EMU Nutrition of the lifetime Final study guide

LO 2.5 Develop a one-day menu for a preconceptional woman and a man based on the CMP.gov food guidance materials.

Healthy dietary patterns are described by 2015 Dietary guidelines Committee as those that focus on basic, nutrient dense foods including fish, poultry, lean meats, vegetables, fruits, legumes, whole grains, and whole grain products, oils, and nuts. 1-day menu Breakfast 1 whole wheat English muffin 1 Tbsp all-fruit preserves 1 hard-cooked egg Beverage: 1 cup water, coffee, or tea Lunch White bean-vegetable soup: 1 1/4 cup chunky vegetable soup with pasta, 1/2 cup white beans 6 saltine crackers 1/2 cup celery Beverage: 1 cup fat-free milk Dinner Rigatoni with meat sauce: 1 cup rigatoni pasta (2 oz dry) 2 oz cooked ground beef (95% lean) 2 tsp corn/canola oil (to cook beef) 1/2 cup tomato sauce 2 Tbsp grated parmesan cheese Spinach salad: 1 cup raw spinach leaves, 1/2 cup tangerine sections, 1/2 oz chopped walnuts, 4tsp oil and vinegar dressing Beverage: 1 cup water, coffee, or tea Snack 1 cup nonfat fruit yogurt

DETERMINE, MUST, and the MNA are three tools to screen for nutritional risk. List five factors that place older adults at risk of malnutrition.

Here are seven factors that put older adults at risk for malnutrition 1. Food insecurity or low income 2. Eating fewer than two meals per day 3. Illness or a condition that has affected dietary intake 4. Lost or gained more than 10lbs in the last 6 months. 5. Polypharmacy 6. BMI below 19 7. Physical limitations to chop, cook, and feed self

Food guidance for older adults is different from that for the general public. Cite two adjustments in food guidance that are particularly important for older adults.

Here are three adjustments of generic food-guides to make for older adults: 1. Greater risk of dehydration requires fluid assessment and recommendations 2. Lower caloric intake needs to be balanced with greater nutrient density, especially when activity level is low 3. Guidance needs to ensure adequate protein intake when caloric intake is marginal

What are the three most common chronic conditions in men over age 65?

Hypertension, arthritis, and heart diseases

What are the three most common chronic conditions affecting women over age 65?

Hypertension, arthritis, and heart diseases, in other words, older men and women face the same chronic diseases

Subfertility

I. Reduced level of fertility characterized by unusually long time to conception (over 12 months) or repeated early pregnancy losses.

LO 3.5 Summarize the major reasons why dietary control of PKU is particularly important prior to pregnancy.

If present during early pregnancy, high levels of phenylalanine accumulate in the embryo and fetus and impair normal central nervous system development. Elevated phenylalanine levels in the first 8 weeks of pregnancy increase the risk of heart defects. The risk increases if high blood levels of phenylalanine are combined with low protein diets early in pregnancy. Untreated women with PKU have a 92% chance of delivering a newborn with mental retardation and a 73% chance that the infant will be born with an abnormally small head. Infants born to women with high blood levels of phenylalanine during pregnancy are at elevated risk of seizures, hyperactivity, and abnormal behavioral patterns later in life.

LO 3.6 Describe three nutritional consequences of untreated celiac disease.

In males, untreated celiac disease is related to alterations in the actions of androgens, delayed sexual maturation, and hypogonadism. In females, untreated celiac disease is associated with amenorrhea, increased rates of miscarraige, fetal growth restriction, low birth-weight deliveries, and a short duration of lactation. It is hypothesized that the effects of celiac disease on reproductive functions in males and females is related to malabsorption-induced deficiencies such as: zinc, folate, and iron; and direct effects of inflammation on intestinal and other tissues. Vitamin and mineral deficiencies due to CD: -Folate -Vitamin B12 -Vitamin A -Vitamin D -Vitamin E -Vitamin K -Calcium -Iron

LO 4.9 Describe two reasons why pregnant women and their fetuses are particularly vulnerable to certain foodborne illnesses.

Increased progesterone levels that normally occur decrease pregnant women's ability to resist infectious diseases, so they are more susceptible to the effects of foodborne infections. One particularly important foodborne illness is Listeria monocytogenes. The placenta does not protect the fetus from listeria infection in the mother. Listeriosis during pregnancy is associated with spontaneous abortion and stillbirth in 1/3 of fetuses and mild infection in mothers.

Describe the states of lactogenesis, including the time frame of breastfeeding, where it occurs, major milk composition changes (if any), and milk production changes.

Lactogenesis 1: the first stage of milk production which extends into the first few postpartum days when suckling is not needed for milk production. Lactose and protein content of milk increases. Lactogenesis II: begins 2-5 days postpartum and continues to about 10 days postpartum. This is when milk comes in, the lactose and fat composition are increasing, the protein content decreases, and the volume of milk produced is increasing. Lactogenesis III: begins about 10 days postpartum and milk composition becomes stable

If you are a typical male or female as represented in Table 16.5, what nutrient shortfalls and excesses should you be worried about and why?

Males consume too much total and saturated fat, cholesterol, sugar, and sodium and not enough fiber, vitamins A, D, E, and K, choline, magnesium and potassium. Females have too much total and saturated fat, and sodium and low intakes of fiber, vitamin A and E, choline, calcium, iron, magnesium, and potassium. Inadequacies and excesses alter substrate availability, cause imbalances at the cellular and subcellular levels, and result in changes in tissues such as bone, blood vessels, skin and mucosal membranes.

Using information from question 8, how would you determine the protein needs of JT in Case Study 18.1? Hint: He weighs 235 lbs (107kg) (Question 8:The AMDR for protein is 10-35% of calories, and the RDA is 0.8g/kg body weight. If the average older adult meets the RDA, why is protein a nutrient of concern for older adults?)

Multiply 107 kg by 0.8-1.3gm protein per kg body weight; distribute the 86-139 gm of protein that would be adequate for JT throughout the day in a way that he would consume food and beverages; use heart-healthy protein sources.

A breastfeeding mother asks you if alcohol can be eliminated from her breast milk by pumping immediately after drinking a few glasses of wine. What would you tell her?

No, the alcohol will still be in the breast milk and will clear from the milk as soon as it clears from the blood stream: roughly 2-3 hours per drink for a 120-lb woman.

A breastfeeding mother asks you if alcohol can be eliminated from her breast milk by pumping immediately after drinking a few glasses of wine. What would you tell her?

No; the alcohol will still be in the breast milk and will clear from the milk as soon as it clears from the blood stream; roughly 2-3 hours per drink for a 120-lb women.

Dehydration can result in confusion. List three or more strategies that can help to restore hydration and provide nutrients an older adult might be missing.

Push fluids by structuring reminders to drink (such as a water jug in the refrigerator that should be empty at day's end), drinking liberal amounts of water when taking medications, offering nutritious beverages to increase nutrient, observing "happy hour" as a time to socialize and consume fluids, and perhaps most importantly for many older women, deal with fears related to incontinence by fixing underlying structural problems and doing exercise(Kegels).

The AMDR for protein is 10-35% of calories, and the RDA is 0.8g/kg body weight. If the average older adult meets the RDA, why is protein a nutrient of concern for older adults?

Reasons might include: lack of money may affect ability to buy high quality protein, compromised ability to chew, inability to cut meats once cooked, cognitive impairment that leads to forgetting to eat.

The following six questions concern Rebecca, who is 36 years old, weighs 182 lbs, and is 5'4" tall. She just found out her LDL cholesterol is 170 and her HDL is 37. Rebecca quit smoking a few years ago. What else can she do to reduce the development of cardiovascular disease?

Reduce caloric intake, while emphasizing foods that are compatible with a cardio-protective diet, and increase physical activity to lose weight. She should get 30 minutes of moderate physical activity most days of the week and work up to longer duration or greater intensity as she is able.

LO 4.10 Identify the basic components of a nutritional assessment of pregnant women.

Routine assessment of dietary practices is recommended for all pregnant women to determine the need for an improved diet or vitamin and mineral supplements. Dietary assessment in pregnancy should cover usual dietary intake, dietary supplement use, and weight-gain progress. For best results, several days of accurately recorded, usual intake should be used for each assessment. Nutrition assessment of pregnant women usually includes lab tests of iron status, and will include tests to determine the status of other nutrients as indicated. Due to the normal physiological changes occurring during pregnancy, such as hemodilution that affects blood nutrient concentrations, assessment of nutrition biomarkers should employ standards developed for pregnancy.

A petite Southeastern Asian woman was not planning to breastfeed because she felt her breasts were so small that they would not produce enough milk What information would be the best for her to knw?

Small breasts would be able to meet infant demands. However, since they store less milk, more feeding may be required.

A petite Southeastern Asian woman was not planning to breastfeed because she felt her breasts were so small that they would not produce enough milk. What information would be the best for her to know?

Small breasts would be able to meet infant demands. However, since they store less milk, more feedings may be required.

Women taking oral contraceptive pills are cautioned against _________.

Smoking

The addition of folic acid as a supplement to grains and flours has helped reduce the incidence of ___________.

Spina bifida

LO 4.13 Describe the nutrition service components of a model nutrition program during pregnancy.

The Montreal Diet Dispensary- 1. Assess the usual dietary intake and risk profile of each pregnant woman, including calories, protein, and selected vitamin and mineral adequacy; also assess stress level. 2. Determine individual nutritional rehabilitation needs based on results of assessment. 3. Teach clients the importance of optimal nutrition and about changes that should be made through practical examples. 4/ Provide regular follow up and supervision. WIC In operation since 1974, WIC provides nutritional assessment, education and counseling, food supplements, and access to health services to over 6 million participants. WIC serves low-income pregnant, postpartum, and breastfeeding women, children up to 5 years of age who are at nutritional risk. Supplemental food provided to women includes milk, yogurt, vegetables, fruits, whole grain products, ready to eat cereals, dried beans, fruit juice and cheese. Some programs offer vouchers for farmer's markets. Participation in WIC is related to reduced rates of iron-deficiency anemia in pregnancy, high-birthweight infants, decreased low-birthweight infants, and lower rates of iron-deficiency anemia in women after delivery.

BMI is a less effective predictor of morbidity and mortality in older than younger adults. Why is BMI a less reliable tool in older adults?

The BMI is calculated using height and weight. Getting an accurate height may be more difficult in older adults who have compressed vertebrae or kyphosis which has reduced normal height. On average, older adults have lost muscle tissue which has been replaced with fat tissue and BMIs were developed with measurements of younger adults. Dehydration can introduce further errors into the interpretation of BMI in an older individual. Thus, less weight may be due to less muscle and body water.

LO 4.5 Correlate three examples of relationships between nutritional status during pregnancy and long-term health outcomes in offspring.

