[09.12] Physiology of Lactation and Breastfeeding V2

Merocrine and apocrine secretion

What are the two types of milk secretion?

Cell remains intact

What happens to the cell during merocrine secretion?

Apical portion of the cell is pinched off

What happens to the cell during apocrine secretion?

Rough endoplasmic reticulum (rER)

Where are protein components synthesized?

Cytoplasmic matrix

Where is the lipid component formed?

Water and ions

What diffuses freely through the apical membrane?

rER

What packages proteins for merocrine secretion?

Cytoplasm and plasma membrane

What encases lipids for apocrine secretion?

Receptor-mediated endocytosis

How is Immunoglobulin A (IgA) taken up by immune cells?

Anterior pituitary

What part of the pituitary gland enhances prolactin secretion?

Positive feedback

Is prolactin secretion a positive or negative feedback?

Mechanoreceptors

What transmits nipple stimulation to the brain?

Posterior pituitary

What part of the pituitary gland releases oxytocin?

Myoepithelial cells

What cells contract due to oxytocin release?

Alveoli to lactiferous sinuses

Where is milk propelled to during letdown?

Pressure on the nipple

What is the afferent arm of the milk letdown reflex?

Contraction of myoepithelial cells

What does oxytocin influence in milk ejection?

Lactation Amenorrhea Method (LAM)

What is a natural method of contraception in the postpartum period?

6-8 months

How long is LAM highly effective after delivery?

Purely breastfed

How should the infant be fed for LAM to be effective?

56 days or 8 weeks postpartum

When should the mother not have had her menstrual period for LAM to be effective?

Suppression of ovarian hormones

What hormonal action makes LAM effective?

Increased level of prolactin

What hormone level is increased due to suckling?

Human nipples and teats/rubber nipples

What concurrent feeding methods lead to nipple confusion?

Early satiety

Why does bottle feeding cause nipple confusion?

Rejects mother’s breast

What does an infant do as a result of nipple confusion?

Slowing down of milk production

What happens to milk production due to lack of continuous suckling?

Lactoproteins

What is colostrum highest in?

Fat

What is colostrum lowest in?

750 mL/day to 1,100 mL/day

How does milk production change with continuous breastfeeding?

88%

What percentage of breast milk is water?

6.9-7.2%

What percentage of breast milk is lactose/carbohydrates?

3-5%

What percentage of breast milk is fat?

0.8-0.9%

What percentage of breast milk is protein?

0.2%

What percentage of breast milk is minerals?

2.3 g/dL

What is the protein content in colostrum?

1.8 g/dL

What does protein content stabilize to over 2-4 weeks?

70% whey

What percentage of human milk is whey?

Alpha-lactalbumin

What form of whey is in human milk?

Rapid gastric emptying

What does alpha-lactalbumin result in?

30-40%

What percentage of human milk is casein?

82% casein and 18% whey

What percentage of cow’s milk is casein and whey?

Lactoglobulin

What type of whey is mostly in cow's milk?

Milk allergies

What can lactoglobulin cause in human babies?

Phenylalanine, tyrosine, and methionine

What amino acids is lactoglobulin lower in?

Brain development

Why is lactoglobulin lower in phenylalanine, tyrosine, and methionine?

Cysteine

What essential amino acid is converted to glutathione?

Antioxidant

What is the function of glutathione?

Taurine

What aids in bile conjugation and fat digestion?

Bile conjugation and digestion of fat

What does taurine aid in?

Better brain development

What does taurine contribute to?

Normal development, maturation, and repair of the GI tract

What are non-protein nucleotides for?

Lower

Is carbohydrate content lower or higher in colostrum than in mature milk?

Lactose

What kind of carbohydrate makes up 40% of breastmilk?

Oligosaccharides

What kind of carbohydrate makes up 30% of breastmilk?

1g/100mL

How many oligosaccharides are present in mature milk?

Some lactobacilli strains

What do oligosaccharides promote?

50%

What percentage of calories in milk come from fat?

Lipid and energy content

What does fat provide?

Palmitic acids

What essential fat is in human milk?

Oleic acids

What essential fat is in human milk?

Linoleic acid (arachidonic acid)

What essential fat is in human milk?

Linolenic acid (docosahexaenoic acid)

What essential fat is in human milk?

Cognition, growth, and vision

What do essential fats contribute to?

Vit. K

Which vitamin is not present in breast milk?

Race, age, parity, or diet

What factors do not greatly affect milk composition?

Infected

When is there a difference in the milk content in the two breasts?

Breast size

What does not affect milk volume production?

Woman’s diet

What hardly affects the quality of milk?

Foremilk vs. Hindmilk

What are the two types of milk expressed?

Initial expression of milk

What is foremilk?

Thin watery consistency

What is the consistency of foremilk?

Lactose and proteins

What does foremilk contain a lot of?

Thirst

What does foremilk quench?

Thick and creamy consistency

What is the consistency of hindmilk?

Hunger

What does hindmilk address?

Continued suckling

When is hindmilk produced?

Fat and calories

What does hindmilk contain more of?

Baby’s growth

What is hindmilk important for?

Antimicrobial factors, Growth factors, Cytokines and Anti-inflammatory factors, Digestive enzymes

What are the significant components of human milk?

Immunological resistance of the baby

What is provided by breastmilk?

Gut microbiome development

What kind of development is promoted by breastmilk?

Anti-inflammatory

What properties does breastmilk possess?

Secretory (IgA, IgM, IgG)

What antimicrobial factors are in human milk?

Epidermal (EGF)

What growth factors are in human milk?

Tumor Necrosis Factor

What cytokines and anti-inflammatory factors are in human milk?

Amylase

What digestive enzymes are in human milk?

Correct amount; easy to digest

What kind of protein is in human milk?

Enough essential fatty acids and lipase to digest

What kind of fat is in human milk?

Present

Are anti-infective properties/immunoglobulins present in human milk?

Executive Order No. 51

What is the Milk Code?

Corazon Aquino

Who signed the Milk Code into law?

October 20, 1986

When was the Milk Code signed into law?

Safe and adequate nutrition for infants

What does the Milk Code ensure?

Promotion of breastfeeding

What does the Milk Code promote?

Regulation of promotion, distribution, selling, advertising, product public relation, and information services of artificial milk formulas and other covered products

What does the Milk Code regulate?

Exclusive breastfeeding for infants from 0-6 months

What does the Milk Code say about breastfeeding for infants?

No substitute or replacement

What does the Milk Code say about breast milk?

Especially during disasters

When is breastfeeding best for babies according to the Milk Code?

6 months only and onwards

When should appropriate and safe complementary feeding of infants start, according to the Milk Code?