Nutrition 352 Final

Protein RDA for adults

0.8 g/kg/day

Which of the following nutrition problems is the LEAST common among young children? a. Iron-deficiency anemia b. Dental caries c. Constipation d. Lead poisoning

d. Lead poisoning

The major contributors to the increase in childhood weight problems are thought to include: a. high-energy, high-fat diets. b. sedentary lifestyles. c. lack of time to eat regular meals. d. a and b e. b and c

d. a and b High-energy, high-fat diets Sedentary lifestyles

A decrease in the production of GnRH (gonadotropin releasing hormone) would result in: a. a decrease in the production of FSH and LH. b. a lack of follicular development. c. the absence of ovulation. d. All of the above e. a and b only

d. all of the above

Females experience a _____ increase in body fat during puberty.

120%

Menstrual Cycle Phases

1st 1/2 of phase: follicular phase 2nd 1/2 of phase: luteal phase

Dental caries:

1 in 3 children ages 3-5 has decay in at least 1 tooth Caused by using bottle at bedtime, bacteria eats through enamel, children who "graze" all day are at increased risk. Prevented by brushing/rinsing or crunchy foods, and fluoride

Energy in breast milk

0.65 kcal/mL or 20 kcal/oz Average intake is about 28 oz/day

True/False: a dry mouth is a normal condition of aging

False

Maternal changes during the 2nd half of pregnancy:

Fat and nutrient stores are mobilized, blood glucose increases, blood TG and FA increase, liver glycogen content decreases

Obesity and fertility in women

Fat cells produce estrogen, testosterone, and leptin. Insulin resistance and elevated insulin is associated with reduced levels of sex-hormone binding globulin (SHBG), which means higher levels of ACTIVE androgen

Babies shouldn't introduce water until

6 months of age

Iron deficiency is most common between ________ due to _________

6 months to 3 years; rapid growth and inadequate intake of dietary iron

Maternal energy for lactation

6 months: +330 kcals/day 6+ months: +400 kcals/day

Human Milk Composition

6% protein 55% fat (needed for brain development) 29% carbohydrates

How many hours can freshly expressed breast milk be left at room temperature and still be considered safe for a baby?

6-8 hours at 78°F

Food allergies and intolerances in children

6-8% of children < 4 have 60-80% of milk and egg allergies are outgrown by age 7 Caused by absorption of intact proteins Symptoms are wheezing and rashes Lower risk with breastfeeding

Serum

Fluid remaining after the blood has clotted and been centrifuged, & the clot and blood cells have been removed

Having a deficiency of which vitamin has been implicated in increased blood levels of homocysteine in the elderly?

Folate

Which hormone triggers the growth/maturation of 6-20 follicles (even though only 1 fully matures and gets released), and stimulates that follicle to produce and release estrogen

Follicle stimulating hormone (FSH)

Development in infants

Follows a proximodistal principle: from center of body outward, with large muscle development in trunk, arms, and legs occurring before small muscle development in hands and fingers

Food restriction can be caused by...

Food morality, weight, body image, performance, etc.

Instrumental Activities of Daily Living (IADLs)

Food prep, phone use/communication, housekeeping, laundry, use of transportation, medication responsibility, money management, shopping These activities allow an individual to live independently in a community

Ms. C. has smell loss due to aging. Because of this sensory loss, Ms. C is now at an increased risk for

Food-borne illness (she may not be able to smell food that has spoiled and could eat it without realizing it is contaminated)

Nutrient dense foods

Foods that are both good sources of nutrients and low in calories

Food sources of Choline:

Found mostly in animal sources

HMO: human milk oligosaccharides

Function as probiotics that stimulate the growth of good bacteria

Indication for TPN Use

Functional immaturity of the GI tract Surgical disorders Short bowel syndrome Inadequate enteral intake Necrotizing enterocolitis of the bowel

Preferred food for fetus

Glucose

Hemoglobin A1C: measures avg blood glucose over the previous 60-100 days

Goal for DM <7%

How to prevent ID in infants

Good maternal iron status, breast milk/iron fortified formula, good iron sources for complementary foods, iron supplements beginning at age 4 months (for breastfed babies)

General physical development in infants

Gross motor skills (head, neck, trunk) Fine motor skills (hands and fingers Cognitive Neurologic (vision, language, psychological)

What is the driving factor for supplemental foods for infants

Growth, needs for energy, needs for iron (an infants iron stores start to run out at 6 months), zinc, and other micronutrients that can no longer be met by exclusive breast feeding

Do not breastfeed if

HIV +

Omega 3 fatty acids during pregnancy

Has good benefits RDA: 300 mg/day during pregnancy

The development of motor control starts with:

Head and trunk control, then lower legs

Acute diarrhea in infants

>3 loose watery stools/day Worried about dehydration Could be due to viral or bacterial infections or food intolerance or excess juice Treatment by increased fluid and normal feeding

LGA (large for gestational age)

>90th %ile

Changes in proportions from birth to adulthood

Head doubles in size Trunk triples Arms and hands quadruple legs and feet grow 5x

Physical changes with aging

Decreased muscle mass, increased fat mass Decrease in muscle strength and power Increased reaction time (takes longer to react) Decreased flexibility

Body proportions at birth

Head is 1/4 of body length (1/8 in adults) Legs are 3/8 of body length (1/2 in adults)

A 5-year old boy with a BMI of 15 would be classified as

Healthy weight (look at growth chart)

Height gain/month in school age children

Height gain: .2 in/month Weight gain: 9 oz/month

Macronutrient differences in formula vs breast milk

Higher protein and carbohydrate content, lower fat content Fats provided as vegetable oils Lactose is the main source of CHO

Minerals in human milk

Highly bioavailable compared to formula Ca Fe Zn Mg

Functions of the placenta

Hormone and enzyme production, nutrient and gas exchange, removal of wastes from fetus, separation of wastes from the fetus, prevention of bacteria transfer to the fetus

Female infertility: problems with ovulation

Hormone imbalances, severe vitamin deficiency, generally poor nutrition. Emotional stress Below normal % body fat Smoking or substance abuse

Total parenteral nutrition (TPN)

Intravenous provision of nutrient for both repletion of tissue loss and tissue accretion of rapid growth during the postnatal period IF enteral feedings are inadequate or impossible. Goal is to provide sufficient calories and Has to prevent negative nitrogen balance.

Recommendations for complementary foods

Introduce 1 single ingredient at a time to monitor tolerance, avoid added sugar and salt, introduce a variety of foods by the end of the first year, Withhold cows milk and other milk alternatives

Importance of Iron before and during pregnancy

Deficiency can decrease fertility, increase risk of preterm delivery, and increase risk of low birth weight. It is easier to build iron stores pre pregnancy than during pregnancy

Zinc in older adults

Deficiency could affect smell and taste acuity

Umbilical vein

Delivers nutrients and oxygen to the baby

B12 in older adults

Despite adequate intake, approximately 40% of older adults have low serum b12 levels Decreased B12 is linked to decreased levels of HCl and pepsin (from tropic gastritis) in older adults Some B12 deficiency is related to lack of intrinsic factor (maybe due to autoimmune disease like pernicious anemia)

DRI

Dietary reference intake. Dietary standards for healthy people only

Treatment for phenylketonuria (PKU)

Dietary: maintain blood Phe concentration of 120-3600 µmol/L by controlling dietary intake of Phe Medication: drugs to replace coenzyme that the mutated PAH enzyme cannot bind to properly Additional treatment: genetic counseling, psychiatrist, social worker

What happens when there is an increase in androgen (testosterone and prercursors) production by ovaries and fat tissues

Disrupts normal egg development, causes irregular menstrual cycles, and contributes to subfertility

ID and IDA in infants

Leads to impaired development, decrements in IQ and socialization. Due to altered protein synthesis in specific areas of the brain and a decrease in myelin formation and neurotransmitter production.

Leptin's role in fertility

Leptin is higher in obese individuals. This results in altered follicle growth, interference with ovulation, possible disturbance of endometrial development, and interference with implantation

Pre-term birth rate is defined as

births <37 weeks gestation/100 live births

Which of the following would NOT be an expected biological change occurring during puberty? a. Sexual maturation b. Accumulation of skeletal mass c. Increases in height and weight d. Accumulation of intra-abdominal fat e. Changes in body composition

d. Accumulation of intra-abdominal fat

Delayed breastfeeding can lead to jaundice because: a. it produces a state of partial starvation. b. it can lead to decreased passage of meconium. c. it causes an increase in bilirubin concentration. d. All of the above e. Both a and c

d. All of the above It produces a state of partial starvation It can lead to decreased passage of meconium It causes an increase in bilirubin concentration

What advice would be helpful for a first-time mom who would like to know how to prevent a decrease in milk production? a. Relax and avoid stress. b. Breastfeed or pump frequently. c. Completely empty your breasts at each feeding, either by nursing or pumping. d. All of the above e. Only a and c are correct

d. All of the above Relax and avoid stress Breastfeed or pump frequently Completely empty your breasts at each feeding, either by nursing or pumping

Which of these adolescents would be the most appropriate candidate for bariatric surgery? Assume that all of them have completed their growth spurt. a. An adolescent whose BMI-for-age is at the 90th percentile b. An adolescent whose BMI-for-age is a the 90th percentile and who has hypertension. c. An adolescent with a BMI of 38 and who has hypertension d. An adolescent with a BMI of 38 and who has type 2 diabetes

d. An adolescent with a BMI of 38 and who has type 2 diabetes

Inspection of hair, eyes, skin, and posture is part of the nutrition assessment component known as the: a. diet history. b. anthropometrics. c. biochemical testing. d. clinical examination. e. initial evaluation.

d. Clinical examination

Increased need for protein during pregnancy due to

requirements for synthesis of new maternal and fetal tissue (protein requirements don't increase until the 2nd semester)

Iron deficiency

Decrease in iron stores

The RD assesses Mark's hemoglobin and hematocrit levels. This is an example of which type of assessment? a. Anthropomentric b. Biochemical c. Client History d. Dietary

b. Biochemical

Which of the following statements about "critical periods of growth and development" is correct? a. It is a period in early pregnancy when toxins that may harm fetal growth and development are able to pass through the placenta to the fetus b. It is a period of rapid cell multiplication soon after conception c. It is a period of fetal rapid growth during the third trimester d. Insults to the fetus during this period can be corrected with good nutritional attention during infancy

b. It is a period of rapid cell multiplication soon after conception

The range of medical and psychosocial complications that accompany overweight among adolescents include all of the following EXCEPT: a. hypertension. b. type 1 diabetes. c. dyslipidemia. d. sleep apnea. e. insulin resistance.

b. Type 1 diabetes.

