CONT...Domain 1, Part 2, Topic D: Nutrition and Supporting Sciences

**What are the 4 different weight gain guidelines for pregnant women?

25-35 lbs. for normal wt (BMI 18.5-24.9) 28-40 lbs. for underweight (BMI < 18.5) 15-25 lbs. for overweight (BMI 25-29.9) 11-20 lbs. for obese (BMI >/= 30)

What is the AI for sodium chloride for adults between 19-50 y/o?

3.8 g/day NaCl

What the recommended daily water intake for adults?

35 ml/kg ~or~ 1ml/calorie ingested

What is the protein requirement for women in their 2nd half of pregnancy and women who are lactating?

71 grams protein

**On the BMI for age growth chart, what are the 4 percentile classifications?

<5th percentile: underweight 5th - 84th percentile: healthy weight 85th - 94th percentile: overweight >95th percentile: obese (or BMI>30)

What does AGA stand for and what is the percentile associated?

AGA = appropriate for gestational age between the 10th and 90th percentile

**Iron-fortified infant formula should be given to....

ALL infants on formula

What is the fluid requirement for older adults compared to younger adults?

Elderly: 25-30 ml/kg body weight Adults: 35 ml/kg body weight

What is the AI for total fiber intake for adult men and women over the age of 50 y/o?

Males: 30 grams fiber Females: 21 grams fiber

What is the AI for total fiber intake for adult men and women under the age of 50 y/o?

Males: 38 grams fiber Females: 25 grams fiber

**What is the RDA of protein for adult men and women (19 y/o or older)?

Males: 56 grams protein Females: 46 grams protein

**What are the caloric needs for 0-6 month old males and females?

Males: 570 kcal/day Females: 520 kcal/day

**What are the caloric needs for 7-12 month old males and females?

Males: 743 kcal/day Females: 676 kcal/day

What is the AI for alpha-linolenic acid (omega 3) for adult men and women?

Men: 1.6 g/day Women: 1.1 g/day

What is the AI for linoleic acid (omega 6) for adult men and women?

Men: 17g/day Women: 12 g/day

What is the AI for water intake for adult men and women 19 y/o or older?

Men: 3.7 L/day Women: 2.7 L/day

**At rest and during normal activities, what type of fuel do we primarily burn?

fat (80-90%) CHO 5-18% PRO 2-5%

Why and when do infants need additional iron from formula or supplemental foods?

fetal iron stores decrease at 3-4 months

**What are the weight gain guidelines for pregnant women based off of?

her BMI

Growth usually does not deviate by more than 25 percentile points from the established pattern of growth ; and if it does it is usually due to....

human error in measurement

How fast does muscle glycogen deplete during continuous exercise at 60-80% of maximal oxygen uptake?

in 2 - 3 hours

Which age group needs the most calories, protein, and water per unit of body weight?

infants

What is colostrum, and what are it's components compared to regular breast milk?

it is fluid secreted from the breast during the first few days AND it meets the infants needs during the first week contains antibodies, more protein, less fat, and less carbs than reg. breast milk

What does neonate mean?

it's a term used to describe the time of life from birth to 1 month in age NOTE: they can absorb whole, intact protein

**What is a secondary cause of FTT?

lack of fiber in the diet which can lead to chronic constipation

You should limit the amount of _________ to ____ oz/day for children ____y/o and younger.

limit the amount of fruit juice to 4oz/day for children 6 y/o and younger.

_____________ and ___________ are inappropriate to feed an infant during the first 2 years of life.

low-fat and non-fat milks

One serving of this food should be introduced to infants 6 months old to enhance iron absorption from non-heme sources.

one serving of vitamin C-rich foods

**What, if any, supplements are needed for infants on formula?

only 0.25 mg fluoride /day after 6 months of age (if water supply is inadequate)

In adulthood, what is the main determiner of energy needs?

physical activity

gravida refers to...

pregnancy

What hormone helps develop the placenta after implantation?

progesterone

Cow's milk has more _____ than human milk.

protein

What are the protein, water, and fat needs for 7-12 month old infants?

protein: 11 g/day water: 1.5 ml/kcal fat: minimum of 30 g/day

What are the protein, water, and fat needs for 0-6 month old infants?

protein: 9.1 g/day water: 125-155 ml/kg/day (based on age) fat: minimum of 30 g/day

What are the 2 maternal hormones from the pituitary glad that are involved in lactation, and what is their function?

1. prolactin: stimulates milk production 2. oxytocin: moves milk through ducts

**What are the 3 most at risk groups of pregnant women?

1. those who fail to gain 4 lbs. / month in last half of pregnancy 2. under 16y/o or above 35 y/o 3. less than 12 months between pregnancies

What is the AI for sodium for adults between 19-50 y/o?

1.5 g/day sodium

Newborns usually lose about 6% of their birth weight, but should regain it by ___-___ days,

10-14 days

You should drink ____ oz water for every 1 lb body weight lost.

