1
Q
T or F: Students who live on campus have better diets than those who live off campus?
A
True
2
Q
BMI measures don’t accurately represent healthy weights for which of the following?
a. athletes with a large % of muscle
b. individuals with little muscle mass
c. individuals with large, dense bones
d. dehydrated individuals
e. all of the above
A
a. athletes with a large % of muscle
3
Q
Fertility is often compromised in women with a body mass index (BMI) > ?
a. 35
b. 30
c. 40
d. 50
A
b. 30 (obese)
4
Q
Fertility is often compromised in women with a body mass index (BMI) < ?
a. 16
b. 18
c. 20
d. 23
A
c. 20
5
Q
The first half of pregnancy is considered the “maternal ______”, while the second half of pregnancy is considered the “maternal ______”
A
anabolic phase / catabolic phase
6
Q
By how much do energy needs increase in the first trimester of pregnancy?
a. 0 kcal
b. 100 kcal
c. 200 kcal
d. 300 kcal
A
a. 0 kcal
7
Q
What are the four main factors that need to be fulfilled in order to achieve food security?
A
- Access
- Availability
- Food supply and systems
- Cultural acceptability
8
Q
What are examples of the four main factors that need to be fulfilled in order to achieve food security?
A
…
9
Q
Which of the following dietary components has NOT been shown to have a relationship to impaired fertility in women?
a. A regular intake of soy foods
b. A low caloric intake
c. Alcohol
d. Caffeine
e. Vitamin D
A
e. Vitamin D
10
Q
The mainstay of treatment for gestational diabetes is to normalize blood glucose levels with _____.
a. oral medications
b. insulin injections or an insulin pump
c. a low-calorie, high-protein diet
d. medical nutrition therapy focusing on diet and exercise
e. a very low calorie intake
A
d. Medical nutrition therapy focusing on diet and exercise
11
Q
What is a calorie?
A
a measure of the amount of energy transferred from food to the body
12
Q
What are the 6 categories of nutrients?
A
- carbohydrates
- proteins
- fats
- vitamins
- minerals
- water
13
Q
Which nutrients can be not make on our home, and can only obtain from our diet?
A
- carbohydrates
- certain amino acids
- essential fatty acids (Omega 3 and 6)
- Vitamins and minerals
- water
14
Q
What are some non-essential nutrients? (Present in foods and used by the body, but not required in the diet since we can also make them)
A
- cholesterol
- glucose
15
Q
Poor nutrition can result from both ______ and ______ levels of nutrient intake
A
inadequate and excess
16
Q
Malnutrition is the term for both:
A
undernutrition and overnutrition
17
Q
What fat-soluble vitamin is given to all infants at birth?
a. Vitamin A
b. Vitamin D
c. Vitamin E
d. Vitamin K
A
d. Vitamin K
18
Q
Milk “comes in” during which stage of lactogenesis?
a. lactogenesis I
b. lactogenesis II
c. lactogenesis III
d. Lactogenesis IV
A
b. lactogenesis II
19
Q
Define: Minerals
A
a group of inorganic compounds essential for proper nutrition and growth, and required in limited amounts in diet
20
Q
Define: Vitamins
A
a group of organic compounds essential for proper nutrition and growth, and required in limited amounts in diet
21
Q
Define: RDAs
A
Levels of essential nutrients; adequate for most healthy people (98% of population); decrease risk of certain chornic diseases
22
Q
Define: Adequate Intakes
A
tentative RDAs; used when scientific information is less conclusive
23
Q
Define: Estimated Average Requirements (EARs)
A
estimated values to meet requirements of half of the healthy individuals in a population group
24
Q
Define: Tolerable Upper Intake Levels (ULs)
A
Upper limits of nutrients compatible with health; these should not be exceeded
25
How many calories per day is the daily value based on?
2000 cal/day
26
List some factors that impact nutrient needs:
- Age
- body size
- gender
- Genetic traits (ie thyroid)
- Growth
- Illness
- Lifestyle habits
- Medications
- Pregnancy and Lactation
27
What is the focus of this course?
- Promoting health (vs treating disease)
- Investigating nutritional needs for the various life-stage groups
- Population (vs individual) level guidance
28
What is the WHOs
| 1948 definition of health?
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
29
What is the WHOs expanded 1984 definition?
