NUIP 2020 exam 1

Describe how social determinants of health can impact food choices and health status.

Social determinants of health care conditions in which people live, financial, education, religion that impact their nutrition.

—Income can make healthy food less affordable (it’s expensive)

—Limited access to grocery stores (accessibility, transportation)

—Religious determinants, restrictions to certain foods, eating habits

—Healthcare access

—Education: understanding what is healthy

follicular phase

Women’s follicular phase:

1. E stimulates hypothalamus to secrete GnRH

2. GnRH causes pituitary gland to release FSH & LH

3. FSH: maturation of follicles on the surface of the ovary & production of E (where ova is) (only 1 ovum will be ovulated each cycle, if not it will be twins)

4. LH causes follicle to secrete Pro. Pro and E work to prepare the uterine wall/endometrium (expanding blood vessels, preparing nutrients)

5. Day 14: FSH & LH concentrations are highest, surge of LH causes the release of the ovum from the follicle —→ this is ovulation! (goes into fallopian tube)

luteal phase

The luteal phase happens after the 14th day (ovulation)

1. the follicle turns into the corpus luteum

2. the corpus luteum secretes Pro & E

3. Pro & E inhibit the production of GnRH (ovulation cannot occur without LH) (this is how hormonal birth control works)

4. Pro and E stimulate endometrium to prepare for the fertilized ovum

5. NOT FERTILIZED: corpus letuem begins to die off (atrophy)

6. Pro & E no longer surge (endometrium constricts-uterine wall is released-menustration) (no more inhibitory effect on GnRH) (NEG feedback loop for females)

7. the follicular phase begins again (28 days are done)

8. FERTILIZED: zygote will implant on endometrium (lining of uterus)

9. the zygote secretes hCG —→ keeps corpus luteum alive —→ Pro & E still surge)

10. the corpus luteum’s production of Pro is replaced by the placenta

spermatogenesis

1. the hypothalamus secretes GnRH

2. GnRH stimulates the pituitary gland to release LH & FSH

3. FSH stimulates sertoli cells in the testis to secrete signaling molecules to begin—→spermatogenesis

4. LH stimulates interstitial cells to secrete—→T (also stimulates sertoli cells) (more spermatogenesis)

5. NEG feedback loop: T inhibts GnRH and shuts down this pathway

What is ovulation?

Caused by a surge in LH causes the release of the ovum from the follicle. Simply, a mature egg is released from an ovary.

What are some nutrition recommendations for someone trying to improve their iron status? What can happen when someone is low iron during pregnancy?

Nutrition rec for improving iron status:

—eat more iron-rich foods (lean red meat, poltury, fish, eggs, beans, lentils)

—iron fortified grains and cereals

Low in iron during preg:

—iron is needed to expand blood supply

—support placenta

Someone with low iron during preg. can develop iron-deficency anemia, which can cause fatigue or weakness and is associated with low birthweight and preterm births.

Describe how weight and adiposity can impact fertility for men and women.

someones who’s losing what percentage of body fat will be a risk factor for fertility for 6 months, what’s the percentage range

whats the BMI that is advised for fertility

what enzyme for men for excessive adiposity (most IMPORTANT part of how visceral adiposity can affect males)

Low body fat can disrupt hormones and cause irregular or absent ovulation. (excessive adiposity=higher levels of estrogen)

(underweight=not enough estrogen)

High body fat can also alter reproductive hormones and also have irregular or absent menustration.]

Men will make less sperm.

10-15%

20

aromatase (converts T to estrodial)

—estrodial stimulates the sertoli cells

How does PCOS impact fertility?

PCOS: Polycystic ovary syndrome

—disrupted hormone signaling → follicles don't fully mature → irregular/absent ovulation—→higher amounts of T

HIGH TESTOSTERONE

—can cause ammenorhea

List appropriate nutrition recommendations for adults in the preconception stage who have diabetes, PCOS, Celiac Disease, and PKU.

diabetes: maintain healthy body weight, keep glucose levels controlled before conception, regular physical activity, consistent carbohydrate intake

PCOS: physical activity, limit added sugars to manage insulin levels, fiber, heart-healthy diet

—higher risk for type 2 diabetes and high BP

Celiac: gluten-free diet, ensure adequate micronutrient intake

PKU: medical foods/formulas, low-protein diet

Explain the diabetogenic effect of pregnancy. What hormones are involved? **Students will not draw the diagram on the exam but do need to understand the steps.

IMPORTANT

During the 2nd half of pregnancy, the main objective is to GET GLUCOSE TO THE FETUS to support development. This is accomplished through 3 mechanisms.

This process result in the mother having high blood sugar levels.

1. Prolactin and hCS inhibit the conversion of glucose to glycogen and fat. (stays in the bloodstream)

2. hPL tells the liver to continue making glucose.

