps used by humans, a milking machine for cows and goats...

Select one:

a. can effectively extract milk without the letdown reflex involving oxytocin.

b. takes advantage of the single streak canal to insert a canula into the teat cistern.

c. has two vacuum sources, one constant and one pulsating.

d. collects from 2 mammary glands at a time, instead of one.

c. has two vacuum sources, one constant and one pulsating.

Milk intake improves bone health by supplying ALL of the following nutrients EXCEPT

Select one:

a. magnesium

b. essential fatty acids

c. calcium

d. vitamin D

b. essential fatty acids

Within a population of people who have symptoms of illness or discomfort when consuming milk products, what is the LEAST likely cause of such symptoms?

Select one:

a. Inability to digest lactose in the intestine allows colonic bacteria to use lactose as a substrate for gaseous end product of metabolism.

b. The high concentration of free glucose in milk can cause a hyperglycemic attack and damage proteins through out the body.

c. A small peptide that results from casein digestion can enter the blood stream and bind to opioid receptors.

d. Milk protein fragments can interact with IgE on immune cells in sensitized individuals.

b. The high concentration of free glucose in milk can cause a hyperglycemic attack and damage proteins through out the body.

Why are hepatitis B, C, and syphilis screened for in the serum of human milk donors?

Select one:

a. Microorganisms involved in hepatitis B, C, and syphilis can change the composition of the milk by binding to the protein, reducing the protein bioavailability to the infant.

b. Hepatitis B, C, and syphilis are passed readily through human milk.

c. Screening for hepatitis B, C, and syphilis is indicative of a mother's lifestyle.

d. Hepatitis B, C, and syphilis can cause inborn errors of metabolism in preterm infants.

c. Screening for hepatitis B, C, and syphilis is indicative of a mother's lifestyle.

Which of the following choices below are theories that could explain how camel milk is protective of diabetes?

Select one or more:

a. Nano particles

b. Fatty acids that have an insulin-like effect

c. Active proteolytic fragment

d. Antibodies that improve beta-cell insulin secretion

ALL

Allergy to milk most commonly occurs in people of what age?

Select one:

a. 2-5 years

b. 7-12 years

c. 15-22 years

d. over 60 years

a. 2-5 years

Possible reasons that higher milk intake may be associated with lower rates of hypertension include ALL of the following EXCEPT:

Select one:

a. higher levels of calcium and magnesium reduce vasoconstriction in the blood vessels.

b. dairy products do not contain any of the hypertension generating anion, chloride.

c. digestion of milk protein can generate bioactive peptides like VPP and IPP that interfere with angiotensin converting enzyme (ACE) activity.

d. the potassium to sodium ratio of milk is much higher that in other beverages, possibly reducing sodium retention.

b. dairy products do not contain any of the hypertension generating anion, chloride.

Lactose intolerance can be caused by ALL of the following conditions EXCEPT...

Select one:

a. Diseases or infections that damage the gut epithelium

b. The normal process of aging for most of the world's population.

c. Competing beta-galactosidase enzyme activity from the intestinal microflora

d. Birth defects (genetic mutations) that create a non-functional lactase enzyme.

c. Competing beta-galactosidase enzyme activity from the intestinal microflora

Why would donor milk be used to feed an older infant?

Select one:

a. If there is a food safety recall on the brand of formula the infant is consuming.

b. If the mother contracts a case of mastitis.

c. Infants with metabolic disorders may benefit from the donor milk.

d. Donor milk would be used if the mother decides she no longer wants to breastfeed her infant because she is too busy.

c. Infants with metabolic disorders may benefit from the donor milk.

A US milk bank will dispense its milk...

Select one:

a. To corporations that further process into bioactive dietary supplements.

b. Only with a physician's prescription or hospital purchase order.

c. To individuals who have a Facebook account in milk sharing sites.

d. For preterm babies and cancer patients who request it.

b. Only with a physician's prescription or hospital purchase order.

Which of the following is the definition of "donor human milk banking"?

