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Life Cyle


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age, weight, addictions (smoke, drink), medical conditions, psychological readiness, diet (eating disorders, folic acid intake), education, SES, housing, access to med. care, previous pregnancies (how spaced out so body can recover)
Preconception factors for pregnancy
Pregnancy will make blood glu control even harder, increased need for insulin, uncontrolled blood glu can damage fetus, glucosuria (fairly common), increase blood volume, decrease GFR (blood flowing through the kidneys)
preexisting type 1 diabetes in pregnancy
family history, obesity, previous large babies, history of miscarriage
risk factors for gestational diabetes
birth defects, spontaneous abortion, perinatal complications, later development of type 2 diabetes (mother)
gestational diabetes causes risk for these things
Lack of enzyme to convert phenylalanine to tyrosine leads to toxic breakdown
phenylketonuria (PKU)
mental retardation, birth defects, spontaneous abortion, postnatal growth and development problems
risks for the child caused by PKU
PKU, celiac disease
inborn errors of metabolism, genetic diseases (can be passed on to babies)
maintain serum Phe as low as possible, maintain serum Tyr levels high enough, control Phe (special low-Phe foods), maintain consistent weight gain during pregnancy (not in spurts), DON'T use aspartame
PKU treatment (1 in 40,000 births lead to PKU in US)
sensitivity to gluten (in wheat, rye, barley), causes malabsorption of fats and flattening of GI tract, general nutrient malabsorption, general nutrient deficiencies, infertility, must follow gluten free diet
celiac disease
hypertension, proteinuria, edema
characteristics of pregnancy-induced hypertension
early delivery, kidney failure, HBP, gestational, type 2 diabetes
risks associated with pregnancy-induced hypertension
preexisting hypertension, diabetes, PIH history, dietary deficiencies: protein, sodium, calcium, vit A & C, age extremes, Do NOT restrict sodium
risk factors for PIH
waves of involuntary muscle contractions in the GI system
physiological (normal) anemia of pregnancy, due to increase in the blood volume during pregnancy
volume of packed red blood cells (RBC)
protein to which oxygen bind in RBC
rate at which fluid passes through the kidneys
Glomerular filtration rate
changed taste acuity, increased appetite, decreased GI motility, enhanced absorption, heartburn, nausea, vomiting, constipation, hemorrhoids
GI system during pregnancy
increased volume, increased flow to uterus, RBC increase
Blood (fluid) during pregnancy
increases at much as 20%: intracellular and extracellular fluid
body water content during pregnancy
drops early, then prone to rise in later pregnancy
blood pressure during pregnancy
increases due to increased efficiency of gas exchange in the lungs
oxygen-carrying capacity during pregnancy
leads to shallower breaths
shift of diaphragm position during pregnancy
10-11 g/dl
200-325 mg/dl
3 mcg/dl
>40 mcg/dl
300-450 mcg/dl
TIBC (total iron binding capacity)
growth of uterus causes
compression (greater need to urinate)
renal blood flow and GFR
increase (greater capacity to clear wastes, greater amounts of nutrients are filtered)
proteinuria and glucosuria are
fairly common
renal function in pregnancy leads to an increased need for
water-soluble vitamins
fetus needs mostly:
fat becomes more important for:
decreases because of relatice lack of amino acids
more is stored for future needs, including lactation
with less GNG and more lipolysis, this may occur
mild ketosis
relaxes smooth muscle cells, increase maternal fat stores, decrease capillary tension, increase renal Na excretion
progesterone (allows uterus to stretch)
promotes uterus growth/function, alters connective tissue structure, increase flexability, increase water -> edema = normal if without HBP and proteinuria
supports fetal growth, anchors fetus to uterus, site of hormone synthesis, suppress immune rejection, exchange of oxygen, nutrients, and waste materials
mother and fetal blood supplies are always:
O2, CO2, fatty acids, fat-soluble vitamins, electrolytes
simple (passive) diffusion
facillitated diffusion
amino acids, water-soluble vitamins, minerals
active transport
immunoglobulin G
(2 weeks) rapid cell division, early placenta, implantation of fertilized ovum
(to 2 months) ectoderm-> CNS, hair, skin; mesoderm-> voluntary muscles, bones, cardio. system, excretory system; endoderm-> digestive and gladular organs
embryonic stage
(38-40 weeks) growth from 6 g. to 3000-3500 g
fetal stage
term for synthetic form used in supplements and in food fortification
folic acid
term for naturally occurring form found in foods; generic term
active form of folacin
cell growth and division (synthesis of certain amino acids, synthesis of muscle acid bases), formation of heme
functions of folate
better form of folate
dietary, synthetic form
folate RDA for adults
folate RDA for pregnancy
severity, timing, and duration of deficiencies matter
growth retardation
if only hypertrophy affected:
later rehabilitation might reverse effects
low birth weight= <2500g (5.5 lbs)
growth failure
placental cells, brain cell #, headsize, organ size, biochemistry
tissue changes
maternal body size, maternal weight gain
correlates of fetal birth weight
low BMI <19.8
recommended gain: 28-40 lbs
normal BMI 19.8-26
recommended gain: 25-35
high BMI 26-29
recommended gain: 15-25
recommended gain: 35-45
deficiency in pregnancy is the number one preventable cause of mental retardation
