FSHN 322 Final

Toddler-sized portions

average 1 tablespoon per year of age

Diabetes Mellitus

fasting blood glucose levels ≥125 mg/dL hemoglobin A1c >6.5%

Early Head Start Program

federal program focused on preventing and reducing risks to infant development Work with infants and their families at risk due to drug abuse, infants with disabilities, or teenage mothers)

Non-modifiable risk factors for bone loss

female, multiple pregnancies, intervals between pregnancies family history, maternal history of hip fracture Caucasian, Asian, thin, small-boned Extensive steroid use

Prebiotics

fiber-like indigestible carbohydrates that are broken down by colon bacteria chicory, wheat, barley, rye, onions, garlic, leeks

Colostrum

first milk (lactogenesis 2) Very high in proteins (secretory IgA and lactoferrin) = "liquid gold"

Soy formula not recommended

may impact developmental and long- term reproductive risks, with an emphasis on hormone- like components Lactose free and hydrolyzed formulas are better for infants unable to breastfeed or be fed cow's milk formulas

Celiac Disease in children

results in diarrhea & caused by sensitivity to the protein gluten found in wheat & other grains Higher in Middle Eastern & Irish ancestry Complete restriction of any gluten-containing foods

DHA in human milk

retinal development (higher IQ scores)

Xerostomia Dysgeusia Glossodynia

Xerostomia: dry mouth Dysgeusia: loss of taste Glossodynia: pain of the tongue

RDA for Vitamin D (adolescence)

600 IU/day Essential role in facilitating intestinal absorption of calcium and phosphorus Essential for bone formation Inverse relationship with PTH Synthesized by the body via skin exposure of ultraviolet B rays of sunlight In northern latitudes, may require supplementation Cod liver oil, fish, fortified cereals, oysters, caviar, soy products, salami, dairy products, eggs, mushrooms

Weight loss for newborn

7% of birth weight in 1st week (10% needs evaluation)

Breast milk components (pro, cho, fat)

7% of calories from Protein 38% calories from carbs 55% calories from fat

Need for supplements in older adults

Lack of appetit from illness/depression Diseases in GI tract Poor diet from food insecurity Taken by non-hispanic white females, educated, higher SES

Factors affecting growth - health conditions in school age children

Age of condition onset May determine if growth charts will be applicable Ex = Seizures Secondary conditions May interfere with accurate measurements Ex = LBW increases asthma risk Scoliosis & CP

Common measurements for toddlers/preschoolers

Gender specific - one set for girls & one for boys Age specific - a set for ages birth to 36 months and 2-20 years Weight-for-age Length- or stature-for-age Head-circumference-for-age Weight-for-length or -stature BMI-for-age

"Sandwich generation"

"Sandwich" generation: the 50s Multigenerational caregivers Health concerns - chronic disease and managing identified risk factors

Leading causes of death for those > than 65

Heart disease Cancer Respiratory disease Cerebrovascular disease Alzheimer's Diabetes

Adequate Intakes (AIs)

"tentative" RDAs based on less conclusive information

5 federal requirements for school wellness policies

#1 - Goals for nutrition education, physical activity, and school-based activities must promote wellness in a manner that the local educational agency (LEA) deems appropriate #2 - Nutrition guidelines selected by the LEA for all foods available on each school campus during the day with the objective of promoting student health and reducing childhood obesity #3 - Guidelines for reimbursable school meals #4 - A plan for measuring implementation of the local wellness policy, including designation of one or more persons within the LEA or at each school charged with operational responsibility for ensuring that the school meets the local wellness policy #5 - Community involvement including parents, students, representatives of the school food authority, the school board, school administrators, and the public in development of the school wellness policy Healthy Hunger-Free Kids Act = Aligned actual practice with national guidelines

maternal anabolic phase

(0-20 wks) changes where energy and nutrient stores and the heightened capacity to deliver stored energy and nutrients to the fetus 10% of fetal growth Blood flow expansion, increased cardiac output Buildup of fat, nutrient, and liver stores Growth of some maternal organs Decreased exercise tolerace Increased levels of anabolic hormones

catabolic phase

(20-40 wks) 90% of fetal growth mobilization of fat and nutrient stores increased production and blood levels of glucose, TGs, and FA (decreased liver glucogen stores) accelerated fasting metabolism increased appetite and food intake decline closer to term increased levels of catabolic hormones

Inches --> meters Pounds --> kg

Inches --> meters = multiply by 0.0254 Pounds --> kg = multiply by 0.454

Protein and calorie needs for 0-6 months and 6-12 months

0-6 months Protein = 2.2 g/kg Calories = 108 calories/kg [80-120] 6-12 months Protein = 1.6 g/kg Calories = 98 kcal/kg 2.2 X 4 = 8.8 g protein 1.6 X 8 = 12.8 g protein

Community assessment

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Individual assessment

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• Most common risk factors for infants and children at WIC

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• Nutrition services provided by WIC

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DRI for protein in school age children

0.95 g/kg body wt

PKU = Phenylketornuria

1 in 10,000 individuals Elevated blood phenylalanine due to lack of phenylalanine hydroxylase (Phe to Tyr) Preventable cause of intellectual disability High Phe in early pregnancy interfere with CNS development of infant Mental retardation Microcephaly Seizures, hyperactivity, abnormal behavior

Dental caries

1 in 3 children ages 3 to 5 Bedtime bottle with juice or milk Leading cause of Early Childhood Caries (ECC) Streptococcus mutans Sticky carbohydrate foods Prevention: Fluoride—supplemental amounts vary by age & fluoride content of water supply Fl suppplements uncommon D/T fluorosis

Dehydration levels

1% lost = thirst 4-6% lost = flushed skin, sleepiness, nausea, confusion, slurred speech 12% lost = wakefulness, delirium 20% lost = bare survival limit

Three stages of lactogenesis

Lactogenesis 1 (birth --> 2-5 days): milk formation begins Lactogenesis 2 (2-5 days after birth): increased blood flow to breast (milk "comes in") Lactogenesis 3 (~10 days after birth): milk composition is stable

Toddlers/preschoolers lack iron, calcium, and zinc

1-3 years IRON = 7 mg/d ZINC = 3 mg/d CALCIUM = 700 mg/d 4-8 years IRON = 10 mg/d ZINC = 5 mg/d CALCIUM = 1000 mg/d

Alcohol's impact on lactation

Alcohol consumed quickly passes to breast milk Level of alcohol in breast milk = maternal plasma Without food: peak plasma levels at 30-60 min With food: 60-90 min Decreases oxytocin & let-down Affects odor of milk Decreases volume consumed by infant Interferes with sleep pattern of infant

4 steps of the Nutrition Care Process

1. Nutrition assessment 2. Nutrition diagnosis 3. Nutrition intervention 4. Nutrition monitoring and evaluation

Alcohol (fertility)

Alcohol may decrease estrogen & testosterone levels or disrupt menstrual cycles Studies on weekly drinks consumed show: 1-5 drinks = 39% decrease in conception >10drinks = 66% decrease in conception

Protein needs (infants)

1.52 g/kg = if growth or digestion are not affected 3.0-3.5 g/kg = preterm or recovery from illness 4 g/kg = ELBW (extremely low birth weight) Form of protein Hydrolyzed protein or single amino acid formulas Specific amino acid formulas such as for PKU

Factors that affect longevity

10% access to healthcare 19% genetics 20% environment (pollution) 51% lifestyle factors

Feeding frequency (infants)

10-12 feedings/day are normal for newborns Stomach emptying occurs in ~1½ hours

Average needs: protein

10-35% of calories

Overweight and obesity based on the CDC growth chart (ages 2-5)

12.1% are obese (BMI/age ≥95%) BMI is lowest from ages 4-6 years Adiposity (BMI) rebound— normal increase in BMI that occurs after BMI declines Best treatment is allowing child to "grow into his or her height" Wt loss NOT > than 1 #/month BMI-for-age as screening tool

DRI for calcium (older adults)

1200 mg/day Carbonate = 40% elemental calcium (more Ca concentration) Citrate = no need for stomach acid to digest

US fertility stats

15% of couples are infertile 44% of couples diagnosed as "infertile" will eventually conceive without use of technology Healthy couples have a 20% to 25% chance of conception within a given menstrual cycle

Subfertility

18% of couples are subfertile Multiple miscarriages Sperm abnormalities Infrequent ovulation

Safest BMI range for older adults

18.5-30 protective effect of adiposity during stress and illness

Limit dietary saturated fats, trans fat & cholesterol in children

2 to 3 years—30 to 35% of calories 4 to 18 years—25 to 35% of calories For children at high risk of CVD limit saturated fat to < 7% of calories & cholesterol to < 200 mg Screening @ age 2 If Family Hx

Meal preparation skills of toddlers and preschoolers

2 years: tear lettuce/greens, rinse vegetables/fruits, snap green beans 3 years: mash potatoes, squeeze citrus fruits, stir pancake batter 4 years: peel eggs and some fruits, crack eggs, make sandwiches/salads 5 years: measure liquids, cut soft fruits with dull knife, use egg beater

Fluids for athletes

6-8 oz fluids prior to exercise 4-6 oz every 15-20 minutes during activity ≥8 oz following exercise Not more than 16 oz in 30 minutes to avoid nausea 16 oz fluid for every lb lost during sport Sports drinks with 6-8% CHO content may prevent dehydration

Fat needs during pregnancy

20 - 35% of calories LA: 13g/day (plant oils) ALA: 1.4 g/day Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) are crucial for fetal neural development Made from dietary ALA but in low amounts Only 9% conversion of ALA to EPA/DHA EPA+DHA recommendation is 300 mg/day

Average needs: fat

20-35% of kcals

Calorie needs during pregnancy

2nd trimester: +340 kcal/day 3rd trimester: +452 kcal/day

Calcium needs during pregnancy

3 cups milk/day, or 2 cups calcium fortified OJ + milk Calcium RDA is 1300 mg/D

Desirable birth weight

3500-4500 g (7 lb. 12 oz.-10 lb.)

Ergogenic aids

4% of adolescents report taking illegal steroids Most common in males Use peaks during 9th grade May be taken orally, injected, or as a patch Few high school athletic programs test athletes for ergogenic supplement use

Iron, zinc, and calcium for ages 4-8 and 9-13

4-8 years IRON = 10 mg/d ZINC = 5 mg/d CALCIUM = 1000 mg/d 9-13 years IRON = 8 mg/d ZINC = 8mg/d CALCIUM = 1300 mg/d

Adjusted gestational age for a preemie

40 - Gestational age at birth /4= months, subtract from current age

Heartburn

40-80% of pregnant women Ingest small meals frequently Avoid trigger foods

RDA for folate (adolescence)

400 mcg Folate required for DNA, RNA & protein synthesis Severe folate deficiency leads to megaloblastic anemia Severe deficiency rare but inadequate folate status appears to be more common fortified foods better for absorption than natural foods Adequate folate intake for female adolescents reduces birth defects like spina bifida, Down syndrome It is imperative that women of reproductive age (15 to 44 years) consume adequate folic acid Increased risk of folate deficiency Skipping breakfast, no fortified foods Lentils, pinto beans, garbanzo beans, spinach, black beans, kidney beans, collard greens, lima beans

Average needs: carbohydrates

45-50% of total caloric intake Sugar = 25% Females: 21-25 g Male: 30-38 g

Polycystic ovary syndrome

5-10% of women of childbearing age Leading cause of female infertility Many with PCOS are obese or have high levels of intra-abdominal fat Cause is uncertain Insulin resistance a possible factor Appears to have strong genetic component (family hx of infertility, menstrual problems, Type 2 DM, hirsutism) Primary goal is to increase insulin sensitivity Insulin-sensitizing drugs (Metformin) Diet recommendations: Lean proteins, whole grains, fruits & vegetables, regular meals, non-fat dairy, & low GI diet Weight loss & exercise improve prognosis

Fat in breastmilk

55% calories from fat Infants need cholesterol for gonad and brain development Short-chain and medium-chain fatty acids = easier to digest and utilize than long-chain fatty acids

DRI's for lactating women (1st year)

6 months: +500 kcal/day After: +400 kcal/day

First foods/drinks for toddlers

6 months—iron-fortified baby cereal Rice cereal is most hypoallergenic 6 months—fruits and vegetables Only one new food over 2-3 days Commercial baby foods are not necessary but do provide sanitary and convenient choices 9-12 months soft table foods

Definitions of "old"

70 - DRI category 60—the Elderly Nutrition Program 65—Eligibility for Medicare 60 - World Health Organization

Protein needs during pregnancy

71 g/day 925 g of accumulate during pregnancy = 2 lbs of wt Protein & amino acids conserved during pregnancy No evidence the body stores protein early in pregnancy Needs must be met by mother's intake of protein

Women need to pump breast milk (frequency)

8-12 sessions (10min per session)

Cow's milk-based formula

9-12% calories from Protein 41-43% calories from carbs 48-50% calories from fat

1. Percentage of children with disabilities that have a nutrition problem

90%

BMI and fertility at what % UBW

<20% or >30%

Nutrition needs differ for teen athletes - considerations when assessing nutritional needs

> than 50% of U.S. adolescents report playing one or more sports 62% of males 50% of females Nutrition concerns include: Fluid & hydration Carbohydrate loading High-protein diets High levels of activity + growth & development = increase needs for energy, protein & certain vitamins & minerals Nutrient needs = higher during intense training & competition seasons Monitor changes in body weight to assess for adequate energy and nutrient intake

Nutrition Programs for risk reduction in adults

A Model Health-Promotion Program ="Sisters Together: Move More, Eat Better" Public Nutrition Programs SNAP Government extension programs Meals on Wheels Soup kitchens and shelters for homeless

Type 1 Diabetes

Main goals of management of Type 1 DM: Blood glucose control Resolution of coexisting health problems Health maintenance Diets are controlled in carbohydrate content (low GI diet) Insulin use Physical activity

Signs of psychosocial development in teens

A sense of personal identity A moral & ethical value system Feelings of self-esteem or self-worth A vision of occupational aspirations Early adolescence (11 to 14) Middle adolescence (15 to 17) Late adolescence (18 to 21)

Physiological development of toddlers

A time of expanding physical and developmental skills Walking begins as a "toddle," improving in balance & agility Progress by month 15—crawl upstairs 18—run stiffly 24—walk up stairs one foot at a time 30—alternate feet going up stairs 36—ride a a tricycle Vulnerable to accidents

