NTR 454: Lactation Nutrition Final Exam Review

Although the recommendations from WHO, CDC, etc., is exclusive breastfeeding for 6 months, an acceptable public health goal in the US according to the Healthy people 2020 (US DHHS) is approximately ___ % of babies

25%

Over the last decade, the rates of all breast feeding and rates of exclusive breastfeeding are

both increasing

Impacts of breastfeeding include ALL of the following EXCEPT: reducing risk factors for chronic disease, reducing child disease rates, reducing undernutrition in developing countries, preventing an inadequate number of calories for infants in the US.

preventing an inadequate number of calories for infants in the US

Worldwide ____% of infants are exclusively breastfed for the first 6 months of life. 

34%

A mother is breastfeeding her 4 month old baby exclusively, is able to sleep for a 6 hour stretch at night without breastfeeding, and menses has not returned. Which of the following is correct regarding her chances of pregnancy? 

She has a higher risk of becoming pregnant than if feeding every 2-3 hr, and should use a complementary family planning method if pregnancy is not desired. 

Complementary foods should be started around 6 months of life because the baby needs higher amounts of which nutrient in his/her diet?

Iron

Regarding the figure, "Biological roles of lactation" discussed in class, match the biological roles of lactation with the hazards from which the young are protected. (1. physical protection, 2. learnt skills, 3. appropriate nutrition, 4. fertility control, 5. warmth, 6. antibodies)

1) predators

2) various hazards

3) starvation

4) excessive birth rate

5) hypothermia

6) disease

Consumption of bovine milk may have which of the following benefits?

prevention of rickets, osteomalacia, osteoporosis, decrease in colon cancer, decrease in oxidative and inflammatory stress, prevention of metabolic syndrome, obesity, cardiovascular disease, hypertension, and type 2 diabetes

Top three milk producing countries (2011)

US, India, China

Total milk production trends in the US have been increasing over the years due to which factors? 

Cows are producing more milk and larger efficient farms with more high producing cows

Cows in cool climates, such as UK, produce most milk in the months of April and May and the least in October, December, and January. 

true

In the US, Americans tend to consume more milk in the cooler months and less milk in the summer. 

True

Reasons that adults consume milk from different species include ALL of the following EXCEPT

milk is usually the lowest cost source of calories in the marketplace

Which are remedies for lactose intolerance?

consuming small amounts of food with fermented lactose, milk containing predigested lactose, pills/drops of lactase

Three cups of milk contains 50% of the RDA for all the following nutrients (b12, riboflavin, calcium, calories) EXCEPT:

calories

Label the pathways

1) Secretory vesicle exocytosis

2) lipid synthesis and secretion

3) eccrine transport across apical membrane (water + ions)

4) transcytosis of interstitial molecules

5) paracellular pathway

Pathways: 1) Paracellular, 2) Exocytosis, 3) Lipid synthesis and secretion 4) Eccrine transport across apical membrane, 5) Transcytosis of interstitial molecules

1) passage between epithelial cells

2) aqueous components secreted (proteins, lactose)

3) triglycerides that become milk fat globule

4) small molecules (monosaccharides, Na, K, Cl)

5) immunoglobulins

Tissue spaces, what fluid? 1) lymphatic ducts, 2) alveolii, 3) vascular system

1) excess interstitial fluid

2) milk

3) blood

What opens up tight junctions?

giving birth, oxytocin, mastitis, weaning

What is least likely to be a rate limiting step in synthesis of lactose by epithelial cells? (Synthesis of whey protein (alpha-lactalbumin, transport of glucose in golgi, overall activity of lactose synthase complex, uptake of galactose from blood stream to mammary cells)

Uptake of galactose from blood stream to mammary cells

Which of the following is the LEAST likely mechanism for secreting lipid into milk? (A portion of the mammary cell membrane is lost into milk by the process of butterfat secretion,
Enzymes that have been secreted by the mammary cell can synthesized fatty acids and triglycerides inside the alveoli and milk ducts, Micro-lipid droplets (MLD) can diffuse through the cell membrane to reach the milk space, Cytoplasmic lipid droplets are pushed out of the cell, surrounded by the cell membrane)

Enzymes synthesizing fatty acids + triglycerides

In embryonic development of the mammary gland, the earliest feature to develop is 

mammary ducts

In a normal cycle of lactation, the latest event to occur is...

involution

The nerves connecting the mammary gland to the brain have the a main function best described as..

release of oxytocin and control of sphincter muscle tone

Different species of mammals can differ from each other with respect to ALL of the following anatomical features EXCEPT...

the presence or absence of mammary glands in the female

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

500K

What must a woman do to become a milk donor?

answer questions, fill out forms, get bloodwork

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

1910, Boston Floating Hospital

What happens to milk to ensure it is safe for premature babies?

must be surplus, cooled, thawed, tested for bacteria, homogenized, pasteurized, mothers are screened