The Dutch Hunger Winter, 1943-1944 -People in many parts of Holland experienced severe food shortages for an 8 month period during WWII due to enemy occupation of major cities. Although people in Holland were generally well nourished and had a reasonable standard of living before the disaster, conditions rapidly deteriorated during the famine. In addition to intakes that averaged only about 1100kcal and 34g of protein per day, fuel was in low supply and the winter was harsh. Carefully kept records by health officials showed a sharp decline in pregnancy rates of over 50% during the famine, an effect attributed to absent and irregular menstrual periods. Average birthweight declined by 372g(13oz), delivery of low-birthweight infants increased by 50%, and rates of infant deaths increased. Birthweight did not fully catch up in infants born to women exposed to famine early in pregnancy, even if they received enough food later in pregnancy. This result supports the notion that the fetal growth trajectory may be established early in pregnancy and that early nutritional deprivations limit fetal growth regardless of food intake later in pregnancy. The Siege of Leningrad, 1942 -Unlike people in Holland, the population of Leningrad had experienced moderate deprivations in nutritional status and quality of life prior to the famine. As was the case for pregnant women in Holland, the famine in Leningrad resulted in average intakes of approximately 1100kcal per day. Infertility and low-birthweight rates increased over 50%, infant death rates rose, and birthweights dropped by an average of 535 g during the famine. Rates of pSGA newborns also increased, suggesting that the poor nutritional status of women coming into pregnancy and persistent undernutrition during pregnancy interfered with critical periods of fetal growth. Food shortages in Japan -Effects of WWII associated food shortages on reproductive outcomes in Japan were similar to those observed in Holland. Japanese women tended to well nourished prior to the shortages. Lack of food before and during pregnancy was reflected in decreased fertility status among women and in reductions in birthweight that averaged 200g. Social and economic improvements occurring in Japan after the war let to increased availability of many foods, including animal product. This higher plane of nutrition achieved during the postwar years in Japan was accompanied by major increases in newborn size and the "growing up" of Japanese children. In a trend that continues today, subsequent generations of Japanese adults averaged 2'' taller than the previous generation. Infant mortality in Japan declined incredibly after the war. The Famine in China -The Chinese famine of 1959-1961 was the largest in human history and mainly affected individuals living in rural areas. Little information about the diet and lifestyles of people in China during that time is available. Given available data, it is concluded that famine exposure during pregnancy was associated with a large reduction in births, an increased risk of type 2 diabetes, a three-fold increase in risk of schizophrenia in adults versus adults not born during the famine. The risk of type 2 diabetes was higher in famine exposed offspring exposed to food-rich urban environment after birth.

Describe the relationship between motor development and oral feedings in infancy.

The correct answer includes: responding appropriately to the infant's hunger and satiety cues, recognizing the infants developmental abilities and feeding skills, fostering the infant's ability to initiate and guide feeding and mealtime interactions, and providing pleasant eating environments.

Identify a genetic condition that is not found by maternal or newborn screening.

The correct answers include: cleft lip and palate, congenital anomalies, and chromosomal disorders.

Describe two or more factors other than nutrition that could impact growth of an infant with special health care needs.

The correct answers include: disorders of the brain growth, side effects of medications, altered body composition, increased or decreased energy expenditure.

Which foods do the National Institute of Allergy and Infectious Diseases recommend that nursing mothers avoid?

The institute does not recommend avoidance of food allergens during lactation.

86ng/ml ferritin=

193nmol/L

A bmi > than _____kg/m2 is typically needed to sustain normal reproductive function in women.

20

Snacks account for approximately _____% of daily food energy among adolescents.

25

A full milk supply is considered _______ oz per day.

25-35

The increased need for energy in pregnancy averages _______kcal/day.

300

The increased need for energy is pregnancy averages _____ kcal/day.

300

Full-term infants are born at _________ weeks gestation.

37-42

The AAP recommendation to limit juice intake to ______ fluid ounces per day for ages 1-6 years applies to all children.

4-6

Macronutrient recommendations for the adults age 70+ are ______________.

45-65% of energy from carbohydrates, 20-35% of energy from fat, and 10-35% of energy from protein

Tony was born at 35 weeks of pregnancy and weighed 2075 grams. His waist circumference was low relative to his weight and length. Tony was hospitalized for an infection at 4 months of age. How much did Tony weigh in lbs and oz?

4lb 10 oz

A loss of _____% of body weight can reduce or prevent the risks associated with obesity.

5-10%

A healthy full-term infant can begin to eat from a spoon easily at _______ months.

5-9

A healthy full-term infant can begin to eat from a spoon easily at ____ months.

5-9.

Weight and body mass index peak between ________ years.

50-59

To lose one pound per week, a person would need to eat ______ fewer calories per day.

500

Freshly expressed breast milk left at room temperature can be considered safe for a baby for up to _____ hours.

6-8

Freshly expressed milk left at room temperature can be considered safe for a baby for up to _____ hours.

6-8

What is the gestation-adjusted age for a 9 mo infant born preterm (32 weeks)?

7 months

What is the gestation-adjusted age for a 9 month old infant born preterm at 32 weeks?

7 months

402ng/ml red cell folate=

911nmol/L

Timothy is Case Study 12.1 returns to his pediatrician 6 months later at 7 1/2 years of age for a weight check. He has gained 10kg in 6 months and now weighs 90 lbs (41kg). His height has increased to 51" (130cm) . What is Timothy's BMI-for-age percentile. Use CDC growth curves to determine percentile.

>99th% for his age and gender

What factors make nutritional requirements higher for an infant who was born at 28 weeks gestation?

A.

Assume a woman with a singleton pregnancy weighed 154 lbs prior to pregnancy and is 5'7'' tall. What was her prepregnancy BMI?

A. 24.1 kg/m2

Corpus leutum

A. A tissue about 12 mm in diameter formed from the follicle that contained the ovum prior to its release. It produces estrogen and progesterone.

Which of the following is considered a risk factor for low vitamin D status?

A. Dark skin pigmentation

Which of the following statements regarding fat in children's diets is correct?

A. Dietary fat is an important source of calories in a young child's diet.

Which of the following is NOT part of national guidelines for physical activity for adolescents?

A. Engage in at least 60 minutes of strenuous aerobic physical activity at least 5 days a week.

Which of the following is not a basic component of a prenatal nutrition assessment?

A. Evaluation of a 7-day food intake record

Which is a true statement concerning fats?

A. Infants need a higher percentage of their daily calories from fat than children and adults.

Which of the following physiological changes in pregnancy is abnormal?

A. Plasma volume increases 30%

A 4 mo infant girl is growing well but not sleeping through the night. Her mother thinks she may be sick because she cries so much. What is a possible explanation for an infant not sleeping through the night?

A. The infant is ready for the introduction of complementary foods.

Feeding and eating problems do not require nutrition services under which of these conditions?

A. When a 3 yo child is diagnosed with GERD and prescribed medications again.

A vegan breastfeeding woman should be advised to

A. continue her vegan diet, if she chooses, while making sure that her intake of vitamin B12 and other nutrients is adequate from food and/or supplements

Colostrum differs from mature human milk in the following ways:

A.It is higher in protein mononuclear cells and is thick and yellow in color.

List the metabolic changes that characterize metabolic syndrome. How many are required for a diagnosis of metabolic syndrome? What is the easiest way to screen for metabolic syndrome?

Abdominal obesity, high blood pressure, elevated fasting glucose, dyslipidemia with elevated LDL cholesterol, low HDL and high triglycerides. Three are needed for a diagnosis of metabolic syndrome. Waist circumference is a simple screening method.

Explain why a child could need an IEP that includes nutrition services.

An IEP is a school educational plan that could include feeding or eating assistant, access to snacks or meals at set times at school, and selection of foods appropriate for the child's abilities or condition.

Which dietary component can protect cells of the reproductive system from damage by free radicals?

Antioxidants

Which child requires in-depth nutrition assessment due to changes in body composition?

B (because this child would have a change in body composition) A child who appears thin and uses a wheelchair most of the time

Assume a woman with a singleton pregnancy weighed 154 lbs prior to pregnancy and is 5'7'' tall. What would be the recommended range of total weight for her pregnancy in pounds and kilograms?

B. 25-35 lbs, 11.4-15.9 kg

Fecundity

B. Biological ability to bear children

When considering a healthy woman about what to eat during breastfeeding, the best advice is:

B. Eat a variety of foods, following a healthy eating pattern for moms.

Which of the following is NOT a behavioral economics strategy to improve food choices?

B. Hanging MyPlate posters in the cafeteria

Which of the following is a nutrition objective included in the Healthy People 2020 document?

B. Increase the proportion of women of childbearing potential by 10% with intake of at least 400mcg of folic acid from fortified foods or dietary supplements

An 8yo child with diabetes is eating birthday cake at school. What is a likely explanation?

B. The child has type 1 diabetes and he has adjusted his insulin pump to cover the cake.

The nutrients most likely to be missing from the diets of vegan adolescents are:

B. Vitamin B6, D, B12, iron, and calcium

Which is a true statement about limiting nutrients in infancy?

B. Vitamin D supplementation is needed in breastfed infants because the content is low in breastmilk.

The best way to increase human milk production is to

B. remove milk from the breast and feed frequently

Vitamin B12 deficiency can cause irreversible neurological damage. List at least three reasons why an older adults might have low B12 levels.

B12 deficiency may result from malabsorption due to atrophic gastritis, GI infections such as H. pylori, lack of animal products in the diet, family history of pernicious anemia, and medications

Timothy is Case Study 12.1 returns to his pediatrician 6 months later at 7 1/2 years of age for a weight check. He has gained 10kg in 6 months and now weighs 90 lbs (41kg). His height has increased to 51" (130cm) . Calculate Timothy's BMI

BMI=wt(kg)/ht(m2) 41kg/1.69=24.26kg/m2

What is biological age (SMR) and why should it be used instead of chronological age to determine adolescent nutrient needs?

Biological age is based on sexual maturation rating. It assesses the degree of physical development, which can vary greatly among individuals of the same gender and age, thus is a better indicator of the nutrient needs of individuals as it provides a physiological estimate of needs based on growth velocity, body composition, and reproductive capacity.

LO 3.4 Cite three key components of the nutritional management of PCOS

The primary goal in the treatment of PCIS is to increase insulin sensitivity. A number of insulin-sensitizing drugs, including metformin, can be used to lower blood insulin levels and reduce the excess production of androgens by the ovaries. The preferred first-line treatment for women with PCOS is dietary modification, weight loss if needed, and exercise. Weight loss and exercise improve insulin sensitivity, benefit blood lipinds, and insulin levels, and lower gasting glucose and testosterone levels in women with PCOS. Dietary recommendations for females with PCOS emphasize lean sources of protein, whole grains, fruits, and vegetables high in antioxidants, ample fiber intake, regular meals, nonfat dairy products, vitamin D adequacy, and low-GI carbohydrates. Basic foods, such as whole grain and high fiber, low-GI carbs are encouraged to limit blood glucose surges and insulin production.

Why is it better to start intervention in the prediabetic state rather than waiting for the diagnosis of diabetes?

There is a long pre-symptomatic phase with marginally elevated glucose during which vascular changes occur. Intervention in the prediabetes phase prevent conversion to diabetes and reduce cardiovascular risk factors.

Timothy is Case Study 12.1 returns to his pediatrician 6 months later at 7 1/2 years of age for a weight check. He has gained 10kg in 6 months and now weighs 90 lbs (41kg). His height has increased to 51" (130cm) . Based on the staged treatment plan for pediatric obesity, describe the recommended approach to treatment for Timothy.

Timothy would enter the Prevention Plus approach to treatment for 3-6 months. If he maintains his weight or his BMI-for-age % is deflecting down, he would continue the Prevention Plus. If he gains weight, the next approach would be a structured weight management program. If he has weight loss or his BMI-for-age % deflects down, he would continue the structured weight management program. If he continues to gain weight, then he would enter a comprehensive multidisciplinary intervention.

The following six questions concern Rebecca, who is 36 years old, weighs 182 lbs, and is 5'4" tall. She just found out her LDL cholesterol is 170 and her HDL is 37. What other information do you need to determine Rebecca's 10-year risk of having a heart attack?

