EXAM 2 - LIFECYCLE NUTRITION - KENT STATE UNIVERSITY

listeriosis

at increased risk for spontaneous abortion and stillbirth caused by bacteria found in raw or cooked foods after processed; prevention involved avoiding raw fish, oysters, unpasteurized milk or cheese, and undercooked meat

listeria monocytogenes can be found in water, soil, and animals

bacteria causing listeriosis

toxoplasmosis

can result in mental retardation, blindness, seizures, and even death of the fetus

toxoplasma which can be found in raw/undercooked eggs and meat, unpasteurized milk, unwashed fruits and vegetables, and cat litters

cause of toxoplasmosis

use gloves when gardening, cover sandboxes when not in use, and wash hands after handling raw meat, soil, sand, or cats

how to avoid toxoplasmosis

individual may develop neurological problems such as seizures, learning problems such as language and attention span, and mental retardation

causes of high mercury consumption during pregnancy

limit amount of canned tuna to 1/week, if body weight is less than 135 lbs they should eat less; children under 6 should eat <1/2 can tuna/week

women of childbearing age fish consumption

bigger fish such as shark, swordfish, tilefish, king mackerel, and albacore white tuna

fish high in mercury

light tuna/haddock, salmon/cod, pollack/sole, shrimp, lobster, crab

fish lower in mercury

spina bifida, anencephaly, encephalocele

3 types of neural tube defect (NTD)

neural tube defect (NTD)

malformation of the spinal cord and brain

spina bifida

a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it

anencephaly

absence of the brain or spinal cord at birth

encephalocele

protrusion of brain through skull

fetal alcohol syndrome (FAS)

alcohol-related birth defects including proportionately short for gestational age (pSGA), mental/behavioral problems including mental retardation, poor coordination, and short attention span, and facial deformity including short noses, flat nasal bridges, and thin upper lips

Fetal alcohol effects (FAE)

same characteristics with FAS except facial deformity

Direct toxic effect/small body size, no enzyme in fetus, maternal malnutrition, potentially genetic susceptibility (?)

possible causes of FAS/FAE

identify alcohol and other drug use in pregnant women as early as possible

prevention of FAS/FAE

calcium during pregnancy

increased need of 300mg/day met by increased uptake within the mother's body by enhancement of absorption and bone demineralization

In order to enhance calcium needs for the fetus, the mother's body demineralizes bones to support fetal growth; after delivery, bone loss due to demineralization recovers

what happens to female's bones during pregnancy?

1000 mg/day

calcium intake recommendations during pregnancy

calcium utilization - bone formation

vitamin D function

small infants, poorly calcified bones, and abnormal enamel

vitamin D deficiency in pregnant women causes in babies

consume small amount of vitamin D fortified milk, have little sun exposure, use sunblock, dark skin, vegans

groups at risk for vitamin D deficiency

15 mcg (or 600IU) per day; 3 c of Vit-D fortified milk or 1/2 - 2 hours of sun exposure/week

vitamin D requirements during pregnancy

9 cups - average intake; need increased due to increase in plasma volume and amniotic fluid

water intake recommendation during pregnancy

megaloblastic anemia and neural tube defect (NTD)

folate deficiency causes

27 mg/day

iron intake recommendation for pregnant women

risk of preterm delivery, LBW infants, low scores on IQ, language, motor skill, and attention tests

iron deficiency anemia outcomes for infants

hemodilution - blood volume expands 50% will RBCs only increase by 30% (<11g/dL during trimesters 1 &3, <10.5 during 2nd trimester)

Iron-status during pregnancy

Pros: usual diet cannot provide required amount of 6mg/1000kcal within diet

Cons: decreased absorption as dose increases, interferes with zinc absorption at a high dose, and exposure of intestinal mucosa to free iron radicals may lead to inflammation and mitochondrial damage

pros and cons of iron supplementation during pregnancy

growth retardation and malformation in animal studies; preterm delivery, infection, prolonged delivery in human studies

zinc deficiency during pregnancy results

11 mg/day

zinc intake recommendation during pregnancy

cretinism and hypothyroidism in infants; supplementation before or during first half of pregnancy resulted in 70% decrease in incidence of hypothyroidism and decreased death rates in infants

iodine deficiency results

iron - only supplement recommended routinely with low intake; other supplements may be recommended for specific individuals including vegans, poor quality diets, smokers, iron deficient individuals, and those that may abuse drugs or alcohol

mother vitamin and mineral supplementation during pregnancy

first pregnancy, obesity/underweight, mother's smallness at birth, multifetal pregnancy, age >35 years, history of preeclampsia, insulin resistance, high homocysteine levels, chronic HTN, renal disease, inadequate diet