Which of these statements accurately describes current recommendations for growth chart use: a. WHO and CDC growth charts can be used interchangeably for children under 18. b. WHO growth charts should be used for children from birth to 24 months, and CDC growth charts should be used for children from 2-20 years. c. CDC growth charts should be used exclusively to evaluate children from birth to 20 years. d. CDC growth charts should be used for children from birth to 24 months, and WHO growth charts should be used for children from 2-20 years.

b. WHO growth charts should be used for children from birth to 24 months, and CDC growth charts should be used for children from 2-20 years.

Hemodilution of nutrients occurs during pregnancy because: a. women are eating less. b. blood volume increases so much. c. amniotic fluid displaces many nutrients. d. glomerular filtration decreases. e. maternal organs and tissues grow.

b. blood volume increases so much.

The best way to prevent/cure a plugged duct is to: a. use a needle to unblock the duct. b. completely empty the breast. c. stop nursing and use a breast pump exclusively. d. take extra vitamin D. e. have a glass of red wine daily.

b. completely empty the breast.

Risk factors associated with developing iron-deficiency anemia include all of the following EXCEPT: a. rapid growth. b. high intake of vitamin C-rich foods. c. calorie-restricted diets. d. meal skipping. e. participation in endurance sports.

b. high intake of vitamin C-rich foods.

Preeclampsia-eclampsia represents a syndrome characterized by all of the following EXCEPT: a. hypertension. b. increased calcium excretion c. edema. d. platelet aggregation and blood coagulation. e. urinary protein loss.

b. increased calcium excretion

Which of the following would NOT be one of the factors accounting for the range of calories an infant needs? a. Weight b. Length c. Sleep/wake cycle d. Growth rate e. Physical activity

b. length

What hormone triggers the production of testosterone by the testes? a. Follicle-stimulating hormone b. Luteinizing hormone c. Progesterone d. Estrogen e. a and b

b. luteinizing hormone

Plasma:

fluid remaining after centrifuging blood that has been treated with an anticoagulant

Protein recommendations for twins (starting at the second trimester)

+50 g/day (additional to already needed amount)

Lactogenesis 1

Begins during the last trimester of pregnancy. Stage at which milk production begins to form

Lactoferrin

Enhances iron absorption

Hormone needed for spermatogenesis

FSH

Sources of DHA

Fish, fish oils, seafood, supplements, eggs, fortified foods

Gastroesophageal Reflux (GER)

"happy spitters". Includes regurgitation and vomiting around 4 months/ Not a concern if infants are growing well. As many as 73 reflux episodes/day is considered normal

EER for infants age 0-3 months

(89 x W (kg) - 100) + 175

EER for infants age 7-12 months

(89 x W (kg) - 100) + 22

EER for infants age 4-6 months

(89 x W (kg) - 100) + 56

EER for 13-36 months

(89 x W - 100) + 20 kcal

Macronutrient distribution ranges

(look up)

Wright gain recommendations for triplets:

+1.5 lbs/week (50 lbs total)

Protein requirements for adults

.08 g/kg (active adults can need up to 1.2 g/kg)

Average height gain/month of infants

0-3 months: 1.2 in/month 3-6 months: .8 in/month 6-12 months: .6 in/month

Average weight gain of infants

0-3 months: 1.3 -2 lbs/month 3-6 months: 1-1.4 lbs/month 6-12 months: .7-.9 lbs/month

Protein requirements for infants

0-6 months: 1.52 g/kg/day (AI) 7-12 months: 1.2 g/kg/day (RDA)

Rules of Normal/Intuitive Eating

1) Eat when you are physically hungry. 2) Stop eating when you are comfortably full. 3) Choose foods that you believe will satisfy you. 4) Eat mindfully and with enjoyment.

Adequate fiber intake in children

1-3 years old: 19 g/day 4-8 years old: 25 g/day

If nursing mothers want to store expressed milk in a refrigerator, what should the temperature setting be?

<39 degrees F

Physical activity recommendations for adolescents:

Ages 6-17: 60 mins physical activity/day Should include muscle and bone strengthening in physical activity at least 3x/week

3 fundamental components of body dissatisfaction:

1. idealization of slenderness or leanness 2. irrational fear of body fat 3. Conviction that weight and shape are central determinants of one's identity

Maternal protein needs for lactation

1.3 g/kg/day

Recommended protein intake for infants from the ages of 6 to 12 months:

1.6 g/kg body weight

Bone health in adolescents:

1/2 of peak bone mass accumulates during adolescence, so adequate amounts of vitamin D, calcium, protein, potassium, and other nutrients involved in bone health are needed along with good amounts of weight bearing activity to reach optimum peak bone mass (which protects against osteoporosis in adulthood)

______ of the protein requirements for infants is EAAs

1/3

Only _____% of fetal growth occurs in the first half of pregnancy

10%

Jill is a very active teenager who has been maintaining her current weight of 125 pounds. Her average daily macronutrient intake consists of 250 g carbohydrate, 100 g total fat, 30 g saturated fat, and 50 g protein. How many Calories from Carbohydrates is Jill consuming daily

1000 kcal

The AVERAGE caloric need of infants in the first six months of life is _____ per kg of body weight, based on growth in breast-fed infants.

108 calories

Adolescence is defined as the period of life between _____ years of age.

11 and 21

Adolescent Male Energy Needs

11-12 year old; sedentary: 1800 kcals 16-18 year old; active: 3200 kcals Around 30-40 kcal/kg

Adolescent Female Energy Needs

11-13 year old; sedentary: 1600 kcals 14-21 year old; active: 2400 kcals Around 30-40 kcal/kg

Nutrient needs for multiples

3 meals + 3 snacks/day increased need for EFAs, iron, and Ca DO not exceed UL

Calcium RDA for adolescents

1300 mg/day

EER for girls 3-8 years old

135.3 - (30.8 x A) + PA x (26.7 x W + 934 x H) + 20 kcal

It is recommended that a woman consume at least _____ of carbohydrate during pregnancy to meet fetal needs for glucose.

175 grams/day

What trimester is the fetus most vulnerable to harmful effects like alcohol, cigarettes, and drugs?

1st trimester (usually before a woman even knows she's pregnant)

Trimesters of pregnancy

1st trimester: week 1-13 2nd trimester: week 14-27 3rd trimester: week 28-40

It will take approximately _____ hour(s) to eliminate the alcohol in one glass of wine from a 120-pound nursing woman.

2 to 3

Recommendations for gender start after

2 years old

Fat free mass declines approximately _____ % per decade from age 30-70

2-3%

On average, lean body mass decreases by _____ per decade from age 30 to 70.

2-3%

How long does it take for no alcohol to appear in breast milk

2.5 hours for each drink

During peak weight gain, adolescent males gain an average of _____ lb/year.

20 lbs/year

Using the standard rule of thumb for serving sizes for toddlers, a toddler who is 3 years old would require what serving size of food?

3 tablespoons (1 tbsp. per year of age)

A critical period of spinal cord development following conception is:

3-4 weeks after conception

The total diet for an infant should provide them with at least ______ of total energy and at least .5% energy from EFA requirements

3-4.5%

American Academy of Pediatrics (AAP) recommends that this standard be used for children age 2-20 years

2000 CDC growth reference charts; for american kids; 16 charts (8 for girls and 8 for boys)

According to the American Diabetes Association, when should pregnant women without diabetes have their blood glucose tested?

24-28 weeks gestation

What is the pregnancy weight gain recommendation for an obese woman carrying twins?

25-42 lbs

The Acceptable Macronutrient Distribution Ranges (AMDRs) for fat are _____ for children 1 to 3 years and _____ for children 4 to 18 years old.

30-40% 25-35%

Body fat increases from age ______; and declines after age _____

30-60; 70

By the age of 18, more than _____ of adult skeletal mass has been formed.

90%

Use the tables in the Appendix of the 2015 Dietary Guidelines for Americans to estimate Mark's energy needs in kcal's. Mark is active. Note: you do not need to include units.

3200 kcal

Breast Milk: carbohydrates

39% carbohydrates Lactose is the main carbohydrate which enhances calcium absorption Oligosaccharides!!!

Weight changes throughout infancy

4-6 months: birth weight doubles 12 months: birth weight triples, length increases by 50%, head circumference increases by 1/3 Growth varies with genetics, hormones, environment, and nutrition

Food texture and development in infants

4-6 months: can swallow pureed foods 6-8 months: can swallow very soft, lumpy foods 8-10 months: can eat soft, mashed foods

Limit juice to:

4-6 oz/day for 1-6 year olds 8-12 oz/day for 7-18 year olds

Micronutrient needs in infancy: Vitamin D

400 IU/day

The recommended daily intake of folic acid for ALL women who may become pregnant is

400 mcg

Jill is a very active teenager who has been maintaining her current weight of 125 pounds. Her average daily macronutrient intake consists of 250 g carbohydrate, 100 g total fat, 30 g saturated fat, and 50 g protein. The percentage of energy that comes from Jill's intake of carbohydrate is:

48%

Prevalence of children with special needs

5-13.2% of children ages 0-5 Up to 90% of children with disabilities have some type of nutritional problem

Breast Milk: fats

55% fats Maternal blood provides fat (reflects on her diet and mobilization of fat storers if she is losing weight -- and from fatty acids produced in the breast) Cholesterol is higher ini man milk (4mg/oz) than in formula -- early composition of cholesterol through breast milk appears to be related to lower cholesterol later in life Brain development

A 3-month-old infant was taking 30 ounces/day of a standard formula. How many Calories did the infant consume each day?