Select one:

a. When a woman derives more than half of her income from the sale of her breastmilk.

b. Process of providing human milk to a recipient other than the donor's own child.

c. Development and production of infant formulas that closely mimic all of the biological properties of human milk.

d. When a mother breastfeeds another mother's infant; it is another term for "wet nursing".

b. Process of providing human milk to a recipient other than the donor's own child.

Cow's milk protein allergy is the leading cause of allergic reactions in infants and children younger than 3 years of age and is resolved in 90% of children by the age of 5.

Select one:

True

Fals

True

Cows milk may be a common allergy in children because

Select one:

a. It contains IgG.

b. It contains large quantities of IgA.

c. It contains IgE that can be transported into the bodies.

d. it contains proteins that immune cell recognize as foreign and respond by making IgE.

d. it contains proteins that immune cell recognize as foreign and respond by making IgE.

Consumption of bovine milk may have which of the following benefits? (check all that apply).

Select one or more:

a. Prevention of rickets, osteomalacia, osteoporosis

b. Decrease oxidaave and inflammatory stress

c. Prevention of metabolic syndrome, obesity, cardiovascular disease, hypertension and type 2 diabetes

d. Decrease in cancer

ALL

Homogenization reduces the particle size of milk fat globules and leaves them coated with

Select one:

a. Immunoglobulins

b. Cell membrane material

c .Phospholids

d. Casein

d.Casein

The most likely cause for the loss of bone mineral content that frequently follows menopause in women is...

Select one:

a. avoidance of dairy products at that time to prevent associate weight gain or loss.

b. the sudden cessation of exercise.

c. dietary changes in the calcium:phosphate ratio.

d. a drop in circulating estrogen concentrations.

d. a drop in circulating estrogen concentrations.

Adequate dairy product intake in childhood and adolescent years is important for _________________________; whereas keeping up dairy product intake in elderly may ___________________.

Select one:

a. developing greater peak bone mass; prevent excess bone resorption.

b. preventing cancer; cause a milk allergy.

c. preventing obesity; cause obesity.

d. normal blood pressure; cause obesity.

a. developing greater peak bone mass; prevent excess bone resorption.

Physiological symptoms of milk-derived opioid peptides binding to receptors in the gut that have been demonstrated in human or animal studies include ALL of the following EXCEPT:

Select one:

a. Inflammation

b. Constipation

c. Loss of the incretin gut hormones that promote insulin release.

d. Osteoporosis

d. Osteoporosis

The hormone responsible for increasing volume of milk mother produces

prolactin

Enzyme that allows growing mammary end bud to grow into mammary fad pad during mammogenesis

matrix metalloprotease

leading bacterial cause of food borne illness in people consuming raw bovine milk

campylobacter

Approximately how many infants are born prematurely in the United States?

500,000

Which of the following steps must a woman go through to become a milk donor?

Answer questions
Fill out forms
Have blood work done

When and where did the first milk bank in North America open?

1910 at the Boston Floating Hospital

Which of the following steps are followed to ensure that the milk is safe for premature babies?
a. Milk is thawed

b. Milk is homogenized 

c. Milk must be surplus milk

d. Milk is cooled 

e. Mothers are screened

f. Milk is tested for bacteria 

g. Milk is pasteurized

All of the above

Has there every been a (known) negative outcome from a baby drinking milk from the Human Milk Banking Association of North America?

No

Which of the following companies makes a fortifier from human milk for premature babies weighing less than 1250 grams?

Prolacta 

In contrast to breast pumps used by humans, a milking machine for cows and goats...

has two vacuum sources, one constant and one pulsating.

UHT (ultra high temperature) treatment (always continuous operation): storage under non-refrigerated conditions <32.2°C for 3–12 months.

storage under non-refrigerated conditions <32.2°C for 3–12 months. → 135–150°C for 1–4 s; mostly at >140°C for 5 s, followed by ‘flash cooling. Absence of viable microorganisms and their spores.