Total cholesterol, smoking status, and blood pressure

List three common causes of persistent nipple pain.

Trauma from poor positioning, poor latch, improper release of suction after a feeding, infection, thrush, incorrect flange size during pumping or too much pressure while pumping and disorganized or dysfunctional suck.

A 4 yo boy with cerebral palsy would have normal growth on the CDC growth charts.

True

A lack of body fat and low levels of estrogen can lead to the loss of bone mineral accretion and density, and increases the risk for osteoporosis and fractures.

True

A woman with mastitis should continue to nurse her baby.

True

According to USDA food-consumption data, children's soft-drink consumption increases with age while milk consumption decreases.

True

Alcohol intake has been found to reduce fertility only in women with a specific gene variant that reduces the rate of alcohol breakdown in the body.

True

Alcohol is transferred through breastmilk.

True

Allergy symptoms associated with a cow's milk protein allergy in the toddler and preschool years may include asthma or skin rashes.

True

Any child with a chronic condition should have a growth assessment as part of determining nutrition status.

True

Bariatric surgery prior to pregnancy decreases the risk of gestational diabetes and preeclampsia during pregnancy.

True

Because toddlers can't eat a large amount of food at one time, snacks are vital in meeting the child's nutritional needs.

True

Before a mother uses galactogogues to improve supple, she should be pumping with a hospital-grade electric pump every 2-3 hours during the day and once at night or she should be pumping after each feeding.

True

Both inadequate and excessive levels of body fat affect fertility.

True

Breastfeeding women on a vegetarian diet tend to get plenty of protein as long as their energy intakes are adequate.

True

Caloric restriction that produces a negative energy balance in underweight and normal weight, menstruating females is related to the development of hypo-thalamic amenorrhea.

True

Data suggest that vegetarian adolescents consume more fruits and vegetables, fewer sweets, fewer salty snack foods, and less fat compared to omnivorous teens.

True

Eating a Mediterranean-style diet is associated with lower CVD mortality in older adults.

True

Energy deficits that characterize hypothalamic amenorrhea appear to suppress the activity of gonadotropin releasing hormone(GnRH).

True

Even a small loss of body weight can improve osteoarthritis.

True

Even with good food choices and no eating problems, children with some genetic disorders tend to be shorter than their age-matched peers.

True

Excess visceral fat and insulin resistance are shared characteristics among women with PCOS.

True

Exercise during pregnancy is associated with a lower risk of preterm delivery.

True

Exposure to famine during prepregnancy has been repeatedly found to increase the risk of schizophrenia in offspring.

True

When a child has a chronic condition that limits activity such as spina bifida, what is the greatest long-term nutrition concern?

C (as this is the only answer having to do with limited activity) Excessive calorie intake further limiting mobility.

All of the following criteria are required for adolescent bariatric surgery, except:

C.

At which state of obesity treatment is a structured eating plan designed to create a caloric deficit?

C.

Which is not a criterion for inpatient treatment of eating disorders?

C.

Why are the infant feeding problems more common in extremely low birthweight and very low birthweight infants?

C.

Which child requires an interpretation of growth modified from the usual CDC growth chart interpretation?

C. (the other conditions are not known to impact growth directly) A child with mild cerebral palsy with scoliosis

Which of the following growth parameters is used as a screening tool for assessing underweight and overweight or obesity in young children?

C. Body mass index-for-age percentile

Which of the following statements is accurate?

C. Complementary foods high in iron and zinc are recommended for breastfed infants.

Famine during pregnancy is associated with pSGA at birth and increased risk of heart disease, stroke, and type 2 diabetes in adult offspring.

True

Fear of inadequate milk supply is a contributor to early breastfeeding cessation. What would be key components of breastfeeding advice to give to a new mother in the early postpartum period to help her develop confidence in her milk supply?

C. Feed the infant when she displays early signs of hunger, and if the infant has about six wet diapers and about three stools daily, she is eating adequately.

Miscarraige

C. Generally defined as the loss of a conceptus in the first 20 weeks of pregnancy.

What is an accurate statement about services for a boy with Down Syndrome who has difficulty chewing when he turns 3 years old?

C. He is no longer eligible for early childhood programs under IDEA

A 4 yo with asthma dose not have food allergies. Her asthma routine requires a home breathing machine and two prescribed medications. Which statement is accurate about her nutrition needs?

C. Her prescribed medications could impact her appetite and growth and so require nutrition services.

The digestive system during infancy can be accurately described by which statement?

C. Infant stools change based on the ability of the intestinal villi to absorb nutrients.

A number of factors influence diet during pregnancy beyond food availability. Which of the following factors does not commonly modify dietary intake during pregnancy even when food is easily available?

C. Lack of appetite

Regarding child nutrition programs, which of the following statements is most correct?

C. Meals served as part of the School Breakfast Program must provide 1/3 of the DRI of key nutrients for the age of the children being served.

What is an accurate statement about newborn infants?

C. Newborn reflexes promote the coordination of feeding and breathing.

Which of the following is not a step in the Nutrition Care Process?

C. Nutrition Supplementation

Which of the following foods should women not consume during pregnancy?

C. Raw sprouts

Fat contributes approximately half of the calories in breastmilk.

True

Which of the following statements is incorrect?

C. The international ranking of the U.S. for infant mortality rate has been improving since the beginning of the 21st century.

Which of the following is true about maternal weight loss while breastfeeding?

C. Women can try to lose weight while breastfeeding as long as it is modest (500kcal/day deficit)

The benefits of breastfeeding include:

C. hormonal, physical, and psychological benefits for the mother, and the infant gets heightened protection from infections and several chronic diseases.

Nipple pain is common in breastfeeding. Women should be counseled to

C. see a lactation consultant for proper positioning of the infant at the breast

How many calories do you need? Use three methods discussed in the chapter to estimate daily energy requirement. What factors would increase or decrease the number of calories you need to eat in a day?

Caloric needs can be determined by using reference tables (Table 16.4), measured through indirect calorimetry, and calculated using the Mifflin-St.Joer formula or the simple method of 15 calories per pound of body weight. Factors that decrease calorie needs are sedentary lifestyle, and aging with declines in metabolic rate and loss of muscle mass. Calorie needs are increased by physical activity, and by increases in weight and muscle mass.

Female adolescent athletes with low calcium consumption appear to be the highest-risk group of all adolescents for bone fractures.

True

Gestational diabetes is associates with high blood triglyceride levels.

True

Healthy infants may have brief periods when their weight gain is slower or more rapid than at other times.

True

In contrast to measuring developmental stages, functional status is a more indicative measure of health than chronological age.

True

In women with type 1 diabetes during pregnancy, high blood levels of ketones can indicate either low or high blood glucose levels.

True

Individual fatty acids and other milk components(oligosacchirides, gangliosides, and glycoconjugates) resulting from digestion of human milk are antimicrobial.

True

Individuals born with PKU who adhere to an adequate, low-phenylalanine diet during childhood and later in life tend to develop normally or at levels that are somewhat below normal.

True

Infant feeding guidelines for term infants are appropriate for use in most preterm infants using their corrected age.

True

Infants born to African American mothers are more likely to have a low birthweight than infants born to Caucasian mothers.

True

Infants born to women with high blood levels of phenylalanine during pregnancy are at elevated risk of seizures, intellectual disability, and abnormal behavioral patterns beginning in the teen years.

True

Infants with galactosemia should not be breastfed.

True

It is easier and more efficient to build up iron stores before pregnancy than during pregnancy.

True

It is estimates that women with twin pregnancy need 150 calories more each day than do women with singleton pregnancy.

True

It is recommended that preconceptional women consume 400mcg of folic acid from fortified foods or supplements, in addition to dietary folate from a variety of foods.

True

Lois was diagnosed with type 2 diabetes two months before she planned to become pregnant. To get her blood glucose under control before pregnancy, Lois worked with a dietitian who specializes in diabetes, and together they developed a plan to reduce Lois's blood glucose levels. Assume Lois will attempt to consume 2,000 cal a day. Based on that level of calorie intake, her fiber intake should total approximately 28g daily.

True

Lois was diagnosed with type 2 diabetes two months before she planned to become pregnant. To get her blood glucose under control before pregnancy, Lois worked with a dietitian who specializes in diabetes, and together they developed a plan to reduce Lois's blood glucose levels. Lois plans to perform aerobic exercise 25 minutes daily because it will help improve insulin resistance, lower blood glucose levels, and improve her lipid levels.

True

Low energy intakes during the periconceptional period due to food restrictions, weight loss, or eating disorders may modify gene function in the embryo in ways that influence the future health of the offspring.

True

Many children with CF have slow growth and are lower in weight and shorter than expected.

True

Meeting vitamin D requirements during pregnancy is particularly important due to the role of vitamin D in fetal bone formation.

True

Menopause is associated with an increase in abdominal fat.

True

Menus generated by ChooseMyPlate include basic foods that are nutrient dense. The amounts of basic foods included in menus are primarily based on a person's age, sex, height, weight, and physical activity level.

True

More frequent family meals are associated with improved dietary intake among adolescents.

True

Most treatments for PMS are based on the prevention of ovulation

True

Neural tube defects are among the most preventable types of congenital abnormalities that exist.

True

Nutrient intake from food, calorie intake, and body fat affect fertility primarily by altering the environment in which eggs and sperm develop, modifying levels of hormones involved in reproductive processes.

True

Nutrition programs that tend to improve pregnancy outcomes include the services of nutrition assessment and counseling based on the results of the assessment.

True

Obese women tend to have higher levels of estrogen, androgens, and leptin than nonobese women.

True

Obesity prior to pregnancy is associated with metabolic disorders that promote the development of hypertensive disorders of pregnancy and gestational diabetes.

True

Often a specific nutrient or group of nutrients is suspected of being inadequate in children with FTT, when the more appropriate emphasis should be placed on energy and protein.

True

Older adults have proportionately more illness than younger adults, and the two leading causes of death are heart disease and cancer.

True

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

True

One likely effective dietary intervention for women with nausea and vomiting is separation of solid food and liquid food intake.

True

Poorly controlled blood glucose levels before pregnancy is a risk factor for congenital malformation in newborns.

True

Questions concern an infant who was born at 32 weeks gestation and weighed 1200 grams( 2lbs 10 oz). He is now 3 months old. This infant has a chronological age of 3 months and a corrected age of 1 month.

True

Salt restriction during pregnancy decreased the incidence of all forms of hypertension during pregnancy and is recommended for all pregnant women.

True

Smoking can lower milk production and decrease fat content.

True

Some alternative therapies have questionable effectiveness and are perhaps even harmful to children.

True

Some potential consequences of a weight-loss program in childhood are a slowing of linear growth and the beginnings of eating disorders.

True

Stage 2 treatment for adolescent obesity can be offered by a single provider.

True

Sticky carbohydrate-containing foods, such as raisins, are strong caries promoters.

True

Sue has a chronic condition with a pattern of weight gain and then loss, without growth over the last year. Identify as true or false statement. Sue's condition can modify her energy needs compared to a healthy child.

True

Sue has a chronic condition with a pattern of weight gain and then loss, without growth over the last year. Identify as true or false statement. The family may be worried about handling Sue if she grows as expected for her age.

True

The CDC recommends that preconceptional health programs include education about weight, iron, and folate status; assessment of alcohol use; and services related to the management of disorders such as diabetes and celiac disease.

True

The OAANP serves individuals aged 60 and older. The congregate meal program was established to increase socialization as well as to improve nutritional intakes of older adults.

True

The alcohol level in breastmilk matches maternal plasma levels.