600 (1 oz formula = 20 Calories)

Vitamin D RDA for adolescents

600 IU (mean adolescent intakes are well below RDA)

The recommended dietary allowance (RDA) for folate during pregnancy is:

600 mcg total with 400 mcg from fortified food or supplements.

Based on your answer to the previous question (108 calories/kg), a 5-month-old infant would require approximately _____ total Calories per day based on a weight of 6 kg.

648 calories/day

Average annual growth during school years

7 lbs and 2.5 inches

SGA (small for gestational age)

<10th %ile Also can be classified as IUGR (intrauterine growth restriction)

Very low birth weight

<1500 g at birth

A 7-month-old infant weighing 16 lbs needs approximately _____ Calories/day.

715 calories/day

RDA for Iron

8 mg for men 18 mg for women 27 mg for pregnant women

Approximately how many exposures to a new food might it take for a toddler to accept the flavor or taste?

8-10

The goal set by Healthy People 2020 is for at least _____% of women to ever breastfeed their infants.

82%

EER for boys 3-8 years old

88.5- (61.9xA) + PA x (26.7 x W + 903 x H) + 20

By age 18, ____% of adult skeletal muscle has formed

90%

Importance of folate before and during pregnancy

Adequate folate intake should be taken 1 month before, to 6 weeks after conception because it helps reduce the risk of having a child with a neural tube defect

Infancy

A period of rapid growth and development, maturation of functions and rogan systems, and dramatic changes in feeding behaviors

AI

Adequate intake. Reflects average daily amount of a nutrient w/o an established RDA that appears to be sufficient (most apply to infants)

Smell and taste in older adults

Affected by deficiencies of some nutrients (like zinc) and diseases and medications Men: sense of smell declines around age 55 Women: sense of smell declines around age 60+ Makes eating less enjoyable

Factors affecting growth assessment

Age of onset of chronic condition, secondary conditions, physical ability/activity level, small muscle mass

Beginning at age 3, the DRI equations for estimating a child's energy requirements are based on a child's:

Age, height, weight, activity level, and gender

Protein requirement for adolescents

Ages 14-18 require .85 g/kg/day

Physical development in the 1st year

Maturation of GI system Mineral content increases Very rapid brain growth First teeth by 5-9 months

AGA (appropriate for gestational age)

A baby that is within the 10th to 90th %ile for gestational age

One of the most positive influences a parent can have on their child's eating habits would be:

Acting as a role model

Anorexia Nervosa

A significantly low body weight that is less than minimally normal, fear of body fat, persistent behavior to avoid weight gain, lack of recognition of low body weight. Seen with: weight loss, food refusal, slow pulse rate, skin changes, loss of menstruation

What triggers ovulation?

A surge in LH mid-cycle

Is a vegan diet safe during pregnancy?

A vegan diet is safe during pregnancy if requirements are met and performed properly

What happens in infants when glucose is limited?

AA from food is converted to glucose and is used for energy (not growth) Growth will slow or stop because protein and fat will be used to meet energy needs

Indicators for infants with nutritional risk

Altered growth, changed energy needs, drug-nutrient interactions, metabolic disorders, impaired nutrient utilization, and poor feeding skills

The functional units of the mammary gland are the:

Alveoli

In initially normal weight women, weight loss of 10-15% below normal may result in

Amenorrhea, anovulation, short/no luteal phase Weight regain tends to restore hormone levels to normal

DRIs identify:

Amount of nutrients needed to prevent deficiency in healthy people Amount of nutrient that may reduce risk of chronic disease Upper level of safety for nutrient intake

"emptying the bottle" or serving larger volumes of formula/feeding

Associated with excess weight gain in the first 6 months. Parents should look for cues for satiety rather than finishing the bottle

How to get older adults to eat

Create a positive atmosphere, make eating a social occasion, eat smaller meals more frequently, use more spices and herbs, add variety and color to meals

Bulimia Nervosa

An emotional disorder involving distortion of body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by depression and self-induced vomiting, purging, or fasting. Eating in a 2 hour period an amount that is larger than most people would eat accompanied by recurrent inappropriate compensatory behavior (i.e. throwing up or excessive exercise) Occurs once/week for 3 months Is caused by body shape concerns

The first half of pregnancy is considered the "maternal _____," while the second half of pregnancy is considered the "maternal _____."

Anabolic phase, catabolic phase

Eating disorder associated with the greatest risk of mortality

Anorexia Nervosa

This eating disorder would be suspected in an individual who has extremely low body fat content and who refuses to eat most foods

Anorexia Nervosa

High risk infant

Any neonate who has a greater than average risk of morbidity or morality, especially the first 28 days of life

High risk pregnancy

Any pregnancy in which the mother or fetus has an increased chance of having a health problem (requires closer monitoring)

Calcium needs during pregnancy

Are the same as non pregnant women (1000 mg/day) Pregnant teens need 1300 mg/day

Which of these adolescents would be most likely to have a BMI-for-age that appears to indicate obesity or overweight even though the adolescent is not overweight or obese?

Athletic male with low body fat (because this athletic individual could have a relatively high BMI because of his higher than average lean body mass)

Type 1 DM

Autoimmune disease resulting in no insulin production due to destruction of pancreatic beta cells 4x more prevalent in T2DM in youth Treatment includes regulation of the timing and composition and exercise along with insulin injections/medications

Lactogenesis 3

Begins 10 days postpartum. At this stage, milk composition becomes stable

Lactogenesis 2

Begins 2-5 days postpartum. Stage at which there is copious milk secretion

Reproductive System

Begins developing in the 1st months after conception and continues to grow in size and complexity of function through puberty. Females are born with ~7 million over-mature ova Males have continuous sperm-producing capabilities

Micronutrients of importance in older adults

B12, Zinc, Vitamin A, and Iron

Measurements that are used to track a child's growth over time include:

BMI Weight Head circumference Height

Nutrition influences semen quality

BMI, antioxidant status/oxidative stress, omega-3 fats, over nutrition/excessive body fat, undernutrition/inadequate body fat/weight loss

Activity of Daily Living (ADLs)

Bathing/showering, dressing, self-feeding, toileting, walking/transferring personal hygiene and grooming When people cannot perform these activities on their own, they need assistance Problem is much higher for older adults Inability to perform ADLs increases with advancing age (especially 85+)

Stages of Psychological Development in middle adolescence (15-17 years)

Beginning of emotional and social independence (teens spend time away from home, particular independence from parents, engage in part time jobs, clubs, and volunteer activities) Increased peer influence: may impact eating habits/behaviors (body image remains important) Cognitively: rapid increase in abstract reasoning (although not consistent), better understanding of health behaviors and outcomes, choices frequently driven by peer acceptance (smoking, EtOH use, sexual activity)

Insulin resistance during pregnancy

Believed to be due to placental hormones that alter the response of maternal cells to insulin

A 7-year old child is considered to be in the "healthy weight" range if the child's BMI-for-age is:

Between the 5th and 84th percentile

This eating disorder is characterized by eating until uncomfortably full on a regular basis but not vomiting or displaying other compensatory behavior (like excessive exercise)

Binge eating disorder

Implantation during pregnancy

Blastocyst implants in uterus around 7 days after fertilization (day 21) Implants near fundus, and placental formation begins HCG secretions help corpus lute to maintain and keep secreting hormones

Movement of nutrients in placenta

Blood cells are too large to move to/from capillaries, but nutrients and waste products move from higher concentration to lower concentration (ex. more glucose or O2 in maternal blood will diffuse into fetal capillaries, More CO2 in fetal blood will diffuse into maternal circulation)

Maternal changes during the first half of pregnancy:

Blood volume increases, cardiac output increases, fat and nutrient stores increase, liver glycogen content increases

Iron RDA for adolescents

Boys age 9-13: 8mg/day Boys age 14-18: 11 mg/day Girls age 9-13: 8 mg/day Girls age 14-18: 15 mg/day (In reality, males need highest amount during growth spurt, and females after menarche) Median iron loss in girls due to menstruation is .45 mg/day

Transitional Milk

Breastmilk produced between colostrum and mature milk, during the first 4-10 days postpartum.

Eating disorder that would be suspected if a person had yellowish teeth and swollen salivary glands

Bulimia nervosa

Amino acids involved in phenylketonuria

Characterized by mutation to the phenylalanine Hydroxylase enzyme Affects the metabolism of the amino acid phenylalanine (Phe) Leads to high concentrations of circulating blood Phe

Food sources of calcium

Dairy, fortified OK, dark green leafy vegetables, tofu, almonds, bok choy, broccoli, tahini, figs

Binge eating disorder

Characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards

Relative Eating Deficiency in Sports (REDS)

Characterized by: Impaired physiological function; decreased immunity, bone health, metabolic rate, and protein synthesis; disrupted menstrual cycle; and reduced cardiovascular health

In general, children ages 1-5 tend to consume more than enough of most nutrients in their diets EXCEPT _____.