HTST pasteurisation: store under refrigerated conditions at <7°C for 3–21 days depending on raw milk quality, processing and packaging conditions and the cold chain

at least 72°C for 15 s, commonly 75°C for 20 s, followed by immediate cooling to ≤6°C. Inactivates pathogens, moulds, yeasts and most bacteria.

Sterilisation (batch or continuous in-container process): non-refrigerated storage conditions for 8–12 months.

110–120°C for 20–40min; Inactivation of all microorganisms including spores and all enzymes but can result in cooked flavor.

Holder pasteurization

62-65°C for 30 minutes. A batch process using relatively simple equipment.

Pathogens: Examples are Salmonellae, Staphylococcus aureus, strains of Escherichia coli, Mycobacterium tuberculosis, Campylobacter jejuni, Coxiella burnetii, Listeria monocytogenes, Yersinia enterocolitica, Leptospira interrogans, Bacillus anthracis

Sources include mastitic udder, skin, hair, feet of the animal, faeces, milkers. Important that these are Killed by pasteurisation

Lactic acid bacteria: such as Lactococcus, Lactobacillus, Leuconostoc, Pediococcus, Streptococcus

Contamination from soil, feed, milking and storage equipment; evolved to be associate with milk and can cause sour fermentation or lactic acid production

Psychrotrophes (thrive at 3–7°C): strains of E. coli , Y. enterocolitica, L. monocytogenes*, Bacillus, Clostridium, Arthrobacter, Microbacterium

Sources include milking equipment, cold chain at farm level, water. Usully come form post pasteurization contamination of processed milk, they continue to multiply under refrigeration. They produce heat-stable lipases and proteinases

Donor milk may cost on average $4.50 per ounce or more, which helps the Human Milk Banking Association of North America to make a profit.

False

Why is it important that donors of human milk view the donation as an altruistic act?

Lack of profit or other personal motive is likely to assure that milk will be well-cared for and unadulterated.

Why is it so important for babies who are born prematurely to receive human milk? 

Human milk feeding significantly reduces the incidence of necrotizing enterocolitis.

Which of the following are thought to be influenced by the calcium that is contained in a diet high in milk and dairy products? (check all that apply)

Osteoporosis, dental caries, colon cancer

The age group with the highest Recommended Dietary Allowance of calcium is...

9-18 years

Which of the following factors increases the likelihood of a person developing osteoporosis at a particular age?

A diet that is low in calcium and vitamin D

Which of the following cells is most responsible for the dissolution of bone mineral to release soluble calcium and phosphate?

osteoclast

Which component of milk is LEAST likely to be involved in increasing bone mineral density in people who consume a diet abundant in dairy products?

potassium

The sites where cancer development is most likely to be decreased by a diet that contained a higher amount of milk and dairy products is...

colon

Which statements regarding components of milk is LEAST likely to be responsible for the relationship between milk and hypertension?

High milk sodium content reduces risk of hypertension.

A Review of the the research that compares dairy product intake to rates of weight gain in children and adults shows...

a small effect of greater intake of dairy products as a proportion of the total diet decreasing the the risk of obesity.

Research has shown that people who consume large quantities of camel milk may consider this practice a beneficial for ALL of the following EXCEPT...

reducing infection with the MERS coronavirus.

Milk has been shown to benefit immune functions by all of the following mechanism EXCEPT

a high concentration of IgE in milk of all species that is lethal to parasites.

An allergy reaction to milk protein that affects 3-5% of children usually requires all of the following steps EXCEPT

macrophage cells in the lumen of the gut attacking the gut epithelial lining when they encounter an offensive milk protein.

The health problem that causes the greatest proportion of people to avoid milk in their diet is

lactose intolerance

Wet nursing common until…

20^th century, when no healthy alternatives to human milk were available

Milk banking started in…

Europe – Geneva, 1909

Milk Bank Director/Manager

IBCLC, nurse, physician, or trained person

Supervises operations

Pasteurization Technicians

Oversee milk processing and handling

Medical Director

Supervises medical decisions

May/may not do a physical exam on donors

Neonatologist, pediatrician, or OB

Board

Panel of consultants with specialties in Lactation, Neonatology / Pediatrics, Microbiology, Nutrition, Public Health, Obstetrics, Food Science

Why Use Donor Milk?