"The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment"
30
List some fundamental conditions and resources for health:
- peace
- shelter
- education
- food
- income
- a stable eco-system
- sustainable resources
- social justice and equity
- Improvement in health requires a secure foundation in these basic prerequisites
31
Please explain the Population Health Approach (aka Public Health Approach):
- our health and health behaviours are the result of numerous determinants from various sectors
- to improve health, action must be taken of the full range of health determinants and involve numerous sectors
32
List the 12 core social determinants of health (According to Public Health Agency of Canada):
- Health services
- education
- physical environment
- social support networks
- income and social status
- employment and working conditions
- biology and genetic conditions
- culture
- personal health practices and coping skills
- healthy child development
- social environment
- gender
33
Define the term "essential nutrients". Identify two essential nutrients, and representative examples of foods that contain them. (Short answer question)
- Carbs and vitamin C (orange juice or fruits)
| - look into this
34
What are the three levels of prevention of disease?
- Primary: reduce new cases of problem behaviour (ie. quit smoking)
- Secondary: Reduce current cases of problem behaviour)
- Tertiary: Reduce complications, intensity, severity of current cases (Already diagnosed with conditions or diseases; e.g. smoking: already been diagnosed with lung cancer)
35
What are some examples of Primary prevention of disease?
- session on healthy eating to prevent cancer
- getting your flu shot
- vaccinations
- putting on sunscreen to prevent skin cancer
36
Define: Primary prevention
- health promotion activities aimed at preventing a specific illness or disease
- precedes disease; applied to generally healthy individuals
37
What are some examples of secondary prevention of disease?
- Breast self-exam
- Blood pressure tests
- screening for a specific illness (e.g. type 2 diabetes)
38
Define: Secondary Prevention
- activities focused on early identification of health problems
- identify and treat individuals who have asymptomatic/preclinical disease
39
What are some examples of Tertiary Prevention of Disease?
- Educating a person with type 2 diabetes how to identify and prevent complications
- referring a person who has had a stroke to rehabilitation centre
40
Define: tertiary prevention of disease
- Educating of an individual with the disease with the goal of returning individual to optimum level of functioning
41
What organizations are involved with Health Promotion in Canada at the federal level?
- Public Health agency of Canada (PHAC)
- Health Canada
- Canadian food inspection agency
42
What organizations are involved with Health Promotion in Canada at the provincial level?
- Ministry of health and long term care
| - public health units
43
What does Health Canada do?
- Health care
- education, food guide
- development of food regulations (food labelling, the food and drugs act)
44
What does the Public Health Agency of Canada do?
- Health promotion
- Prevention and control of disease
- Disease surveillance
- Public Health emergencies (food borne illness outbreaks)
45
What does the Canadian Food Inspection Agency do?
- Enforcement of food regulations set by Health Canada
- Inspection of facilities
- Identification and oversight of food recalls
46
Is scientific evidence required for any health claim that is put on a label?
- Yes, health claims that are on products are very strictly regulated
47
What are the branches of the Public Health Agency of Canada?
- Infectious disease and emergency preparedness
- Health promotion and chronic disease prevention
- Public Health practice and regional operations
- Strategic policy, communications and corporate services
48
What are the PHAC areas of emphasis?
- New: healthy eating, physical activity, and their relationship to healthy weights
- Existing: tobacco, diabetes, chronic disease prevention, etc.
- Possible Future: mental health, injury prevention
49
What is a high sodium diet associated with?
- elevated blood pressure
- some evidence risk factor osteoporosis
- stomach cancer
50
What is the recommended sodium intake?
- 1500 mg/day (9-50 years)
| - UL: 2300 mg/day (14 and older)
51
What are some actions that the Ministry of Health and Long Term Care has taken?
- Health eating and active living (HEAL) action plan: est. 2006; ontario's effort to meet Pan-Canada's health living strategy targets
- Healthy Change Ontario's Action Plan: Est 2012, focused mainly on improving clinical care, includes a child obesity strategy, does not replace HEAL
52
What are some examples of the HEAL program?
- Access to healthy food for children (northern fruit and veg program, health school recognition program)
- Help Ontarians access dieticians (Eat Right Ontario until 2018 telephone line to dieticians, replaced with www.unlockfood.ca)
53
What are the three priorities of Healthy Change Ontario?
1) keep Ontario healthy
2) faster access to stronger family health care
3) right care, right time, right place
54
What are the differences in the Ministry of Health and Long Term Care programs, in terms of overall strategies? (Short answer)
Healthy Change Ontario: aging population calls for needed changes in health care delivary, action plan to build a quality system that is more responseive to patients, focuses mainly on improving clinical care
HEAL: Access to healthy food for children (especially up North), access to dieticians
55
What are some successful Public Health Messages?
- Lower your sodium intake
- Stop smoking
- Eat smaller portions of food
- the most successful messages are the clear messages
56
What are some poorly worded/confusing public health messages?