Alcohol during pregnancy

Alcohol passes freely through the placenta to the fetus No safe intake level has been set for all women, but the recommendation is "better safe than sorry" Excess intake (binge drinking, 5+ drinks at a time) associated with abnormal mental development Low intake (1-2 drinks per week) or infrequent intake has not been associated with significant negative outcomes

Principles of Basic Nutrition

A. Food is the basis needs of humans = 14% US households are food insecure B. Foods provide energy (calories) nutrients, and other substances needed for growth and health C. Health problems related to nutrition originate within cells - homeostasis D. Poor nutrition can result from both inadequate and excessive levels of nutrient intake E. Humans have adaptive mechanisms for managing fluctuations in food intake F. Malnutrition can result from poor diets and from disease states, genetic factors, or combination of these causes G. Some groups of people are at a higher risk of becoming inadequately nourished than others H. Poor nutrition can influence the development of certain chronic diseases I. Adequacy, variety, and balance are key characteristics of a healthy diet J. There are no "good" or "bad" foods

Recommendation for breastfeeding (duration)

AAP & AND = 1 year of breastfeeding or longer US Surgeon General = exclusively for 6 months and best for 12 months

Jaundice treatment

AAP guidelines recommend phototherapy using fluorescent lights Light is absorbed in bilirubin changing it to a water-soluble product that can be excreted via the kidneys AAP encourage continuation of breastfeeding

Energy needs for infants

AAP suggests 120 cal/kg for preterm infants The European Society for Gastroenterology and Nutrition gives a caloric range of 110-135 cal/kg Recovering infants may need as much as 180 cal/kg

Increased calories needed as activity increases (school age children)

ADHD or ASD-more active Ask in depth questions about physical therapy & walker/cane use

Effects of diabetes

Amputations Macular degeneration Visual loss Cataracts Glaucoma Neuropathies

Assessing growth in children with chronic conditions - warning for problem with growth

CDC Charts are good starting point Long-term health goals less important for children with life-shortening conditions Spinal Muscular Atrophy (SMA) or CF Plateau in weight Pattern of weight gain & then loss Failure to regain weight lost during an illness Unexplained/unintentional wt gain

Specific disorders with feeding difficulties

CF, DM, Seizures, Inborn Errors of Metabolism, Pediatric HIV, CD 70% of children with developmental delays have feeding difficulties Accepting foods + chewing them safely + ingesting enough foods and beverages

Nutritional preventions for cancer

Maintain or reach healthy weight Eat 2 ½ cups of fruits & vegetables daily Limit processed and red meat Alcohol in moderation, if at all Exercise Health care professionals provide guidance on diet/food-related side-effects of treatment

Twin Pregnancies

Dizygotic 2 eggs are fertilized, AKA Fraternal,~70% of twins Different genetic "fingerprints" Incidence increased by perinatal nutrient supplements Monozygotic 1 egg is fertilized , AKA Identical, (or almost identical) Always same sex, ~30% of twins Rates appear not to be influenced by heredity

Metabolic abnormalities that increase risk of type 2 diabetes

Abdominal obesity increased blood insulin, fasting glucose,TG, BP decreased HDL

Hindu dietary factors

Don't consume garlic and onions

Calcium and antacids

Don't take calcium with antacids Consume vitamins C, D, B6, and K 800-1000 IU vitamin D/day

Food-bound malabsorption Vit B12-often due to hypochlorhydria

Abnormal stomach function such as bacterial overgrowth B12 is not digested, absorbed, or bacteria may use B12 for own metabolism Prevalence Estimates range from 1-46% of the population Hard to detect, need confirmation of elevated MMA & Hcy for accurate Dx Effects Irreversible neurological damage, walking & balance disturbances High Hcy =High risk of PAD Definition and effects Lack of intrinsic factor which prevents B12 absorption Symptoms: Large, undeveloped RBC Glossitis Tongue fissures Irreversible neurological symptoms

Food allergies and intolerances infants

About 6-8% of children < 4 yrs have allergies Absorption of intact proteins causes allergic reactions Common symptoms are wheezing or skin rashes Treatment may consist of formula with hydrolyzed proteins Lactose interolance: inability to digest the disaccharide lactose Characterized by cramps, nausea and pain Alternating diarrhea and constipation Lactose intolerance in uncommon and tends to be overestimated

Iron needs during pregnancy

Additional needs in pregnancy: +1000 mg 300 mg (fetus & placenta) 250 mg (lost at delivery) 450 mg (increased red blood cell mass) Deficiencies and anemia: 18% of pregnant U.S. women have iron deficiency Associated with preterm delivery, LBW, poor cognitive scores, decreased iron stores in infant Hemoglobin and ferritin levels are different from those for non-pregnant women due to plasma volume expansion 30 mg daily supplement after the 12th week 60-180 mg daily supplement for women with anemia Multi-mineral supplements have lower iron absorption Side-effects: nausea, cramps, gas, constipation

Effects of obesity (adults)

Adipocytes can lead to chronic inflammation and insulin resistance role in chronic disease development can lead to low self-esteem and depression, discrimination, social stigma Associated with shorter life expectancy

Physical activity and strength training guidelines for teens - benefits of exercise in adolescence

Adolescents should be active daily = 60 min/day Engage in muscle-and-bone-strengthening activities three days/week Improves aerobic endurance and muscle strength May reduce risk of developing obesity Builds bone mass density Improves self-esteem, decreases anxiety Only 50% of adolescents meet the guidelines

Races or ethnic groups with health disparities

African American American Indian Hispanic children Odds of being obese significantly higher for non-Hispanic Black children and Mexican American children Maternal = most significant predictor of childhood obesity Followed by low family income and lower cognitive stimulation

Ethnic groups least likely to breastfeed

African American Cultural and learned parenting technique Lack of access to lactation consultants Lowest feeding rates: southeastern states

Luteal Phase (last half of menstrual cycle)

After ovulation Formation of corpus luteum in estrogen & progesterone stimulate menstrual flow Prostaglandins & cramps Sperm are stored in the epididymis & released in semen

Energy and proteins needs of toddlers and preschoolers

Age 1- 3 years 1.1 g/ kg/ d or 13 g/ day* 4- 8 years 0.95 g/ kg/ d or 19 g/ day*

Factors that impact nutrient needs

Age Body size Gender Genetic traits Growth Illness Lifestyle habits (smoking, alcohol intake, etc) Medication use Pregnancy and lactation

Stroke risk factors

Age Long-term high blood pressure Family history African American, Asian, Hispanic Physical inactivity Cigarette smoking

Division of Responsibility

Age RDA* g/ kg/ d (Protein) 1- 3 years 1.1 g/ kg/ d or 13 g/ day* 4- 8 years 0.95 g/ kg/ d or 19 g/ day*

Hypothalamic amenorrhea

Also known as "functional hypothamic amenorrhea" or "weight related amenorrhea" Caused by deficits in energy & nutrients Suppression of GnRH

Epigenetics

Alterations in gene activity that do not change the structure of DNA. Gene activity can be shut off or turned on, or slowed or sped- up by epigenetic mechanisms. Epigenetic mechanisms are affected by environmental factors

Common nutrition problems

Altered energy and nutrient needs Delayed growth Oral-motor dysfunction Elimination problems Drug/nutrient interactions Appetite disturbances Unusual food habits Dental caries, gum disease

3 hallmarks of the female athletic triad

Amenorrhea Disordered eating Osteoporosis Triggered when energy intake is ~30% less than requirement Decreases in LH, FSH & estrogen Low hormone levels lead to reduction in bone density Vit D, Calcium supplements needed Correction of ED Weight restoration

Breastfeeding contraindications

An infant diagnosed with galactosemia, a rare genetic metabolic disorder The infant whose mother Has been infected with the human immunodeficiency virus ( HIV) Is taking antiretroviral medications Has untreated, active tuberculosis Is infected with human T- cell lymphotropic virus type I or type II Is using or is dependent upon an illicit drug Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in breastfeeding

How ED affects fertility

Anorexia Nervosa and Bulimia Nervosa are linked to hypothalamic amenorrhea in some women More likely to miscarry, have preterm delivery, have low birth weight infants (< than 5.5 #) Menses typically resumes with weight gain Care involves evidence based practice interdisciplinary group of experienced health professionals

3 diagnosable eating disorders

Anorexia nervosa Extreme wt loss, poor body image, & irrational fears of wt gain & obesity Bulimia nervosa Recurrent episodes of rapid uncontrolled eating of large amounts of food in a short period of time frequently followed by purging Binge-eating disorder Periodic binge eating not followed by vomiting or use of laxatives

Disordered eating in adolescence

Anorexic or bulimic behaviors—with less frequency or intensity=unable to do a formal diagnosis Most frequent behaviors: Vomiting Laxatives Fasting or extreme dieting Excessive exercise

Supplements used to treat PMS

Antidepressants containing serotonin uptake inhibitors reduce PMS Supplements Calcium—1200 mg/day Vitamin B6—50 to 100 mg/day Chasteberry - 20 mg/day Reduced caffeine intake, supplementation of vit D and magnesium - limited results

Stage 4: Tertiary Intervention

Appropriate with severely obese youth or those who have significant, chronic co-morbidity conditions Level of treatment provided through a tertiary wt management center Diet and activity counseling with behavior modifications

Best Start Approach (for breastfeeding)

Ask open- ended questions to identify the woman's concerns Dietitian: "What have you heard about breastfeeding?" Client: "I hear it's best for my baby, but all my friends say it really hurts!" Affirm her feelings by reassuring her that these feelings are normal Dietitian: "You know, most women worry about whether it will hurt." Educate by clarifying how other women like her have dealt with her concerns. Avoid overeducating or giving the impression that breastfeeding is hard to master Dietitian: "Did you know that it is not supposed to be painful, and if you are having discomfort, there are people who can help make it better?"

Physical Activity (adults)

At least 150 minutes/week of moderate-intensity physical activity Muscle strengthening activities 2 times a week Regular physical activity leads to changes in body composition with reduced fat mass and increased lean mass Even without caloric restriction, aerobic physical activity decreases adiposity

Recommendations for physical activity for children - determinants

At least 60 minutes activity daily Parents should set a good example, encourage physical activity, and limit screen time Actual: Only 7.9% of middle & junior high schools require daily physical activity Determinants may include: Girls are less active than boys Physical activity decreases with age Season & climate impact level of physical activity Physical education classes are decreasing

Cardiovascular Disease (adults)

CHD and stroke are characterized by atherosclerosis,- hardening of arteries, due to plaque buildup Arteries narrow increasing risk of: Myocardial infarction = shut off blood in heart (heart attack) Stroke = blood shut off to cerebral artery of the brain Risk Factors for CVD Dyslipidemia High blood pressure Lifestyle factors (Diet, Physical activity, Smoking) Obesity Diabetes Infection and inflammation

School Breakfast Programs

Authorized in 1966 (NSLP rules apply to the School Breakfast Program) States may require schools who serve needy populations to provide school breakfast Breakfast must provide ¼ the DRI

2 behavioral disorders that may affect nutritional status

Autism Spectrum Disorder (ASD) Attention deficit hyperactivity disorder (ADHD) May be suspected in preschool years but usually treated in the school years

Celiac disease

Autoimmune disease characterized by chronic inflammation of small intestine Inherited sensitivity to gluten in wheat, rye, barley, which causes malabsorption & flattening of intestinal lining Prevalence in U.S. is ~1 in 133 Linked to infertility in some women & men Eliminate gluten in diet Look for "gluten free" labels Gluten found in many non-grain foods like hot dogs, deli meats, supplements, chips, bouillon, salad dressing, etc. Correction of vitamin & mineral deficiencies

CHO and fiber needs in older adults

CHO = 45-65% fiber = 22-28 g/day (females/males)

Stage 1: Prevention plus

BMI >85th but <95th without co-morbidity conditions Level of treatment builds upon Basic nutrition Physical activity Goal Promote health Prevent disease

BMI calculation

BMI calculated from height and weight Multiply body weight in pounds by 703 Divide that number by height in inches Divide that number by height once more

Assessing wt status in teens

BMI for age & gender is used to assess weight status BMI ≥85th to <95% are "overweight" BMI ≥95% are "obese" Assessment of BMI using age and gender Specific NCHS Growth Charts >85 but <94th percentile with risk factors Fasting lipid levels >85th but <94th percentile with risk factors Fasting lipid levels AST and ALT Fasting glucose level >85th but<94th percentile with risk factors Fasting lipid levels AST and ALT Fasting glucose levels Microalbumin

Bariatric Surgery requirements

BMI ≥40 BMI ≥35 with co-morbidities Must be highly motivated for aftercare guidelines Are at risk for micronutrient deficiencies

Dietary Guideline for Americans

Balancing calories to manage weight Foods and food components to reduce Foods and nutrients to increase Building healthy eating patterns

Bilirubin Encephalopathy

Bilirubin is toxic to cells & may cause brain damage Brain & brain cells destroyed by bilirubin do not regenerate Mortality rate is 50% May cause: cerebral palsy, hearing loss, paralysis of upward gaze, and intellectual and other handicaps

Body composition changes

Bone loss begins around age 40 Positive energy balance resulting in increase in weight and adiposity; decrease in muscle mass Fat redistribution = gains in the central & intra-abdominal space, decrease in subcutaneous fat Hypertension Insulin resistance Diabetes Stroke Gallbladder disease Coronary artery disease

Model programs for breastfeeding

Breastfeeding Promotion in Physicians' Office Practices (BPPOP) Innovative program designed to boost breastfeeding promotion and support The Rush Mothers' Milk Club Evidence based program of breastfeeding interventions in NICU

Dietary Strategies for Bronchopulmonary dysplasia (BPD) and asthma

Bronchopulmonary dysplasia (BPD) & asthma New lung tissue can grow until age 8 Asthma causes most ER visits for children Breathing problems increase nutrient needs, lower interest in eating & can slow growth Preterm infants at highest risk of breathing problems Recommend small, frequent meals with concentrated energy, Pediasure, etc.