Decrease morbidity rates

Decrease NEC

Decrease incidence and severity of infections

Decrease feeding intolerance

Decrease length of hospital stay

Support breastfeeding

What We Do at a HMBANA Milk Bank

Screen Donors

Receive Milk

Pool

Pasteurize

Bacterial Testing

Dispense

Screen Donors

Preliminary Phone Screening (Medications, Prohibited herbs & supplements, Illegal drug use, Alcohol, Risk for HIV, Travel)
Written interview
Provisor sign off
Blood screening (HTLV, HIV, Hep B, Hep C & Syphilis)

True False: A mom cannot donate her milk if she takes 50mg of Zoloft daily.

FALSE

True False: A mom can donate if she takes a fenugreek supplement.

FALSE

True False: A mom’s baby is refusing her frozen milk. She notices it has a sour smell and suspects that she has “high lipase.” She can donate this milk to her local HMBANA milk bank.

TRUE

True False: HMBANA milk banks charge a fee for their milk but don’t pay their donors.

TRUE

Supplemental Nursing Systems

Consist of a container for milk with one or two thin flexible lengths of tubing attached.

ADVANTAGES to manual expression over mechanical methods

Some mechanical pumps cause discomfort and are ineffective.

It is more natural.

Skin to skin contact is more stimulating; easier milk ejection reflex.

It's convenient.

It's ecologically superior.

It's portable. How can a mother forget her hands?

Best of all it's free!

Pacifiers

Treat delayed swallowing

In non-orally fed infants, pacifiers help maintain oral motor patterns, stimulates production of gastric enzymes, and tactile response that will be necessary to transition to feeding at the breast

Comfort

Frequently used to calm fussy baby when mother is not available

Infant Scale

Determine breast milk intake during a feeding session

Determine weight loss or gain

Can help determine if supplementation is necessary

May help in decision to discharge premature infant from hospital

Early milking machines

Straw or cannula to hold open streak canal

Vacuum pump to suck out milk

Circa late 1800’s

Pressures in the teat cup

Top: relaxation closes streak canal; constricts teat; reduced blood flow.

Lower: negative pressure on teat opens streak canal; blood inflow, milk outflow

Pulsator adjusts timing

The Vacuum System

One pump

Pulls on milk line to pull milk into tank

Constant vacuum at teat end

Pulsator varies vacuum to teat cup, outside liner

Factors affecting milk flow

Pulsation rate (45-70/min)

Pulsation +/- ratio

Vacuum level (375mm Hg=1/2 Atm=50 kPa)

Milk Processing Steps

Test for purity and adulteration

Clean it up

Balance fat content

Homogenize

Pasteurize

Package

Store

Ship

Positive Effects of Homogenization

No cream line in final product

Milk’s susceptibility to oxidative rancidity is reduced

Whiter, more attractive color

Enhanced mouth feel

Full bodied flavor

Greater stability in cultured products

Milk intake may reduce risk for chronic diseases:

Dental caries

Cardiovascular disease

Osteoporosis

Colon cancer

Hypertension

Obesity

osteoporosis

Thinning of cancellous (tribecular) bone
Risk factors:

Calcium intake
Other dietary factors – F, P, vitamin D
Race sex, build
Exercise, hormonal status
Tobacco, alcohol, steroidal drugs

Non-Calcium Milk Components that May Influence Bone

Casein phosphopeptides

Magnesium

Phosphate

Vitamin D

Protein

Lactoferrin

miRNA in exosomes (miR-26a)

A1C test

result reflects your average blood sugar level for the past two to three months.

Protective proteins of Camel Milk

Lysozymes & Lactoferrin (kills pathogens.)

Immunoglobulin’s (for immunity.)

Low in as-casein and b-lactoglobulin

camel milk insulin

Protected from digestion

Nano particles

Active proteolytic fragment

Small insulin-like molecules