- Low-fat diets are good
- Low-fat products are high-carb products
- not all fats are bad
- promotion of high protein diets for weight loss
57
What do Dieticians do in Public Health?
- Preparation of kits, educational material (healthy faces healthy places- manual for licensed child care programs locally)
- Liaise with policy makers to work on nutrition policy implementation and guidelines
- public level screening (secondary level)
- Public level education
- Nutrition counselling
58
What are the markers of transition to adulthood?
1) Completed education
2) Left parent's home
3) Full-time work (financial independence)
4) Life Partner
5) Starting a family
59
What is emerging adulthood?
- A period of time to explore possibilities and define one's self, while feeling caught in between adolescence and adulthood
60
Why is emerging adulthood a new life stage?
- more university educated women than men
- people are generally leaving school at older ages
- people re leaving their family home later in life
- age of marriage is gradually increasing
- Average age of marriage in 1972: Men 25, women 22
Average age of marriage now: men 31, women 29
- age of parenthood is also increasing
61
What are some characteristics of emerging adulthood?
- Don't see themselves as adults
- Time of identity exploration (work, love, worldviews, lifestyle)
- High levels of transition
62
When does the human brain reach mull maturity?
in the mid 20s
63
What does the Prefrontal Cortex do?
- Involves the processing of tasks such as:
- calibration of risk and reward
- problem solving
- prioritizing
- long term planning
- self-evaluation
- regulation of emotion
64
Define: Myelination (changes to prefrontal cortex)
More extensive myelination of nerves in this area of the brain = more efficient signal transmission
65
Define: Synaptic pruning (prefrontal cortex)
nerve connections are pruned back = more efficient signal transmission among remaining nerves
66
What changes are made by the end of emerging adulthood?
- More complex thinking (consider both present and future)
- Appreciation of diverse views
- Emotional regulation
- Risk taking and decision making (increased ability to modulate risk-taking; making decisions about the future)
67
What is the overall health and wellbeing of emerging adults like?
- self reported health is good to excellent
- rates of disease and disability are low
- peak in substance use, sexually transmitted infections
- Psychiatric disorders also peak, but depression tends to decrease
68
Eating 'on the run' is associated with what?
- sugar sweetened beverages
- fast foods
- total fat and saturated fat
- fruit and vegetables
69
What are the obesity rates among emerging adults in Canada?
- 13% of males
| - 18% of females
70
What are the key considerations for using BMI?
- 18+ years of age
- based on population level data
- only part of an individuals risk assessment
- does not take into account bone density
- not to be used with pregnant or lactating women
- does not capture risk with weight change
71
BMI results are LESS accurate for who?
- Emerging or young adults
- muscular/lean individuals
- certain population groups
- older adults >65
Dehydrated individuals
72
What is the estimated impact of social determinants of health? (%)
- Physical environment (10%)
- Biology and genetics (15%)
- Health care system (25%)
- Social and Economic Development (50%)
73
List the 14 social determinants of Health (york university study):
- Income and income distribution
- education
- unemployment and job security
- employment and working conditions
- early childhood development
- food insecurity
- housing
- social exclusion
- social safety network
- health services
- aboriginal status
- Gender
- race
- Disability
74
Review Social-Ecological Model for short answer question (know examples for each)
:)
75
Social-ecological Model: Individual: Examples
- personal level factors (e.g. age, food preferences)
| - impact: mental health, allergies, being vegetarian or vegan, religious reasons)
76
Social-ecological Model: Interpersonal/Intrapersonal
- factors relating to the influence of families, peers and partners, culture
- ex. eating out with friends, what they order may influence what you're going to order
77
Social-ecological Model: Organizational/ Institutional
- practices, and physical environment of an organization
- eg. a school/child care, workplace
- ex. less autonomy to choose when you eat at work or school, if you have a place to walk around at lunch times)
78
Social-ecological Model: Community
- cultural values or norms unique to urban, rural and remote settings
- downtown food may be expensive,, rural environment you absolutely need transportation to get to the grocery store)
79
Social-ecological Model: Public Policy
- broader guidelines at various levels of government (ie Canada's Food Guide)
- ex. access to health services and health care
80
Social-ecological Model: EXAMPLES
Individual: Lactose intolerant
Interpersonal: Do you eat meals with family?
Organizational/ Institutional: Time and space to eat lunch?
Community: Living in food desert or in rural community?
Public Policy: Nutrition North Policy (subsidy to bring in perishable and nonperishable goods to northern communities)
81
Define: Food Security
- all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy lifestyle (FAO 1996)
82
Define: Food Insecurity
- the inability to acquire nutritionally adequate foods in culturally acceptable ways (Anderson, 1990)
83
What are the four factors of food security?