Numerous innovative nutrition programs exist that promote nutrition to youth

CANFIT (California Adolescent Nutrition & Fitness) Helps low income communities & minority communities develop & implement culturally competent nutrition/fitness programs Enhances leadership & collaboration with health professionals through competitive grants

Factors decreasing iron absorption

Calcium supplements Dairy products Coffee, Tea High-fiber foods

Nutritional intervention for underweight adults

Calories eat & exercise to build muscle mass & strength, 30 kcal/kg/day Protein 1 to 1.5 g/kg, 1.5-2.0 if severely malnourished Water 1 mL/kcal, rehydrate slowly

Feeding skills of preschool children

Can use a fork, spoon, & cup Spills occur less frequently Foods should be cut into bite-size pieces Adult supervision still required Appetite related to growth Appetite increases prior to the "spurts" of growth Include child in meal selection & preparation

Carbohydrate/fiber needs for adolescence

Carbohydrates: 130 g/day or 45-65% of calories Dietary Fiber: 26 g/day for adolescent females 31 g/day for males <14 years of age 38 g/day for older adolescent males

Centenarian Super-centenarian Life expectancy in US

Centenarian = 100 years or more Super-centenarian = 11- years or more Life expectancy in US = 78 years

Cerebral embolism Carotid Artery Disease Atrial Fibrillation Transient Ischemic Attacks (TIA)

Cerebral embolism: wandering blood clot (embolus) lodges in artery and blocks blood flow to brain Carotid Artery Disease: arteries that supply blood to the brain and neck become damaged Atrial Fibrillation: degeneration of the heart muscle causing irregular contractions Transient Ischemic Attacks (TIA): temporary and insufficient blood supply to the brain

Dietary strategies for a child with Cerebral Palsy

Cerebral palsy (CP): Group of disorders characterized by impaired muscle activity & coordination present at birth or developed during early childhood Spastic quadriplegia: form of CP, involuntary muscle control in arms & legs Reduced dietary intake results from child easily becoming tired while eating Meal pattern may be changed to provide small, frequent meals, and snacks to prevent tiredness at meals Foods recommended are easy to chew and soft

Conditions interfere with adequate nutrition

Chewing or other feeding problems (Food refusals) Side effects from prescribed medications Treatment of condition = restriction of certain foods

Conditions that may require supplements

Chewing problems need liquid supplements Diabetes or ketogenic diets should avoid supplements with added CHO PKU should avoid supplements with certain artificial sweeteners Cystic fibrosis requires fat-soluble vitamins Galactosemia & Cystic Fibrosis Calcium, Vit D, Phosphorus Spina bifida may require high dose Vit C if recurrent UTIs

Obesity treatment (adults)

Cognitive restructuring Stress management Support system Regular exercise Maintenance Long-term effectiveness

Nutrition services/programs for children with special needs

State programs Early intervention programs Early childhood education programs (IDEA) Head Start Early Head Start WIC Low birth weight follow up Child care feeding program

FightBAC

Clean: wash hands & surfaces often Separate: don't cross-contaminate Cook: cook to proper temperatures Chill: refrigerate promptly

Recommendations for OTCs during lactation

Combined oral contraceptives (OC) may reduce the volume of breast milk The ACOG & WHO recommend against use of combined OC during first 6 weeks postpartum Progestin only OC & implants are safe & effective

4 C's of behavior change in older adults

Commitment Cognitive processing Capability Confidence

Signs and symptoms of iron deficiency

Common: Fatigue, Headache exertional dyspnea, Difficulty concentrating Rare: Pica, Glossitis (tongue inflammation), Cheilosis, Koilonychia (spoon nails), Dysphgia (difficulty swallowing) Prevalent problem among toddlers: (15.9% on NHANES) May cause delays in cognitive development and behavioral disturbances Diagnosed by hematocrit and/or hemoglobin concentration Hb < 11 g/dL Hct < 32.9% Other causes = Folate, Vit B 12, infections, inflammation, etc

Basic nutrition and fluid recommendations for teen athletes

Competitive athletes may need 500-1500 additional calories per day Protein should supply no more than 30% of calories in the diet Special concern for vegetarian athletes or restricted caloric intake to maintain a particular weight Follow MyPlate guidelines to start May need upper limit of food group servings because of increased energy needs Eat pre-event meal at least 2-3 hours prior to exercise Post-event meals should contain 400-600 calories & be high in complex carbs & adequate non-caffeinated fluids Avoid foods high in fat, protein & dietary fiber for at least 4 hours before event Increased risk of bone fractures make adequate calcium intake important Reasons for risk for dehydration: Young adolescents do not regulate body temperatures well Ignore physiological signs of fluid loss May be unaware of need for fluids All athletes should be counseled on fluid needs

How to prevent GDM

Considered to be a form of type 2 diabetes Pre-pregnancy weight loss, increased fiber intake (+10 g/D) and exercise reduce risk of GDM (150 min/wk) Adherence to healthful diet high in fruits and vegetables (low GI Diet)

Successful weight loss maintenance

Consistently control calorie intake Exercising more often and strenuously Tracking weight Eating breakfast

Constipation

Continue to gain weight Separate liquids and solids Avoid odors and foods that are triggers Select well-tolerated foods Consume 30g dietary fiber/day

Most common chronic conditions in school age children

Cystic fibrosis Diabetes mellitus Cerebral palsy Phenylketonuria Behavioral disorders

Development of Eating Disorders

Environmental factors: Media Influences Societal and cultural norms Food availability and accessibility Family factors: Family dynamics Weight-related behaviors of parents and siblings Feeding behaviors reinforced during childhood and adolescence Interpersonal factors: Peer norms and behaviors Abuse experiences Personal factors: Biological Psychological Knowledge, attitudes and behaviors

Risk nutrients for adults

Fiber Viscous (soluble) = oatmeal, lentils, apples, oranges, pears, celery Fermentable (Insoluble) = whole wheat, wheat bran, seeds, nuts, zuchinni, raisins Calcium Vitamin D, A, E Folic acid Choline Vit B12 Potassium Sodium Magnesium

Food groups teens are usually low in

Dairy Grains Fruits and Vegetables 32% of calories from fat & 21% from added sugars

Growth hormone (adolescence)

Decrease subcutaneous fat Strengthen ligaments and tendons Side effects include: Physeal closure Hyperlipidemia Glucose intolerance Myopathy

Lead (fertility)

Decreased sperm production, abnormal motility, and shape Build-up of cadmium, molybdenum, manganese, boron, and other

Causes of miscarriage

Defect in fetus Maternal infection Structural abnormalities of uterus Endocrine or immunological disturbances

Children with developmental delays - higher risk for iron deficiency or lead toxicity

Developmental delay may be suspected when: Specific nutrients are inadequately or excessively consumed May result from iron deficiency or lead toxicity Physical growth may be impacted

Nutritional problems and their consequences

Developmental delay—range of symptoms reflecting slow development such as: Slow growth Feeding problem Autism - condition of deficits in communication and social interaction Mealtime behavior and eating problems occur

Comorbid conditions

Diabetes mellitus Carotid artery disease Atrial fibrillation Sickle cell anemia Depression Transient ischemic attacks Living in poverty Excessive use of alcohol; Drug abuse

Metabolic syndrome

Diagnosed if 3 of 5 conditions exist: Waist circumference (WC): >40" in men & >35" in women Blood triglycerides (TG) ≥150 mg/dL HDL-cholesterol: <40 mg/dL in men & <50 mg/dL in women Blood pressure (BP) >130/85 mm Hg Fasting blood glucose ≥100 mg/dL

Physical activity guidelines for young children

Dietary guidelines Offer a variety of foods, limiting foods high in fat & sugar 60 minutes of vigorous physical activity each day MyPlate developed by the USDA for young children Children need active play several times a day No screen time before age 2 Suggested activities Family walks after dinner, walking the dog Riding a tricycle or bicycle Freestyle dance Playing catch Hide and seek

Conditions needing increased energy needs (infants)

Difficulty breathing Infections, fever Temperature regulation Recovery from surgery

Determine Checklist

Disease Eating poorly Tooth loss/mouth pain Economic hardship Reduced social contact Multiple medicines Involuntary weight loss or gain Needs assistance in self-care Elder years above 80

Chronic conditions with lower energy needs

Down syndrome Spina bifida Nonambulatory children with deplegia Prader-Willi syndrome Nonambulatory children with short stature

Factors for counting children with chronic conditions

Duration Reporters Who makes doctor appointments Progress in Health Care

Energy needs for adolescence

EER for Boys 3-8 years 88.5 - (61.9 x age[y]) + PA x (26.7 x weight[kg] + 903 x height [m]) + 20 EER for Girls 3-8 years 135.3 - (30.8 x age[y]) + PA x (10 x weight[kg] + 934 x height [m]) + 20 EER for Boys 9-18 years 88.5 - (61.9 x age[y]) + PA x (26.7 x weight[kg] + 903 x height [m]) + 25 EER for Girls 9-18 years 135.3 - (30.8 x age[y]) + PA x (10 x weight[kg] + 934 x height [m]) + 25

Early adulthood

Early adulthood: age 29-39 Becoming independent Leaving the parental home Finishing formal schooling Starting career Developing relationships "for the kid's sake" interest in nutrition

Successful weight loss plans

Eating plan that reduces caloric intake Nutritional needs at a safe level Incorporates physical activity Compatible with individual's lifestyle Pharmacotherapy may also have to be used

Girls: peak weight gain follows linear growth spurt by 3-6 months

Gain of 18.3 pounds per year Average lean body mass decreases 44% increase in lean body mass (LBM) 120% increase in body fat 17% body fat is required for menarche to occur 25% body fat needed to maintain normal menstrual cycles

Cognitive development of toddlers

Egocentric—cannot accept another's point of view Learning to set limits for himself Cooperative & organized group play Vocabulary expands to >2000 words Begins using complete sentences

Barriers to breastfeeding initiation

Embarrassment Time and social constraints Lack of support from family and friends Lack of confidence Concerns about diet and heath Fear of pain

Teen overweight and obesity has increased over the past years

Environmental factors Genetic factors Additional factors: Having 1 or more overweight parents From a low income family African American, Hispanic, Native American or Native Alaskan descent Having a condition that limits mobility Inadequate physical activity Diets high in calories, sugars, & fat

Child-care nutrition standards

Estimated 23 million preschool-age children attend a child care program Not all states have nutrition standards for care Should meet 1/3 to ½ of DRIs Offer food at intervals not less than 2 hours & no more 3 hours

Predicting energy expenditure in adults

Estimating Energy Needs Based on BMR+TEF+Activity Basil Metabolic Rate (BMR) Daily BMR expenditure- 60 to 75% for, involuntary processes Thermic Effect of Food (TEF) TEF (metabolism of food) ~10%

How OTCs affect fertility

Estradiol, progestin, or combo therapy Progestin only (Depo Provera)-weight gain, decreased bone mineral accretion Combination contraceptives-altered blood lipid levels (decrease HDL, increase LDL, TG), increased blood and insulin levels, increased stroke Male Hormonal Contraception not FDA approved Testosterone alone or in combo with progestin

Hormones in the development of the mammary gland

Estrogen: ductal growth Mammary gland differentiation with menstruation Progesterone: alveolar development After onset of menses and during pregnancy Human growth hormone: development of terminal end buds Mammary gland development Human placental lactogen: alveolar development Pregnancy

Nutritional strategies for underweight elderly

Etiology Not problematic if person has always been thin Weight cycling is problematic In older adults, underweight is more serious than overweight Protein-calorie malnutrition leads to underweight

Caffeine needs during pregnancy

Evidence for the need to either limit or stop consuming caffeine during pregnancy is weak Recommendations need to be reevaluated, since: <4 cups/day: not associated with poor birth outcomes or adverse maternal health Moderate intake (3 cups/day): no risk to either maternal or fetal health Caffeine restriction: no improved pregnancy outcomes

Common health compromising or enhancing eating behaviors for teens

Excessive dieting or healthy eating practices Meal skipping, fad diets Use of unconventional nutritional and nonnutritional supplements Physical activity Interest in a healthy lifestyle

Infant allergies

Exclusive breastfeeding for ≥4 months protects against allergies, dermatitis & wheezing Development of food allergies influenced by numerous factors: Genetics, duration of breastfeeding, time of introduction of other foods, maternal smoking, air pollution, exposure to infectious disease, maternal diet and immune systems

Bariatric surgery warranted in teens

Failure to obtain adequate weight loss after minimum of 6 months of intensive weight loss program participation SMR / Tanner at stage IV or higher or 95% of adult physical maturity BMI > 35 with major medical comorbidities type 2 diabetes moderate to severe obstructive sleep apnea Nonalcoholic fatty liver disease Pseudotumor cerebri BMI > 40 with mild comorbidities mild obstructive sleep apnea mild nonalcoholic fatty liver disease hypertension dyslipidemia significantly impaired quality of life

Nutritional problems in infants

Failure to thrive (FTT) Inadequate weight or height gain Energy deficit is suspected Intervention for FTT: May be complex and involve a team approach including the registered dietitian, social worker Colic - the sudden onset of irritability, fussiness or crying Episodes may appear at the same time each day Disappear at 3rd or 4th month Cause unknown but associated with GI upset, infant feeding practices

Risk factors for hyperlipidemia

Family history Cigarette smoking Overweight Hypertension Diabetes Physically inactive <35% calories from total fat <10% calories from saturated fat Cholesterol intake ≤300 mg/day Adequate fruits, vegetables, grains, & low-fat dairy

Risk factors for hypertension

Family history of Hypertension High intake of sodium Overweight/obese Sedentary Smoker

Acceptable Macronutrient Distribution Ranges (adults)

Fat = 20-35% of calories Carbohydrate = 45-65% of calories Protein = 10-35% of calories

Recommended fat intake to prevent CVD - other nutrition recommendations

Fat = 25% to 35% of energy for ages 4 to 18 years Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids Limit saturated fats, cholesterol & trans fats Increase soluble fibers, maintain weight, & include ample physical activity Diet should emphasize: Fruits and vegetables Low-fat dairy products Whole-grain breads and cereals Seeds, nuts, fish, and lean meats

Fat needs for adolescence

Fat: required as dietary fat and essential fatty acids for growth and development 25-35% of calories from total fat <10% calories from saturated fat Cholesterol: < 300 mg/D

Challenges to feeding VLBW or ELBW infants

Fatigue Low tolerance of volume "Disorganized feeding"

Prevent and treat iron deficiency anemia

Females should be screened: Every 5 yrs Annually if have risk factors Treatment = increase intake of foods rich in iron & vitamin C

Major nutritional deficiencies after bariatric surgery

Fertility may return post-surgery Bariatric surgery increases risk for the following deficiencies Calcium, iron, copper, zinc, thiamin, B6, B12, and vitamin D Pregnancy is not recommended during first year after surgery Monitor nutritional status because of poor nutrient status during post-surgery weight loss