Calcium and Zinc

Micronutrients of importance in adolescence:

Calcium, Vitamin D, Iron

External eating cues

Calories, nutrient facts, serving size, guidelines, clock

Nutrient needs for infants

Can be as high as 2-3x adult requirements on a basis of body weight

Downsides of formula

Cannot add all components of breast milk to formula like hormones, growth factors, and antibodies Different bioavailability of some nutrients

Nutrient Requirements During Pregnancy:

Carbs: additional 175+ g/day required to meed glucose needs for fetal brain Protein: additional 25 g/day, or 71 g/day in 2nd and 3rd trimester (50% more protein is recommended for pregnant than non pregnant) Fat: 1st 1/2 of pregnancy -- fat accumulates, 2nd 1/2 -- fat is mobilized for fetus Average energy increase throughout pregnancy is 80,000 kcals

Vision problems in older adults:

Cataracts (cloudiness of lens) Glaucoma (incr. eye pressure) Macular degeneration (atrophy of photoreceptors, leading cause of blindness in older adults, affects 30%) Lutein and zeaxanthin may be protective (eat green leafy vegetables, egg yolks, best absorbed with a source of fat)

Vitamin D Deficiency in Older Adults

Caused by: Limited exposure to sunlight Certain medications Decreased cutaneous (skin) synthesis Decreased absorption of vitamin D3

Cerebral palsy

Causes scoliosis, GER, and constipation; spastic quadriplegia (slow weight gain and feeding challenges); supplemental Ca and vitamin D needed; change in caloric needs due to increased/decreased activity

Constipation in infants

Changes in frequency, size, and consistency and easiness of passing stool. Focus on fluids and fiber intake if infant is old enough for complementary foods Some formulas containing iron can contribute to constipation

Both a mothers pre conception weight, and weight gain during pregnancy are 2 of the most important prenatal determinants of childhood obesity

Childhood obesity can be caused by both low birth weight and high birth weight

Corrected age

Chronological age in mouth - # of months premature # of months premature = 40 weeks - GA at birth / 4

Atrophic gastritis (gastric mucosa atrophy)

Compromised absorption of iron, calcium, folate, b12, and b6)

Osteoporosis

Condition in which low bone density or weak bone structure leads to an increased risk of bone fracture. Results from an imbalance in bone remodeling that favors resorption (breakdown) over accretion (synthesis) In general, risk of developing osteoporosis is related to peak bone mass that is achieved in early adulthood Happens mainly to women, but can occur later to men due to hormonal status (around late 70s-80s)

Stages of psychological development in early adolescence (11-14 years)

Conscious of physical appearance Desire to "fit in" Issues with timing of physical development Cognitively: concrete thinking (limited ability to understand complex health issues, cannot generally link current health behaviors to future outcomes) Egocentrism: everyone is looking at me! Impulsive behavior

Preschooler development (3-5 years old)

Continue to develop and mature, vocab increases to several thousand words, able to dress and interact cooperatively, more self confident and willing to test limits

Benefits of breastfeeding for mom

Contraction of uterus postpartum (BF secretes oxytocin which promotes uterine contractions) Lactational amenorrhea Convenient and hygenic Cheaper Reduced risk of breast and ovarian cancer reduced risk of rheumatoid arthritis Reduced risk of postpartum depression Maternal/infant bonding

Male Infertility

Contributes to 50% of infertility cases (25% of infertility in couples is related to sperm quality)

Your period starts on what day of your menstrual cycle:

Day 0

Skeletal maturity in kids

During childhood and teen years, the diaphysis and epiphysis will fuse together, indicating skeletal maturity. (occurs around age 18 for girls, and 20-22 for boys)

The difference between assessing nutrient needs in adolescents and adults is _____.

During puberty, adolescents have significantly more body composition changes than adults

Boys % body fat during early childhood vs puberty

Early/middle childhood: 13% Puberty: 14%

Girls % body fat during early childhood vs puberty

Early/middle childhood: 16% Puberty: 19%

What are the top two conditions with the highest scores on the DETERMINE nutritional health checklist?

Eating <2 meals/day, and not having enough money to buy food

Autism Spectrum Disorder (ASD)

Eating/nutrition problems affect up to 3/4 of kids with ASD. May not understand eating instructions and insist on same foods and utensils. Cannot recognize hunger/satiety and have difficulty with motor skills and development. Growth is variable. Kids with ASD typically refuse to try new foods, have increased sensitivity to food characteristics, and tend to eat fewer fruits and vegetables, and like to eat crispy/crunchy snack foods

Full term infant energy and nutrient needs:

Energy: 108 kcal/kg Protein: 2.2 g/kg Iron: 2-6 mg/kg Ca: 210 mg/kg Vitamin D: 400 IU Phosphorus: 100 mg/kg

Preterm infant energy and nutrient needs:

Energy: 110-120 kcal/kg Protein: 3.5-4.5 g/kg Iron: 2-6 mg/kg Ca: 120-220 mg/kg Vitamin D: 400-1000 IU Phosphorus: 60-140 mg/kg

A new mother goes to the mall shopping with her friends. She is gone longer than planned and is not able to nurse her baby until she returns 6 hours later. What is the most likely problem she will have?

Engorgement

EAR

Estimated average requirement. Amount estimated to meet 50% of individuals (used to determine RDA)

Rising levels of _______ and _________ push follicle maturation

Estrogen & FSH

The follicle remaining after egg release increases production of ________ and ________ to prepare endometrium in the event that conception occurs

Estrogen and Progesterone

Menstrual cycle

Estrogen stimulates hypothalamic release of FSH and LH, FSH triggers growth/maturation of 6-20 follicles and stimulates follicular estrogen production, estrogen and FSC continue to rise, pushing follicle maturation, rising LH levels trigger progesterone secretion which promotes endometrial maturation, an LH surge mid-cycle triggers ovulation, follicle remaining after egg release increases production of estrogen and progesterone to prepare endometrium in the event that conception occurs

Which hormone stimulates hypothalamic release of LH and FSH?

Estrogen stimulates hypothalamic releases of LH and FSH.

Factors that promote bone accretion and maintenance

Eumenorrhea (normal menstrual cycles) Adequate Ca and Vit D status Body weight Parents with high bone mass Physical activity

Appetite and older adults

Hunger and satiety cues weaken with age (older adults may need to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted)

Internal eating cues

Hunger, fullness, cravings, flavors, textures, colors, smells

Symptoms of T1DM

Hyperglycemia, poliuria, polydipsia, weight loss, and ketosis

Problems associated with early term infants

Hypoglycemia, respiratory distress, risk of infection

Reproductive hormones in action

Hypothalamus secretes gonadotropin releasing hormone (GnRH). GnRH regulates the release of gonadotropins from cells in anterior pituitary gland (luteinizing hormone (LH) and follicle stimulating hormone (FSH). Hormones are released in short pulses every 1-4 hours

What major concerns might there be in a vegan/vegetarian diet during pregnancy?

If deficient in major vitamins, can be concerns with... decrease in fertility Increased risk of preterm delivery Increased risk of LBW and SGA Risk of IDA (along with side affects that come from that) Neural tube defects and other fetal disorders

Mismatch concept

If extrauterine environment matches intrauterine environment, individuals will have protection from obesity and future diseases, HOWEVER, if extrauterine environment is unlike intrauterine environment, individuals may be at a higher risk for adult obesity and disease

Undernutrition in toddlers/preschoolers

Impairs cognitive development and ability to explore environment

DHA in human milk

Important component fo neural and retinal membranes Affected by: genetic and environmental factors, and maternal diet DHA helps visual function and neurodevelopment

At 12 months of age, a baby boy weights 27 pounds and is 29.5 inches long. Use the appropriate growth chart to evaluate length for age. This infants' length for age is

In a healthy range

Common nutritional issues in infants:

Incorrect enteral feeding (formula, volume), inadequate weight gain and overall growth, incorrect parenteral micronutrients and additives, osteopenia/chemical rickets of prematurity

Toddler development (1-3 years old)

Increase in gross and fine motor skills, exploring their surroundings, developing language, curious, no sense of risk, easily become frustrated

Gestational Diabetes

Increased blood glucose levels in mother --> brings extra glucose to fetus --> fetus gains extra weight Risk factors include obesity, women >35 years, hx of GDM, ethnicity, mother is SGA (risk decreases by 26% for every 10g of plant based fiber)

Increased cholesterol and its relation to the placenta

Increased cholesterol is used by the placenta for steroid hormone (estrogen and progesterone) synthesis, and by fetus for nerve and cell membrane formation. (increased dietary cholesterol is not necessary since we can synthesize cholesterol)

Exercising before pregnancy

Increased incidence of delayed onset of puberty and lack of menstrual cycles in competitive female athletes (likely related to caloric deficits relative to energy output)

Issues associated with premature infants

Increased nutrient requirements, small stomach capacity, slow gastric emptying and intestinal motility, decreased enzyme production, and immature immune system

Risks of being overweight while pregnant

Increased risk of GDM, pregnancy complications, LGA infant

Risks of being underweight while pregnant

Increased risk of LBW infant

Preeclampsia and eclampsia

Increased risk of blood clots that can harm the placenta, kidneys, liver, and brain (affects both mother and infant) Can restrict growth and increase risk of preterm birth Signs include: increased BP, Increased ketones in urine, weight gain >2lbs/week, and swelling

Appropriate cord clamping in infants

Increases amount of blood coming from placenta as much as 30%

Lactose intolerance

Increases with age Causes GI discomfort Avoid by: choosing foods low in lactose, using lactase pills or products, and emphasizing non-lactose containing sources of Ca and vitamin D

Infants for risk of special needs

Infants affected by abnormal development in utero, cardiac malformations, exposure to drugs and alcohol, genetic conditions, risk for chronic health problems, treatments, or home environment

Supplements are not needed for:

Infants being fed infant formula

PICA diet

Ingestion of non-food items

All of the following substances are transported through the placenta easily, with the exception of _____, which is not transferred at all.

Insulin

Clinical Assessment

Involves detailed history and physical examination of the patient Dietitians are generally less comfortable with a clinical assessment careful clinical observations can be important in identifying nutritional problems, particularly in environments where other methods are not available (ex. eye color, skin/hair, teeth, gums, tongue and lips)

Pregnancy increases the absorption of _____ and _____.

Iron and Calcium

What nutrients are especially important for a vegan/vegetarian pregnant mother to pay attention to?