- Food availability
- Food Access
- Food supply and systems
- Cultural acceptability
84
Discuss Food Availability:
- Daily energy, macronutrient and micronutrient needs must be met
- quantity as well as quality of the foods available are both important
- if it is at the store
85
Discuss Food Access:
- It's one thing to have food that's available in our local environment, but it is another thing to actually have access to these foods
- having access to foods at their peak nutrient content time
- whether you can actually bring the food home with you
86
Discuss Food supply and Systems:
- The environmental impacts of climate change can also lead to droughts, floods, sharp price increases, especially in Northern Canada
87
Discuss Cultural Acceptability:
- First Nations, Inuit, Metis version of Canada's Food Guide
| - Ie. wild rice, bannock, smoked salmon
88
Discuss Health inequality vs inequity
- health inequality or disparity is the difference in health status experience by various groups in society
- Health inequities are the structural, systemic, social-produced and unfair differences in health or determinants that are avoidable and could be mitigated through policy and action
89
What are four main factors that need to be fulfilled in order to achieve food security?
- access
- availability
- food supply and systems
- cultural acceptability
90
Define: fertility
production of children
91
Define: infertility
inability to bear children
92
Define: fecundity
biological ability to bear children
93
Define: infecundity
biological inability to bear children after one year
94
Define: subfertility
reduced level of fertility or early pregnancy losses
95
What % of couples are subfertile in Canada?
about 16% (approx 44% of these will conceive with no intervention in 3 years
96
Healthy couples have a ___ % chance of diagnosed pregnancy within a single menstrual cycle?
20-25%
97
Define: puberty
period in which humans become biologically capable of reproduction
98
Define: Ova
female reproductive cells that are produced and stored within the ovaries
99
Define: Follicle
cellular structure in ovary where an ovum matures
100
Define: sperm
male reprodictive cells
101
How long does puberty occur?
occurs over the course of 3-5 years
| - reproductive systems begin to develop within the first months after conception
102
Reproductive Physiology: Women
- born with lifetime supply of approx 7 million immature ova
| - during fertile years about 400-500 ova will mature and be released
103
What are the four hormones involved in the menstrual cycle?
- Gonadotropin- releasing hormone (GnRH)
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Estrogen
104
Define: Gonadotropin- releasing hormone (GnRH)
- released by hypothalamus
| - stimulates the anterior pituitary gland to release FSH and LH
105
Define: Follicle- stimulating hormone (FSH)
- stimulates maturation of ovum (and sperm in men)
| - stimulates production of estrogen
106
Define: Luteinizing hormone (LH)
- Stimulates secretion of progesterone
| - surge in LH causes the release of the ovum
107
Define: Estrogen
- stimulates further growth and maturation of follicle
- Stimulates vascularity and storage of glycogen and other nutrients
- Decrease in estrogen at end of the menstrual cycle stimulates release of GnRH
108
Define: Progesterone
- Prepares uterus for fertilized ovum, increases vascularity of endometrium, and stimulates cell division of fertilized ova
109
What are the two phases of the menstrual cycle?
- Follicular phase (first half of menstrual cycle)
| - Luteal Phase (last half of menstrual cycle)
110
Define: Follicular Phase
- follicle growth and maturation
| - Main hormones: FSH, LH, estrogen and progesterone
111
Define: Luteal Phase
- after ovulation (day 14)
| - if ovum not fertilized, decrease in estrogen stimulates the release of GnRH and it all starts again
112
Reproductive Physiology: Men
- men born with sperm producing capability
- sperm production begins during puberty, decreases somewhat after age 30 with production continuing to old age
- Ongoing versus cyclic
113
Sperm Production Hormones:
- GnRH signal release of FSH and LH
- FSH and LH stimulate production of testosterone by testes
- Testosterone stimulate maturation of sperm, takes 70-80 days
- Sperm are stored in the epididymis (on top of testes) and released in semen
114
What are the main fertility disruptions?
- contraceptive use (eg. effects on hormones that regulate ovulation)
- Severe stress
- infection (eg. Pelvic inflammatory disease and STIs which can result in scarring and blockage of fallopian tubes)
- tubal damage or other structural damage
- chromosomal damage (sperm and eggs)
115
List some nutrition and lifestyle factors affecting fertility:
- mostly related to erengy status and nutrient adequacy
- obesity
- weight loss
- undernutrition
- high intensity training
- low intake of specific foods and food components
116
What do changes in levels of estrogen, testosterone and leptin affect?
- Follicular development
- Ovulation
- Sperm Production and maturation
117
True or false: both excess and inadequate levels of body fat are related to decreased fertility in women and men?