risk factors of preeclampsia

hypertension, proteinuria, excessive edema

symptoms of preeclampsia

preeclampsia

abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, and headache; most dangerous type of hypertension

nutritional recommendations: calcium - 1000 mg/day, Vitamin C - 1000mg/day, vitamin E - 400 IU/day, Folate - 600 DFE/400 mcg folic acid, greater than or equal to 5 servings of fruits and vegetables per day, no sodium restriction, choose MyPlate, moderate exercise, attaining recommended weight gain, 3 regular meals and 3 snacks/day, consumption of low GI foods

prevention/treatment of preeclampsia

due to it decreasing cardiac output, it would decrease the size of the placenta and the birthweight of the baby

why is there no sodium restriction for pregnant individuals to prevent preeclampsia?

hypertensive disorders during pregnancy

diagnosed when greater than or equal to 130/80 mmHg

preeclampsia, premature labor, anemia, and maternal mortality; higher energy requirements to support growth of both the mother and the baby, increase calcium intake of 1300 mg/day

risks associated with adolescent pregnancy

a cluster of milk making secretory cells

alveolus (alveoli)

surround secretory cells responsible for milk ejection into ducts responding to oxytocin

myoepithelial cells

large duct for storage of milk behind nipple

lactiferous sinuses

stimulated by E2/P during puberty, usually finished around 12-18 months after menarche (first menstrual period)

breast physiology during puberty

E2/P, LH, and placental hormones (lactogen and chorionic gonadotropin), produces milk as early as 16 weeks of gestation but high level of progesterone inhibits milk secretion before delivery

breast physiology during pregnancy

stimulates milk production; released by suckling, stress, sleep, sexual intercourse; important in inhibiting ovulation

Prolactin

stimulates ejection of milk from milk glands; released by nipple stimulation, suckling; contraction in milk duct causes tingling, shooting sensation; promotes uterine contractions

oxytocin

prolactin and oxytocin

two hormones acting on mammary glands and reproductive organs

prolactin inhibits ovulation while oxytocin promotes uterine contractions

how do prolactin and oxytocin interact with reproductive organs?

letdown reflex

caused by suckling, hearing infant crying, sexual arousal, and thinking about nursing; inhibited by psychological disturbances

fast uterus contraction - back to nonpregnant size, postpartum blood loss minimized; delay in ovulation - may not be very distinctive; lower risk of breast and ovarian cancer

benefits of breastfeeding for mothers

balanced nutrients; isosmotic - no water necessary; protein - readily digestible form, relatively low protein, bound with minerals (especially iron) high bioavailability; EFAs, LCPUFAs, DHA - promote CNS development

nutritional benefits of breastfeeding for infants

the most important benefits: lymphocytes/macrophages - 80% of bloods cells in breastmilk; immunoglobulins - IgA, protect mucus in throat, lungs, and GI tract (e. Coli and enteroviruses); growth factors/hormones - help GI tract maturation; bifidus factor - promotes growth of lactobacillus bifidus, protective effect against bacteria in intestine

immunological benefits of breastfeeding for infants

due to DHA - assessed by IQ, greater effect on premature infants

cognitive benefits of breastfeeding for infants

diarrhea - 50%, ear infection - 19%, prolonged episodes of ear infection - 80%, coughing and wheezing - 17%, vomiting - 29%, allergy and asthmatic disease, obesity, and sudden infant death syndrome (SIDS)

reduced morbidity of breastfeeding for infants

increased bonding between baby and mother, socioeconomic benefits - saves lots of money due to decrease in medical care, absence from work 2/3 higher in non-breastfeeding mothers, analgesic effects, healthy teeth - suckling promotes jaw/arch development and anticariogenic, convenience, savings for parents

other benefits of breastfeeding

embarrassment/fear of pain - especially when mothers are younger, and when in public; lack of support from family and friends; time and social constraints and concerns about loss of freedom - can cause mothers to lose sleep and take time away from work if needed to pump; on the babies time; commercial promotion of formula, lack of breastfeeding education, early hospital discharge, health professionals' apathy and inadequate knowledge; lack of broad societal support; absence of facilities and support for breastfeeding at work; lack of routine follow-up care - 7-10 days post-partum is most critical period, home or office visits required

barriers of breastfeeding

suckling

most effective stimulus for drawing out breast milk

volume and rate of milk production

adjusted by the requirement of the infant; emptier/fuller

storing milk, maintaining milk volume, preventing engorgement

why pump out breast milk?

can reduce milk production causing early cessation of breastfeeding

what is a possible problem with pumping?

milk composition

except fat and vitamins, independent from maternal nutrition status until malnutrition becomes very severe