True

The amount of stored body water decreases with age.

True

The energy needs of infants are higher per kg of body weight than at any other time of life.

True

The fetus is able to modify gene functions in response to exposure to adverse conditions that threaten its immediate chances of survival.

True

The following six questions concern Rebecca, who is 36 years old, weighs 182 lbs, and is 5'4" tall. She just found out her LDL cholesterol is 170 and her HDL is 37. Rebecca is obese.

True

The following six questions concern Rebecca, who is 36 years old, weighs 182 lbs, and is 5'4" tall. She just found out her LDL cholesterol is 170 and her HDL is 37. Rebecca should be assessed for metabolic disease.

True

The highest rate of weight gain generally occurs during mid-pregnancy, prior to the time the fetus gains most of its weight.

True

The maturation of sperm takes 70-80 days.

True

The need for DHA increases during pregnancy because DHA is a major structural component of phospholipid in cell membranes of the central nervous system.

True

The need for folate increase during pregnancy due to its functions as a cofactor in the replication of DNA, gene expressions, and amino acid metabolism.

True

The presence of excess intra-abdominal fat is related to insulin resistance, elevated levels of insulin, chronic inflammation, oxidative stress, and the metabolic syndrome.

True

The recommendations for healthy children concerning dietary fiber, prevention of lead poisoning, and iron-deficiency anemia usually apply to children at risk or already diagnosed with special health care needs.

True

The size of a woman's breast limits her ability to store milk.

True

The size of a woman's breasts limits her ability to store milk.

True

Tony was born at 35 weeks of pregnancy and weighed 2075 grams. His waist circumference was low relative to his weight and length. Tony was hospitalized for an infection at 4 months of age. Tony was born preterm.

True

True or False: According to food consumption surveys, young children exceed estimated needs for calories.

True

Weight loss and exercise improve insulin sensitivity, benefit blood lipids and insulin levels, and lower fasting glucose and testosterone levels in women with PCOS.

True

Weight loss of 7% of body weight and exercise reduce the risk of type 2 diabetes.

True

Weight loss, healthy dietary patterns, and exercise prior to pregnancy are related to a reduced risk of gestational diabetes.

True

Women should enter pregnancy with a good level of stored iron because it is easier to build up iron stores before than during pregnancy.

True

Women with HIV/AIDS who are well nourished prior to pregnancy tend to have better pregnancy outcomes than do poorly nourished women.

True

The DASH diet has been shown to reduce HBP; additional sodium restrictions have led to further reductions in blood pressure.

True, adherence to the DASH diet reduces blood pressure. An additional dose-response effect on blood pressure reduction results from sodium restriction.

The CDC suggests that longevity depends more on lifestyle factors than on genetics.

True, lifestyle factors are estimated to account for 51% of longevity compared to 19% contribution from genetics.

You have been appointed to the Campus Dietary Guidelines Committee. What things do you need to consider when developing dietary guidelines for the campus community?

Considerations include: Priority health issues and nutrient needs of young adults and older faculty and staff. and current Dietary Guidelines for Americans. The challenge on college campuses is to provide nutrient-dense foods, minimize solid fats and added sugars, and offer appropriate serving sizes while taking into account product availability, cultural and taste preferences, convenience and cost. Education messages should include guidance on what and how much to eat, and could incorporate components of the Eating Competence Model. You might consider environmental changes and policies to support healthful food choices and opportunities for physical activity.

When a child with ADHD refuses to eat, what are two possible explanations?

Correct answers include medication side effects and ability to concentrate or attend to meals.

Describe four of the nutritional benefits of human milk to the infant.

Correct answers include: The balance of nutrients in human milk matches human infant requirements for growth and development closely; no other animal milk or HMS meeds infant needs as well Human milk is isomotic (of similar ion concentration in this case human milk and plasma are of similar ion concentration) and therefore meets the requirements for infants without other forms of food or water. The relatively low protein content of breast milk compared to cow's milk meets the infant's needs without overloading the immature kidneys with nitrogen. Minerals including iron and zinc are provided in a form that is highly available.

What is a disadvantage of feeding a larger volume of formula or breastmilk than recommended?

Correct answers include: increase gastrointestinal distress, increase gastroesophageal reflux, stifle infant hunger and fullness cues, increase spitting up

Describe two other modes of feeding infants in addition to breast and bottle feeding.

Correct answers include: nasogastric feeding, orogastric feeding, parenteral feeding, and gastrostomy tube feeding

Vitamin K levels present in dark green vegetables may interfere with warfarin (anti-coagulant) therapy.

True. Approximately 11% of men above age 65 and 4.5% of women over age 65 take warfarin and must keep their vitamin K levels stable for effective blood-thinning results.

LO 4.4 Identify recommended weight gain ranges for women who enter pregnancy underweight, normal weight, overweight, and obese.

Underweight- <18.5 kg--28-40lbs(12.7-18.2kg) Normal-18.5-24.9--25-35lbs(11.4-15.9kg) Overweight-25-29.9--15-25lbs(6.8-11.4kg) Obese->30kg--11-20lbs(5.0-9.1kg) Twins- 25-54lbs(11.4-24.5kg)

Briefly describe why measuring head size is a part of a nutritional assessment for a toddler or preschooler with a suspected special health care need.

Correct answers include: to identify a decreasing rate of head growth, because any change in brain growth can impact weight and height or length growth, conditions such as spastic quadriplegia, cerebral palsy, Rett syndrome, Prater-Willi Syndrome, or Down Syndrome

Which of the following nutrients may be required in greater amounts by adolescents who use alcohol and tobacco?

D.

Signs of a hyperactive letdown are:

D. All of the above: milk streams quickly, infant may be overwhelmed by the volume, infant may choke, cough, or gulp

Which of the following statements about "critical periods" of growth and development is true?

D. Critical periods of growth and development are characterized by hyperplasia, or an increase in cell multiplication

Assume Ming, who weighed 123 lbs and was 5'4'' tall prior to pregnancy, is diagnosed with gestational diabetes at 25 weeks of gestation. She is referred to a registered dietitian for medical nutrition therapy. Which of the following statements of advice would be appropriate for the dietitian state related to Minh's dietary intake?

D. Distribute carbohydrate intake across meals and snacks

Marijuana is excreted into breastmilk at what ratio compared to maternal plasma levels?

D. Eightfold

Which of the following pieces of legislation determines components of school wellness policy guidelines?

D. Healthy, Hunger-Free Kids Act

Which of the following is a result of eating family meals most days of the week?

D. Higher intake of fruits and vegetables, less risk of drug and alcohol use, better academic performance

Although the incidence of neural tube defects in the U.S. declined post-folic acid fortification, some women are still at risk. Which of the following options represents a risk group for inadequate folate status and a neural tube defect affected pregnancy?

D. Hispanic Women

Preterm infants have higher readmission rates because of:

D. Hypoglycemia, Suck-swallow coordination, hyptothermia

Which of the following factors contributes to increased iron needs among adolescents?

D. Increased growth velocity during puberty, low dietary intake of iron, onset of menarche

Regarding fluid intake in school-age children, which of the following statements is most correct?

D. Obese

Which of the following would be the best choice for a between-meal snack for a preschooler? Choose the one best answer.

D. Peanut butter crackers

Which of the following strategies would be appropriate for parents to use in teaching their young child healthy eating behaviors?

D. Serve child-sized portions or allow the child to self-serve portions

What is an accurate statement about a preschool girl who has a diagnosed milk-protein allergy?

D. She may grow out of this allergy as she gets older.

Puberty

D. The period in life during which humans become biologically capable of reproduction

The composition of human milk changes

D. over the time of a day, within a single feeding, and over the time since birth

Which meal carries the lowest choking risk for a 9- month-old infant?

D.Cooked carrot, applesauce, beef and macaroni dinner

Name two strategies for decreasing a school-age child's sedentary behaviors.

Decrease "screen time" to less than two hours per day. Remove televisions, video games, and computers from children's bedrooms. Be active as a family.

List three reasons a breastfeeding mother may develop mastitis.

Development after cracked or sore nipples, missing a feeding or mom sleeping through the night, restrictive clothing or a tight bra.

List the main considerations in developing a diet plan (nutrition prescription) for an individual with diabetes.

Diet flexibility within an individualized plan. This includes a target calorie level based on current weight and weight goal, with a defined distribution of calories among carbohydrate, protein, and fat. A meal plan including snacks that provides relatively stable carbohydrate intake throughout the day. A variety of food to meet basic nutrient needs (RDA and DRI) and is consistent with healthy eating/cardio-protective diet (Dietary Guidelines for Americans)

What three things differentiate population recommendations to minimize cardiovascular disease risk from therapeutic lifestyle changes for individuals at high risk?

Differences between recommendations to reduce risk of the population and treatment of high risk individuals: -Population messages vs. individualized behavioral counseling and on-going intervention with health care providers to help make therapeutic lifestyle changes. -Cardio-protective diet that emphasizes plant foods and is similar to Dietary Guidelines for Americans vs. tighter restrictions on dietary fats and cholesterol intake and high amounts of fiber with emphasis on viscous fiber. Pharmacotherapy is often added for high risk individuals to lower LDL cholesterol and reduce plaque formation on the lining of arterial walls.

A health care professional was asked by a nursing mom, "How many glasses of water should I drink a day?" What would be an appropriate recommendation.

Drink enough fluids to keep your urine pale yellow.

Timothy is Case Study 12.1 returns to his pediatrician 6 months later at 7 1/2 years of age for a weight check. He has gained 10kg in 6 months and now weighs 90 lbs (41kg). His height has increased to 51" (130cm) . Which of the following classifies Timothy's BMI-for-age percentile?

E

Obesity is defined as

E. BMI-for-age percentile >/= 95th

Anovulatory Cycles

E. Menstrual cycles in which ovulation does not occur.

How does the use of substances such as alcohol, tobacco, and recreational drugs affect the nutritional status of adolescents?

Energy intake that results from the consumption of alcohol may displace energy intake from food. Because alcohol does not provide micronutrients, the overall dietary quality would be reduced in an individual who consumed alcohol frequently. The use of tobacco increases vitamin C requirements. The use of recreational drugs may result in increased intakes of snack foods and other highly refined simple carbohydrates which are high in sodium and fat and low in micronutrients.

How would you design a lifestyle-change program based on cognitive behavioral therapy?

Essential components of cognitive behavioral change programs include: -Long duration- programs are 12-16 weeks long to build knowledge, modify beliefs and attitude, and integrate new behaviors. -Combination of skills training and analysis of behavior and thought processes. -Two key features are helping the client recognize and replace automatic and irrational thoughts and beliefs (cognitive restructuring) and increasing awareness and control of cue associated with eating (stimulus control) -Strategies include setting realistic goals, calorie deficit if needed for weight loss, individualized meal plan that includes variety of enjoyed foods and fits lifestyle and budget, skills development, problem solving, self-management, cognitive restructuring, stress management, having a support system, and regular exercise, followed by maintenance support--all directed to long-term effectiveness.

A 21 mo boy has a growth pattern that plots lower on the standard CDC growth chart than on the WHO growth charts; his growth is plotted incorrectly.

False

A one-day diet for a woman in her first trimester of pregnancy who has an estimated need for 2000 calories a day would include the food group amounts of 6 oz of grain products, 2.5 cups of vegetables, 2 cups of fruits, 2 cups of milk, 5 oz protein foods, and 6 tsp of oil.

False

A wide variety of dietary supplements, ranging from evening primrose oil to St. John's Wort, have been found to effectively and safely treat the symptoms of PMS.