Iron, Zinc, Choline, and B12

First foods for infants:

Iron-fortified infant cereals Pureed vegetables, fruits, and meats

Challenges in children with diabetes

Irregular appetite and activity, peer pressure, desire for independence, growth and pubertal changes resulting in altered insulin requirement, lack of understanding, parental stress, and activities

Hormone needed for testosterone synthesis

LH

Infertility

Lack of conception after 1 year of unprotected sex

Ketosis and ketoacidotic coma:

Lack of insulin and CHO in cells causes metabolism of fats

Barriers to breastfeeding

Lack of knowledge, social norms, poor family or social support, embarrassment, lactation problems, employment/childcare, and health services

Stages of Lactogenesis

Lactogenesis I (birth to 2-5 days) milk formation begins Lactogenesis II—(begins 2-5 days after birth) increased blood flow to breast; milk "comes in" Lactogenesis III—(begins at ~10 day after birth) milk composition is stable

Milk "comes in" during which stage of lactogenesis?

Lactogenesis II

Nutrients promoting Ca absorption:

Lactose, vitamin D, unsaturated fats, limiting oxalates and phylates

Alternative beverages during infancy

Linked to IDA and blood loss

Excess Juice in children

Linked to chronic diarrhea and a dull appetite and lead to slowing growth OR can cause excess weight gain

Early development in females

Linked to poorer body image and increase disordered eating patterns Increased likelihood to smoke or engage in early sexual activity

Late development in males

Linked to poorer body image. Increased supplement use (males seek larger body size, as opposed to weight loss in females)

Miscarriage or spontaneous abortion (SAB)

Loss of fetus in the first 20 weeks of pregnancy (1/3 of conceptions end up in pregnancy loss, 2/3 are unrecognized pregnancies)

Feeding problems with children who have special needs

Low interest in eating, long mealtimes, preferring liquids over solids, food refusals, excessive fluid intake

Breast Milk: protein

Low protein content presents a relatively modest nitrogen load to immature kidneys Casein: main protein in mature human milk (facilitates Ca absorption by keeping it in soluble form, gives milk its white color) Whey: other major protein that forms a soft, easy to digest curd in the baby's stomach

Why breastfeed?

Lower risk for many diseases like ear infection, respiratory tract infections, asthma, IBD, obesity, celiac diseases, DM, leukemia, and SIDS)

Rising levels of _______ trigger progesterone secretion, promoting endometrial maturation

Luteinizing hormone (LH)

Water in breast milk

Major component -- quenches thirst of a child (infants do not require additional water in their diet)

Increases in body calcium during peak growth spurt:

Male 13-18 years: increase Ca by 400mg/day Female 10-14 years: increase Ca by 240 mg/day (avg. increase in Ca-body content at peak of growth spurt)

Biochemical Assessment

Measured from blood, urine, and feces. Looks at nutrients and compounds containing nutrients (hemoglobin contains iron), and activity of enzymes requiring nutrients Assess specimens including: serum, plasma, erythrocytes, leukocytes, urine, feces, and saliva, nails, hair, sweat, and blood spots

Anthropometric Measurements

Measurement of physical dimensions of the body Useful technique to estimate body composition (body fat and somatic protein status) 2 primary purposes: to evaluate the progress of growth in pregnant women, infants, children, and adolescents; and to detect under/over nutrition in all ages Measures include: height and weight, mid arm circumference, head circumference, and waist/hip circumference (A combination of high BMI for age, skin-folds, and circumferences are positively correlated with % body fat in children)

Food sources of Zinc:

Meat, eggs, seafood, legumes, nuts, whole grains

Food sources of iron

Meat, fortified cereals and grains, dried peas, beans, and greens (spinach)

Client History

Medical/health history Family history Medication use Treatments Behaviors Physical activity Social history

Severe folate deficiency in adolescence can result in:

Megaloblastic anemia

School age children

Middle childhood: 5-10 years old Preadolescence: Girls 9-11 years, boys 10-12 years

Benefits for baby when breastfeeding

Milk meets infants protein needs without overloading the kidneys, contains easily digestible curd, provides health promoting lipids, lower minerals (but more bioavailable) reducing stress on kidneys, promotes GI maturation

Milk production is restricted when

Mother does not get more than 1500 kcals/day

Physiological development in school aged children

Muscular strength, motor coordination, and stamina increase. More complex pattern movements and increased sports/physical activity, and changes in body fat

Food sources of vitamin D:

Naturally occurring vitamin D is rare in foods (found in fatty fish, fish oils, eggs, irradiated mushrooms)

Energy/nutrient needs with aging

Need less energy (fewer kcal) to maintain weight Muscle mass declines, BMR declines, PA decreases for many. Body needs fewer calories, but the same (if not more) amounts of vitamins and minerals)

Blood glucose testing (use capillary blood from a finger stick and a gluucometer)

Normal FBS: <100 mg/dL DM: BS>200 mg/dL, FBS >126 mg/dL Goal with DM: Post prandial: 90-130 mg/dL Post prandial: <180 mg/dL

3 Factors insuring adequate iron for the first 6 months

Normal birth weight Adequate maternal prenatal Fe intake Full transfer of placental blood after birth

Youth with body mass index (BMI) values > 50th percentile, but < 75th percentile are considered:

Normal weight

Weight gain recommendations for twins:

Normal weight: 17-25 kg (37-54 lbs) Overweight: 14-23 kg (31-50 lbs) Obese: 11-19kg (25-42 lbs)

Folate RDA:

Normal: 400 mcg/day During pregnancy: 600 mcg/day

Dietary interventions for preeclampsia and eclampsia

Normalize weight prior to pregnancy, good nutritional status, weight gain in accordance with recommendations, adequate Ca and Vit D levels (The only actual CURE is to deliver)

Placental attachment

Normally on the top or the side of the uterus (other placement can cause problems)

Cystic fibrosis:

Nutrient malabsorption due to lack of pancreatic enzymes, need an exogenous source of enzymes, high calorie and protein needs (2-4x typical requirements), supplements and additional nutrient dense meals/snacks

The placenta provides _____ and ________ to the fetus, and removes _______ from the fetus blood (has maximal growth prior to the time of maximal fetal growth)

O2 and nutrients; waste products

How to develop eating skills in infants

Offer foods of increasingly challenging textures, allowing the infant to finger feed, and be willing to tolerate messiness

Immune system issues with older adults

Often declines with aging, can prolong recovery from illness, can increase risk for food borne illness

When preparing for pregnancy, women should...

Plan ahead, eat healthy, be active, take folic acid, avoid chemicals, update vaccines, avoid drugs or alcohol, get to an acceptable weight range (BEFORE getting pregnant)

Vitamin A in older adults

Plasma levels and liver stores increase with age May be linked to decrease clearance from blood Older adults are more vulnerable to toxicity and possible liver damage than deficiency Beta-carotene will not damage the liver (a little concerning in supplement form because it will accumulate)

Breastmilk composition changes...

Over a single feeding, over the day, based on the infants age, with the presence of infection in the breast, with maternal nutritional status (this varies by nutrient) In the beginning, it is higher water and glucose content, by the end it has more nutrients and more fats

A body mass index (BMI) in the 90th percentile would indicate that a 3 year old was:

Overweight

The hormone responsible for uterine contractions and the minimization of maternal postpartum blood loss is:

Oxytocin

What hormone is necessary for the let-down reflex?

Oxytocin

Nutrition factors and influences

Parents influence, family mealtimes are encouraged, peer influence increases, media influence is important, body image/increased dieting.

Feeding behaviors of infants

Parents should feed infants when they are hungry rather than on a set feeding schedule

Hypothalamus

Part of the brain controlling homeostasis (link between nervous system and pituitary gland)

Female infertility: damage to fallopian tubes

Pelvic inflammatory disease (PID), endometriosis

What part of digestion is not well coordinated in early infancy

Peristalsis. Can lead to gas, loose stool, constipation, GER

Hyperemesis Gravidarum

Persistent vomiting throughout pregnancy, can be dangerous if becomes very severe

Nutrients decreasing calcium losses (holding Ca in the bones)

Phosphorus, avoiding caffeine, limiting sodium, high fruit and veggie intake

Foodborne illnesses during pregnancy

Pregnant women are at a higher risk of contracting a food borne illness Listeria: raw or smoked fish/meat, oysters, unpasteurized/soft cheeses/milks. Can result in miscarriage or stillbirth in 1/3 of fetuses. Mothers have flu like symptoms

Female infertility: cervical mucus abnormalities

Presence of antibodies that attack sperm Can form a plug that blocks passage of sperm

Why is breastmilk protective?

Prevent infection (contain immunoglobulins which are antibodies) Colostrum is rich in antibodies Probiotic bacteria and fatty acids provide antimicrobial properties Contain growth factors and hormones the promote infant gut maturation

2 main hormones involved in breast feeding

Prolactin: stimulates milk production Oxytocin: stimulates release of milk

LH and FSH in females

Promote ovulation and stimulate secretion of estraidol and progesterone for ovaries

Macronutrient recommendations for adolescents

Protein (14-18 year olds): .85g/kg Carbs: 45-65% of kcals Fat: 25-35% of kcals

Nutrient requirements for 4-8 year olds

Protein: .95 g/kg/day Iron: 10 mg/day Zinc: 5 mg/day Calcium: 1000 mg/day

Nutrient requirements for 1-3 year olds

Protein: 1.1 g/kg/d or 13 g/day Iron: 7mg/day Zinc: 3 mg/day Calcium: 700 mg/day

Benefits of solid foods in infants

Provide an opportunity to experience new tastes and textures. Foods of different textures also contribute to speech development

Infant formula:

Provides 20 kcal/oz preterm formula provides 22-24 kcal/oz Based on cows milk or soy protein

Erythrocytes

RBCs and their precursors (hemoglobin, hematocrit)

You are assessing the adequacy of an individual's diet. Which standard should you use, EAR or RDA?