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

Sterilization

110-120C for 20-40 mins; inactivation of all microorganisms, may result in cooked flavor

Holder pasteurization

62-65C for 30 mins, batch process w/ simple equipment

High temp, short time (HTST)

72C for 15 secs; sometimes 75C for 20 secs, followed by immediate cooling to <6C; inactivates pathogens, molds, yeast, and most bacteria

Ultra high temperature

135-150C for 1-4secs; mostly >140C for 5 secs followed by flash cooling; microorganisms and spores killed

Psychrotrophs

milking equipment, cold chain at farm level, water (normally post pasteurization)

Pathogens

mastitis organisms from udder, skin, hair, feet, feces, milkers; killed by pasteurization

Lactic acid bacteria

soil, feed, milking/storage equipment, can cause sour fermentation

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

Colostrum contains a higher concentration of immunoglobulins than most later milk.

true

Most of the fat in milk is surrounded by a material that closely resembles cell membrane. 

true

Cow's milk contains all of the essential amino acids.

true

Percent fat content of milk varies with species.

true

Water is not a major component of milk.

false

During lactation glucose, amino acids, fatty acids, and minerals are extracted from the bloodstream by the mammary gland. The process of quantifying the amount taken up can be computed in experiments that measure flow rate and concentration of the substance in question in the arterial and venous blood supplies and apply the Fick principle.

true

There is a greater abundance (total concentration) of whey proteins in cow's milk than casein proteins.

false

_______________ is the secretion received during the first few milkings that is held back from the market and fed to the calves.

colostrum

The primary source of raw carbohydrate in cow's milk is ______________.

lactose

Which of the following components is NOT found predominantly in the aqueous (water-soluble) phase of the milk? (alpha-lactalbumin, sodium, lactose, vit A)

vitamin A

The cells responsible for milk secretion are the _____________.

Mammary epithelial cells/lactocytes

How do oligosaccharides contribute to a human infant’s health status?

Oligosaccharides are carbohydrates that inhibit the binding of enteric and respiratory microorganisms and their toxins to the epithelial cells in the infant’s gut.

____________ is a glycoprotein in milk that assists iron absorption in the infant and inhibits bacterial growth.

lactoferrin

Milk is produced, and then immediately stored in the ______________.

alveoli

After a baby is born, about 3-5 days postpartum, a mother’s milk “comes in.” This onset of milk production is called _____________.

lactogenesis

All of the following (reduced health care expenses, cost of breast pumps/bottles, long term health care savings, reduced time off work to care for sick infant) are economic benefits of breastfeeding, EXCEPT:

cost of breast pumps/bottles

Colostrum differs from mature milk in that colostrum contains: 

higher amounts of protein and sodium and lower amounts of water and lactose. 

What are the global breastfeeding recommendations from the World Health Organization and the United Nations Children's Fund?

Exclusive breastfeeding for 6 months, followed by complementary feeding with continued breastfeeding up to 2 years of age or beyond

The most abundant component of milk of both humans and cows, other than water, is

Lactose

What is the most prominent whey protein in mid-lactation bovine milk

Beta-lactoglobulin

A major structural difference between the bovine and human mammary glands is

the human gland does not have a gland cistern.

A carton of cows milk contains nutrients in ALL of the following physical states (liquid, suspended solids, covalently cross-linked protein gel, dissolved solids) EXCEPT:

covalently cross-linked protein gel

Milk is the most complete biological source of nutrients for human growth and development, leading to the strong dairy industry we have today. Other qualities of milk supporting this industry include ALL of the Following (As it comes from the cow (raw milk), it is a poor medium for the growth either pathogenic or spoilage microorganisms; The fluid physical and chemical properties of milk allow for transportation and processing in massive volumes; Milk tastes good to most people so is a readily accepted food and food ingredient; Much of the United States has a climate conducive to raising dairy cattle and growing their feed.)EXCEPT:

As it comes from the cow (raw milk), it is a poor medium for the growth either pathogenic or spoilage microorganisms.

The structures responsible for holding the bovine udder, which can weigh as much as 70 kg, adjacent to abdominal wall of the cow are termed…

Suspensory ligaments

Early in the embryonic development of mammals, a thickening and invagination of ectodermal (Outer layer) tissue that will eventually allow mammary glands to develop. This tissue is referred to as…

The milk line

Why does the mRNA for casein lead to synthesis of a protein that is excreted from the cell, rather than one that is a component of the cytoplasm?

The leader sequence in the protein contains a signal peptide that docks with rough endoplasmic reticulum proteins, which directs the peptide through the RER membrane

The source of the fatty acids that are incorporated into the triglycerides of milk fat in most species often include ALL of the following (fatty acids stored in adipose tissue during pregnancy, fatty acids synthesized in the mammary gland, trans-fatty acids that are made by industrial hydrogenation processes, fatty acids consumed in the diet) EXCEPT...

trans-fatty acids that are made by industrial hydrogenation processes

What is the most prominent WHEY protein in mid-lactation HUMAN milk

alpha-lactalbumin

Milk is almost the only biological source of the disaccharide lactose. Possible functional or evolutionary advantage for this sugar in milk include ALL of the following:

There are no membrane transporters for lactose that would allow reabsorption of lactose from the milk through the epithelial cells of the milk ducts.