Common GI problems in infants

Fetus swallows amniotic fluid which stimulates intestinal maturation and growth At birth the healthy newborn can digest fats, protein and simple sugars. Common problems include gastroesophageal reflux (GERD), diarrhea, and constipation Factors that impact rate of food passage in colon Osmolarity of foods or liquids Colon bacterial flora Water and fluid balance in the body

Fluid needs in older adults

Fluids: >6 glasses of fluid/day to prevent dehydration 1 mL of fluid/kcal consumed (minimum of 1500mL)

Nutrients and non-nutrients for infants

Fluoride = 0.1 mg/day (6 months) 0.5 mg/day (6-12 months) Incorporated into enamel for forming teeth (even those not yet erupted) Low in breast milk Vitamin D = 400 IU per day (exclusively breastfed infants as supplement) Ultra-violet skin-protective lotion to exposed skin Sodium = 120 mg (o-5 months) 200 mg/day (6-12 months) [BM standard] Iron = 0.27 mg of elemental iron 11 mg/day (7-12 months) Supplemental iron for exclusively breastfeeding infants at 4 months Lead = toxic to developing rain, Ca/Fe absorption, and growth Screening for poisoning (9-12 months) Lead based paint in older homes (> than 1950s)

Infants and supplements

Fluoride—for breastfed infants after 6 months or if in any area with no fluoridated water Iron— after 4 months if breastfed Vitamin B12—for vegans Vitamin D—needed if exclusively breastfed

Pprimary weight reduction methods for treating obesity

Focus on lifestyle changes Decrease calorie intake Increase physical activity levels Weight loss surgery if other efforts fail - bariatric surgery

Follicular Phase: (first half of menstrual cycle)

Follicle growth & maturation Main hormones: GnRH, FSH, estrogen, & progesterone

Jewish dietary factors

Food must be kosher or fit Judaic law Six fasting days that call for total abstinence from food or drink

Parents' role in the dietary behaviors of teens

Gatekeepers of foods Serve as role models Teenagers eat based on availability and convenience Parents can capitalize on this Stock a variety of nutritious ready-to-eat foods

Introduction of solids and drinking from a cup

Food offered from spoon stimulates mouth muscle development At 6 months, offer small portions of semisoft food on a spoon once or twice each day Infant should not be overly tired or hungry Use small spoon with shallow bowl Allow infant to open mouth & extend tongue Place spoon on front of tongue with gentle pressure Avoid scraping spoon on infant's gums Pace feeding to allow infant to swallow First meals may be 5-6 spoons over 10 minutes Offer water or juice from cup after 6 months Wean to a cup at 12 to 24 months First portion from cup is 1-2 oz Early weaning may result in plateau in weight (due to reduced calories) and/or constipation (from low fluid intake)

Muslim dietary factors

Foods must be halal No pork nor slaughtered animals Prohibits alcohol

"Wear and tear" theories of aging

Free-Radical or Oxidative Stress theory Rate of living theory Faster living results in faster aging

Nutrition interventions that help with feeding problems

Frequent growth assessment Monitor intake Adjust feeding frequency/volume Adjust timing of nursing, snacks or meals Assess feeding position and support Nutrient density to facilitate eating Parent education Observe parent-infant interactions Consider developmental abilities

AAP recommends supplements for children

From deprived families With anorexia, poor appetites or poor diets, FTT, or a dietary program for wt mgmt Who consume only a few types of foods Vegetarians without dairy products

Define full term vs preterm

Full term: 37 weeks of gestation or later 2500-3800 grams Average = 40 weeks (37-42) and 47-54 cm 88% of million US births were full term (2009) Preterm: born at 37 weeks or less (regardless of weight) 40 weeks 7.9 (3.6 kg) 20 (51 cm) 14 (35.5 cm) 35 weeks 5.6 (2.5 kg) 18.1 (46 cm) 12.6 (32 cm) 32 weeks 4.2 (1.9 kg) 16.9 (43 cm) 11.8 (30 cm) 28 weeks 2.5 (1.15 kg) 15 (38 cm) 10.2 (26 cm) 24 weeks 1.4 (0.65 kg) 12.6 (32 cm) 8.7 (22 cm)

Congenital abnormalities that may impair nutritional status

GI tract disorders Diaphragmatic hernia - displacement of the intestines up into the lungs Tracheoesophageal atresia - incomplete connection between the esophagus and the stomach Cleft lip and palate - upper lip and roof or mouth are not formed completely

Three main reflexes that infants have in regards to feeding

Gag reflex: prevents infant from taking food and fluids into lungs Oral search reflex: infant opens mouth wide when close to breast & thrusting tongue forward Rooting reflex: infant turns to side when stimulated on that side

Diet sometimes used for ASD

Gluten-free & casein-free diets have been used by parents but not endorsed by professional societies

"Underweight" in older adults

Grade 1 = BMI 17-18.49 Grade 2 = BMI 16-16.99 Grade 3 = BMI <16

Cerebral Palsy

Group of disorders resulting from brain damage with impaired muscle activity & coordination Constipation common Spastic quadriplegia presents most nutritional problems Nutrition concerns: Slow growth Difficulty feeding & eating Athetosis (less common form of CP)—uncontrolled movement which increases energy expenditure

Physiological changes during adulthood

Growing stops by 20s Bone density continues until 30 Muscle strength peaks around 25-30 Decline in size and muscle mass + increase in body fat Dexterity and flexibility decline Hearing and vision loss Women Decline in estrogen menopause Increase in abdominal fat Increase in risk of cardiovascular disease & accelerated loss of bone mass Men Gradual decline in testosterone level & muscle mass

Measurement techniques for preadolescence

Growth velocity will slow down during the school-age years Should continue to monitor growth periodically Weight and height should be plotted on the appropriate growth chart Average annual gains during school-age 7 lbs 2.5"

HIV/AIDs during pregnancy

HIV/AIDS related to poor nutritional status and inability to fight diseases Diarrhea: nutrient losses and malabsorption Inflammation: decresaed lean muscle mass Loss of calcium from bone and low bone density HIV/AIDS medications increase insulin resistance and central adiposity Poor immunity increases susceptibility to foodborne infections Full nutrition assessment (ABCD) Social: address food and water safety concerns, facilitate access to food assistance programs Appropriate weight gain and healthful diet (kcal, fatty acids, iron) Multivitamin/mineral supplement for pregnancy

"Programmed aging"

Hayflick's theory of limited cell replication Difficult to prove b/c we usually die from chronic disease 1st Molecular Clock Theory Loss of telomeres stops chromosome replication

Diagnosing diabetes in older adults

HbA1C goals = <7.5-8%

Health care professionals working with children from other cultures

Healthy People 2020 - eliminate health disparities among different segments of the population Health care professionals should learn about cultural dietary practices

Infants born with desirable wt are less likely to develop...

Heart and Lung diseases, DM, Hypertension

Teratogenic in terms of diabetes and pregnancy

High blood glucose levels (> than 200 mg/DL) during the first 2 months of pregnancy are "teratogenic" 2-3 fold increase in congenital abnormalities in newborn Malformations of pelvis, CNS, & heart seen in newborns, higher rates of miscarriage

Hypertension in older adults

High blood pressure (HBP)-hypertension (HTN) BP ≥140/90 mm Hg

Childhood Obesity more common in ethnic groups

Hispanic or Latinos African Americans

Key questions for infants at risk

How is the baby growing? Is the diet providing all required nutrients? How is the infant being fed?

Risk factors for older adults

Hunger, poverty, low food & nutrient intake Functional disability Social isolation or living alone Urban & rural demographic areas Depression, dementia, dependency Poor dentition & oral health Diet-related acute or chronic diseases Polypharmacy Minority, advanced age

Risk factors associated with being overweight as a teen

Hypertension Dyslipidemia Insulin resistance or type 2 diabetes mellitus Sleep apnea Hypoventilation disorders Orthopedic problems Hepatic disease Body image disturbances Lower self esteem

Four risk factors for CVD for older adults

Hypertension (≥140/90 mmHg) Increased LDL cholesterol (≥130 mg/dL) Diabetes Race (African Americans)

Nutrition services for special needs and premature infants

IDEA, Part C Early Head Start WIC MCH Block Grant Specialty clinic services (nutrition consultant attend a cystic fibrosis clinic) Contractual services for providing special formulas or therapy for groups of patients who need more nutrition care than usually provided Visiting at schools or programs to conduct nutrition assessments or coordinate follow-up recommendations Transporting teams of specialists to rural or isolated areas for direct care Development and distribution of nutrition education materials for staff training

Food safety for older adults

Improper holding temperatures Poor personal hygiene Contaminated food preparation equipment Inadequate cooking time

Importance of infant seating position

Improper positioning may cause choking, discomfort, and ear infections Position young bottle-fed infants in a semi-upright position Spoon-feeding should be with infant seated with back and feet supported Adults feeding infants should be directly in front of infant making eye contact

Failure to Thrive (FTT) TREATMENT

Inadequate wt or ht gain with growth declines more than 2 growth percentiles May result from: Digestive problems Asthma or breathing problems Neurological conditions Pediatric AIDS Medical Neglect Recovery can include catch-up growth

Phenylketonuria (PKU) in school age children

Inborn error of metabolism Body lacks enzyme needed to metabolize phenylalanine Require intervention to manage breakdown of dietary proteins Diet is adequate in vitamins, minerals, pro, fat and calories Phe-deficient Protein powder (PKU metabolic food) required Dietary treatment includes avoiding meats, eggs, dairy products, nuts & soy beans

Feeding skills and eating behaviors

Increase motor coordination & improved feeding skills Masters use of eating utensils Involved in food preparation Complexities of skills increase with age Learning about different foods, simple food prep and basic nutrition facts Parents & older siblings influence food choices in early childhood with peer influences increasing in preadolescence Parents should be positive role models Family meal-times = Higher intakes of nutrients, less fat and less soft drinks when meals eaten at home Media has strong influence on food choices Loss of internal cues of satiety & hunger

Sodium needs during pregnancy

Increased water volume and tissue synthesis require increasd sodium and other electrolytes Sodium restriction is NOT an approach for dealing with edema in pregnancy - may be harmful to the mother and fetus water balance and plasma volume expansion Restriction is NOT indicated to control edema Should be consumed "to taste" unless specifically contradicted to a medical condition

Creatine (adolescence)

Increases LBM Naturally formed in liver & kidneys Main dietary sources are meats Studies show mixed results on benefits Side effects are numerous Chronic use may be associated with renal damage

Effects on energy needs (adolescence)

Increases in lean body mass, skeletal mass and body fat Energy & nutrient needs during adolescence exceed those of any other point in life Needs = to physical maturation stage Energy needs are influenced by: Activity level Basal metabolic rate (BMR) Pubertal growth & development Because males have greater increases in ht, wt, & lean body mass (LBM), they have a higher caloric need than females Level of physical activity declines during adolescence resulting in reduced energy requirements Linear growth & sexual maturation can be delayed with lack of adequate energy

Signs of infant hunger

Infant bringing hands to mouth, sucking on them, & moving head from side to side Crying is late sign of hunger Allow infant to nurse as long as they want to ensure they get hindmilk with its high fat content that provides satiety

Late Preterm Infants

Infants born 34 to 37 weeks May have subtle immaturity making breastfeeding difficult Complications include: Cardio-respiratory instability, poor temperature control, lower glycogen & fat stores, immature immune system, weak suck-swallow coordination

Conditions that have special growth charts

LBW or VLBW Special head circumference growth chart Can indicate Rett syndrome

Infant food preferences are influenced

Infants vary in temperament Crying or fussiness may be interpreted as hunger resulting in overfeeding First foods may appear to be rejected due to immature tongue movement Infants learn food preferences based on experiences with foods Flavor of breast milk influenced by mother's diet Genetic predisposition to sweet taste Food preference from infancy sets stage for lifelong food habits

Pelvic Inflammatory Disease (PID)

Infection of the cervix, uterus, fallopian tubes, ovaries Side effect of gonorrhea or chlamydia

Risk factors for cancer

Initiation & progression of cancer linked to the following factors Environmental exposures Lifestyle Dietary constituents - promotion or inhibition Smoking—linked to 30% of cancers Nutrition-related risks: Obesity & insulin resistance Alcohol consumption Intakes of fruits, vegetables, & calcium

Barriers to breastfeeding continuation

Insufficiently paid maternity leave Rigid work schedules Lack of understanding/knowledge by employers Legislation is in progress to support breastfeeding or pumping in the workplace

Type 2 Diabetes during childhood

Insulin injections, pumps & SMBG Illness & stress greatly impact BG levels Diabetes Summer Camps

Folate (fertility)

Intake by women of multivitamins with folate associated with decline in ovulatory infertility Intake by men of multivitamins with folate associated with improved sperm counts, motility, decreased abnormal forms of sperm

Cystic fibrosis

Interferes with lung function and causes decreased absorption nutrients One of most common lethal genetic conditions Malabsorption due to lack of pancreatic enzymes = High risk for DM Calories & protein increase 2 to 4 fold Enzymes taken with meals to aid in digestion Frequent meals & snacks Fat-soluble vitamin supplements Gastrostomy feeding at night may be needed to boost energy intake

Conditions that may require a G tube - unique considerations (both oral and enteral routes)

Kidney disease Some cancers Severe cerebral palsy Cystic fibrosis

Sources of iron, zinc, and calcium

Iron = meat, fish, poultry, and fortified cereals (plus vitamin C foods) Zinc = lamb, beef, scallops, sesame seeds, pumpkin seeds, oats, yogurt, turkey, shrimp, green peas Calcium = spinach, kale, okra, collards, soybeans, white beans, beef liver, cheese, egg yolks

Common nutrition disorders and treatment of school age children

Iron deficiency - Less common in children than in toddlers Dietary recommendations to prevent: encourage iron-rich foods Meat, fish, poultry and fortified cereals Vitamin C-rich foods to help absorption Dental caries - Seen in 50% of children aged 6 to 9 Reduce dental caries by limiting sugary snacks & providing fluoride Choose fruits, vegetables, and grains Regular meal and snack times Rinse (or better yet, brush the teeth) after eating

Intervention for Iron Deficiency

Iron supplements (3 mg/kg/D) Counseling with parents Repeat screening @ 4 weeks Want > 1g/dL in Hb, > 3% in Hct

Risks of using cow's milk in infancy

Iron- deficiency anemia Low iron availability may come about as a result of gastrointestinal blood loss low absorption of other minerals ( calcium and phosphorus) lack of other iron-rich foods

MyPlate for children

Iron- meats, fortified cereal, dried beans and peas Fiber- fruits, vegetables, whole grains Fat- follow Dietary Guidelines and MyPlate Calcium- dairy, canned fish with soft bones, green leafy vegetables, calcium-fortified beverages Fluids- beverages, foods and sips of water

Common nutritional problems in toddlers

Iron-deficiency anemia Dental caries Constipation Elevated blood lead levels Food security Food safety

Questions to determine if nutrition services are needed

Is child's growth on track? Is child's food and nutrient intake adequate? Are feeding or eating skills age appropriate? Does medical diagnosis affect nutritional needs?