True
118
Increased body fat and fertility in women:
- Estrogen and leptin levels increase with high body fat and reduced with low body fat
- Obese women tend to have higher levels of estrogen, androgens and leptin
- Hormonal differences can result in irregularity of the menstrual cycle, ovulatory failure and amenorrhea (ovulatory failure) - loss of menstrual period altogether
119
Increased body fat and fertility in men:
- Obesity associated with lower testosterone levels, and increased estrogen and leptin levels
- Lower levels of testosterone- lower sperm production
- Other hormonal changes associated with erectile dysfunction
120
True or false: Weight loss can reduce or even eliminate fertility problems
True
121
What should weight reduction strategies do?
- focus on lifestyle changes
- improve overall diet quality
- decrease caloric intake (as appropriate)
- Increase physical activity
122
Define: Acute undernutrition
associated with a dramatic decline in food energy and nutrients that recovers with normal food intake or eating behaviour
123
Define: chronic undernutrition
- Primary effect = birth of small and underweight infants with high likelihood of death in the first year of life
- reduced fertility
124
Factors of undernutrition
- body's adaptation to undernutrition likely prevents normal reproductive cycles when calorie and nutrient requirements for fetal growth cannot be met
- food shortages in countries have been accompanied by dramatic declines in birth rates
125
For women, what are some adverse effects of intense physical activity over the long-term?
- delayed age at puberty
- lack of regular menstrual cycles
- reduced levels of estrogen
- low levels of estrogen
- low levels of body fat
- decreased bone mass; may cause stress fractures
- effects are the result of hormonal and metabolic changes due to severe caloric deficits
126
What does the female athletic triad consist of?
- Amenorrhea
- Eating disorder
- Osteoporosis
127
Information about female athletic triad:
- triggered when energy intake is substantially less than the requirement
- results in decreased LH and FSH levels and lack of estrogen
- Low hormone levels can lead to reduction in bone density and increased risk of stress fractures; critical since peak established before age 30
128
What is oxidative stress?
occurs when the production of free radicals exceeds the body's own antioxidant defenses
129
What happens when there is oxidative stress for men?
- decreased sperm motility
| - reduces ability of sperm to reach egg
130
What happens when there is oxidative stress for women?
- harm egg and follicle development
| - interferes with implantation of the egg
131
What are some key antioxidants?
- vitamin C
- vitamin E
- beta-carotene
- selenium
(increased intake associated with increased fertility)
132
Preventing Oxidative Stress: Zinc
```
In men only:
Prevents oxidative damage
Involved in sperm maturation
Involved in testosterone synthesis
Low zinc status associated with:
Low sperm count
Low sperm quality
Abnormal morphology
Supplementation can improve sperm quality
Foods that contain zinc: nuts, meats, seafood, whole grains
```
133
What is low iron intake linked to?
- premature delivery
| - low iron status of infant
134
True or false: rate of infertility is lower in women who use iron supplements
true
135
True or false: heavy metals are related to decreased sperm production and abnormal motility and mobility
true
136
True or false: folate intake is related to increased fertility in women and the healthy development of an embryo following conception
true
137
True or false: Folate is not very important in the periconceptional period- after conception, but before the pregnancy is diagnosed
False, folate is VERY important
138
What can insufficient amounts of folate affect?
- insufficient amounts can affect embryonic development especially neural tube defects
- defects occur in the very early stages of pregnancy
139
What is the recommended amount of folate?
- 400 ug/day in supplemental form (multivitamin) to all women who are sexually active and at risk of becoming pregnant
140
Who is most vulnerable to not having enough folate?
- single women
- unplanned pregnancies
- low education
141
Where can you find naturally occurring folate?
- green leafy vegetables
- asparagus, broccoli, brussel sprouts
- dried beans, lentils and peas
- Avocado
- Corn, beets
- Fruits
- Whole grains
- Beef liver
- Yeast preparations
142
Define: Bioavailability of nutrients
- the efficiency of absorption, utilization and/or retention of the nutrients present in food
143
What can bioavailability be affected by?
- nutrient content of the food
- food processing
- the physical state of the person
- ability to digest and absorb nutrients compromised
- interactions among components of the diet
- the presence of anti-nutritional factors
144
How can bioavailability be improved?
- Fortification: the addition of nutrients not originally present in the particular food
- Enrichment: the addition of nutrients that were lost during food processing
145
What is the difference between folate and folic acid?
Folate:
- natural form
- limited bioavailability (~50% absorbed)
- prone to damage
- found in leafy green veg, corn, beets, citrus, whole grains, etc.
Folic Acid:
- Synthetic form
- high bioavilability
- found in supplements and supplemented foods
146
What are some examples of foods in Canada that are fortified by folic acid?