Disaccharides like lactose provide more energy per osmole than sugars like glucose or galactose.

Lactose helps the milk to provide appropriate quantities of water to the infant.

Gram for gram, lactose has more energy than fats, protein, or glycogen.

EXCEPT:

Gram for gram, lactose has more energy than fats, protein, or glycogen.

Casein micelles in bovine milk are clusters of proteins held together by ALL of the following:

High concentration of fucose-containing oligosaccharides.

Phosphate groups covalently attached to the serine residues on the casein proteins.

Calcium ions, divalent cations that form ionic crossbridges between negatively charged phosphate groups.

Kappa-casein molecules at the exterior region of the micelle.

EXCEPT:

high concentration of fucose-containing oligosaccharides

Recent studies of the microbiome sampled from the mammary gland or streak canal provide information on…

The number of different bacterial species in each known genus or class of microorganisms.

Which of the following (calcium, glucose, alpha-lactalbumin, casein) is NOT required for synthesis of lactose inside the Golgi/ secretory vesicle system?

casein

The polymeric Ig receptor (pIgR) is responsible for...

Adding secretory component during the transfer of IgA.

Gram-for-gram, the milk sugar lactose is sweeter than

starch

What are the Subcutaneous fatty tissues and why are they important in humans?

Supportive tissue that gives the breast shape

The components of bovine diets that are most likely to be metabolized further by rumen bacteria before being transferred to milk are:

long chain polyunsaturated fatty acids

The hormone that is most responsible for increasing the volume of milk a mother produces when a breast fed baby increases the duration and intensity of nursing is...

prolactin

An enzyme that allows a growing mammary endbud to continue its growth into the mammary fad pad during the process of mammogenesis is...

matrix metalloprotease

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

62.5, 30

Risk for a mother who has been infected or exposed to COVID-19 of transmitting the disease to her infant is reduced by effective handwashing, good sanitation practices, and wearing a good-fitting mask when she is within 6 feet of her infant.

true

Lactose intolerance can be caused by ALL of the following conditions:

Birth defects

Disease/infections that damage gut

normal process of aging

Competing beta-galactosidase activity from the intestinal microflora

EXCEPT...

Competing beta-galactosidase activity from the intestinal microflora

Mechanisms of camel milk, describe health effect!

1) Low in alpha-casein and beta-lactoglobulin

2) Angiotension 1-converting enzyme inhibitory activity

3) Orotic acid, bacterial and milk peptides, and possibly small fat droplets

4) lysozyme, lactoferrin, lactoperoxidae, hydrogen peroxide, and immunoglobulins

5) Insulin, IgG, casein

1) hypoallergenicity effect

2) lowers blood pressure

3) hypocholesterolaemic effect

4) antimicrobial effect

5) hypoglycemic effect

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

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.

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

true

What theories could explain how camel milk is protective of diabetes? 

Fatty acids with insulin-like effect, antibodies that improve beta-cell insulin secretion, nano particles, active proteolytic fragment

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

temperature-controlled shaking water baths

surfaces that are easy to sanitize and clean air working surface

a walk-in freezer for storage

instruments for high pressure processing and irradiation of breast milk

EXCEPT:

instruments for high pressure processing and irradiation of breast milk

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

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

Benefits of consuming bovine milk?

Decrease in oxidative and inflammatory stress

decrease in colon cancer

prevention of rickets, osteomalacia, osteoporosis

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

In the US, approximately 11% of the population has diabetes, and similar or greater incidence is seen and many developing countries. Many drugs are available to treat this condition in the US, but milk from camels has been found to reduce elevation in blood sugar, so is a traditional medical practice in...

middle eastern countries

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

2-5 years

Milk intake improves bone health by supplying ALL of the following nutrients (calcium, vitamin D, magnesium, essential fatty acids)

EXCEPT:

essential fatty acids

definition of “donor human milk banking”?

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

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

wheat

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

a drop in circulating estrogen concentrations

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:

osteoporosis, loss of incretin gut hormones that promote insulin release, inflammation, constipation

EXCEPT:

osteoporosis

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

Provide human milk for mother’s who are too busy to breastfeed

Promote breastfeeding

Feed infants who cannot survive without human milk

Decrease gold drain caused by purchasing formula

Improve outcome for preterm/sick infants

Provide human milk for mother’s who are too busy to breastfeed

TOP THREE populations with the highest prevalence of lactose intolerance

Apache, inuit, thai

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

Infants with metabolic disorders may benefit from the donor milk