Ischemia Aneurysm Thrombus

Ischemia: blockage of blood vessel lack of blood supply Aneurysm: ballooning of the blood vessel wall Thrombus: blood clot

Soy (fertility)

Isoflavones (from soy) decrease levels of estradiol, progesterone, LH Also related to reduced sperm count in men Related to reduced sperm count in obese men 90% of men on high soy diets still had sperm counts WNL Asians consume soy as primary pro source, no issues with sperm functioning

Major component of human milk: water (breast milk is isotonic with plasma)

Isotonic: babies don't need fluids to maintain hydration Allows suspension of milk sugars, proteins, immunoglobulin A, sodium, potassium, citrate, magnesium, calcium, chloride, and water-soluble vitamins

Creating Ed Materials for older adults

Larger type size Serif lettering (such as Times Roman) Bold Type High contrasts (black on white) Non-glossy paper Avoid blue, green & violet color Reading level of 5th-8th grade

Later adulthood

Later adulthood: age 65+ Transition to retirement More leisure time - greater attention to physical activity

Premenstrual Syndrome

Life-disrupting physiological and psychological changes in the luteal phase of the cycle Symptoms disappear in 2 d after menses onsets Affects 15-25% of all women

Prevent and treat overweight and obesity in children

Limit sugar-sweet beverages Encourage fruits & vegetables Limit screen time (< 2 hrs/D) Daily breakfast Limit fast foods Limit portions Calcium-rich diets Diets high in fiber Follow the DRI for carbs, pro & fat Promote physical activity Limit energy-dense foods

Pregnant women are more susceptible to foodborne infections

Listeria monocytogenes (spontaneous abortions and stillbirth) Avoid: raw fish, oysters, uncooked meat, unpasteurized milk; correctly store luncheon meats and hotdogs Toxoplasma gondii (mental retardation, blindness, death) Avoid: raw and uncooked meats. Can be passed to humans from cats that consume raw meats or wild animals Mercury (fetal neurotoxin) Avoid: large, long-lived fish (shark, swordfish, tilefish, albacore tuna, bass)

Eating behaviors are common in adolescence

Little time to sit down for a meal Snacking and meal skipping common Breakfast most common Eating away from home and at fast-food restaurants ~59% eat out daily Close proximity of high schools = more soda Consuming more soft drinks, less nutrient dense drinks Eating meals in front of the television ~64% have TVs on during meal time

Causes of obesity (adults)

Loss of appetite control due to disturbances in hormonal controls of hunger and satiety Psychological, socioeconomic, lifestyle, cultural & environmental factors play a role in obesity

Miscarriage

Loss of conceptus in 1st 20 weeks of pregnancy

Children with chronic conditions vary in their nutritional requirements

Low energy intake with small muscle size High protein, fluid or fiber Increases or decreases in vitamins or minerals Frequent hospitalizations

Feeding problems in children with special health care needs TREATMENT?

Low interest in eating Long mealtimes Preferring liquids over solids Food refusals

Nutrition standards for the National School Lunch Program

Lunches must be based on nutritional standards Children who are unable to pay for lunches = lunches for free/reduced price with no discrimination Programs operate on a non-profit basis Programs must be accountable & participate in commodity program The National School Lunch Program (NSLP) Standards: Both fruits and vegetables every day; increasing whole grains Only fat-free or low fat milk Limiting calories based on child' age Reduce saturated and trans fats, and sodium

Nutritional Interventions for Symptoms of HIV/AIDS

Maintain weight & nutritional status Consume adequate protein and other nutrients During early phase, adequate nutrient intakes to immune function & susceptibility to infection Choose calcium-rich foods and vitamin D to prevent progressive bone loss Dietary strategies to manage symptoms of drug therapies Even the best nutritional advice and self-care cannot restore immune function Nutritionally adequate diets can Help weight maintenance Avoid depletion of nutrient stores Increase level of control and sense of well-being

Nutritional strategies for treatment of stroke and hypertension

Maintaining healthy weight Reducing sodium to <1500 mg/d Moderation in alcohol Adequate potassium, magnesium, & calcium intakes Following MyPlate & DASH guidelines High F/V & Low fat dairy intake

CHO, PRO, FAT for 2-5 years

Males CHO = 56% PRO = 14% FAT = 31% Sat. fat = 11% Cholesterol = 170 mg/d Females CHO = 55% PRO = 15% FAT = 32% Sat. fat = 12% Cholesterol = 178 mg/d

Average fluid needs

Males = 15-16 cups Females = 11 cups

Mifflin-St. Jeor equation

Males: REE = (10 x wt) + (6.25 x ht) - (5 x age) + 5 Females: REE = (10 x wt) + (6.25 x ht) - (5 x age) - 161

Risk factors for hyperbilirubinemia

Maternal Diabetes Rh Sensitization Previous child with phototherapy Race- East Asian or Mediterranean Infant Premature or late- preterm High total serum bilirubin( TSB) levels at discharge Poor breastfeeding in exclusive breastfed infant Blood group incompatibility, e. g., ABO Hemolytic disease, e. g., Gluocose- 6- phosphate dehydrogenase deficiency ( G6PD)

High protein diets not recommended for adolescence

May consist of 3-4 times the DRI Protein foods typically high in total & saturated fats Protein & fat may delay digestion & absorption, limiting total energy available for activity More water required for protein breakdown which increases dehydration risk

MCT formulas

Medium-chain triglycerides (MCT) beneficial to VLBW and ELBW infants because of low pancreatic and liver enzymes Preterm infant formulas Vary in caloric content (>20 kcal/oz) MCT oil Whey protein = similar to human milk

Total Water AI for Adults

Men = 3.7 liters = (125 oz) Women = 2.7 liters = (91 oz) While caffeine does act as a diuretic, the DRI committee concluded caffeine-containing beverages contribute to the total daily water intake --> 1 cup water per cup caffeine

Fiber reccomendations for adults

Men = 38 g/d Women = 25 g/d

Middle adulthood

Middle adulthood: age 40-64 Nurturing children and teenagers Time of reviewing life's accomplishments and recognition of mortality

Definition of middle childhood and preadolescence

Middle childhood = 5-10 years Preadolescence = 9-11 for girls 10-12 for boys

Top 8 Food Allergies

Milk Eggs Peanuts Tree nuts Fish Shellfish Wheat Soy

Medication considerations for breastfeeding

Milk/Plasma Drug Concentration Ratio (M/P Ratio): concentration of drug in milk to the concentration of drug in maternal plasma Exposure Risk: average infant milk intake per kilogram body weight per day X (the milk plasma ratio divided by the rate of drug clearance) X 100

Caffeine (fertility)

Mixed results on effects of caffeine Some studies have shown increased time to conception, others have failed to find effects If individuals choose to cut back on caffeinated beverages, it is their choice

Intervention programs for risk reduction in children

Model program Bright Futures Nutrition Public food and nutrition programs WIC WIC's Farmers' Market Nutrition Program Head Start and Early Head Start Supplemental Nutrition Assistance Program (formerly Food Stamps)

T2 DM more common in...

More common in Asian/Pacific Islanders, Native American

T1DM @ high risk of hypoglycemia

More common in Caucasians

Dieting adolescence

Most common in Hispanic females then white females Increase chance of future overweight or obesity Effective nutrition messages should focus on lifestyle changes Adolescents with low levels of body satisfaction are more likely to use unhealthy weight control behaviors & participate in less physical activity

Infant motor development

Motor development: ability to control voluntary muscles Motor development is top down— controls head first and lower legs last Muscle development from central to peripheral Influences ability to feed self & the amount of energy expended

Weight gain guidelines for multifetal pregnancies

Multidisciplinary programs that provide education, nutritional counseling, and additional support decrease negative outcomes Weight gain (for twins, based on prepregnancy weight) Normal: 37-54 lbs Overweight: 31-50 lbs Obese: 25-42 lbs Rate: Continually positive (5-7 lbs in 1st trimester, then 1-2 lbs/week) Balanced diet appropriate for pregnancy Increase caloric needs (+450 kcal/day for twins) or target appropriate weight gain Vitamins and minerals similar to singletons (insufficient research)

Main physical activity guidelines for older adults

Muscle strengthening of all muscle groups 2 x/wk 150 min of moderate aerobic activity Drink water while exercising Get adequate pro for muscle building

Physiological development in school age children

Muscular strength, motor coordination, & stamina increase In early childhood, body fat reaches a minimum then increases in preparation for adolescent growth spurt Adiposity rebounds between ages 6 to 6.3 years, monitor BMI-for-age. Boys have more lean tissue than girls Boys have 13% BF Girls have 16% BF

Nutritional concerns for vegetarian children

Must provide adequate calories, protein, calcium, zinc, iron, omega-3 fatty acids, Vitamin B12, riboflavin and Vitamin D

Teen supplements

National data = > 1/3 adolescents use Vitamin-Mineral supplements Most common: Vitamin C Calcium Iron Vitamin E B-vitamin complex Prevalence of use: Household income High food-security status Some form of health insurance Parental education Adolescents who take supplements tend to consume a more nutritionally adequate diet than those who don't USP = United States Protected label (intensive testing) [Nature Maid]

Fluoride during pregnancy

No specific needs above those for non-pregnant women Placental transfer is low Enamel does not develop until the neonatal period

Preventing Iron Deficiency

Nutrition - Limit milk consumption to 24 oz/d since milk is a poor source of iron Infants at risk should be tested at 9 to 12 months, 6 months later, and annually from ages 2 to 5

Key considerations for doing nutrition education with teens

Nutrition instruction required by 67% of middle schools & 72% of high schools Most nutrition is offered in health education courses Nutrition education to health ed teachers has from 43% to 65% from 2000 to 2006 Average of 5 hours of nutrition & dietary behavior to high school students Teacher training typically increases the time spent on teaching nutrition in the classroom

Medical nutrition therapy strategies for weight management (adults)

Nutrition prescription for weight loss Eating plan deficient in calories Meets guidelines for healthy eating Balanced vitamin/mineral supplements (may be recommended) Meal replacements helpful for individuals having trouble with portion control

Risk factors for osteoarthritis

Obesity (excess wt & cytokine release from adipose tissues) Joint injuries Continuous exposure to oxidants Possibly low vitamin D

Multidisciplinary breastfeeding task force

Physicians Hospitals and birthing centers Public health Home visitors La Leche League Government, industry, & school boards Journalists

Roles of minerals in human milk

Osmolality: growth of infant Decreases over first 4 months, except for magnesium Bioavailability: most are high (low risk of anemia despite low iron content in milk) Zinc: bound to protein and highly available Rare defect in mammary gland uptake may be poor = diaper rash

3 classes of obesity

Overweight—defined by BMI of 25.0-29.9 Obesity -defined by BMI of 30.0 or greater (Further classified as I, II and III) Morbid Obesity—defined by BMI of 40 or more

"Maternal PKU"

PKU diet for life, low Phe diet Blood Phe 120-360 µmol/L, takes 4-6 months to lower blood Phe Meat, fish, eggs, wheat excluded Veg, fruit, fats, sugars, high-CHO foods, milk-ok Supplemental DHA (200 mg/D) Women who go off the PKU diet after childhood and become pregnant

Endometriosis

Painful, abnormal menstrual cycles Causes infertility in 30-40% of women Endometrial tissue embedded in uterine wall, ovaries, etc.

Risk factors for diabetes

Parent or sibling with diabetes History of gestational diabetes Elevated A1c, IFG, IGT Racial or ethnic background Sedentary lifestyle Hypertension Low HDL, High Trig, CVD

Define parenteral and enteral feeding

Parenteral—nutrients delivered directly to the bloodstream Gastrointestinal problems may interfere with oral feeding Damage or inflammation to GI tract from necrotizing enterocolitis (NEC) Enteral—nutrients delivered directly to GI tract Oral-gastric (OG) = mouth to stomach Transpyloric = nose/mouth to upper small intestine Gastrostomy = tube in stomach (better because it starts higher) Jejunostomy = tube in upper small intestine

Post-bariatric surgery in teens

Participation in psychological and medical counseling before surgery with agreement to continue counseling after surgery Must have adequate support of family and a home environment conducive to long- term dietary change Capability to follow medical nutrition therapy protocol after surgery Agreement to prevent pregnancy for at least 1 year after surgery Roux- en- Y gastric bypass should be considered safe and effective Adjustable gastric banding and laparoscopic sleeve gastrectomy should be considered investigation and are notcurrently approved for use in the U. S. by the FDA Biliopancreatic diversion and duodenal switch surgical procedures are not recommended in adolescents due to the risk of malnutrition and potential effects on growth, development, and reproductive outcomes

Boys: peak wt gain at the same time as peak linear growth & peak muscle mass accumulation

Peak wt gain, ~20 lb per year Body fat decreases to ~12% ~Half of bone mass is accrued in adolescence

Factors affecting eating behaviors in teens

Peer influence Parental modeling Food availability, preferences, cost , convenience Personal & cultural beliefs Mass media Body image

Dietary Recommendations for Pregnant Teens

Poor pregnancy outcomes are likely due to lifestyle factors, not biological immaturity (except in very young adolescents): Drug use, smoking, poor diet (low iron, vitamin D intake) Risks increase because teens are both growing AND may be overweight/obese during pregnancy LBW, C-section, preeclampsia, anemia, perinatal death Similar weight gain and protein needs as adults Increased caloric needs if still growing Increased calcium (+300 mg) and vitamin D needs Social support: referral to food and nutrition programs or other healthcare-related support

Lower calories needed by children with slow growth or decreased muscles (school age children)