RDA because it is adequate for nearly all healthy people

Iron in older adults

RDA for 70+ years = 8mg/day Iron needs decrease after menopause Most older adults consume more than needed Excess iron causes oxidative stress Iron deficiency could be caused by: iron loss from disease, decreased acid secretion, and decreased energy intake

Calcium RDA for adolescents

RDA for boys and girls ages 9-18: 1300 mg/day (boys typical high energy intake often makes their diets include close to Ca RDA)

What is phenylketonuria

Rare metabolic disorder of when there is too much phenylalanine circulating in the blood characterized by a mutation to the Phenylalanine hydroxylase enzyme (PAH enzyme)

Should pregnant women et more fish?

Recommendation: eat 8-12 oz fish/week that are low in Hg Fish is important in growth and development

RDA *Most commonly used*

Recommended daily allowance. Average daily intake level required to meet the needs of nearly all (97-98%) healthy people -- RDA for individuals

Stages of Psychological Development in late adolescence (18-21+ years)

Reduced economical and emotional dependence on parents Develop closer relationships with fewer people; decreased peer pressure response Decreased impulsivity Fully perceive future consequences of current behaviors (legal system and health behaviors) abstract thinking

Subfertility

Reduced fertility characterized by greater than 1 year to conceive, or repeated pregnancy losses (2-3) Affects 18% of US couples

Endocrine System in Older Adults

Reduced glucose tolerance, effects vitamin D metabolism (causing deficiency)

Importance of vitamin B6 before and during pregnancy

Reduces chances of loss of pregnancy and helps with conception Deficiency causes a higher chance in pregnancy loss and subfertility

Umbilical artery

Removes CO2 and waste from the baby

Muscle dysmorphia

Rigid and excessive weight training. Strict adherence to a high protein, muscle enhancing diet with use of muscle-enhancing drugs or supplements. People avoid social engagements that might interfere with their regimen. They frequently perform critical body self-evaluation

Infant reflexes

Rooting, coordinated breathing and swallowing, suck/swallow, tongue thrust, and gagging

Physical activity recommendations for older adults:

Same as those for adults, At least 150-300 minutes/week of moderate to vigorous intensity aerobic activity PLUS 2+ days/week of at least moderate intensity muscle strengthening activities (additional health benefits gained if exercise exceeds 300 mins) Older adults should additionally include balance training

Anterior pituitary gland

Secretes growth hormone (GH), thyroid secreting hormone (TSH), adrenocorticotropic hormone (ACTH), prolactin (used for lactation), melanocyte stimulating hormones, and *gonadotropins (LH and FSH)

Cognitive development in school aged children

Self efficacy: knowledge of what to do and ability to do it Decrease in egocentrism characteristic of younger years (can easily see other's perspectives). Reasoning becomes more rational, develop sense of self, more independence, and peer relationships become important.

Female infertility: anatomical abnormalities (congenital)

Septate uterus, bicornuate uterus, unicornuate uterus

Intrinsic factor in older adults

Some B12 deficiency related to lack of intrinsic factor (could be due to an autoimmune disease) Parietal cells secrete intrinsic factor B12R and intrinsic factor travel to small intestines Pancreas is secreting enzymes and proteases to separate B12 from R, then B12 and intrinsic factor bind and travel to ileum where it is absorbed

Common lactation problems

Sore nipples, engorged breasts, letdown issues, leaking milk, plugged ducts, mastitis, failure to latch

Spermatogenesis:

Sperm synthesis -- occurs in the seminiferous tubules of the testes Zinc is crucial in sperm production

LH and FSH in males

Stimulates testosterone secretion and sperm production

Colic

Sudden onset of irritability, fussiness, or crying in a young infant between 2 weeks and 3 months who is otherwise growing and health No known cause, but treatments include trying a different formula, eliminating cows milk, and rocking/swaddling

Food choices made by adolescents while snacking tend to favor foods high in _____ and relatively low in _____.

Sugar, sodium, and fats; vitamins and minerals

Micronutrient needs in infancy: Iron

Supplement 1 mg/kg/day beginning t 4 months and continuing until iron containing foods are introduced

Micronutrient needs in infancy: Vitamin B12

Supplement if mothers diet is inadequate or if dietary source are lacking

Effective feeding

Supporting the childs autonomy, respects tempo in accepting new foods, and is willing to stop feeding promptly when the infant wants to quit

Failure to Thrive (FTT)

Suspected when growth declines more than 2 growth %iles, and child is near or below lowest percentiles per age. Growth may slow or stop after growth curve. Physical skills are compromised. Treatment includes mainly increasing caloric intake

Infants prefer _________ tastes

Sweet

2 simultaneous processes involved in bone growth in adolescence

Synthesis of new bone & modeling-remodeling of previously synthesized bone

Diets catered to oral health problems in older adults

Tender cuts of meat Soft protein foods (eggs, milk, cheese, yogurt) Fruits and veggies peeled and cut Fruit juice, canned fruits, cooked fruits and veggies Mashed or pureed foods if needed Drink plenty of fluids with meals

Specific growth charts for conditions like...

VLBW, down syndrome, spastic quadriplegia, marfan syndrome

Mature milk

The breastmilk after colostrum and transitional milk, typically beginning 2 weeks postpartum.

Endometriosis

The condition in which endometrial tissue becomes embedded within other body tissues

Iron deficiency anemia

The last stage of iron deficiency. Decrease in iron stores and low hemoglobin and hematocrit levels.

The term fetal alcohol spectrum is now being used to describe:

The range of effects alcohol has on fetal growth and development

Programmed aging theories propose that senescence occurs because

The telomeres capping the ends of chromosomes become shorter with each cell division and their loss eventually stops the chromosomes from replicating.

Why do kids age 6 months - 3 years have the greatest risk for iron deficiency

They are growing at a high risk and need more iron for growth

Colostrum

Thin, milky fluid secreted by the breast during pregnancy and during the first days after birth before lactation begins (milk a newborn can easily digest)

Thirst in older adults

Thirst-regulating mechanisms decrease with age Issues include dehydration, water losses, poor bladder control, poor fluid intake Still need 6+ glasses of fluid/day

Weight gain per month for toddlers and preschoolers

Toddler: 8 oz/month Preschooler: 6 oz/month

Height gain per month for toddlers and preschoolers

Toddlers: .4 in/month Preschoolers: .2 in/month

UL

Tolerable upper level intake level. Maximum daily amount thats safe, and beyond has increased risk of adverse health effects.

Oral health problems in older adults:

Tooth loss or ill fitting dentures Gum disease Dry mouth (xerostomia) Swallowing difficulty (dysphagia) Difficulty chewing

Growth charts

Track growth over time to determine growth compared to reference standards, detect growth abnormalities, monitor nutritional status, and evaluate effects of nutrition intervention

After 1 year of age, an infant's birth weight has usually:

Tripled

True/False: A woman with mastitis should continue to nurse her baby

True

True/False: Even small loss of body weight can improve osteoarthritis

True

True/False: Maternal diet does not affect the amount of fat in human breast milk but can affect the fatty acid profile of breast milk

True

True/False: Older adults who suffer from sarcopenia may benefit from high-protein diets. High protein intake will also help to keep their bones strong.

True

True/False: conversion of ALA to DHA is especially poor in infants

True

True/False: soy formulas are only available in iron-fortified form

True

Role of the placenta in pregnancy

Umbilical vein carries oxygenated, nutrient rich blood from the placenta to the fetus. The umbilical arteries carry deoxygenated, nutrient-depleted blood from fetus to the placenta

Weight gain for normal pregnancy

Underweight (<18.5): 28-40 lbs Normal (18.5-24.9): 25-35 lbs Overweight (25-29.9): 15-25 lbs Obese (>30): 11-20 lbs You should never lose weight during pregnancy

Dietary Assessment

Used to assess dietary intake 24 hour recall Food frequency questionnaire (less formal, widely used) Dietary history (supplement use, knowledge, beliefs, attitudes, food availability, activity) Screening tools (assess urgency, quick online assessments)

Energy needs of school aged children

Varies by activity level and body size. DRIs are based on gender, age, heigh, weight, and PA EER = total energy expenditure + energy for PA kcal/kg/day declines with age due to decreased growth velocity

Due to the great variability in the timing of growth and maturation among adolescents, the calculation of energy needs based on _____ will provide a better estimate than one based on chronological age.

Velocity of growth

Oligosaccharides in breastmilk

Very important! Oligosaccharides are medium length CHOs that pass through the infant undigested in feces and are thought to interfere with pathogens binding to host cell receptors (reduces infection and diarrhea) Found in garlic, onions, beans, etc.

Birth terms

Very preterm: <34 weeks Preterm: <37 weeks Full term: 38-42 weeks Post term: >42 weeks

Fat soluble vitamins in human milk

Vitamin A Vitamin D Calcium (200mg/day transferred from mom to infant)

Exclusively breastfed infants, particularly those with darkly pigmented skin, need a supplement of _____________.

Vitamin D

Leukocytes

WBC and WBC fractions

American Academy of Pediatrics (AAP) recommends that this standard be used for infants from birth to 2 years.

WHO growth standard charts; international standard with data from 6 countries

The major component of breast milk is _____, while the second largest component is _____.

Water, Lipids

Normal weight and length of full term infants:

Weight: 2500-3800g (5.5-8.5lbs) Length: 18.5-21.5 inches

What happens when phenylketonuria is uncontrolled?

When uncontrolled can affect developing children's social skills and social cognition (facial/emotional recognition), and lower IQ (intellectual and developmental disabilities) Uncontrolled maternal PKU can lead to neural tube defects, microcephaly, SGA, congenital heart disease, facial deformities

Foods that should not be served to children less than two years of age because of their potential as choking hazards include:

Whole grapes, hot dogs, peanuts or popcorn, and hard candy

The best reason for advising young adolescents to consume foods that provide adequate calcium is _____.