- white flour
- enriched pasta
- infant formula
- simulated egg/meat/poultry
147
What is the leading cause of female infertility?
Polycystic Ovary Syndrom (PCOS)
148
What are some clinical signs associated with PCOS?
- high levels of intra abdominal fat
- obesity
- menstrual irregularities
- acne
- polycystic ovaries
- high testosterone
- insulin resistance
149
Info about PCOS
- approx 70% are infertile
- absence of ovulation (outer layer of ovaries thickened, difficult for egg to break through and be released)
- Irregular menstruation
- Increased Risk of spontaneous abortions and gestational diabetes
150
What is the suggested diet for management of PCOS?
- veg and fruit, lean protein
- whole grains, fibre, nonfat dairy
- regular meals
- healthier fat sources
- low Glycemic Index (GI) foods
151
Define: Glycemic Index (GI)
- measure of the extent to which 50gm of carbohydrate containing food raises 2 hour post-meal blood glucose compared to a similar amount of glucose or white bread
152
True or false: a low GI diet may be helpful in management of PCOS
true
153
Which food has the highest GI?
a) cornflakes
b) bagel
c) banana
d) apple
e) orange juice
a) cornflakes
154
Which food has the lowest GI?
a) cornflakes
b) bagel
c) banana
d) apple
e) orange juice
d) apple
155
Exposure to high blood glucose levels in early pregnancy is related to what?
- increases risk of miscarriage
| - increases risk of mother and infant developing type 2 diabetes later in life
156
What can be done to reduce the risk of developing gestational diabetes?
- weight loss
- exercise
- healthful dietary pattern
- increased fibre intake
- intake of low GI carbohydrate sources
- Increased vegetable and fruit consumption
157
Define: Gestational Age
- assessed from date of conception
| - average pregnancy is 38 weeks
158
Define: Menstrual age
- assessed from onset of last menstrual period (LMP)
| - average pregnancy is 40 weeks
159
What are the two phases of pregnancy?
- Maternal anabolic (week 1-20)
| - Maternal catabolic (week 20-40)
160
Discuss Maternal anabolic:
- focus is building mother's capacity to carry the child
- approx 10% of fetal growth occurs
- week 1-20
161
Discuss maternal catabolic:
- stored energy and nutrients to fetus
- approx 90% of fetal growth occurs
- week 20-40
162
How much body water does a woman hold during pregnancy?
Increases between 7 and 10 litres
- results from increased plasma and extracellular volume and amniotic fluid
- begins first few weeks after conception
163
Define: Edema
- swelling due to accumulation of extracellular fluid
164
Carbohydrate Metabolism in Pregnancy:
- Glucose is preferred fuel for fetus
- Early pregnancy (anabolism)
Hormones promote increased insulin production
- Later pregnancy (catabolism)
Increased insulin resistance in mother
- “ Diabetogenic effect of pregnancy” results from maternal insulin resistance
165
Protein Metabolism in Pregnancy:
- About 925g of protein accumulated for new maternal and fetal tissue
- No extra protein is stored; less used for energy and more used for protein synthesis
- Additional need for protein primarily met by mother’s intake
166
Fat Metabolism in Pregnancy:
- Accumulate in first half of pregnancy (anabolic)
- Enhanced fat mobilization in last half (catabolic)
- Blood lipid levels increase
- Know that third trimester tryglyceride and cholesteral are highest
167
Mineral Metabolism in Pregnancy:
- Calcium
Increased bone turnover; more calcium absorbed from food
- Sodium:
Increased requirement due to elevated body water and tissue enlargement
Is necessary, restricting sodium intake could be dangerous
168
What is the function of the placenta?
- hormone and enzyme production
- nutrient and gas exchange
- removal of waste from fetus
169
What is the placenta?
- disk-shaped organ of nutrient and gas exchange between mom and fetus
170
What are the factors that affect the nutrient transfer in the placenta?
- size and charge of molecules: small molecules with little charge pass through most easily
- lipid solubility of particles: lipids pass through more easily
- concentration of nutrients in maternal and fetal blood (high to low concentration)
171
What is the order of priority for nutrients?
mother > placenta > fetus
172
When is the most critical time for fetal development?
first two months post-conception
173
Define: Very preterm birth
- a gestational age less than 32 completed weeks
174
Define: Perinatal mortality
- the combined mortality of stillbirths and live births with death occurring up to 6 days of age as a proportion of all births
175
What is considered a low birth weight?
birth weight < 2500 g (5.5 lbs)
176
Define: Small for gestational age (SGA):
- dSGA: disproportionately small for gestational age; asymmetrical
- pSGA: proportionately small for gestational age; symmetrical
177
Define: Large for gestational age (LGA)
- >90th percentile for sex and gestational age
| - also birth weight greater than 4500 g or 10 lbs
178
What are some risk factors for preterm birth?