3. hPL, E, Pro is released from the placenta. Adrenal glands produce cortisol. hPL, E, Pro, cortisol all tell the pancreas to make more insulin —→ high levels create a resistence

**insulin normally allows for glucose to leave the bloodstream and go into the cells

**insulin resistence is when the body’s cells become less receptive to insulin (bloodsugar gets left in the bloodstream)

Describe the difference between pSGA and dSGA.

pSGA: proportionate small for gestational age (the baby is small but proportionally developed) equally small all over

dSGA: disproportionate small for gestational age (baby appears wrinkled, wasted, thin)

Why is it so important for pregnant women to consume sufficient calcium in their diet? If she does not get enough calcium during pregnancy, what chronic disease is she at high risk for later in life?

The developing fetus needs calcium to build strong bones and teeth.

If the mother’s diet doesn’t have enough calcium, her body will draw calcium from her bones to meet the needs of the fetus.

Higher risk for osteoporosis later in life

What are the health risks for an infant born with iron deficiency anemia?

• Impaired brain development and cognitive development

• Delayed psychomotor development (delays in movement and coordination)

• Behavioral and learning problems

• Poor growth and development

• Weakened immune function

preterm and low birthweight

What are the management strategies for heartburn, nausea, and constipation during pregnancy?

heartburn: small frequent meals

nausea: small frequent meals, avoid laying down right after eating

constipation: increase fiber, hydration

Describe nutrition recommendations for pregnant women with hypertensive disorders and diabetes.

Hypertensive

—do not restrict sodium

—adequate calcium

Diabetes

—glucose levels within good range

—high fiber, nutrient dense carbs

—consistent carbohydrate intake

Explain the differences in nutrient needs for women with multifetal pregnancies compared to a singleton pregnancy.

multifetal:

—energy needs are higher

—increased protein intake for blood volume expansion

—more calcium needed

Summarize the consequences of alcohol consumption during pregnancy and breastfeeding.

During preg:

—alc crosses the placenta

—interferes with fetal growth and brain development

—issues with learning, behavior, and physical development

—miscarriages, low birth weight

Breastfeeding:

—passes into breastmilk
—liver is immature, cannot metabolize alc

—changes in development

Explain what nutrients pregnant teens need more of than pregnant adults and why. 

—more calcium (especially important because they are still building bone mass)

—more calories needed

—more iron

What are the 2 hormones involved in milk production and let down?

—prolactin (stimulates breastmilk production), oxytocin (letdown, contraction of uterus, return to prepregnancy size)

Describe the difference (in carbs, fat, protein, immunoglobulins, etc.) between colostrum and mature milk. Also describe the difference between hindmilk and foremilk.

Colostrum

—less carbs, easier digestion

—higher in protein compared to mature milk

—higher in immune factors, antibodies

—HELPS SEAL THE INFANTS GUT BARRIER

—IMMUNE PROTECTION TO HELP PROTECT DIGESTIVE SYSTEM

Foremilk

—higher in fluids and lower in fat concentration

—more carbs than colostrum

Hindmilk

—higher in fat concentration

Describe infant behaviors that indicate readiness to feed.

-becoming more alert

-mouth opening

-turning head towards the breast (rooting)

-bringing hands to mouth (sucking)

crying is a LATE hunger cue

Describe the relationship between feeding frequency and supply. What are effective ways someone can increase their supply of breastmilk?

Breastmilk works on a supply and demand system.

—feeding/pumping frequently

—emptying the breast

Provide vitamin supplement recommendations for breastfeeding infants (you won’t need to know the daily dose, but you do need to know what micronutrients are recommended to supplement).

what do prepterm moms need to combine with their breastmilk

—vitamin D supp

—human milk fortifier

**note: breastmilk is actually low in iron

—preterm breastmilk is actually lower in carbs (lactose) and higher in protein

List common barriers and facilitators to breastfeeding.

Barriers

—stress

—education

—healthcare access

—concern over supply

—premature babies

Facilitators

—access to healthcare

—having enough time

—lactation education

—adequate maternity leave

—experience/success

—caloric intake

Describe prevention and management strategies for the common breastfeeding conditions (sore nipples, engorgement, mastitis etc.)

sore nipples

—deep latch, proper positioning

—putting breastmilk on nipple

engorgement

—breastfeed frequently

—express small amount of milk before latching to soften the breast

—massage, avoid tight clothing

mastitis

—help stop breastmilk accumulation by expressing/pumping/breastfeeding more frequently

—continue breastfeeding from the affected breast

—antibiotics

List benefits of human breast milk for premature and late-preterm infants. How is this breastmilk compositionally different from a full-term infant’s breast milk?

—contains immune factors/antibodies

—associated with better and more normal growth and neural outcomes

—more protein, more energy