Young adolescents retain four times as much calcium than adults and build bone mass

Which of the following would be a type of anthropometric assessment that the RD might use to assess Mark's nutritional status? a. Collect Mark's height and weight measurements and assess his BMI b. Administer a 24-hr recall and use Cronometer to assess calcium intake c. Review Mark's serum cholesterol concentration d. Inquire about Mark's medication usage

a. Collect Mark's height and weight measurements and assess his BMI

A 15-year old female cross country runner has had 3 stress fractures in the past 12 months. She has amenorrhea. You suspect that she has Female Athlete Triad. Which of the following would best support your suspicion? a. She reports that she has been trying to lose weight in order to improve her race performance. b. She reports that she has been taking extra calcium and vitamin D. c. She reports that she has noticed that she can't run as fast as she could a year ago.

a. She reports that she has been trying to lose weight in order to improve her race performance. (Energy deficiency, low bone mass, and absence of menses are all characteristics associated with the Female Athlete Triad.)

Nutritional and physical activity recommendations that may benefit women at risk for preeclampsia include all of the following EXCEPT: a. high-dose iron supplements. b. 5 or more servings of fruits and vegetables daily. c. moderate exercise. d. adequate fiber intake. e. adequate vitamin D.

a. high-dose iron supplements.

Age-associated physiological system changes that affect nutritional health include all of the following EXCEPT: a. increased secretion of saliva. b. reduced levels of estrogen and testosterone. c. blunted appetite regulation. d. reduced breathing capacity. e. less blood flow.

a. increased secretion of saliva.

Good feeding practices to limit baby bottle caries and ear infections related to baby bottles include all of the following EXCEPT: a. letting the baby have juice in a bottle throughout the day as desired. b. offering juice in a cup. c. limiting the use of a bottle as part of a bedtime ritual. d. examining and cleaning emerging baby teeth on a regular basis. e. offering only water in a bottle to sleep with.

a. letting the baby have juice in a bottle throughout the day as desired.

Small for gestational age (SGA) is different than low birthweight because: a. low birth weight is <2500 g (5 lb 8 oz), while SGA is ≤10th %tile for gestational age. b. SGA is <2500 g (5 lb 8 oz), while low birth weight is ≤10th %tile for gestational age. c. SGA is <1500 g (3 lb 5 oz), while low birth weight is ≤10th %tile for gestational age. d. SGA is ≤10th %tile for gestational age, while low birth weight is <1500 g (3 lb 4 oz).

a. low birth weight is <2500 g (5 lb 8 oz), while SGA is ≤10th %tile for gestational age.

Age to introduce foods to babies

around 6 months -- look for signs like ability to sit up on its own (trunk stability), disappearance of tongue thrust reflex, ability to swallow/move foods from the front to the back of mouth, interest in foods, ability to indicate hunger

The most important step to prevent sore nipples is to _____. a. take a prophylactic dose of antibiotics b. make sure the baby is positioned properly c. place cabbage leaves on your breasts before nursing d. place herbal salve on the nipple area e. nurse frequently

b. make sure the baby is positioned properly

Of all the physiologic changes that occur with aging, the biggest effect on nutritional status is due to shifts in the _____. a. endocrine system b. musculoskeletal system c. gastrointestinal system d. nervous system e. renal system

b. musculoskeletal system

Recommendations for introducing a baby to food on a spoon include all of the following EXCEPT: a. time the first spoon-feeding experiences for when the baby is not overly tired. b. offer a large variety of foods for him/her to choose from. c. give the baby time to open his or her mouth and extend the tongue towards food. d. place the bowl of the spoon on the tongue with slight downward pressure. e. keep the spoon level and do not scrape food into the baby's mouth.

b. offer a large variety of foods for him/her to choose from.

It is common for the elderly to have suboptimal vitamin D status or develop vitamin D deficiency due to all of the following EXCEPT: a. inadequate exposure to sunlight. b. wearing of lighter clothing to stay comfortable. c. nutrient-drug interactions. d. decreased skin synthesis capacity. e. All of the above would be reasons why the elderly have vitamin D deficiencies.

b. wearing of lighter clothing to stay comfortable.

Continuing to nurse while you are sick actually protects your baby because: a. you do not pass germs through breast milk. b. your breast milk is full of antibodies that are passed on to your baby. c. you do not contaminate bottles by handling them. d. infant formulas are higher in vitamins and minerals and help boost the baby's immune system.

b. your breast milk is full of antibodies that are passed on to your baby.

Which of the following statements reflects the most accurate assessment measurement? a. An older adult weighing herself at home b. A new breastfeeding mom recording what she ate over the past 24 hours c. A dietitian interviewing a mom with a 5-year-old toddler about what he ate over the past 24 hours and then asking her to record what the toddler ate over the next two days d. A physician asking the height of an 80-year-old male patient

c. A dietitian interviewing a mom with a 5-year-old toddler about what he ate over the past 24 hours and then asking her to record what the toddler ate over the next two days

Which of the following statements correctly describes similarities and/or differences between WHO and CDC growth curves for children aged 24-59 months? a. There is no difference. CDC and WHO growth curves for this age group is based on the same sample populations. b. National Health and Nutrition Examination Survey (NHANES) was used to develop standards for both CDC and WHO growth curves. c. Approximately 50% of infants are ever breastfed in the sample used to determine CDC growth curves, and 100% of infants are ever breastfed in the sample used to determine WHO growth curves. d. Both WHO and CDC growth curves are based on an international sample of infants. e. Both c and d are correct.

c. Approximately 50% of infants are ever breastfed in the sample used to determine CDC growth curves, and 100% of infants are ever breastfed in the sample used to determine WHO growth curves.

How can the change in lipid blood levels that occurs during pregnancy best be described? a. Cholesterol and triglyceride levels decrease due to the increased water volume in the blood b. Cholesterol and triglyceride levels remain the same as pre-pregnancy levels c. Cholesterol and triglyceride levels increase substantially from pre-pregnancy levels d. Cholesterol and triglyceride levels fluctuate daily depending on when the fetus is building nerve cells

c. Cholesterol and triglyceride levels increase substantially from pre-pregnancy levels

MyPlate tips for an active preschooler include all the following EXCEPT: a. Eat at least half of all grains as whole grains. b. Use fruit as snacks or desserts. c. Drink whole milk. d. Eat a variety of protein foods every day. e. Include vegetables in meals and snacks.

c. Drink whole milk.

Which of the following is true of maternal energy requirements during pregnancy? a. Energy requirements are highest in the first trimester due to rapid fetal brain development b. Energy requirements are highest in the second trimester due to increases in amniotic fluid c. Energy requirements are highest in the third trimester due to rapid fetal growth d. Energy requirements are the same for all trimesters

c. Energy requirements are highest in the third trimester due to rapid fetal growth

All the following are common diseases/conditions that are more prevalent in the elderly except a. Osteoporosis b. Kyphosis c. Failure to thrive d. Hypertension e. Constipation

c. Failure to thrive

Which of the following statements is false regarding metabolic changes in normal pregnancy: a. Carbohydrate requirements increase during pregnancy due to increased glucose utilization b. Insulin resistance increases during the second half of pregnancy c. Maternal liver glycogen content increases during the first half of pregnancy and continues to increase during the second half of pregnancy d. Plasma triglyceride and cholesterol levels increase during pregnancy

c. Maternal liver glycogen content increases during the first half of pregnancy and continues to increase during the second half of pregnancy

At a daycare center, a small chocolate candy bar was given to only the three year olds who ate everything at mealtime. Choose the best description of the feeding relationship problem between the daycare center staff and three year olds. a. The daycare center staff has served inappropriate portion sizes for toddlers. b. The daycare center staff has severely restricted "junk foods." c. The daycare center staff has inappropriately used coercion to control food intake. d. The daycare center staff has taught the children to like sweets.

c. The daycare center staff has inappropriately used coercion to control food intake.

A 65 year old was buying an iron supplement for her "weak blood." She asked the pharmacist about the highest amount she should take daily. What dietary intake standards could the pharmacist use to provide the best recommendation? a. Recommended Dietary Allowances (RDAs) b. Adequate intakes (His) c. Tolerable Upper Intake Levels (ULs) d. Estimated average requirements (EARs)

c. Tolerable upper intake levels (ULs)

Which of the following is true of vitamin and mineral needs during pregnancy compared to pre-pregnancy needs? a. Women need a higher amount of fluoride during pregnancy to prevent dental caries b. Women need a higher amount of calcium during pregnancy to support the development of fetal bones c. Women need a higher amount of iodine during pregnancy to support fetal brain development d. Women don't require a higher amount of iron during pregnancy because they are not menstruating e. Both b and c are correct

c. Women need a higher amount of iodine during pregnancy to support fetal brain development

The two hormones secreted by the pituitary gland during the FOLLICULAR phase of a woman's cycle are: a. progesterone and estrogen. b. follicle-stimulating hormone and progesterone. c. follicle-stimulating hormone and luteinizing hormone. d. luteinizing hormone and progesterone. e. luteinizing hormone and estrogen.

c. follicle-stimulating hormone and luteinizing hormone.

The FIRST step in correcting failure to thrive (FTT) is: a. feeding the baby on a regular schedule. b. providing a stimulating environment when the baby is eating. c. increasing calorie and protein intakes. d. enrolling the child in an early intervention program. e. obtaining social support for the family.

c. increasing calorie and protein intakes.