False

Body image issues are not much of a concern during middle adolescence.

False

Breast milk is unlikely to be recommended for a preterm infant.

False

Changes in gene functions related to inadequate fetal supply of glucose in utero tend to decrease the risk that offspring will become obese in adulthood.

False

Chronic inflammation and oxidative stress occur in preeclampsia but not in other hypertensive disorders of pregnancy.

False

Combination hormonal contraceptive use is associated with weight gain.

False

Complementary foods can be introduced at 3 months.

False

Corrected age is the same as chronological age for preterm infants.

False

Cow's milk formula is an equal alternative to human milk.

False

During illness or with the use of medications, both older and younger individuals have equally reduced ability to detect salty, bitter, sweet, and savory tastes.

False

Estrogen is produced by fat cells, the pituitary gland, and the testes.

False

Famine during pregnancy in women who were well nourished prior to pregnancy does not adversely affect pregnancy outcomes.

False

Foods with high dietary fiber content are recommended for infants with constipation.

False

Gestational diabetes appears to be cause by a woman's intake of sugar.

False

Gestational diabetes appears to be caused by a woman's intake of sugar.

False

Health problems related to anorexia nervosa resolve after the eating disorder is successfully treated.

False

High-protein diets are recommended as a pre-performance dietary regimen among adolescent athletes.

False

In order to be eligible for WIC services the only criteria is that children must live in a low-income household.

False

In pediatrics, the goal is to strive for a specific BMI value in the healthy weight range, as is the goal for adults.

False

Individuals with PKU can safely consume high-protein foods such as beef, chicken, or eggs once a day.

False

Individuals with active celiac disease share the problems of abdominal pain, headache, nutrient malabsorption, and iron deficiency.

False

Individuals with celiac disease have overt symptoms that are easily identified. Consequently, the existence of celiac disease tends to be strongly suspected in cases of infertility.

False

Iron and vitamin C status may be compromised in many pregnant adolescents.

False

Iron needs increase during pregnancy primarily due to the loss of iron that occurs with bleeding after delivery.

False

It is recommended that women with diabetes gain 5 lbs less during pregnancy than the IOM-recommended, lower limit of their weight gain range based on prepregnancy BMI.

False

Lois was diagnosed with type 2 diabetes two months before she planned to become pregnant. To get her blood glucose under control before pregnancy, Lois worked with a dietitian who specializes in diabetes, and together they developed a plan to reduce Lois's blood glucose levels. Lois should take a chromium supplement to help lower her blood glucose levels.

False

Lois was diagnosed with type 2 diabetes two months before she planned to become pregnant. To get her blood glucose under control before pregnancy, Lois worked with a dietitian who specializes in diabetes, and together they developed a plan to reduce Lois's blood glucose levels. As part of the plan, Lois would have to exclude from her diet sugar and foods containing sugar

False

Men with high amounts of body fat end to have low levels of testosterone and elevated estradiol levels. These hormonal changes do not appear to effect sperm production, however.

False

Metabolic syndrome designates a cluster of unaltered metabolic conditions.

False

Nutrition programs that tend to improve pregnancy outcomes include the routine provision of a multivitamin and mineral supplement to women.

False

Obesity is related to impaired fertility and chronic inflammation in men only.

False

PCOS ovary syndrome is easy to diagnose because the signs and symptoms are the same for all women.

False

Physicians typically are well trained to counsel women on breastfeeding.

False

Polycystic ovary syndrome is easy to diagnose because the signs and symptoms are the same for all women.

False

Pregnant women are more susceptible to the effects of foodborne infections in part because decreased pregesterone level decrease resistance to infectious diseases.

False

Progestin-only contraceptives are related to increased blood glucose and LDL cholesterol levels.

False

Questions concern an infant who was born at 32 weeks gestation and weighed 1200 grams( 2lbs 10 oz). He is now 3 months old. Standard infant formula would be appropriate at this time

False

Questions concern an infant who was born at 32 weeks gestation and weighed 1200 grams( 2lbs 10 oz). He is now 3 months old. This infant's nutritional needs can be met with exclusive feeds of breastmilk.

False

Regular intake of soy foods such as tofu, soymilk, tempeh, and textured soy protein is related to elevated sperm count in men and increased fertility in women.

False

Restriction of dietary cholesterol is recommended in infancy.

False

Routine salt restriction is advised to lower the risk of preeclampsia.

False

School wellness policies are only required for schools that offer a la carte foods for sale.

False

Sexual maturation rating is a method of determining when adolescents have completed menarche or spermarche.

False

Shrinking in height due to osteoporosis happens quickly and with sharp, jabbing pains in the spinal column.

False

Some individuals have an increased need for folate due to the gene variant 5, 10-methylenetetrahydrofolate reductase that blocks the absorption of folate from food.

False

Studies have consistently shown that high intakes of caffeine or coffee reduce fertility.

False

Studies show that overweight and obesity result entirely from taking in more energy than you are expending.

False

Sue has a chronic condition with a pattern of weight gain and then loss, without growth over the last year. Identify as true or false statement. Sue's nutritional intake must not be sufficient, since her growth is not as expected.

False

Supplementation with vitamin A and iron is recommended for women with HIV during pregnancy.

False

Supplementation with vitamins C and E before and early in pregnancy is associated with a decreased risk of preeclampsia during pregnancy.

False

Teenagers are future-oriented and tend to be concerned about how their eating will affect them in later years.

False

The AAP recommends vitamin and mineral supplementation for children who are experiencing a food jag.

False

The American Diabetes Association recommends that women with diabetes during pregnancy monitor urine glucose and ketone levels daily.

False

The basic food groups presented in ChooseMyPlate are milk, meat and beans, vegetables, fruits, and breads and cereals.

False

The current generation of oral contraceptives increases the risk of iron deficiency.

False

The following six questions concern Rebecca, who is 36 years old, weighs 182 lbs, and is 5'4" tall. She just found out her LDL cholesterol is 170 and her HDL is 37. Eating high-fiber foods a few times a week will help lower her LDL cholesterol.

False

The following six questions concern Rebecca, who is 36 years old, weighs 182 lbs, and is 5'4" tall. She just found out her LDL cholesterol is 170 and her HDL is 37. Rebecca needs to lose over 20 lbs to reduce her risk of developing type 2 diabetes.

False

The frequent ingestion of small meals does not appear to help relieve heartburn during pregnancy.

False

The main obstacle to nursing multiples is milk supply.

False

The need for iron decreases during pregnancy because women do not menstruate during pregnancy.

False

The vast majority of women experience significant problems with breastfeeding.

False

Time-tested clinical assumptions about appropriate dietary therapies during pregnancy tend to work as well in practice as do evidence-based therapies.

False

Tony was born at 35 weeks of pregnancy and weighed 2075 grams. His waist circumference was low relative to his weight and length. Tony was hospitalized for an infection at 4 months of age. Tony was hospitalized during the perinatal period.

False

Tony was born at 35 weeks of pregnancy and weighed 2075 grams. His waist circumference was low relative to his weight and length. Tony was hospitalized for an infection at 4 months of age. Tony was proportionately small for gestational age.

False

U.S. life expectancy at birth is the highest in the world.

False

Weight loss of 10-15% body weight in normal weight men, but not in normal weight women, decreases fertility.

False

Weight loss surgery is the recommended, first-line treatment for obesity in adults.

False

Women should discontinue all medications while breastfeeding.

False

Women trying to get pregnant should avoid all sources of caffeine.

False

Women who did not exercise prior to pregnancy should not start exercising during pregnancy.

False

Women who received WIC services from one pregnancy through to a subsequent pregnancy appear to gain more weight during the subsequent pregnancy than do women who receive WIC benefits during pregnancy only.

False

Women with anorexia nervosa cannot conceive because they do not ovulate.

False

Fat-free mass or lean body mass tends to shrink in old age. This results in significantly decreased needs for calories, vitamins, and minerals.

False (its a trick question) While energy needs decrease with age, some vitamins (B6, C, D) and minerals (Mg and Ca) increase with age while iron and chromium decrease

Fertility refers to the _______-

actual production of children

Women should allow infants to drain one breast completely before offering the other breast primarily to ___________.

allow the infants to get both foremilk and hindmilk, possibly decreasing diarrhea.

Women who pump milk _____________

are encouraged to pump early and often ot obtain an adequate milk supply.

Women who pump milk ________

are encouraged to pump early and often to obtain an adequate milk supply.

Many children with cerebral palsy often have constipation _________________.

because coordinated muscle movements are part of bowel emptying.

Which food item would be acceptable in a PKU diet plan?

broccoli

Pregnant adolescents have a higher requirement for _______ than pregnant adults.

calcium

Distance runners and other endurance athletes traditionally use a __________ to improve the glycogen content of muscle.

carbohydrate-loading regimen

The ketogenic diet severely limits_______.

carbohydrates.

An estimated 44% of children with FASD have __________ system impairments that result in behavioral and intellectual disabilities.

central nervous system.

Which nutritional component would a newborn be unable to digest?

complex carbohydrates.

Title IIIC of the Older Americans Act provides _________.

congregate and home-delivered meals.

Two grains that people with celiac disease can safely consume are

corn and rice

One sign of feeding problems in high-risk infants younger than 6 months is ____________.

coughing during the feeding

Which common nutrition problem may decrease growth in young children?

elevated blood lead levels.

What would be the best response if you suspected your breastfed baby was responding adversely to milk in your diet?

eliminate milk from your diet and monitor the baby for changes

The development of facial and heart defects in the fetus has been linked to _________ in the mother.

excess vitamin A intake

Inadequate intake of _________ during pregnancy has been associated with neural-tube defects.

folate

The Mifflin-St.Jeor energy estimation formula calculates energy expenditures using _________.

gender, age, weight, and height.

Breastfeeding is unadvisable if the mother ______.

has HIV

Dumping syndrome is a condition characterized by the abnormally rapid emptying of the stomach and is seen in women who

have undergone bariatric surgery

Risk factors for the development of overweight and obesity among children and adolescents include _____________.

having at least one overweight or obese parent.

Several measurements are used to assess infant growth. An exception is __________.

head circumference for weight

Several measurements are used to assess infant growth. An exception is ___________.

head circumference for weight

When a women develops carbohydrate intolerance during pregnancy, this means that _______.

her blood glucose levels increase abnormally after she eats carbohydrate-containing foods.

Goals for the nutritional management of women with HIV/AIDS advise against

high doses of vitamin and mineral supplements

Hindmilk has a ________ content than foremilk.

higher fat and higher caloric

During middle childhood and preadolescence, the child is responsible for _________.

how much he or she eats.

Adults who engage in strenuous exercise programs have increased nutrient and ________ needs to meet the demands of training, competition, and recovery.

hydration

Among causes of low milk supply is ___________.

inefficient emptying of the breast caused by a poor latch.

An unfavorable metabolic change associated with excessive body fat is ______.

insulin resistance.

Infants are generally considered to have experiences _____ if their weight for gestational age or length is low.

intrauterine growth retardation (IUGR)

Binge-eating disorder differs from bulimia nervosa in that binge-eating disorder ______________.

is not followed by compensatory behaviors.

Risk factors for cardiovascular diseases include ________.

low level of HDL

Nutrition advice for people who are taking blood-thinning medication due to a stroke is to _________.

maintain a stable vitamin K intake.

The primary outcome goal for pregnant women with type 2 diabetes is to _______.

maintain blood glucose levels with normal range.