16 oz water

What is the Adequate Intake (AI) of calcium for pregnant and lactating women?

18y/o or younger: 1,300 mg older than 18y/o: 1,000 mg

What are the calorie needs of lactating women during the 1st 6 months and between 6-12 months after birth?

1st 6 months after birth: +330 kcals/day 6-12 months after birth: +400 kcals/day

What are the calorie needs of pregnant women in all 3 trimesters?

1st Trimester: no change, normal intake 2nd Trimester: +340 kcals / day 3rd Trimester: +452 kcals / day

**What is a normal infant birth weight?

2,500 - 4,000 grams (5.5 - 8.8 lbs)

**How many calories are in 1 ounce of infant formula, and what is the recommended intake?

20 calories/ ounce formula -need 2.5 oz/lb/day

human breast milk has how many calories per ounce?

20 calories/ ounce of milk

What are the 6 symptoms of lead poisoning?

1. irritability 2. lethargy 3. anorexia 4. vomiting 5. diarrhea 6. anemia

What are percentile charts based off of (3)?

1. height 2. weight 3. age

What are the 3 indicators that the infant's milk supply is adequate?

1. infant gains weight and length 2. frequent stools 3. 6-8 wet diapers /day

What is the hydration recommendation for adult athletes during continuous endurance PA of 1-4 hours?

-drink 100% fluid lost during moderate-vigorous activity -plus 5.5 - 15% CHO -and 55 - 164 mEq Na+

**What is the hydration recommendation for adult athletes after continuous PA for 1-2 hours?

-drink a volume = 100-150% fluid lost during exercise -containing 6.0 - 7.6% CHO -and 57.5 - 1,150 mg/dl Na+

**What is the ADA's breast feeding recommendations?

-exclusive breast feeding for first 4-6 months -then supplemented by weaning foods for at least 12 months

What is the Weight for length/stature growth chart used for, and what are the concerning percentiles and what do they reflect?

-identifies under/over nutrition, or within normal limits -used to distinguish between stunting and wasting -detects short term changes in nutritional status CONCERNING: <5th percentile: acute illness or wasting >95th percentile: over-nutrition

**What does infant formula have more of and less of compared to breast milk?

-it has more protein and more iron -lacks antibodies

**What does the "weight for length/stature" growth chart reflect, and what are the concerning percentiles?

-reflects current nutritional status <5th percentile: may reflect acute illness or wasting >95th percentile: over-nutrition

**What does the "stature/length for age" growth chart reflect, what does it detect, and what are the concerning percentiles?

-reflects long-term nutritional status -detects stunting of growth <5th percentile: short stature

**What does the "weight for age" growth chart reflect, and what are the concerning percentiles?

-short-term marker of growth -anything <5th percentile and >95th percentile BUT further evaluation is needed NOTE: -NOT used to classify under/over weight -CANNOT distinguish btw stunting and wasting because it does not include height

**When introducing solids to infants at 4-6 months, what should you begin with and then move on to?

-start with iron-fortified cereals -then stained vegetables or fruit

**What is the expected weight gain for pregnant women (#/m or week)?

1 lb / month x first 3 months 1 lb / week thereafter

What is the Adequate Intake (AI) for calcium for ages 9-13 y/o?

1,300 mg Calcium/day

What is the RDA for protein for age groups 1-3 y/o, 4-8 y/o, 9-13 y/o, 14-18 y/o Males, and 14-18 y/o Females?

1-3 y/o: 13 G protein/day 4-8 y/o: 19 G protein/day 9-13 y/o: 34 G protein/day 14-18 y/o Males: 52 G protein/day 14-18 y/o Females: 46 G protein/day

Fill in the blanks. 1-3 year old's growth rate _____ 4-6 year old's growth rate _____ 7-10 year old's growth rate _____

1-3 year old's growth rate SLOWS 4-6 year old's growth rate INCREASES 7-10 year old's growth rate SLOWS

**What are the two supplements breast-fed infants need, how much is needed, and when should they take it?

1. 400 IU Vitamin D/day (from birth) 2. 0.25 mg fluoride/day (after 6mo, if water contains inadequate amounts of fluoride)

**What are the 5 botanicals that may have potential interactions with anticoagulants?

1. Black cohosh 2. Garlic 3. Ginger 4. Ginkgo Biloba 5. Ginseng

What are the pre-natal supplements prescribed?

1. Folic Acid (B9) 2. Ferrous Sulfate (Iron)

**what are the 4 different types of growth charts for infants, children, and adolescents?

1. Weight for length/stature 2. Stature / length for age 3. Weight for age 4. BMI for age

Because we are living a lot longer, elderly has been redefined to what 3 categories?