- poor uterine blood blow
- incompetent cervix
- pre-eclampsia
- cigarette smoking
- undernutrition
- low weight gain during pregnancy
- short interval between pregnancies
- multi-fetal pregnancy
- stress
- anxiety
- depression
179
Where does the weight go when a woman is pregnant?
- Baby: 7-8 lbs
- Maternal fat and nutrient stores: 7 lbs
- Maternal blood: 4 lbs
- Fluids in maternal tissue: 4 lbs
- Placenta: 1-2 lbs
- Amniotic fluid: 2lbs
- Uterus: 2 lbs
- maternal breast tissue: 2lbs
Total: 30 lbs
180
What risks are associated with a mother gaining too little weight?
- preterm birth
- poor fetal growth
- small for gestational age
181
What are the risks associated with a mother gaining too much weight?
- Preterm birth
- large for gestational age
- caesarean birth
- weight retention mom- future risk of obesity
182
What are the energy needs in each trimester?
- Trimester 1: No increase in Kcal
- Trimester 2: Increased Kcal by 340
- Trimester 3: Increased Kcal by 452, essentially 2-3 more servings from EWCFG
183
Info about increased fluids in pregnancy:
- met by increased levels of thirst
- average consumption during pregnancy ~ 9 cups fluid per day
- recommended water, diluted fruit juice
184
Carbohydrate intake during pregnancy is about _____ % of total Kcal?
50-65%
185
How much protein does a pregnant woman need?
- +25g/day or ~71 g particularly in second and third trimester
- average intake of typical female ~ 78g
186
What is folate needed for?
- organ and tissue growth, gene expression
187
What happens if a pregnant woman has inadequate intake of folate?
- birth defects: cleft palate, heart and brain defects, neural tube defects
- low birth weight and preterm delivery
188
What role does vitamin A play in pregnancy?
- critical in cell differentiation
| - Deficiency --> adversely affect fetal lungs, urinary tract, heart
189
What is additional iron needed for in pregnancy?
- used by fetus and placenta
- increased red blood cells
- blood loss at delivery
190
What are the two types of iron?
- Heme Iron: found in meat poultry and fish; is more readily absorbed
- Non-heme Iron: found in eggs, plant-based foods, and whole grain products
191
What are the three main inhibitors of iron absorption?
- Polyphenols from tea and coffee
- Phytate in legumes and some vegetables, and unrefined rice and grains; phytate is the storage form of phosphorus in some plant tissues
- calcium at levels above 300 mg
192
How can a pregnant woman optimize her iron absorption?
- Include at least one source of vitamin C with meals, particularly plant-based meals
- drink tea or coffee 1 or 2 hours after meals rather than with meals
- advise against taking calcium supplements or calcium- containing antacids with meals
193
What are some benefits of physical activity during pregnancy?
- may decrease risk of developing gestational diabetes
- better placenta function and birth outcomes
- helps prepare for birth- shorter labour
- prevents weight retention postpartum
194
What causes milk ejection?
Myoepithelial cells, that line the alveoli, contract during letdown causing milk ejection
195
What are the two key hormones in lactogenesis?
- Prolactin: suckling doubles secretion, also stress, sleep and sex
- Oxytocin: sometimes associated with pain, suckling, thinking about child, crying, sex
196
What are the stages of lactogenesis (milk production)?
- Lactogenesis I
- Lactogenesis II
- Lactogenesis III
197
Describe Lactogenesis I:
- Begins during last trimester of pregnancy and lasts until 2-5 days after birth
- milk formation begins, and lactose and protein content of milk increases
- lactose is major CHO in milk
- may be affected by premature delivery
- Mothers with premature births typically unable to provide full milk supply
198
Describe Lactogenesis II:
- Begins 2-5 days after birth
- Characterized by increased blood flow to breasts; milk "comes in" or onset of milk secretion
- significant changes in milk composition and quantity over the first 10 days of life
199
Describe Lactogenesis III:
- Begins about 10 days after birth
| - Milk composition is more stable
200
Discuss Human Milk Composition:
- Human milk is the only food needed by the majority of health infants for up to 6 months of age
- composition changes over a single feeding, over a day, based on age of the infant, presence of infection in the breast, with menses, and maternal nutritional status
- also allows for transfer of energy, nutrients and antibodies (IgA) from mother to infant to protect against infections
201
What is Colostrum?