All of the following are food preferences of toddlers EXCEPT _____. a. sweet foods b. salty foods c. sour foods d. energy-dense foods

c. sour foods

Morning sickness (NVP)

can be treated by eating small, frequent meals of easily digestible CHOs, drinking between vs with meals, avoiding highly seasoned foods, eating breakfast in bed

Changes of breastmilk

colostrum --> transitional milk --> mature milk

Which of these suggestions would be most likely to be helpful for someone with dry mouth? a. Eat spicy foods to stimulate saliva flow b. Avoid liquids with meals to reduce choking risk. c. Puree all foods d. Drink water with meals to aid with swallowing

d. Drink water with meals to aid with swallowing

Mr. G is 75 years old and has been diagnosed with Helicobacter pylori infection. Which condition is Mr. G also at risk for? a. Vitamin B12 deficiency b. Achlorhydria c. Poor calcium absorption d. H. Pylori increases the risk of all three conditions

d. H. Pylori increases the risk of all three conditions Vitamin B12 deficiency Achlorhydria Poor calcium absorption

Which of the following is NOT one of the infant growth charts developed by the National Center for Chronic Disease Prevention and Health Promotion (part of the CDC)? a. Weight for age b. Length for age c. Weight for length d. Head circumference for weight e. Head circumference for age

d. Head circumference for weight

Which of the following would NOT be considered one of the four components of nutrition assessment? a. Anthropometric b. Biochemical c. Clinical/physical d. Initial evaluation e. Dietary

d. Initial evaluation

Secondary malnutrition may be precipitated by: a. medication. b. a disease state. c. a surgical procedure. d. All of the above e. b and c only

d. all of the above

Which of the following are components of maternal weight gain during pregnancy: a. Increased blood volume b. Development of the placenta c. Increased maternal breast size d. All of the above

d. all of the above

High maternal blood glucose levels cause the fetus to _____________. a. increase insulin output b. convert glucose into triglycerides and store it as fat c. potentially develop type 2 diabetes later in life d. All of the above

d. all of the above Increase insulin output Convert glucose into triglycerides and store it as fat Potentially develop type 2 diabetes later in life

According to Ellyn Satter, which of the following would be considered a common mistake that a parent might make when feeding a toddler? a. Parents don't allow the child to determine how much or whether they want to eat. b. Parents allow the child to determine what food to eat and where the food is eaten. c. Parents don't provide appropriate eating environments at home and elsewhere. d. All of the above are common mistakes that parents make when feeding toddlers. e. b and c only

d. all of the above Parents don't allow the child to determine how much or whether they want to eat Parents allow the child to determine what food to eat and where the food is eaten Parents don't provide appropriate eating environments at home and elsewhere

Pregnancies among women with chronic hypertension are associated with higher rates of: a. placenta abruption b. preterm delivery c. fetal growth retardation d. All of the above

d. all of the above Placenta abruption Preterm delivery Fetal growth retardation

Parents can influence the eating behaviors of toddlers in which of the following ways? a. What they bring into the house and have available to eat b. How they prepare food and when they serve it c. Their attitudes and behaviors around food d. All of the above e. a and b only

d. all of the above What they bring into the house and have available to eat How they prepare food and when they serve it Their attitudes and behaviors around food

Dietary fiber reduces the risk of coronary heart disease, but older adults are more often concerned with the role of fiber for: a. decreasing the incidence of diverticular disease. b. decreasing the incidence of type 2 diabetes. c. decreasing the risk of hypertension. d. gastrointestinal health. e. supplying essential nutrients.

d. gastrointestinal health.

Which of the following services do Title IIIC programs NOT pay for? a. home meal delivery b. ethnic meals c. nutrition education d. grocery delivery

d. grocery delivery

Newborn health status is assessed by a number of indicators of growth and development taken right after birth, which include all of the following EXCEPT: a. birthweight. b. length. c. head circumference. d. knee to ankle length.

d. knee to ankle length

A symptom NOT related to PCOS is _________. a. insulin resistance b. amenorrhea c. infertility d. low testosterone levels

d. low testosterone levels

Female athlete triad

disordered eating leads to REDS, changes in menstrual function, and bone health

For someone wishing to increase her vitamin B12 intake through food alone, what foods could you suggest that are leading sources of this vitamin? Select one: a. Beef b. Milk c. Fish d. Fortified cereals e. All of the above f. a and d only

e. All of the above Beef, Milk, Fish, Fortified cereals

Women with which of the following characteristics are at increased risk of developing preeclampsia? a. Obesity b. Insulin resistance c. First pregnancy d. High triglyceride levels e. All of the above

e. All of the above Obesity Insulin resistance First pregnancy High triglyceride levels

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.

Which of the following is a nutritional benefit of breastfeeding? a. It provides optimal nutrition to the infant. b. The balance of nutrients matches requirements needed for human growth. c. Infants do not need additional fluids or water when breastfeeding. d. The low protein content is easily tolerated. e. All of the above are considered nutritional benefits. f. Only a and b are correct

e. All of the above are considered nutritional benefits.

Nutritional exposures before and very early in pregnancy may disrupt fetal growth and development. Which of the following would NOT be considered an adverse nutritional exposure? a. Iodine deficiency b. Obesity c. Alcohol intake d. Poorly controlled glucose e. All of the above would be considered adverse nutritional exposures.

e. All of the above would be considered adverse nutritional exposures.

Which statement describes how physiologic doses found in a vitamin-mineral supplement for the elderly differ from doses in supplements for the general adult population? a. Additional vitamin B12 is added b. Little or no iron is added c. Decrease in zinc d. Additional vitamin E is added e. a and b

e. a and b Additional vitamin B12 is added Little or no iron is added

After observing several family meals, you notice that the parents continually praise their children for cleaning their plates. They are: a. unconsciously rewarding the children for eating. b. altering the children's ability to self regulate food intake. c. encouraging their children to be good eaters by offering praise. d. All of the above e. a and b

e. a and b Unconsciously rewarding their children for eating Altering the children's ability to self regulate food intake

When may it be beneficial to recommend a vitamin or mineral supplement to an elderly person? a. When the person experiences loss of taste or smell b. When the person has an illness causing a loss of appetite c. When the person is consuming a nutrient-dense diet d. All of the above e. a and b

e. a and b When the person experiences loss of taste or smell When the person has an illness causing a loss of appetite

Dietary recommendations for women with PCOS emphasize: a. whole grains, fruits, and vegetables high in antioxidants. b. lean sources of protein. c. high-glycemic index carbohydrate sources. d. All of the above e. a and b only

e. a and b only

When too few calories are consumed, the body will obtain energy from which of the following sources? a. Glycogen b. Fat stores c. Protein from organs d. All of the above e. a and b only

e. a and b only (fat stores and glycogen)

Which of the following statements best describes motor development in infants? a. Voluntary control of muscles starts from the head and moves down to the legs. b. Voluntary control of muscles starts from being able to fan toes out at birth to blinking eyes in response to a loud noise or light. c. Voluntary muscle control develops with central muscles first and then moves out to hand muscles. d. Voluntary muscle control develops with rooting reflex and then moves out to hand muscles. e. a and c

e. a and c Voluntary control of muscles starts from the head and moves down to the legs Voluntary muscle control develops with central muscles first, then moves out to hand muscles

Which of the following statements is TRUE regarding the spectrum of fetal alcohol disorders? a. For fetal alcohol syndrome to be diagnosed, a specific set of characteristics must be exhibited in the child. b. Typical maternal characteristics associated with fetal alcohol syndrome or fetal alcohol spectrum disorders are older age and multiple pregnancies. c. There is no known absolute safe level of alcohol consumption during pregnancy, so women should be counseled that the safest approach is to not drink during pregnancy. d. With intense early intervention after birth, the behavioral and cognitive abnormalities associated with fetal alcohol spectrum disorders can be completely reversed. e. a and c only

e. a and c only For fetal alcohol syndrome to be diagnosed, a specific set of characteristics must be exhibited in the child. There is no known absolute safe level of alcohol consumption during pregnancy, so women should be counseled that the safest approach is to not drink during pregnancy.

Studies have shown that restricting a young child's access to palatable food may: a. promote desirability of that particular food. b. reduce their interest in new foods. c. encourage them to overeat these foods and have negative feelings. d. All of the above e. a and c only

e. a and c only Promote desirability of that particular food Encourage them to overeat these foods and have negative feelings

Which of the following is a major function of the placenta? a. Hormone and enzyme production b. Nutrient and gas exchange between mother and fetus c. Removal of waste products from the fetus d. Barrier to drugs and alcohol e. a, b, and c

e. a, b, and c Hormone and enzyme production Nutrient and gas exchange between mother and fetus Removal of waste products from the fetus

Which of the following statements is true about calcium supplementation and absorption? a. Low calcium levels have been linked to colon cancer, overweight, and hypertension. b. A high intake of calcium interferes with zinc and iron absorption. c. A high intake of calcium may result in elevated urinary excretion of calcium. d. Calcium is better absorbed in pill form. e. a, b, and c only

e. a, b, and c only Low calcium levels have been linked to colon cancer, overweight, and hypertension A high intake of calcium interferes with zinc and iron absorption A high intake of calcium may result in elevated urinary excretion of calcium

Which of the following federally funded programs may benefit young children? a. WIC b. Head Start c. SNAP d. WIC's Farmers' Market Nutrition Program e. All of the above

e. all of the above

The specific 2020 nutrition objective to reduce iron deficiency in females of childbearing age by 10% is important because: a. women with iron deficiency are at increased risk for having babies with neural tube defects. b. women with iron deficiency are at increased risk for early delivery. c. babies of women with iron deficiency are at increased risk for developing iron deficiency within the first year of life. d. All of the above e. b and c only

e. b and c only (women with iron deficiency are at risk for early delivery and babies of women with iron deficiency are at increased risk for developing iron deficiency within the first year of life)

Infants often have conditions that reflect the immaturity of the gastrointestinal tract, which include all of the following EXCEPT: a. colic. b. gastroesophageal reflux (GER). c. unexplained diarrhea. d. constipation. e. urinary tract infections.

e. urinary tract infections

Traditional carbohydrate loading is the process of:

eating low-carbohydrate foods for the first 3 days of the week, while continuing to exercise, and then consuming a high-carbohydrate diet the 3 days prior to competition while exercising minimally.

Improve weight status prior to conceiving

if overweight, women should take 6 months to lose ~10% body weight to improve chances of conceiving

Eating patterns and behaviors of adolescents are influenced by many factors, which include: a. peer influences. b. cost and convenience. c. body image. d. food availability. e. a and c only f. All of the above

f. All of the above Peer influences Cost and convenience Body image Food availability

Drinks should be given in a cup rather than a bottle in order to...

prevent tooth decay

Neural Tube Defects (NTDs)

~4000/year in the US Malformations of the spinal cord and brain Neural tube closes by day 28 of pregnancy