The best way to prevent sore nipples is to ______.

make sure the baby is positioned properly.

The best way to prevent sore nipples is to ___________.

make sure the baby is positioned properly.

The mainstay of treatment for gestational diabetes aimed at normalizing blood glucose levels is

medical nutrition therapy focusing on diet and exercise

The three components of the female athlete triad are _____

menstrual dysfunction, eating disorder, and osteoporosis

The three components of the female athlete triad are _______.

menstrual dysfunction, eating disorder, and osteoporosis.

Spina bifida is an example of a _________

neural tube defect

"If you drink, do so in moderation," is defined as ________.

no more than 2 drinks/day for males and no more than 1 drink/day for females.

Which food item is least likely to be considered a common pediatric food allergen?

oats

The presence of nausea or vomiting during pregnancy _________.

occurs in about 80% of women

An example of a complementary food is ________.

orange juice

Oxidative stress occurs when cells are exposed to more _________ molecules than _________molecules.

oxidizing; antioxidant

Provision of adequate energy and nutrients to the very preterm infant requires ________, followed by slow transition to _______.

parenteral feeding; enteral feeding

Provision of adequate energy and nutrients to the very preterm infant requires ____________, followed by slow transition to ___________.

parenteral feeding; enteral feeding

Diets characterized by a high intake of __________ have been linked to a decreased risk of preeclampsia.

plant foods.

Colostrum is higher in _____ and lower in _______ than milk produced after a milk supply is established.

protein; lactose, fat

Which diet strategy would be inappropriate to treat individuals with type 2 diabetes?

regular intake of refined grain

Heartburn in pregnant women is likely caused by ______.

relaxation of lower esophageal sphincter at the top of the stomach.

Population-wide improvements in social circumstances, infectious disease control, and availability of ______ have corresponded to greater reductions in infant mortality than have technological advances in medical care.

safe and nutritious foods

Women taking oral contraceptive pills are cautioned against ___________

smoking

The National Academy of Nutrition and Dietetics has developed a set of standards called _____ to serve as guidelines for the delivery of nutrition services.

the Nutrition Care Process

The National Academy of Nutrition and Dietetics has developed a set of standards called _________ to serve as guidelines for the delivery of nutrition services.

the Nutrition Care Process

One of the nutritional benefits of breastfeeding is that _____.

the balance of nutrients in human milk matches requirements needed for human growth.

The periconceptional period is the __________

time period around conception measured in weeks or months.

Women who enter pregnancy obese are more likely to gain ___ during pregnancy compared with normal weight women.

too much weight

Women who enter pregnancy obese are more likely to gain _________ during pregnancy compared with normal weight women.

too much weight

A pregnant women experiencing nausea may be recommended to take _______ supplements to decrease her symptoms.

vitamin B6

The AAP encourages the use of _____________ for hydration in most instances.

water

Dietary recommendations for women with PCOS emphasize _________

whole grains, fruits, vegetables high in antioxidants, and lean sources of protein

Dietary recommendations for women with PCOS emphasize ________.

whole grains, fruits, vegetables high in antioxidants, and lean sources of protein.

Abnormal facial features, such as a flat mid-face, abnormally shaped ears, and the presence of a smooth ridge between nose and lips characterize infants _________.

with fetal alcohol syndrome

Infant mortality refers to deaths that occur ______________.

within the first year of life.

It is difficult to meet vitamin and mineral needs via foods at calorie levels below ________.

1600

Leutinizing hormone

H. A hormone that stimulates secretion of estrogen, progesterones, and testosterone and growth of the corpus luteum.

What nutrition-related concerns develop as a result of having HIV?

HIV raises energy requirements by 10%. Macro and micro nutrient need increase during periods of high viral load, decline of immune function, secondary infections and altered absorption and metabolism. Changes in gut and gastrointestinal pathogens can lead to nutrient malabsorption. Weight maintenance is associated with a person's ability to survive HIV disease. Adults with HIV have high rates of metabolic syndrome and are at risk for cardiovascular disease and type 2 diabetes. Often guidelines for CVD and diabetes and other comorbidities must be added to HIV nutrition considerations. Medication regimens require careful meal spacing. In later stages of the disease oral lesions, nausea, and diarrhea make eating difficult. Substance abuse, economic issues and food insecurity may also be complicating factors.

List at least three major risk factors for developing severe hyperbilirubinemia.

Jaundice observed in the first 24 hours of life, blood group incompatibility or haemolytic disease, gestational age 35-36 weeks, previous siblings received phototherapy, significant bruising, exclusive breastfeeding when not going well and/or excessive weight loss, east Asian race.

52ng/ml vitamin D(25 hydoxyvitamin D)=

130nmol/L

One rule of thumb regarding serving sized for toddlers is ________ of food per year of age.

1 tablespoon

A simple calculation used to give you a "ballpark" calorie level for weight maintenance is to multiply your body weight in pound by the number ______.

15

It is recommended that overweight women gain approximately ____________ pounds during pregnancy.

15-25

It is recommended that overweight women gain approximately __________pounds during pregnancy.

15-25

LO 2.2 Identify 6 major hormones involved in the regulation of male and female fertility processes, and identify their source and effects on the regulation of fertility processes.

-Gonadotropin-releasing hormone(GnRH):hypothalamus: Stimulates the release of FSH and LH -Follicle-stimulating hormone(FSH):Pituitary: Stimulates ovarian follicle growth and maturation, estrogen secretion, and endometrial changes characteristic of the first portion of the menstrual cycle in females. It stimulates sperm production in males. -Luteinizing Hormone(LH):Pituitary: Stimulates ovulation, the development of the corpus luteum(which secretes progesterone), and the production of testosterone in males. -Estrogen(most abundant form is estradiol):ovaries, testes, fat cells, corpus luteum, and placenta(during pregnancy): Stimulates release of GnRH in follicular phase and inhibits in luteal phase: stimulates thickening of uterine wall during menstrual cycle -Pregesterone(progestin, progestogen, and gestagon are similar):ovaries and placenta: "Progestational," it prepares uterus for fertilized ovum and to maintain a pregnancy; stimulates uterine lining buildup during menstrual cycle; helps stimulate cell division of fertilized ova; inhibits action of testosterone -Testosterone:mostly by the testes, ovaries: Stimulates maturation of male sex organs and sperm, formation of muscle tissue, and other functions.

LO 2.1 Cite 3 examples of the Healthy People 2020 nutrition related objectives for the preconception period.

-Increase the proportion of women who are at a healthy weight prior to pregnancy by 10% -Reduce the proportion of women aged 18-44 years who have impaired fecundity by 10% -Reduce the proportion of men aged 18-44 years who have impaired fecundity by 10% -Increase the proportion of women who did not drink alcohol prior to pregnancy by 10% -Reduce iron deficiency among females of childbearing age by 10% -Increase the proportion of women of childbearing potential with intake of at least 400mcg of folic acid from fortified foods or dietary supplements by 10% -Reduce the proportion of women of childbearing potential who have low red cell folate concentration by 10% -Increase the proportion of women delivering a live birth who received preconception care services and practiced key recommended preconception health behaviors by 10%

LO 2.4 Cite four examples of relationships between nutrient intakes and nutritional status during the periconceptional period and the outcome of pregnancy.

-Low-energy intakes during the periconceptional period due to food restriction, weight loss, eating disorders; or exposure to high amount of vitamin A in the form of retinol or retinoic acid from supplements or drugs used to treat acne for example, can modify gene functions in a developing embryo in ways that influence the future of health of the offspring. -Folate status prior to conception is an important concern because inadequate folate very early in pregnancy is related to the development of approximately 50% of cases of NTD's, such as spina bifida. -Excessive vitamin A intake increases the risk the fetus will develop facial and heart abnormalities. -High maternal blood levels of lead increase the risk of intellectual disability in the offspring. -Iodine deficiency early in pregnancy increases the risk that children will experience impaired mental and physical development. -Iron deficiency increases the risk of early delivery and development of iron deficiency in the child within the first few years of life. -Poorly controlled blood glucose levels early in pregnancy increase the risk of fetal malformations, excessive infant size at birth, and the development of diabetes in the offspring.

LO 2.6 Identify three nutrition-related consequences that may be related to the use of combination hormonal contraceptives, and a consequence that is related to the use of estrogen or progestin contraceptives only.

-Progestin-only hormonal contraceptives such as Depo-Provera are associated with weight gain. -Estradiol and progestin contraceptive use appears to be associated with altered blood lipid levels and glucose metabolism, as well as other changes in health status. -Combination contraceptives tend to decrease HDL cholesterol, increase LDL cholesterol and triglyceride concentrations, increase blood glucose and insulin levels, and increase inflammation somewhat. -Metabolic changes associated with estradiol appear to increase the risk of stroke due to blood clots and heart attack in some users.

LO 4.7 Identify three factors that influence dietary intake during pregnancy that are not related to food availability.

1. Effect of taste and smell changes on dietary intake during pregnancy- Changes in the way certain foods taste, and the odor of foods and other substances, affect two out of three women during pregnancy. 2. Pica- Women experiencing pica are more likely to be iron deficient than those who don't and iron-deficiency anemia is especially common among pregnant women who compulsively consume ice or freezer frost. Pica does not appear to be related to newborn weight or preterm delivery. It can, however, complicate control of gestational diabetes is starch is eaten, and it has caused lead poisoning, intestinal obstruction, and parasitic infestation of the GI tract. 3. Cultural considerations- The belief that consumption of certain foods marks the baby is common in many cultures. People may think, for example, that a woman who loves mangoes and eats of them during pregnancy may have a baby born with a mango shaped birthmark. Some cultures would hold that the baby will also have learned to love mangoes because its mother ate them often while pregnant. Other people believe, for example, that beets and beet juice are good sources of iron (they are not) and will increase consumption of them during pregnancy.

LO 4.6 Provide five examples of how the need for energy and specific nutrients change due to pregnancy.

1. Energy requirements during pregnancy increase mainly due to protein and fat tissue synthesis, and the energy cost of maintaining an expanding amount of metabolically active tissues. Expanded metabolic activity related to the increased work of the mother's cardiovascular, respiratory, and renal systems is responsible for much of the increase in energy needed for basal metabolism. 2. Protein requirements increase during pregnancy due to protein tissue accretion. Of the approximately 925 g of protein accumulated in the protein tissues during pregnancy, 440 g are taken up by the fetus, 216 g are used for increases in maternal blood and extracellular fluid volume, 166 g are consumed by the uterus and 100 g are accumulated by the placenta. Additional protein is also required to maintain the protein tissue developed. 3. Fat consumed in foods is used as an energy source for fetal growth and development and serves as a source of fat-soluble vitamins. Fat also provides essential fatty acids that are specifically required for components of fetal growth and development. 4. Inadequate folate during pregnancy has long been associated with anemia in pregnancy and reduced fetal growth. Discovering of the multiple effects of inadequate folate intake on the development of congenital abnormalities and clinical complications of pregnancy represent some of most important advances in our knowledge about nutrition and pregnancy. 5. The need for choline increases during pregnancy due to its roles as a component of phospholipids in cell membranes and a precursor of intracellular messengers. Choline can be converted to betaine, while, like folate, serves as a source of methyl groups used to regulate gene function, neural-tube and brain development, and the conversion fo homocysteine to methionine.

LO 4.12 Asses three common health problems during pregnancy and the evidence on the effectiveness of dietary interventions for their treatment or amelioration.