Prader-Willi syndrome

Predictors and treatment for school age children

Predictors Age at onset of BMI rebound Normal increase in BMI after decline Early BMI rebound, higher BMIs in children later Home environment Maternal and/or Parental obesity predictor of childhood obesity Treatment = multi-component, family-based program consisting of: Parent training Dietary counseling/nutrition education Physical activity/addressing sedentary behaviors Behavioral counseling

Dietary Supplements needed (adults)

Pregnancy Certain illness Low calorie or nutrient restricted diets

Preterm Term Post term

Preterm: (< 37 wks) Term: (38-42 wks) Post term: (>42 wks)

Risk Factors for prehypertension (older adults)

Prevalence in adults ≥65 < 64 yrs-more common in men > 65 yrs-more common in women Increases with age, etiology, family history, African Americans ~20% of cases linked to salt intake High alcohol consumption High saturated fat intake Overweight & obesity Low dietary calcium

Mormons dietary factors

Prohibit alcohol and discourages caffeine

Sikhism dietary factors

Prohibit alcohol and un-kosher meat Halal methods avoided

PRO needs in older adults

Protein: 1-1.3g/kg body weight

Fluid recommendations for children

Provide plain water or sports drinks to prevent dehydration (Cold water is the best fluid) Limit soft = empty calories, displace milk consumption & promote tooth decay Energy drinks should not be consumed by children

Stage 3: Comprehensive Multi-disciplinary Intervention

Same behavioral goals as stage 2 More structured eating More structured physical activity plan Designed to lead to negative caloric balance

Stage 2: Structured Management

Same behaviors as stage 1 More structured Screen time is limited to <1 hour per day Emphasize nutrient-dense foods Minimize energy-dense foods

Risk factors for iron deficiency anemia - effects

Rapid growth Decreased intake iron- or vitamin C-rich foods Vegan diets Caloric restriction, meal skipping Participation in strenuous or endurance sports Heavy menstrual bleeding Effects: Delayed or impaired growth & development Fatigue Increased susceptibility to infection Depressed immune system Impaired physical performance & endurance Increased susceptibility to lead poisoning

Increased iron needs for adolescence

Rapid rate of linear growth Increase in blood volume Menarche in females In females, iron needs greatest after menarche In males, iron needs greatest during the growth spurt Determined by low serum iron, plasma ferritin & transferrin saturation Expensive to test Iron deficiency more frequent than anemia Often undiagnosed because of expense African American & Mexican American females @ highest risk

Morbid obesity in teens - 2 drugs that are FDA approved

Rapid weight loss may be medically necessary Intensive medical supervision required with the following: Very-low-calorie diets or protein-sparing modified fasts (~800 calories) Appetite suppressants or other drugs Bariatric surgery

Iron (fertility)

Rate of infertility lower in women who use iron supplements or iron from plant foods 14% of U.S. women enter pregnancy with inadequate iron stores Iron may affect ovulation (mechanism unknown)

Cognitive Behavioral Therapy (adults)

Realistic goals Caloric deficit The meal plan Skill development Problem-solving techniques Self-management

Vitamin D needs during pregnancy

Recommendation: 15 mcg (600 IU)/day from food Fetal growth Addition of calcium to fetal bone Maternal immunity Inadequacies are common One study found 35% of pregnant women are deficient, and others that 47-83% or 66-93% are deficient, depending on race 3 cups vitamin D milk, sunlight (2 x 15min = 1,250 IU) Deficient women may need 50 mcg (2,000 IU), supplemented as vitamin D2 (cholecalciferol)

Choline needs during pregnancy

Recommendation: 450 mg/day Phospholipids, cell membranes, and intracellular messengers Choline to betaine conversion provides methyl donors (like folate) Women in the U.S. consume ~ 270 mg/day, and choline is not included in a prenatal supplement Eggs, beef, turkey, salmon, pork chop, lamb, bread, pasta, ham, rice

Folate needs during pregnancy

Recommendation: 600 mcg DFE/day 400 mcg from fortified foods or supplements 200 mcg from fruits & vegetables Orange, juice, pinnepple juince, cereal, bread, pasta, rice, beans Poor maternal folate status 21-27 d after conception is associated with neural-tube defects (NTDs) Function: DNA & amino acid synthesis, gene expression Folic acid - synthetic (in fortified foods and supplements) Bioavailability: 85% (consumed with food) or 100% (consumed on empty stomach) Dietary folate - found naturally in foods Bioavailability: 50% Assessment: Red blood cell folate is preferred over serum, as it represents long-term intake Women with a history of NTDs may need as much as 4000 mcg/day

Vitamin A needs during pregnancy

Recommendation: No more than 5,000 IU as retinol from supplements Cell differentiation Deficiencies are common in the developing world but rare in developed countries Vitamin A toxicity increases fetal abnormalities Retinol/retinoic acid intake >10,000 IU/day Accutane/ Retin-A for acne and wrinkles

CDC's Preconception Health Initiative

Recommends that primary health care visits include: Preconception health & pregnancy outcome education Screening for vaccination, weight, iron, and folate status Assessment of alcohol use Management of diabetes & celiac disease

Zinc (fertility)

Reduction of oxidative stress Sperm maturation Testosterone synthesis Potential role in infertility 10 mg zinc supplements

Vegetarian diet guidelines for toddlers/preschoolers

Several meals / day (3 meals, 2-3 snacks) Avoid excessive bulky foods (i.e. bran) Include energy dense foods (cheese / avocado) Fat- include omega-3 fatty acids Sources of Vitamin B12, Vitamin D and Calcium should be included or supplemented

TV viewing time impacts childhood obesity

Resting energy expenditure decreases while viewing TV Healthy People 2020 = increase # of kids who watch 2 hours or less of TV per day from 78.9% to 86.8%

Human Milk Storage

Room temperature = 6-8 hours Cooler bag = 24 hours Refrigerator = 5 days Freezer of fridge = 2 weeks Freezer w/doors = 3-6 months Deep freezer = 6-12 months

Infant reflexes

Rooting reflex—infant turns head toward the cheek that is touched Suckle—reflex causing tongue to move forward and backward Babinski: toes fan out when sole is stroked Blink: baby's eyes close in response to bright light or loud noise Moro A: baby throws its arms out and then inward ( as if embracing) Palmar A: baby grasps an object placed in the palm of its hand Stepping A: baby who is held upright by an adult and is then moved Sucking A: baby sucks when an object is placed in its mouth Withdrawal A: baby withdraws its foot when the sole is pricked with a pin

Recommendations for nutrition education in schools

School-age = a prime time for learning about healthy lifestyles Schools can provide an appropriate environment for nutrition education & learning healthy lifestyles Education may be knowledge-based nutrition education or behavior based on reducing disease risk All foods available in schools should be consistent with the U.S. Dietary Guidelines & DRIs Sound nutrition policies need community & school environment support + community leaders to support the school's nutrition policy The School Health Index (SHI) should be completed & implemented

High blood levels in children

Seen in ~0.9% of children ages 1-5 Has been decreasing since NHANES 1999-2002 data Low levels of lead exposure linked to lower IQ & behavioral problems High blood lead levels may decrease growth Reduce lead poisoning by eliminating sources of lead AAP requires lead screening Children on Medicaid Screen @ 9-12 months

Cognitive growth for school age children

Self-efficacy...the knowledge of what to do and the ability to do it Change from preoperational period to concrete operations Develops sense of self More independent & learn family roles Peer relationships become important More outside influence food choices

Premenstrualysphoric Disorder

Severe form of PMS Characterized by marked mood swings, depressed mood, irritability, & anxiety Physical symptoms: Breast tenderness Headache Joint & muscle pain Related to abnormal serotonin activity following ovulation

Tanner Stages

Sexual Maturation Rating (SMR)—scale of secondary sexual characteristics used to assess degree of pubertal maturation SMR 1 = pre-pubertal growth & development Breast development, pubic hair, testicular & penile development SMR 2-5 = occurrences of puberty SMR 5 = sexual maturation has concluded

Biological changes during puberty

Sexual maturation Increases in ht & wt Accumulation of skeletal mass Changes in body composition

Assessing growth, development, and nutritional needs in teens

Sexual maturation (or biological age)—not chronological age—should be used to assess growth and development and nutritional needs

Bereavement

Shock and denial Disorganization Volatile reactions Guilt Loss and loneliness Relief Reestablishment

Short and long term health care issues for preadolescence

Short term health care issues Fe-deficiency anemia, under nutrition, dental caries Long term health care issues Obesity, T2DM, CVD Improved academic performance

Wt Loss Drugs

Sibutramine - Appetite suppressant > 16 yo Orlitstat - Fat malabsorption >12 yo Metformin - Insulin sensitizer Not FDA approved for < 18 yo Nausea, tummy ache

How does breast milk composition change

Single feeding Over a day Based on age of infant Presence of infection in the breast With menses Maternal nutrition status

Resources & prevention programs to combat infant mortality

Social/economic status of families and women Access to health care Medical interventions Teenage pregnancy rates Availability of abortion services Failure to prevent preterm and low birth-weight births

Hyperglycemia

Sodium depletion & dehydration Trace mineral depletion Insomnia, nocturia, blurred vision

Breastfeeding conditions

Sore Nipples: prevented by proper positiong of baby on breast Areola should be in baby's mouth with tongue extended against lower lip Flat/inverted nipples: should not impact breastfeeding if latch is correct Letdown failure: when milk does no eject from breast (very uncommon) Oxytocin nasal spray and relaxation techniques Hyperactive letdown: streams of milk come from breast May cause infant to choke Engorgement: breast are overfilled with milk Supply-demand process is not yet established and milk is abundant Hyperlactation: milk production > baby's needs Plugged Duct: cause by milk staying in the ducts (painful knot in the breast) Mastisis: breast inflammation (1-33% of breastfeeding women) Low Milk Supply: most common reason for cessation of breastfeeding (pump every 2-3 hours + 1 at night)

Conditions needing decreased energy needs (infants)

Spina bifida Down syndrome

4 Stages for obesity intervention

Stage 1: Prevention Plus Stage 2: Structured Weight Management (SWM) Stage 3: Comprehensive Multidisciplinary Intervention (CMI) Stage 4: Tertiary Care Intervention (reserved for severely obese adolescents) GOAL = develop healthy eating and physical activity behaviors for a lifetime

Continuum of nutritional status

Stages of nutritional status that range from optimal to unable to sustain life resilient and healthy altered substrate availability nonspecific signs and symptoms clinical conditions chronic conditions terminal illness and death

Seventh Day Adventists dietary factors

Strict lacto-ovo vegetarian and exclude alcohol and caffeine

Diabetes Intervention for carbs, pro, and fiber

Subtract half of fiber grams if >5 Subtract half of sugar alcohol grams if >10

Healthful Eating Standards

Sufficient calories for appropriate weight gain ChooseMyPlate food group recommendations Provide all essential nutrients from diet 600 mcg folate and 400 mcg of folic acid 300 mg EPA and DHA daily 28g/day of fiber 9 cups of fluid daily Salt "to taste" Exclude alcohol and limit coffee to <4 cups per day

2 other national school nutrition programs

Summer Food Service Program: Provides summer meals to areas with >50% of students from low-income families Team Nutrition: Provides training, technical assistance, education, or support to promote nutrition in schools

Nutrition services for chronic conditions and Nutrition Intervention Model Program

Supplemental Social Insurance (SSI) = Provides insurance to children with special needs Americans With Disabilities Act = Requires schools to accommodate wheelchairs USDA Child Nutrition Program = Requires schools to provide modified diets, ex-PKU diet USDA 504 Accommodation = Modifies curriculum for special needs, including dietary Individuals with Disabilities Education Act (IDEA) = Must follow IEP guidelines Maternal and Child Health Block Grants Maternal and Child Health Bureau (MCH) is part of the department of Health and Human Services (HHS) Funds nutrition services for chronically ill children = Develops and promotes model programs by funding competitive grants Pediatric Pulmonary Centers Bright Future Guidelines

Prehypertension

Systolic BP 120-139 and/or Diastolic pressure of 80-89

Prehypertension

Systolic or diastolic blood pressure .90th but ,95th percentile for age and gender or 120/ 80 mm Hg Stage 1 Hypertension Systolic or diastolic blood pressure .95th but ,99th percentile 15 mm Hg for age and gender on 3 consecutive visits Stage 2 Hypertension Systolic or diastolic blood pressure .99th percentile 15 mm Hg for age and gender

Physical attributes of overweight children (Compared to normal weight peers)

Taller with advanced bone ages/Look older Experience earlier sexual maturity Are at higher risk for obesity-related chronic diseases

Treating eating disorders

Team may consist of Physician Dietitian Nurse Psychologist Psychiatrist Restore body weight Improve social and emotional well-being Normalize eating behaviors

2 model programs for risk reduction

The National Fruit and Vegetable Program (Formerly "5 A Day" program) Public-private partnership of the CDC and other health organizations High 5 Alabama = Study to evaluate the effectiveness of a school-based dietary intervention

Dieting impacts eating behaviors

The mother's concern of her own weight issues may increase her influence over her daughter's food intake Young girls are preoccupied with weight & body size at an early age Early dieting may be a risk factor for obesity & disordered eating The normal increase in adiposity at this age may be interpreted as the beginning of obesity Imposing controls & restriction of "forbidden foods" may increase desire & intake of the foods

Water soluble vitamins

Thiamin Riboflavin Niacin Vitamin B6 Folate Vitamin B12 Biotin Pantothenic acid Choline Vitamin C

Iodine during pregnancy

Thyroid function Energy production Fetal brain development Hypothyroidism in kids Half of pregnant women in the U.S. consume less than recommended Iodized salt is the primary source Half of all prenatal vitamins also contain iodine, but amount can be different from what is labeled

Protein needed during adolescence

To maintain existing LBM For growth of new LBM DRI = 0.85 g/kg body wt Highest @ 11-14 y for females, 15-18 y for males Low protein intakes linked to: Reductions in linear growth Delays in sexual maturation Reduced LBM

How substances affect nutrition status

Tobacco increases Vitamin C needs Alcohol replaces nutritious foods and beverages Thiamin & B-vitamins Illicit drugs may increase risk for disordered eating behaviors

Weight percentiles in school age children

Underweight = Less than the 5th percentile Healthy weight = 5th percentile to less than the 85th percentile Overweight = 85th to less than the 95th percentile Obese = Equal to or greater than the 95th percentile