1. Young old: 65-74 y/o 2. Aged: 75-84 y/o 3. Oldest old: 85 y/o and up according to the US Census Bureau

**When should solids be introduced (3 factors)?

1. between 4-6 month 2. when sitting posture is sustained 3. extrusion reflex diminishes

**Which two groups of pregnant women usually strive to achieve the upper end of weight gain to reduce risks?

1. black women 2. very young women

Why is it common for older adults to develop constipation (2 reasons)?

1. decreased gastric motility 2. decreased secretion of HCL (hydrochloric acid) from stomach

**During and after continuous physical activity, one should drink fluids containing what 3 things?

1. fluid 2. carbohydrate 3. sodium

**What are the 3 adverse reactions of using unmodified cow's milk in infant formula?

1. hard to digest 2. less EFA (essential fatty acids) 3. increased renal solute load

Who creates percentile growth charts?

CDC and NCHS (national center for health statistics)

**What supplement is needed for the development of the fetal nervous system, and what is recommended daily intake?

DHA = linolenic acid (omega 3) for pregnancy: 1.4g/day linolenic acid or 300 mg DHA for lactation: 1.3g/day linolenic acid

What does DSHEA stand for, and what do they do?

DSHEA = Dietary Supplement Health and Education Act of 1994 -regulates herbs, botanicals, and supplements

**What does FTT stand for, and what are the 5 most common causes?

FTT = Failure To Thrive may result from: 1. acute or chronic illness 2. restricted diet 3. poor appetite 4. lack of fiber leading to chronic constipation (*SECONDARY CAUSE*) 5. diminished intake

What is the usual prescription (amount, directions, etc...) for pre-natal supplements iron and folic acid?

Ferrous Sulfate: 30 mg -take during 2nd and 3rd trimesters -take btw meals, not with milk, tea or coffee Folic Acid (B9): 400 mcg -with food, should be getting a total of 600 mcg

What is considered a low birth weight (LBW), a very low birth weight (VLBW), and an extremely low birth weight (ELBW)?

LBW: under 5.5 lbs (<2500 grams) VLBW: under 3.3 lbs (<1500 grams) ELBW: under 2.2 lbs (<1000 grams)

What does LGA stand for and what is the percentile associated?

LGA = large for gestational age above the 90th percentile

What is an OCF measurement?

OCF = occipital frontal circumference measures head circumference NOTE: done until age 3

What does SGA stand for and what is the percentile associated?

SGA = small for gestational age below the 10th percentile

**Out of all populations of pregnant women, who is usually the most at risk, and why??

THE PREGNANT TEENAGER!!! bc she needs extra iron, calcium, and zinc

Creatine supplements do NOT...

enhance endurance (not helpful for marathon runner or soccer player)

What botanical should be avoided if you have liver disease?

Valerian root

Elderly often develop atrophic gastritis, a chronic autoimmune disease that causes inflammation in the stomach. What supplements (2) might these patients need?

Vitamin B6 - Pryidoxine Vitamin B12- Cyanocobalamin

**What should be the main weight gain target for all pregnant women?

achieve at least the lower limit in your specified guideline

What age group has the most dietary deficiencies, and why?

adolescence due to their final growth spirt

**How much vitamin D-fortified infant formula is required to meet Vit D requirements?

at least 1 quart /day

How much daily physical activity is recommended for children ?

at least 60 minutes

By the 4th-5th month, birth weight should...

be doubled

by 2 years, birth weight should...and length should..

birth weight should be quadrupled and length should increase by 75%

by 1 year, birth weight should...and length should...

birth weight should be tripled and length should increase by 50%

For exercise above 60-65% of maximal oxygen uptake, what is needed as a fuel source?

carbohydrate

For infants who cannot tolerate cow's milk-based or soy products, what formula is recommended?

casein hydrolysate (Pregestimil) formula

Why do older adults often lack calcium and iron?

decreased absorption due to decreased HCL (hydrochloric acid) secretions by the stomach

What % lactose is in dried whey and casein hydrolysate infant formulas?

dried whey formula: 73% lactose casein hydrolysate formula: 0% lactose

What is hyperbilirubinemia , when and why does it occur, and how can it be prevented?

elevated bilirubin levels within the first week of life -due to increased RBC breakdown or decreased intestinal mobility -to prevent: encourage 9-12 feedings per day of breast milk or formula to PROMOTE HYDRATION AND INTESTINAL MOTILITY

What does carbohydrate loading enables athletes to...

store 2-3 times the normal amount of glycogen in the muscle

What does the American Academy of Pediatrics say about the growth charts to assess children with Down syndrome?

that they no longer reflect the population and should not be used

Herbs, botanicals, and supplements are regulated by..

the DSHEA = Dietary Supplement Health and Education Act 1994

What is the most important advice you can give to an athlete?

to drink water

During prolonged exercise, why is carbohydrate needed?

to provide PYRUVATE for continued fat oxidation

**BMI for age growth chart starts at age...

two

Up till what age do boys and girls have the same daily iron needs?

up to age 10; at age 11 girls need more iron than boys

During the 1st year of life, infants should not be fed...

whole cow's milk