1. Nausea and vomiting- Ways to treat- continue to gain weight, separate liquid and solid food intake, avoid odors and foods that trigger nausea, select foods that are well tolerated. 10-25mg, up to 100mg daily of B6 reduces the severity of nausea in many women. Diclegis is a mix of B6 and doxylamine that helps reduce nausea and vomiting. Ginger for 4 days can also help nausea and vomiting. 2. Heartburn- Ways to treat- ingest small meals frequently. do not go to bed with a full stomach, avoid foods that seem to make heartburn worse, consume adequate fiber, and elevate your head and upper body during sleep. Constipation- Ways to treat- Consume 30 g of dietary fiber daily, metamucil, citrucel and perdiem are safe fiber supplements during pregnancy.

As many as _____ of women who experience nipple pain and trauma switch to bottle feeding within the first 6-8 weeks postpartum.

1/3

About _______% of women with gestational diabetes will develop type 2 diabetes within 2-5 years.

10-15

The average caloric need of infants in the first six months of life is _______ calories per kg of body weight, based on growth in breastfed infants.

108

Measurements for weight, length, or head circumference below the ______percentile indicate an infant is small for gestational age (SGA) while measurements above the _____ percentile indicate an infant is large for gestational age (LGA).

10th; 90th

The recommended age for weaning an infant from the breast or bottle to a cup is from __________ months.

12-18

LO 4.2 Describe 5 physiological changes that normally occur during pregnancy that would be considered abnormal if they did not occur during pregnancy.

Blood Volume Expansion -blood volume increases 20% -Plasma volume increases 50% -Edema (occurs in 60-75% of women) Hemodilution -concentrations of many vitamins and minerals in the blood decrease Blood lipid levels -increased concentrations of cholesterol, LDL cholesterol, triglycerides, HDL cholesterol Blood Glucose levels -increased insulin resistance (increased plasma levels of glucose and insulin) Maternal organ and tissue enlargement -Heart, thyroid, liver, kidneys, uterus, breasts, adipose tissue Circulatory System -Increased cardiac output through increased heart rate and stroke volume(30-50%) -Increased heart rate (16% or 6 beats/min) -Decreased blood pressure in the first half of pregnancy (29%), followed by a return to nonpregnancy levels in the second half Respiratory system -Increased tidal volume, or the amount of air inhaled and exhaled (30-40%) -Increased oxygen consumption (10%) Food intake -Increased appetite and food intake; weight gain -Taste and odor changes, modification in preference for some foods -Increased thirst Gastrointestinal Changes -Relaxed gastrointestinal tract muscle tone -Increased gastric and intestinal transit time -Nausea (70%), vomiting(40%) -Heartburn -Constipation Kidney Changes -Increased glomeruler filtration rate (50-60%) -Increased sodium conservation -Increased nutrient spillage in urine; protein is conserved -Increased risk of UTI Immune System -Suppressed immunity -Increased risk of urinary, reproductive tract, and other infections Basal metabolism -Increased basal metabolic rate in second half of pregnancy -Increased body temperature Hormones -Placental secretions of large amounts of hormones needed to support physiological changes of pregnancy

Describe the physiological changes that occur during the adult years. How do those changes relate to the continuum of health? Which changes have implications for development of chronic diseases?

Bone density and muscular strength peak by age 30. By middle adulthood there is a loss in muscle mass and an increase and redistribution of body fat. With the decline of estrogen production bone loss is accelerated, abdominal fat increases, and blood cholesterol and triglyceride levels raise. Risk for hypertension, insulin resistance, diabetes, stroke, gallbladder disease and coronary artery disease increase with the accumulation of additional body fat. These changes shift the person from resilient and healthy with metabolic homeostasis to observable physiologic and metabolic alteration and the development of clinical conditions and chronic diseases.

LO 3.2 Identify two mechanisms by which a negative energy balance can influence fertility.

Caloric restriction that produces a negative energy balance in underweight, and normal weight, menstruating females is related to the development of hypothalamic amenorrhea. This condition produces a loss of menstrual cycles due to the absence of ovulation and is most likely to occur in women with restricting-type eating disorders and female athletes who maintain a low body weight. It is suggested that these mechanisms come into effect to prevent pregnancy in women who are malnourished and poorly prepared for the calorie and nutrient costs of fetal growth and development. Energy deficits that characterize hypothalamic amenorrhea appear to suppress the activity of GnRH. Amenorrhea associated with the female athlete triad appear to be triggered when energy intake is about 30% less than energy requirements. This level of energy deficit leads to a loss of normal secretion of LH and FSH, a lack of estrogen production, and other hormonal changes seen in hypothalamic amenorrhea. Metabolic changes triggered by hormonal shifts result in decreased bone density and an increased susceptibility to stress fractures in affected athletes.

LO 5.2 Distinguish the different types of hypertensive disorders that occur during pregnancy, and connect two components of nutrition care recommended for women with each type.

Chronic Hypertension- Hypertension that is present before pregnancy or diagnosed before 20 weeks of pregnancy. Hypertension is defined as blood pressure </= 140 mm HG systolic or >/= 90 mg HG diastolic blood pressure. Hypertension first diagnosed during pregnancy that does not resolve after pregnancy is also classified as chronic hypertension. Gestational hypertension- This condition exists when elevated blood pressure levels are detected for the first time after mid-pregnancy. It is accompanied by proteinuria or the onset of new symptoms. If blood pressure returns to normal within 10 days postpartum, the condition is considered to be transient hypertension of pregnancy. If it remains elevated, then the woman is considered to have chronic hypertension. Women with gestational hypertension are at lower risk for poor pregnancy outcomes than are women with preeclampsia. Preeclampsia-Eclampsia- A pregnancy-specific syndrome that usually occurs after 20 weeks gestation in previously normotensive women. It is determined by increased blood pressure during pregnancy to >/= 140/90 mm Hg blood pressure and accompanied by proteinuria. In the absence of proteinuria, the disease is highly suspected when increased blood pressure is accompanied by headache, blurred vision, abdominal pain, low platelet count, and abnormal liver enzyme values. Chronic hypertension with Superimposed Preeclampsia- This disorder is characterized by the development of proteinuria during pregnancy in women with chronic hypertension. In women with hypertension and proteinuria before 20 weeks of pregnancy, it is indicated by a sudden increase in proteinuria, blood pressure, or abnormal platelet or liver enzyme levels. Treatment: Decrease BP -Regular intake of colorful fruits and vegetables, dried beans, and whole-grain products -Vitamin D sufficiency -Physical activity Increase BP -Frequent intake of process and high-fat meats -Frequent consumption of soft drinks, other high-sugar beverages -Physical Inactivity -High levels of body fat, especially visceral fat -Smoking It has been recommended that women with hypertension that was managed successfully with the help of a reduced salt or sodium diet before pregnancy continue that approach during pregnancy. Inadequate sodium intake during pregnancy can impair fetal growth so the restriction in salt intake should not be excessive.

Identify and discuss at least three themes that are common across all the conditions--overweight and obesity, cardiovascular disease, metabolic syndrome, diabetes, cancer, and HIV disease--presented in this chapter.

Common themes- -Maintain a healthy weight--if overweight, this means a weight loss of 5-10% of body weight. For HIV disease, the focus is on maintaining weight and maintaining lean body mass. -Avoid or reduce central or abdominal adiposity, because this is associated with insulin resistance and hyperglycemia, hyperlipidemia, metabolic syndrome, cardiovascular disease, and type 2 diabetes. -A healthy, cardio-protective diet emphasizes plants foods (vegetables, fruit, whole grains, legumes), healthy fats, low fat dairy products, and lean meats. Trans fat is avoided and saturated fat is limited to 5-6% of calories; and intake of sweets and red meat is minimized.

What do you need to do to meet the Physical Activity Guidelines for Americans? What are the benefits if you do? What are the consequences if you don't?

Compare your current level of activity with the national guidelines on Table 16.9. Being more physically active increases muscle strength, balance, and endurance, support physical and mental health, improves cognitive function, helps manage weight and combat weight gain, reduces blood cholesterol, and blood pressure, and helps prevent the onset or progression of several chronic disease. Sedentary lifestyle results in the loss of these benefits.

LO 5.4 Explain three differences in nutrient needs and cite two specific considerations for delivery of effective nutritional care for women with multifetal pregnancy.

Evidence of higher caloric need for tissue maintenance and growth in multifetal than in singleton pregnancy comes from studies that show increased weight gain and a quicker onset of starvation metabolism in women expecting more than one newborn. Reduced rates of twin deliveries, as well as the higher incidence of twins in overweight and obese women, imply that energy status is an important factor in multifetal pregnancy. The need for essential fatty acids(linoleic and alpha-linoliec acid) appears to be increased in multifetal pregnancy. Poor essential fatty acid status is related to neurologic abnormalities and vision impairments in twin offspring. Requirements for iron and calcium have also been found to be increased based on the magnitude of physiological changes that take places in multifetal pregnancy. Recommended effective nutritional care -Weight gain Twins -Overall gain of 35-45 lbs; Underweight women should gain at the upper end of this range, overweight and obese women at the lower end. -First trimester: 4-6 lbs -Second and third trimester: 1.5lbs per week through pregnancy. Triplet pregnancy -Overall gain of approximately 50 lb -Gain of 1.5 lb per week through pregnancy -Daily Food Intake Twin Pregnancy (2400-2800kcal) -Grains, primarily whole (8-10 oz) -Vegetables (3-3.5 cups) -Fruits (2-2.5 cups) -Fish, poultry, beans: (6.5-7 oz) -Milk (3 cups) -Oil (3 tsp) -Extra calorie allowance (362-426) Triplets -Food intake from the basic food groups should be consumed at a level that promotes targeted weight gain Calorie intake Twins -450 kcal above prepregnancy intake; the amount should be consistent with targeted weight-gain progress Triplets -Caloric intake levels should promote targeted weight-gain progress Nutrient intake Both -RDA levels or somewhat more than these levels -Intakes should be lower than UL's Vitamin and Mineral Supplements Both -Use vitamin and mineral supplements as needed

What are two examples of family support that would assist a child with a chronic condition?

Examples of support services for families are maternal and child health services, school nutrition programs, and school educational programs.

Progesterone

F. A hormone that prepares the uterus for a fertilized ovum and helps to maintain a pregnancy; stimulates uterine lining buildup during menstrual cycle.

Name two strategies for increasing a school-age child's physical activity.

Find a safe rout for walking or biking to school. Encourage at least 60 mins of active play per day. Work within the community to maintain parks and other safe places for children to play. Child can participate in organized sports that are appropriate for his stage of development and physical abilities.

Which statement correctly describes food allergy or food intolerance?

Food allergy is an exaggerated immunologic response

Which statement correctly describes food allergy or food intolerance?

Food allergy is an exaggerated immunologic response.

Amenorrhea

G. Absence of menstrual cycle.

The most common GI-related diagnosis given in clinic visits is _______________.

GERD

LO 5.3 Connect the different major types of disorders in carbohydrate metabolism that occur during pregnancy and the key components of the nutritional management of each type.