- The first milk secreted in lactogenesis II
- very high in protein compared to milk once established
- Secretory Immunoglobin A (IgA) and lactoferrin; both involved in immune function
- lower in energy, lactose and fat
202
Which is higher in fat, foremilk or hindmilk?
hindmilk
203
Discuss water and energy in human milk:
- Water: major component in human milk, Isotonic with maternal plasma (same concentration)
- Energy: Approx 0.65 kcal/ml, higher-fat milk has more calories than lower-fat milk; can vary during a feed, less in calories than human milk substitutes
204
Discuss Lipids in Human Milk:
Lipids:
- second largest component in human milk
- provide half the calories in human milk
Maternal diet affects the fatty acid profile, but not total fat content
205
Discuss DHA (omega 3) and lactation:
- essential for retinal development
- associated with higher IQ scores
- Present in human milk from maternal diet
206
Discuss cholesterol and lactation:
- more in human milk than human milk substitutes
- early consumption of cholesterol through breast milk appears to be related to lower blood cholesterol levels later in life
207
Discuss protein and lactation:
- protein content relatively low compared to other mammals (lower than whole cow's milk)
- Protein concentration in breast milk mostly dependent on time since delivery:
Proteins have both nutritional and non-nutritional effects, some have antiviral and antimicrobial effects
208
Discuss Protein fractions in human milk: Casein
- main protein in mature human milk; contributes to white appearance
- facilitates calcium absorption; increases calcium bioavailability by creating a soluble complex
209
Discuss Protein fractions in human milk: Whey
- Other water-soluble proteins in milk
- some mineral-, hormone- and vitamin- binding proteins are part of whey; example is lactoferrin which carries iron in a form that is easily absorbed
210
What are the fat-soluble vitamins?
Vitamin K:
- all children supplemented at birth
- about 5% of breastfed infants at risk for K deficiency based on clotting factors
- infants who did not receive at birth may be deficient
Vitamin E:
- levels linked to milk's fat content
- levels adequate to meet needs for full-term infants
- muscle development; prevention of red blood cell lysis
- Levels are inadequate to meet needs of preterm infants
211
What are the fat-soluble vitamins in human milk?
Vitamin A:
- important for cell differentiation
- content in colostrum is about twice that of mature milk
- yellow colour of colostrum comes from vitamin A in form of beta-carotene
Vitamin D:
- Key for fetal growth, addition of calcium to bone, and tooth enamel formation
- milk content varies with mother's diet and sun exposure
- maternal sun exposure can increase Vitamin D levels in ___ to 10 fold
- exclusively breastfed infants need supplements
- Only vitamin recommended as a supplement to infants
212
What are the benefits of breastfeeding on the baby?
- best nutrition
- increased bioavailability, composition changes
- protection from GI, respiratory and ear infections
- Decreased infant mortality
- Decreased risk of allergy, asthma, eczema, inflammatory bowel disease, metabolic conditions
- special benefits for preterm infants
213
Benefits of breastfeeding for the mother:
- reduced postpartum bleeding
- delayed return of ovulation
- decreased risk of breast and ovarian cancer and osteoporosis
- return to pre-pregnancy weight
- increased self-confidence and bonding with infant
- practical
214
What are the three categories of breastfeeding recommendations?
1. Duration
2. Process
3. Maternal Diet
215
Explain Breastfeeding Duration:
- early initiation of breastfeeding within 1 hour of birth
- exclusive for six months of life
- introduction of texture appropriate solids after 6 months
216
Explain Breastfeeding process:
- positioning the baby
- positioning the breast
- presenting the breast
- proper infant latch
217
Explain the Maternal Diet:
- increase in energy
- drink 16 cups of fluids per day
- increased protein intake
- Increased vitamin C, A, E, potassium, zinc, iodine, selenium, copper, manganese, chromium, choline
- No increase in vitamin D, K, sodium, chloride, calcium, phosphorus, magnesium, fluoride
218
Some conditions associated with breastfeeding:
- Neonatal Jaundice
| - Bilirubin Metabolism
219
What % of newborns are visibly jaundiced?
60-70%
220
Define: Bilirubin
a pigment produced as heme from red blood cells break down
Usually processed by the liver and excreted in the baby’s stool
Newborn’s liver not fully mature so jaundice is most common during first few days of life
Colour appears first in the eyes, face and upper body then progresses downward toward the toes
221
Which of the following is NOT a common barrier to breastfeeding initiation?
a. Embarrassment
b. Lack of confidence
c. Fear of pain
d. Lack of support
e. All of the above are common barriers to breastfeeding
e.All of the above are common barriers to breastfeeding
NUTR 2050
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