Pregnancy wt gain guidelines (from IOM)

Underweight: 28-40 lbs Normal weight: 25-35 lbs Overweight: 15-25 lbs Obese: 11-20 lbs

Definition of toddlers and preschoolers

Toddler: 1-3 years rapid increase in gross & fine motor skills Preschoolers: 3-5 years Increasing autonomy, broader social circumstances, increasing language skills, & expanding self-control

FAT/Cholesterol needs in older adults

Total Fat = 20 to 35% of calories Eggs OK except in lipid disorders

Diagnosis of hyperlipidemia

Total cholesterol, mg / dL acceptable ,170 borderline 170- 199 abnormal > 200 LDL cholesterol, mg/ dL acceptable ,110 borderline 110- 129 abnormal > 130 Triglycerides, mg/ dL abnormal .150 ~1 in 4 adolescents have elevated cholesterol

National Cholesterol Education Program

Total fat intake from 25-35% of calories Sat. <7% calories Mono up to 20% calories Poly <10% calories Trans fat to <1% of calories Dietary cholesterol <200 mg/day CHO from 50-60% calories Dietary fiber 20-30 g/day (5-10 g viscous) Treatment = Weight reduction for overweight and obese ≥200 cal/day spent for physical activity

Factors that determine infant growth

Tracking growth reflects nutritional status Growth charts for specific diagnoses Biochemical indicators Body composition Head circumference Medications that impact growth Variety of growth charts Olsen Intrauterine Growth charts Fenton chart All preterm growth charts show head circumference as main indicator of healthy recovery

Low birth weight or preterm infants at high risk of dying in 1st year of life

Two- thirds of deaths of liveborn infants occur within the first month after birth, or during the neonatal period

Diabetes Type 1 and Type 2

Type 1 = Minimal or no production of insulin by pancreas Daily insulin injections required Type 2 = Body's inability to use insulin (Most common type)

Type 1 Diabetes in Pregnancy

Type 1 Diabetes puts both mother and fetus/newborn at risk Blood glucose should be monitored and controlled continuously Management: Monitor blood glucose, and adjust: Dietary intake Exercise Insulin dose Ketones should be monitored to prevent ketosis

Type 2 Diabetes

Type 2 diabetes may be managed with: Diet Exercise OHA to increase insulin production and insulin sensitivity Preferred management program Individualized diet and exercise recommendations Weight loss (5-10%)

HIV in adults

US: over 1.1 million (13 years and older) HIV infection raises energy requirements by 10% Weight maintenance and adequate protein stores - increases survival

How nutritional environment of the school affects dietary choices of teens

USDA sponsors the National School Nutrition Program & the School Breakfast Program School lunches & breakfasts should complement & reinforce what is learned in class & help students develop healthy eating habits Chips, candy, or soft drinks sold in vending machines, as fund-raising events, or offered as rewards by teachers send inconsistent nutrition messages to students Commercial messages and advertisements, easy access to high-fat, high-sugar, high-sodium food products—send conflicting messages about nutrition

Community food and nutrition programs for older adults

USDA's Supplemental Nutrition Assistance Program (SNAP) Seniors' Farmers Market Nutrition Programs Commodity Supplemental Foods Child and Adult Care Food Program

Special fluid considerations

Uncontrollable drooling Constipation from neuromuscular disorders Multiple medication use

Iron supplements (under/over age 12)

Under age 12—60 mg/day Over age 12—60 (males) to 120 (females) mg/day Common side effects Constipation Nausea Cramps Reduce side effects by taking small, frequent doses and take with meals

Nutrition-related disruptions in fertility

Under nutrition Weight loss Obesity High exercise levels Intake of specific foods and food components

Childhood Celiac Disease

Underdiagnosed in children (1/100) May interfere with learning and growth - will need gluten free diet for life

Issues with herbals and supplements for children with chronic conditions

Use of supplements or herbs has not been shown to improve prognosis for special health needs May use diet claims for one condition and expect it to work for a different condition Strategies to counter unscientific claims include: Recognize the benefits of supports for families (e.g. advocacy groups) Improve communication with health care providers Provide factual information without endorsing any claim & allow families to make informed choices

Why teens use steroids - risks and side effects

Used to increase LBM & strength Highest use in competitive athletes Linked to infertility, hypertension, physical closure, depression, aggression, & increased risk of atherosclerosis precursors of testosterone & estrogen Androstenedione (Andro)— controlled substance DHEA (Dehydroepiandrosterone) widely available as supplements Claims for DHEA: Reduce body fat Decrease insulin resistance Increase immune system function & LBM Decrease risk of osteoporosis Possible Side effects: Gynecomastia (breast enlargement) Prostate enlargement Hirsuitism (facial hair in females)

CHO loading - certain athletes

Used with endurance athletes such as distance runners Consists of high-carb diet to increase glycogen stores combined with resting prior to athletic event CHO loading begins 1 week prior to event Low CHO to high CHO to store glycogen for improved performance

Vegetarianism

Vegan: no animal foods or products of any kind, no honey Lacto-vegetarian: no meat, poultry (no eggs), fish Lacto-ovo vegetarian: no meat, poultry, fish Vegetarian: no "red meat" (beef, pork, lamb, venison, buffalo, or other red meat)

Buddhists dietary factors

Vegetarian or eat fish as their only meat

Decreased micronutrient needs in older adults

Vitamin A Iron

Fat soluble vitamins

Vitamin A Vitamin D Vitamin E Vitamin K

Fat Soluble Vitamins in Human Milk

Vitamin A: colostrum very high content (yellow color) Vitamin D: most as 25-OH2 and D3 (sun exposure) Vitamin E: linked to milk's fat content (not adequate for preemies) Vitamin K: ~5% of breastfed infants at risk for K deficiency based on clotting factors Injections at birth

Pernicious anemia

Vitamin B12 due to lack of the intrinsic factor Uncommon, even in older adults Takes 3-6 yrs to develop Risk factors History of Helicobacter pylori Decreased stomach acid Family history Nutritional remedies DRI = 2.4 mcg/D Fortified cereal

Water-Soluble Vitamins in Human Milk

Vitamin B6: most likely to be deficient Vitamin B12 and folate: bound to whey proteins Low B12 in women: hypothyroidism or latent pernicious anemia, vegans/malnourished, had gastric bypass

Supplements for infants that are breastfed by a vegan mom

Vitamin D Vitamin B12 Possibly iron and zinc

Micronutrient needs in older adults

Vitamin D = 800 IU daily Vitamin K = blood coagulation Vitamin E = enhanced immune function and cognitive status Vitamin B12 - 30% of older adults have decreased serum B12 levels Folate/folic acid

Four key antioxidants for fertility and food sources

Vitamin E: sunflower seeds, almonds, spinach, Swiss chard, papaya Vitamin C: citrus fruits Beta-carotene: sweet potato, kale, carrots, turnip greens Selenium: halibut, tuna, cod, sardines, shrimp, salmon, barley, turkey, lamb, scallops

Vitamins supplemented in infants

Vitamin K: all U.S. infants receive injections at birth Vitamin D: exclusively breastfed infants need supplements at 2 months

Vitamins and minerals added to preemie formula

Vitamins and minerals = calcium, phosphorus, sodium, chloride, vitamin A, D, C)

National programs for breastfeeding promotion & support

WIC National Breastfeeding Promotion Project—Loving Support Makes Breastfeeding Work Loving Support to Grow and Glow Office of Women's Health - Business Case for Breastfeeding Wellstart International

Why teens use ephedra - potential side effects

Was banned as OTC supplement in 2004 Does increase BMR but no known benefits to athletic performance Side effects include cardiac arrhythmia, hypertension, increased risk of myocardial infarction, cerebral vascular accidents, & death Ephedrine use (low dose of ephedra): 26% of females 12% of males

Cue that infants may give for feeding readiness

Watching the food (anticipation) Tight fists/reaching for spoon Irritation with slow feeding Playing with food or spoon (infant is full) Slowed feeding pace (end the meal)

Hypoglycemia

Weakness and confusion

Growth measurements for infants

Weight for age Length for age Weight for length Head circumference for age

Central adiposity affects fertility

Weight loss & fertility 1st line of treatment for obese patients Weight loss can reduce or eliminate fertility problems

"Ballpark" caloric levels

Weight maintenance = 15 calories per pound Weight loss = 13 calories per pound Weight gain = 17 calories per pound

Other proteins are available in human milk

Whey: soluble protein that precipitates by acid or enzyme Some minerals, hormones, and vitamin binding proteins Includes lactoferrin (iron carrier) Non-protein nitrogen: 20-25% in human milk Used to make non-essential amino acids

Potassium (food source)

White beans, spinach, baked potatoes, squash, yogurt, salmon

Nutritional benefits of breastfeeding

Widely recognized as optimal nutrition Human milk is isosmotic Meets infants' protein needs without overloading the kidneys Contains soft, easily digestible whey curd Provides generous amounts of the right lipids PUFAS (DHA) Minerals more bioavailable

Type 2 Diabetes in Pregnancy

Women who enter pregnancy with T2DM will need Medical Nutrition Therapy and close monitoring Good glucose control before pregnancy, with consistent self-monitoring Time meals with glucose levels and insulin (if used) Minimize hypo- OR hyper-glycemia Monitor and adjust weight gain Manage carbohydrates, and include appropriate fiber, fruits, vegetables, and unsaturated fats

Nutritional remedies for osteoarthritis

Wt loss is 1st treatment

AMA recommends to screen teens

Wt, ht, & BMI Disordered eating tendencies Blood lipid levels Blood pressure Iron status (hemoglobin/hematocrit) Food security/insecurity Dietary intake/adequacy Vegetarian diets

Polycystic ovary syndrome (definition)

a condition in females generally characterized by insulin resistance, high blood insulin levels, obesity, polycystic ovaries, menstrual dysfunction, amenorrhea, infertility, hirsutism ( excess body hair), and acne

Bilirubin metabolism

a pigment produced as heme from red blood cells (RBC) break down Processed by the liver, excreted in the baby's stool In the fetal state, high levels of hemoglobin were needed to carry oxygen delivered by the placenta At birth, infants have very high levels of hematocrit of 50% to 60% As infant breathes on his own, high hemoglobin is not needed, so RBC begin to break down

Hyperlipidemia

abnormally elevated levels of any or all lipids and/or lipoproteins in the blood

Amenorrhea

absence of menstrual cycle

Amenorrhea

absence of menstruation in a women of reproductive age

Food Security

access at all times to a sufficient supply of safe, nutritious foods

Fortified

addition of any other nutrient refined flour = folic acid milk = vitamin D low fat and skim milk = vitamins A and D some salt = iodine

Special calcium considerations (adolescence)

adequate intake of calcium is critical to ensure peak bone mass Calcium absorption rate in females = highest around menarche Calcium absorption rate in males = highest during early adolescence ~4 times more calcium retained during early adolescence compared to early adulthood Adolescents who do not include dairy should consume calcium-fortified foods Soft drink consumption displaces nutrient-dense beverages such as milk & fortified juices DRI for ages 9-18 years is 1300 mg/d Average intake is: 948 mg for females 1260 mg for males Weight-bearing activities may lead in increased bone mineral density Calcium-fortified foods needed

Recommended Dietary Allowances (RDAs)

adequate levels of essential nutrients to meet needs of all healthier persons while decreasing risks of disease

Physiological jaundice

begins after 1st day of birth rising steadily with peak ~day 6-7 Bilirubin <12 mg/dL Condition resolves in a few days Cause: normal heme breakdown

Pathological jaundice

begins within 1st day after birth rises rapidly and lasts longer Bilirubin >8 mg/dL in 1st day Medical intervention with phototherapy Cause: various pathological conditions

Infecundity

biological inability to bear children after 1 year of unprotected sex

Letdown reflex

both hormones act on mammary glands and reproductive organs Prolactin stimulates milk production and inhibits ovulation Oxytocin stimulates milk ejection and promotes uterine contractions

Kernicterus

chronic and permanent clinical sequelae that are the end result of very high untreated bilirubin levels. excessive bilirubin in the system is deposited in the brain, causing toxicity to the basal ganglia and various brainstem nuclei

Vitamin B12 (food source)

clams, liver, mackerel, crab Tofu, Swiss cheese, eggs plant milks, some soy products and some breakfast cereals

Calories per mL in breastmilk

calories per mL = 0.65 Vary with fat, protein, and carbohydrate composition Lower in calories than human milk substitute (HMS) or formula

Top five leading causes of death in the US that nutrition and exercise help prevent in adults

cancer heart disease stroke diabetes liver disease

Major protein in human milk

casein Facilitates calcium absorption Total proteins: lower than in whole cow's milk (0.32 vs 0.96 g/fl oz) Have antiviral and antimicrobial effects

Vitamin D (food source)

catfish, oysters, salmon, trout, soymilk, cereal, mushrooms

Secretory cells

cells in acinus (milk gland) that are responsible for secreting milk components into ducts

Folic Acid (food source)

cereals, breads, pastas

Coenzyme

chemical substances that activate enzymes fish, organ meat, wheat germ

Dementia

condition of progressive cognitive decline (impaired memory, thinking, decision making, linguistic ability) In the U.S. - 14% of older adults have dementia ~10% have Alzheimer's disease (AD) Confusion Anxiety Agitation Loss of oral muscular control Impairment of hunger/appetite regulation Changes in smell & taste Dental, chewing, & swallowing problems

Oxidative stress

condition that occurs when cells are exposed to more oxidizing molecules than to antioxidant molecules that neutralize them Causes damage to lipids, DNA, cells, and tissues Decreases sperm motility Reduces ability of sperm to fuse with an egg Harms egg and follicular development Interferes with corpus luteum function

"People first language"

convention names the person first and then the condition

Infant colic

crying for more than 3 hours a day Treatment: components of maternal diet (cow's milk, onions, cabbage, broccoli, chocolate)

2. Chronic conditions with higher energy needs

cystic fibrosis renal disease ambulatory children with diplegia pediatric AIDS Brochopulmonary dysplasia (BPD)

Weight loss over 10-15%

decreases estrogen , LH, and FSH Amenorrhea, an ovulatory cycles, and short/absent luteal phases 30% of impaired fertility cases related to weight loss Hormone levels return when weight is restored to within 95% of previous weight

Results of low levels of body fat

delayed time to conception, amenorrhea, lowered libido, and reduced sperm production