Gestational Diabetes The prevalence of gestational diabetes varies from 2-12% depending on the population studied. The incidence increases along with obesity and this affect is pronounced among Asian American Women whose dietary patterns and lifestyles have become Westernized. Gestational diabetes accounts for 88% of all cases of diabetes in pregnancy and is similar in many ways to type 2 diabetes. Women who develop gestational diabetes tend to enter pregnancy with insulin resistance, or a predisposition to insulin resistance, and impaired insulin production, which is expressed due to physiological changes that occur during pregnancy. Nutritional management: For most women, blood glucose levels can be successfully managed by diet and exercise. Diet and exercise-controlled management of gestational diabetes is often preferred because it eliminates the need for women to use insulin injections, is not related to increased appetite and weight gain associated with insulin use, adn may foster longer-term health diet and exercise patterns. Metformin or insulin will generally be added to diet and lifestyle efforts if targeted blood glucose levels are not obtained within several weeks. The following are components of the nutritional management of women with gestational diabetes: -Assess dietary habits and exercise habits -Developing an individualized, culturally appropriate, and acceptable dietary pattern and exercise plan for blood glucose control -Monitoring weight gain, dietary intake -Interpreting blood glucose and urinary ketone results -Ensuring follow-up during pregnancy and postpartum Type 2 diabetes More women are entering pregnancy with type 2 diabetes than in the past largely due to increasing rates of obesity. Care for women with type 2 diabetes in pregnancy should be individualized and follow evidence-based protocols. The primary goal of management is maintenance of blood glucose levels with the normal range. This can be challenging because insulin requirements change throughout pregnancy and requires that women be closely monitored and that care providers remain alert and ready to modify care plans. Medical nutrition therapy is a major part of the management of type 2 diabetes during pregnancy, and should be undertaken by an experienced registered dietitian in concert with other members of the clinical team and the woman. Nutritional Management -Aim fo pregnancy weight fain towards the lower end of the IOM's recommended pregnancy weight gain range by prepregnancy BMI. -Monitor weight gain, adjust energy intake based on rate of gain, physical activity level, and fetal growth pattern -Develop a personalized daily food plan based on food preferences, calorie need, and a healthy dietary pattern. -Include around 175 g of carbs in the food plan -With input from the woman on effects of various carbohydrate foods on her blood glucose level, distribute carb intake across meals and snacks to control glucose and ketone levels -Include 28 g of fiber daily from whole grains, vegetables, and fruits in the food plan -Encourage consumption of unsaturated fats -Monitor dietary intake and adjust dietary pattern as needed.

What are the differences between individual and external or environmental factors that determine nutrition status and health? Give examples for how each type is monitored.

Individual factors- Things individuals are primarily responsible for, including food and nutrient intake and nutritional adequacy, physical activity and other lifestyle habits; and the results of individual behavior on weight status and chronic disease risk factors. These are monitored at the individual level using standard indicators, summarized across population groups, and compared to national Healthy People 2020 objectives. External or environmental factors- Things that are the result of decisions made by planners, retailers, employers, and healthcare providers and other that affect the environments in schools, worksites, and the community; as well as the social environment (support systems, income, education, discrimination), physical environment (housing, transportation, location of retail stores and restaurants), and availability and quality of health and nutrition services. These are monitored at the local community, state, and federal levels and compared to the Healthy People 2020 objectives.

Make a table of different strategies for helping adults achieve good nutritional health.

Individuals- Education and counseling to increase knowledge and encourage behavior change, primary care providers assessing and talking about BMI, eating habits, and physical activity. Organizations- Health promotion programs, sponsored events, community gardens, food shelves, and policies about types of foods served in cafeteria and events. Environmental changes- Increased access to grocery stores, farmers markets and community gardens, healthful food and beverage choices vending machines, point of purchase signage about calories and fat content. Product Development and Marketing- functional foods, front-of-package food rating symbols, smaller package and serving sizes. Policies- Enrichment of foods, food labelling and health claims, and nutrition programs to improve food security.

LO 4.1 Identify three problem areas related to pregnancy outcomes in the U.S.

Infant mortality, low birthweight, and preterm delivery

LO 5.6 Identify two primary components of nutritional care of women with eating disorders during pregnancy.

It is recommended that pregnant women with eating disorders be referred to an eating disorders clinic or specialist. Most large communities have special clinics and programs for women with eating disorders, and they commonly use a team approach to problem solving around the eating disorder. Nutritionists or dietitians often participate in these services because they are knowledgeable about the woman/s individual nutritional needs and those pregnancy. Health professionals serving women with eating disorders in pregnancy can facilitate open communication and behavioral change by gently encouraging women to talk about their eating disorder, fears, and concerns. Behavioral changes required for improvements in nutritional status and weight gain in women with eating disorders are most likely to work when the changes are considered acceptable to the women with the disorder. Frequently, the health professional presents the type of changes that need to by made and explains why, and then works with the woman to develop specific plans accomplishing these changes. The term pregorexia is emerging in clinical practice as an unofficial term for women with restrictive eating behaviors during pregnancy. The term regers to women with eating disorders who fail to gain weight during pregnancy and are at high risk of intrutierine growth retardation and early delivery. In order to stress the importance of eating right and gaining weight, some dietitians will supply the women with keto sticks ask them to check their urine several times a day. It is explained that when test results are positive for ketones, not enough calories and food are being consumed. It is intended that, faced with positive results about inadequate food intake, women will eat more.

LO 5.5 Identify the components of nutritional care for women with HIV during pregnancy.

Nutrition Assessment >Dietary assessment -adequacy of calorie -food security, maternal access to food -food and water food safety -food taboos -dietary supplement use >Anthropometric assessment -Height, weight, weight gain during pregnancy -Estimate BMI prior to or early in pregnancy -Estimate body composition >Biochemical assessment -Screen for iron deficiency -Test for gestational diabetes in women with BMI>/= 25 -Test for clinically suspected nutrient deficiencies (D, C, etc) >Clinical assessment -Screen for nausea, vomiting, diarrhea, oral lesions, etc. that might affect dietary intake or nutritional status (each prenatal visit) >Nutrition intervention -Intervene to modify unhealthful dietary pattern -Facilitate access to food assistance programs -Counsel/assist in ensuring adequate intake of calories, essential fatty acid -Intervene to modify inappropriate patterns of weight gain -Treatment of iron deficiency with high iron foods, adequate vitamin C intake, and iron *not to exceed 27 mg/day* -Address food and water safety consideration

LO 5.1 Cite three specific examples of nutrition-related recommendations intended for women who enter pregnancy obese.

Nutrition and other health care services that address weight gain in obese women should be provided in the same nonjudgmental, respectful, and nondiscriminatory manner as for other groups of women. Many nutrition recommendations for pregnancy in obese women, including meeting nutrient needs through consumption of a variety of basic foods, participating in physical activities of choice, and maintaining appropriate rates of weight gain, are the same as those for women of other sizes. Intervention programs should be aimed at reducing excessive weight gain among obese women during pregnancy. These intervention programs are more likely to have meaningful success in improving rate of weight gain and infant outcomes if they include development of individualized plans for food intake and physical activity, behavioral change goal setting, follow-up, and modification of the plan over time to meet the person's needs.

Identify two examples of when standard nutrition guidance for healthy toddlers and preschoolers must be modified for a preschool-age child with special health care needs.

Offering food textures that make the child a successful eater, allowing a monotonous diet if required for limited oral feeding skills, allowing a bottle longer than expected due to developmental delays requiring it.

Describe the role of physical activity in a healthy lifestyle for young children. Give examples of appropriate activities for kids.

Physical activity plays a role in maintaining energy balance. Physical activity helps to build muscle strength. Being physically active is a healthy lifestyle behavior that is important to establish at a young age. Appropriate activities for children include riding a bike, walking, skipping, running, and active play. Limiting screen time and moving screens from young children's bedrooms is also recommended.

LO 3.7 Identify four common symptoms of premenstrual syndrome and the proposed effects of dietary supplements on the symptoms of premenopausal dysphoric disorder (PMDD)

Physical: tender breasts, abdominal bloating, swelling, headache Psychological: angry outbursts, depression, irritability, confusion, anxiety, social withdrawal A few types of dietary supplements, including vitamin B6, calcium, and chasteberry extract, may be useful as adjuncts in the treatment of PMDD.

What are a dietitians' priorities for nutrition intervention in each of the four stages of cancer care?

Prevention- Healthy diet with caloric intake adjusted to achieve or maintain weight within normal ranges. Treatment- Medical nutrition therapy to restore nutrient shortages, maintain nutritional health, and prevent or manage complications of cancer and the side effects of treatment. Remission- Healthy diet with caloric intake adjusted to achieve or maintain weight within normal ranges. Advanced stages of Cancer- Food and fluid intake adjusted to meet patient wishes and manage symptoms and improve quality of life.

LO 2.8 Describe the four steps of the Nutrition Care Process.

Step 1: Nutrition Assessment --Food and nutrient intake( diet history, fat intake) -Medicinal/dietary supplement intake (medications, supplement use) -Knowledge/beliefs/attitude(level of nutrition knowledge, unscientific beliefs, attitudes) -Nutrition-related behaviors(binge-eating behaviors, willingness to try new foods) -Food and supplies availability (eligibility for and utilization of government/community food and nutrition program) -Physical activity (physical activity history, intensity) --Biochemical Data, Medical Tests, and Procedures -Tests (resting metabolic hr, bone density) --Anthropometric Measurements -Body size, growth (BMI, growth pattern) --Client History -Medical history, treatments, use of alternative/complementary medicine, social history Step 2: Nutrition Diagnosis --Identification of nutrition- specific problems based on results of the nutrition assessment. Diagnoses are classified as being related to: -Food and nutrient intake (food and nutrient amounts consumed relative to need, such as "excessive energy intake," "underweight," "excess fat intake") -Clinical (nutrition problems related to medical and physical conditions such as "swallowing difficulties due to [insert factors]" "breastfeeding difficulty due to ......", "altered lab value, low vitamin D due to...." -Behavioral-environmental (problem related to behavior, knowledge, beliefs, and access to food such as "food and nutrition related knowledge deficit,""limited access to food") Step 3: Nutrition Intervention --Identify and implement effective, individually tailored nutrition interventions that will resolve or improve the nutrition problems identified. Nutrition intervention strategies are organized into four categories: 1. Food and/or nutrient delivery 2. Nutrition education 3. Nutrition counseling 4. Coordination of nutrition care Step 4: Nutrition Monitoring and Evaluation -Measure and monitor changes in the client's nutrition-related health status and evaluate the effectiveness of the intervention based on client nutrition and health outcomes.

The mother should hear _________ sounds when the infant is breastfeeding and in the proper position.

Swallowing

What nutrient is predominant in human milk?

Water

Identify two examples of when a vitamin or mineral supplement has to be a part of a nutrition services plan.

When a child has to have a restricted diet, such as a result of allergies; when medications cause side effects that lower appetite; when a child has behaviors that limit food choices, such as autism, Prader-Willi syndrome; treatment with a calorie-restricted diet

How does binge-eating disorder differ from bulimia nervosa?

While both conditions include eating large amounts of food in a short period of time, a diagnosis of bulimia nervosa requires frequent purging methods to compensate for the calories consumed while the diagnosis of binge-eating disorder does not include a criteria for purging.

Several health and professional organizations an agencies, such as the American Academy of Pediatrics, the American Heat Association, and the USDA, have published similar recommendations for a healthy diet for young children. Briefly describe the food components of such a diet.

Whole-grain breads and cereals Fruits and vegetables Low-fat dairy products Lean meats, fish, and beans Limited amount of sweetened beverages and sweets

LO 4.11 Identify three health benefits to women of regular exercise during pregnancy.

Women who exercise regularly during pregnancy tend to feel healthier, have an enhanced sense of well-being, and somewhat shorter labors than is the case for women who do not exercise. Women who exercise regularly during pregnancy reduce their risk of developing gestational diabetes, pregnancy-induced hypertension, low back pain, excessive weight gain, and blood clots.