600-900ml/day; may be limited by severe food restriction

milk volume production

colostrum

thick, yellow fluid secreted in the first few days after birth; contains more protein and less sugar and fat than mature milk; high in immune factors protecting newborn's GI tract; has a laxative effect helping the passage of early stools

lactoferrin

primary protein of colostrum; increases iron absorption, keeps iron in a more absorbable form requiring much less iron in diet, has an antibiotic effect, not available in infant formula

meconium

the first bowel movement of the newborn, high in bilirubin

bilirubin

byproduct of the disruption of RBCs; may cause jaundice in a newborn

contains more protein and less sugar and fat than mature milk; high in immune factors protecting newborn's GI tract; has a laxative effect helping the passage of early stools

components of colostrum

foremilk

secreted during the beginning of feeding, high in water and lactose

foremilk and hind milk

what are the two types of mature milk?

hind milk

secreted after initial release of milk, higher in fat, which is important for baby development, gives baby satiety

protein - 35% casein which increases Calcium absorption, 65% whey including immunoglobulins and lactoferrin

Lipids - affected by maternal intake; DHA which is essential for brain and vision, cholesterol which is higher in breast milk, is needed for CNS development, and stimulates enzyme synthesis for cholesterol breakdown which equips the baby with the ability to excrete cholesterol later in life

Carbohydrates - lactose which is higher in breast milk than in infant formula, promotes growth of good bacteria, improves calcium absorption; energy source = 0.65kcal/mL which is less kcal than in cow's milk/formula

macronutrient composition of human milk

Fat-soluble vitamins - vitamin A is affected by maternal intake and is higher in colostrum than mature milk; vitamin D is also affected by maternal intake and sunlight exposure, low in breastmilk when compared to infant formula, supplement recommended 200 IU/day; vitamin E is higher in breast milk; vitamin K is lower in breast milk than in infant formula, infant's intestine is sterilized

Water-soluble vitamins - most affected by maternal intake, vitamin B12 and folate are less effected than the others

Minerals - iron and zinc have a higher absorption rate in breast milk; calcium is not affected by mother's diet, lower in breast milk which is compensated for by high lactose in the breast milk

micronutrient composition of human milk

infant formula is higher in casein protein which are harder to digest and may cause an upset stomach

proteins in infant formulas

sIgA (secretory immunoglobulin A)

predominant immunoglobulin in breast milk; plays a crucial role in protecting infants against bacteria and other pathogens by binding to them and preventing their attachment to mucosal surface, such as the GI tract

can cause diarrhea when over consumed

side effects of too much foremilk

lipids, vitamin A, vitamin D, water-soluble vitamins (most affected excluding B12 and folate which are less so)

nutrients impacted by maternal intake

Calcium, iron, zinc, protein, and lactose

nutrients that are NOT impacted by maternal intake

Reflux - weak stomach motility which leads to milk being in the stomach longer causing the reflux with low lower esophageal sphincter pressure

what is the cause of an infant "spitting up?"

They should never use a long-acting form of the drug; taking the medication after nursing gives the mother enough time to metabolize and clear from their system - should watch baby for signs and symptoms such as a change in their feeding and sleeping pattern, fussiness, or development of a rash

what is a safe time for a nursing mother to take a drug?

poor latching, pumping with excessive suction, and infection

what causes sore nipples?

you can try to air dry the breast after feeding, rubbing expressed milk and ointment on the nipples, and/or warm compression

what are some things you can try to prevent sore nipples?

overfilled breast with milk due to milk stasis

what causes engorgement?

pain, swelling, and a hard breast

signs and symptoms of engorgement

prevention - frequent nursing

treatment - pump until breast becomes soft, warm shower and compression

what are some ways to prevent and treat engorgement?

prolonged milk stasis

what is the cause of a plugged duct?

similar to engorged breast symptoms + redness on the breast surface

what are some symptoms of a plugged duct?

gentle massage, warm compresses, and emptying the breast

treatments for plugged duct

engorgement or plugged duct, cracked nipple, and/or a blood-born source

what causes mastitis?

plugged duct symptoms + fever with flu-like symptoms

symptoms of mastitis

same techniques for plugged duct + acetaminophen/antibiotics

treatment for mastitis

pica

craving for nonfood items

most common cause is iron deficiency

cause of pica

lead poisoning, GI obstruction, and parasitic infestation

what are some consequences or risks for those with pica?

birth weight (2500-3800 g or 5.5-8.5 lbs)

what is the best indicator of health in a newborn baby?

47-54 cm (18.5 to 21.5 in)

healthy birth length

as long as between 5th and 95th %ile it should be healthy; outside of that range --> possible mental retardation

healthy head circumference at birth

apgar score

system for rapid neonatal assessment at 1 minute and 5 minutes after birth