Chronic Hypertension

diagnosed prior to pregnancy (no proteinuria) Increased risk of preeclampsia, preterm, growth retardation, placenta abruption, and C-section Follow hypertension-related diet prescribed before pregnancy, while adjusting for increased needs Salt restriction is not recommended, but sodium intake can be decreased if this was previously effective Estimated incidence is 3% More common in: African American, obese, >35 years of age, or history of HTN with previous pregnancy

Medical nutrition therapies (adults)

diet flexibility and individualization ADA Exchange Lists Carbohydrate Counting Self-Monitored Blood Glucose Physical Activity in Diabetes Management Pharmacological Therapy for Type 2 diabetes Whole grains & other fibrous foods Unsaturated fats Regular meals & snacks CHO counting Antihyperglycemic drugs such as Metformin Use herbal remedies with caution

Aphasia in stroke patients

difficulties in self-expression, including inability to speak, finding the right words or understanding print or spoken word causes difficulty in swallowing

Peak velocity for growth in boys

during SMR 4 & ends with appearance of facial hair ~age 14.4

Herbs that affect lactation

echinacea and ginseng root, St. John's Wort, Fenugreek, Goat's Rue and Milk Thistle Scientific information about herb use during lactation is sparse Medicinal herbs should be viewed as drugs Many herbs are contraindicated during lactation

Choline (food source)

eggs, chicken, turkey, scallops, shrimp, sardines Cauliflower, soy milk, tofu, quinoa, and broccoli

Gestational Hypertention

first occurs during preganacy (no proteinuria) Increased risk of later hypertension and stroke (mother) Associated with maternal obesity and central adiposity Similar dietary recommendations as for chronic hypertension

Functional Foods

foods made functional by removing harmful or increasing beneficial substances

Trans fat in human milk

from maternal diet

Prostaglandins

group of physiologically active substances derived from the essential fatty acids - constriction or dilation of blood vessels and stimulation of smooth muscle and the uterus (cramping)

Constipation in toddlers

hard, dry stools associated with painful bowel movements Causes: "Stool holding" and diet Prevention: Adequate fiber and fluid

"Diabetogenic Effect of Pregnancy"

maternal insulin insensitivity that occurs in the 3rd trimester in order to increase glucose availability to the fetus

Hypertension

high blood pressure. It is defined as blood pressure exerted inside blood vessel walls that typically exceeds 140/ 90 mmhg ( millimeters of mercury). Decrease sodium intake Limit fat to 30% of calories Consume adequate fruits, vegetables, whole grains, & low-fat dairy Weight loss if overweight Dietary recommendations should be encouraged even if meds are prescribed Normal Blood Pressure Systolic and diastolic blood pressure ,90th percentile for age and gender

Cholesterol in human milk

higher in human milk early consumption through breast milk = lower blood cholesterol levels later in life

Obesity delivery risks

higher rates of stillbirth, LGA, C-section, increase risk of child becoming overweight, Type 2 DM later in life

Benefits of breastfeeding

hormonal, physical, psychological, immunological, chronic illness reduction, maternal weight management, cognitive, analgesic, socioeconomic Lower risk of breast CA for mothers Lower risk of osteoporosis for mothers Lower risk of childhood eczema Lower risk of childhood allergies

Prolactin

hormone necessary for milk production Alveolar development and milk secretion Stimulates letdown Tingling of the breast may occur corresponding to contradictions in milk duct Causes uterus to contract, seal blood vessels, and shrink in size Pregnancy and breastfeeding (3rd trimester to weaning)

Oxytocin

hormone produced during letdown that causes milk to eject into ducts Letdown ejection of milk from myoepithelial cells Released in response to suckling, stress, sleep, and sexual intercourse From the onset of milk secretion to weaning

Results of a loss of body fat

improvements in hormone levels, reduced oxidative stress, and improved conception rates in both men and women 1 in 3 men and women in US is obese)

Bariatric surgery for weight loss

increased & associated with rapid weight loss due to: Limited food intake, Fat malabsorption, Dumping syndrome Deficiencies of many nutrient stores: Thiamine, Vitamins D, B12, Folate, Iron & Calcium

Body water during pregnancy

increases from 7-10 L Results from increased blood and body tissues & extracellular volume & amniotic fluid Edema-Swelling due to accumulation of extracellular fluid

Infertility

involuntary absence of production of children

Oligomennorhea

irregular period

Dominant CHOs in human milk

lactose and oligosaccharides Lactose: dominant CHO Oligosaccharides: medium length CHO Prevent binding of pathogenic microorganisms to gut (infection and diarrhea)

Myoepithelial cells

line the alveoli and can contract to cause milk to be secreted into ducts

Probiotics

live, beneficial bacteria that enter food products during fermentation and againg process yogurt, buttermilk, kefir, cottage cheese, soy sauce, tempeh, miso

Vitamin A (food source)

liver, sweet potatoes, carrots, collard greens

Sarcopenia

loss of LBM associated with aging LBM decreases 2-3% per decade from age 30 to 70 22 more # of fat and 24 # less of muscle in males in 70's In older adults, weight-bearing & resistance exercise increase lean muscle mass & bone density Regular physical activity helps maintain functional status

Sarcopenic obesity

low lean body mass combined with excessive fat stores

Anovulatory cycles

menstrual cycles in which ovulation does not occur

Metabolic Syndrome (adults)

metabolic abnormalities that increases the risk of type 2 diabetes and cardiovascular diseases. insulin resistance, abdominal obesity, high blood pressure and triglyceride levels, low hDL cholesterol, and elevated fasting glucose or impaired glucose tolerance. also called Syndrome X, insulin- resistance syndrome, and the dysmetabolic syndrome Seen in 1/3 of U.S. adults Diagnosis made when individual has 3 of the symptoms

Caffeine effect on lactation & the infant

moderate intake causes no problems Level in breast milk is only 1% of that in mother's plasma May accumulate in infants younger than 3 to 4 months—varies from infant to infant May interfere with sleep or cause hyperactivity & fussiness of infant

Attention Deficit Hyperactivity Disorder (ADHD)

most common neurobehavioral problem (~5% to 8%) Chaotic meals & snacks with difficulty staying seated May be given fewer opportunities in the kitchen due to impulsiveness Medications - may decrease appetite & growth Medication peak activity is aimed at school hours Appetite returns to normal when meds are not given such as on weekends & school holidays No evidence of nutrition as a cause and treatment but families may choose herbal medicines anyway

Osteoarthritis

most common type of arthritis (most disabling) cartilage loss bone hypertrophy changes in the synovial membrane hardening of soft tissues & inflammation Pain with joint movement

Polymennorhea

multiple periods

Modifiable risk factors for bone loss

muscle wasting, sarcopenia cigarette smoking long-term dietary phosphorus deficiency heavy alcohol consumption malnourished - inadequate dietary calcium, vitamin D intake

Gestational Diabetes

occurs in 2-12% of pregnancies (increases with maternal obesity) Early C-section, shoulder dystocia, maternal death, preeclampsia, gestational diabestes, hypertention, and tSDM later, hypoglycemia Stillbirth, spontaneous abortion, congenital anomalies, increased risk of obesity, hypertention, T2DM later, hypoglycemia, hypocalcemia

Preeclampsia-eclampsia

occurs in 4% of first pregnancies and 1.7% of subsequent ones Oxidative stress and endothelial dysfunction Platelet aggregation and increased coagulation Restricted blood flow Hypertension Insulin resistance Increased FA, TG, cholesterol proteinuria risks: early C-section, acute renal dysfunction, increased risk of gestational diabetes, hypertension, T2DM later, placenta abruption, preterm delivery, growth restriction, respiratory distress, fetal and maternal death

Lineolenic

omega-3 (green vegetables, flaxseed, walnuts) 1.6g/day for men 1.1g/day for women

Lineoleic acid

omega-6 (vegetable oils, meats, human milk) 17g/day for men 12g/day for women

Menarche

onset of first menstrual period occurs 2-4 years after initial development of breast buds Age of menarche ranges from 9 to 17 years Peak linear growth occurs ~6 to 12 months prior to menarche Highly competitive athletes, severely restrictive diets may delay or slow growth ***15-25% of final ht gained in puberty!

Smoking & lactation (during pregnancy)

otitis media, exacerbation of asthma, respiratory infections, gastrointestinal dysregulation Levels 1.5-3 times higher in breast milk than mother's blood Marijuana's effect: transferred and concentrates in breast milk and is metabolized by the nursing infant May change DNA/RNA formation & neurotransmitter systems needed for growth

Lactogenesis is impacted by...

premature delivery, method of delivery, and other factors

Progesterone

prepares uterus for fertilized ovum, increases vascularity of endometrium, and stimulates cell division of fertilized ova

Carcinogenesis

process by which normal cells are transformed into cancer cells Cancers can originate in any cell, but the majority develop in epithelial tissue, where cells replicate at a high rate, including the skin, lungs, prostate, breast, colon and rectum, uterus, pancreas, oral cavity, esophagus, stomach, and urinary tract Groups at highest risk: White women, Black men

Leptin

protein secreted by fat cells that by binding to specific receptor sites in the hypothalamus, decreases appetite, increases energy expenditure, and stimulates gonadotropin secretion Elevate by high/reduced by low levels of body fat

Lipids in breastmilk

provide more than ½ the calories in human milk Fatty acid profile reflects dietary intake of mother Low fat diet with adequate CHO and protein = milk high in medium-chain fatty acids Foremilk: fat is low at the beginning of a feeding 39.7-46.7% (17.9-23.6 kcal/oz) Hindmilk: higher in fat at the end of feeding 20.9-26.2% (23.5-33.2 kcal/oz)

Magnesium (food source)

pumpkin seeds, spinach, Swiss chard, soybeans, sesame seeds, halibut, black beans

Growth velocity

rate of growth over time From birth to 1 year, average infant triples his birthweight Toddlers gain 8 oz and grow 0.4 in per month Preschoolers gain 4.4 lb and grow 2.75 in per year Under age 2: Calibrated scales & height board Weighed without clothes or diaper Determine recumbent length Over age 2: Weighed with light clothing Measure stature with no shoes

Enrichment

refined grain products have added thiamin, niacin, riboflavin, and iron

Preterm Delivery

risk for death, neurological problems, congenital malformations, & chronic health problems Multivitamin supplements or folate intake decrease risk 1-3 fish meals per week are protective Underweight and obesity increase risk Elevated blood lipids increase risk

School Health Index

self-assessment and planning tool for schools that is offered by the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Health Education Physical Education Health Services Nutrition Services Counseling, Psychological, and Social Services Healthy School Environment Health Promotion for Staff Family/Community Involvement

Ketogenic diets

severely low-CHO diet with increased calories from fat May cause wt gain Need MVI

Groups at highest risk for food insecurity

single parent, minority population, lower-income-level houses

Infant malnourished (signs)

sleepy, non-responsive, weak cry, and few wet diapers By day 5-7 = 6 wet diapers and 3-4 soiled diapers

Calcium (food source)

spinach, kale, white beans, orange juice, milk, yogurt, cheese

Diagnosis for Gestational Diabetes

standard T2DM screen at first prenatal visit HbA1C ≥ 6.5% Fasting glucose ≥ 126 mg/dL 2-hour glucose ≥ 200 mg/dL after 75g bolus Classic symptoms of hyperglycemia Random glucose ≥ 200 mg/dL Women tested at 24-28 weeks of gestation Fasting glucose ≥ 92 mg/dL 1-hour glucoglucose se ≥ 180 mg/dL 2-hour ≥ 153 mg/dL 80-90% of women can manage GDM with diet and exercise Assess diet and exercise habits Develop individualized diet and exercise plan Monitor weight gain & dietary intake Interpret blood glucose and urinary ketone results Follow-up during pregnancy and postpartum

Follicle-stimulating hormone (FSH)

stimulates maturation of ovum and sperm, production of estrogen

Gonadotropic-releasing hormone (GnRH

stimulates pituitary to release FSH and LH

Estrogen

stimulates release of GnRH in follicular phase and follicle growth and maturation of follicle Stimulates vascularity and storage of glycogen and other nutrients within uterus

Luteinizing hormone (LH)

stimulates secretion of progesterone and testosterone

Nutrigenomics

study of nutrient-gene interactions and effects of these interactions on health PKU, Galactosemia, Hemochromatosis

Toddler diarrhea

sucrose & sorbitol content of fruit juices Limiting juice may be recommended

Sodium (food source)

sun dried tomatoes, cheese, pickled foods, crab

Vitamin E (food source)

sunflower seeds, almonds, spinach, Swiss chard, papaya, asparagus, bell peppers

Seizures

uncontrolled electrical disturbances in brain (epilepsy) Range from mild blinking to severe jerking Postictal state—time after seizure of altered consciousness Feeding or eating during postictal state not recommended due to chocking risk Medications—may impact growth and/or appetite

Pre-term delivery risks

underweight and gain less than recommended, prepregnancy obesity, increased cholesterol, TG, FFA, markers of inflammation, and oxidative stress

Body mass index

weight in kg/height in m3 18.5-24.9 = healthy weight

Jaundice

yellow color of the skin seen in about 40% of full-term & 80% of preterm infants (hyperbilirubinemia) serum bilirubin levels exceeding 5 to 7 mg/ dl ( 85 to 199 µmol/ L) Can cause permanent neurological damage Most frequent cause for hospital readmission for newborns

Prognosis for Anorexia Nervosa

~10% to 15% die from the disease Deaths related to Weakened immune system Gastric ruptures Cardiac arrhythmia Heart failure Suicide Restricting type vs Non-restricting type Early diagnosis & treatment improves chances for recovery Recovery rates <50% fully recover ~33% show improvement ~20% chronically affected

Common nutritional problems for teens with chronic health conditions

~18% of children & adolescents have a chronic condition or disability Condition may put person at risk for: Altered consumption, digestion or absorption Biochemical imbalances Psychological stress Environmental factors

Why teens adopt vegetarian lifestyles at this age - types and vitamins/minerals deficiencies

~4% of adolescents - tend to be leaner Cultural or religious beliefs Moral or environmental concerns Health beliefs To restrict fat and/or calories A means of independence from family Consume more F & V, less fat, sweets, salty snacks Well-planned vegetarian diets can offer many healthy advantages Best when small amounts of animal-derived foods Vegans may have inadequate intakes Protein Calcium, Zinc, and Iron Vitamins D, B6, and B12