increased BMR, blood pressure, increased need for Vit C & folate, damages platelets -> blood clots, decrease bone density, increase nitrosamine exposure
physiological effects of smoking
lung cancer, coronary heart disease, stroke, hypertension, osteoporosis, multiplies risks from alcohol
health effects of smoking at risk factors for chronic diseases
decrease placental blood flow, decrease nutrient delivery, decrease oxygen delivery to fetus, decrease birth weight
health effects of smoking during pregnancy
decreased intellectual and behavioral development, SIDS, earlier menopause, decrease volume of breast milk
smoking correlates
fewer spontaneous abortions, "easier" labor and delivery, higher Apgar scores, no greater preterm complications
vigorous exercising during pregnancy
stimulates milk production and release of milk into mammary ducts
stimulates let down and promotes uterine contractions
volume of human milk
340 to >1,000 ml/day
lower in lactose, higher in nitrogen, calcium, IgA, some minerals, high in DHA
Stage 1 milk
(0 to 3-6 days) yellowish, high in carotene, electrolytes, high in protein (2%), low in kcal, CHO, and fat
Stage 2 milk: colostrum
(3-6 to 10 days) shift in CHO, fat, protein
Stage 2 milk: transitional
(10 days to weaning) kcal: 75/dl, protein (1%) CHO (7%) lipids: slow increase from 2-5%, carnitine, lipases, increase in cholesterol
Stage 2 milk: term
caseins, whey, albumin, hormones, increase in nonprotein, ideal amino acid content, low in methionine, high in cystein, low in Phe, and Tyr, rich in Tau
protein in term human milk
high linolein and linolenic, high in AA, EPA, DHA, lack associated with insulin resistance in young children
fatty acids in human milk
fat-soluble, water-soluble (folate, B6)
vitamins in human milk
K, Ca, P, Cl, Na, iron absorption (50%) zinc absorption (59%)
minerals in human milk
bifidus, immunoglobulins, lysozyme, lactoferrin, lactoperoxidase, prostaglandins, complement, B12 binding protein, lymphocytes, macrophages
resistance factors in human milk
% of maternal dose that enters milk
use short-acting forms, schedule to minimize transfer to milk, use form less likely to be excreted in milk, watch for side effects
strategies to minimize medicine exposure
microbiologically safe, automatically ideal, anti-infective properties, decreased rish for atopic dermatitis, promotes better jaw and teeth alignment
advantages of breastfeeding
reduced risk of allergy, slower growth past 3-4 months, best fatty acids for brain development and visual acuity, bonding
advantages of breastfeeding
bonding, maternal self-esteem, necessitates daily rest, east and convenience, recovery, decrease rick of cancer, improved blood lipid profile, cost
advantages for mother of breastfeeding
sufficient quantity, quality of milk, schedule, pain, engorgement, poor let-down, clogged milk ducts, necessary separations
concerns about breast feeding
genetic diseases, addictions, maternal malnutrition, ifections, need for cancer treatment, environment
contraindications to breastfeeding
period of naturation from childhood to adulthood, hormonal changes/body composition triggers
physiological changes during puberty
sexual maturation, increased height/weight (15-25% of adult ht is gained during adolescence and up to 50% or wt), body composition ->nutrition, men (LMB->protein, Fe, Zn, Ca) women (body fat ->menses->Fe), acne, bone (50% of adult bone mass a
physical changes during puberty
establish identity, values, abstract thinking, egocentrism, imaginary audience (high self-consciousness), personal fable ("it won't happen to me")
psychological characteristics of adolescence
45-50% of total bone growth occurs during adolescence, can absorb 4 times as much as adults, AI is st at 1300 mg/day to take advantage of opportunity to build peak bone mass (9-18 yrs old), high coke intake is a concern
Calcium during adolescence
Adolescences are generally low in:
Vit A, thiamin, iron, and calcium
Adolescents get 2 times more than needed
adolescents need for sexual maturation, bioavailability increases
Adolescents need .5g/kg bw; keep <35 g total
smoking increases need for:
Vit C
Teens will take increasing responsibility for their choices, they still probably need snacks (25-35% of intake), skipping breakfast/meals is common but unhealthy, only 29% of adolescents eat breakfast, advertising, peer groups, and ready access to fast f
eating behaviors of adolescents
start puberty shorter, leaner, and later but no differences eventually, concern for vit B12, D, B6, Ca, Fe, Zn, protein, DHA, higher prevalence of eating disorders
plant foods that are a complete protein:
soy and amaranth
animal sources NOT a complete protein:
food is not primary problem, food is symptom, early detection is crucial, help is available
eating disorders
this kind of treament for ED's works best:
discourage dieting and skipping meals, downplay scale readings, promote healthful behavior, promote eating when hungry, do not use food as a reward, teach proper nutrition and healthy wt approaches
ED prevention
the nutrient of primary concern for athletes
a performance and a health risk
replace _ cps of water for ever lb lost in sweat
+6-7 g/day (15-20% of kcal)
protein for athletes
causes high fat intake, delayed digestion, absorption, greater dehydration risk
more than 15-20% kcal from protein
primary for still-growing adolescent athletes
Boys: maintain _
linear growth
girls: Maintain_
big concern is athletes who:
manipulate weight
increase bulk, but also stunt growth and pose health risk
anabolic steroids
long-term effects of _ are unknown
disordered eating
low bone density
female athlete triad
most people need _____ for ever negative comment
6 positive comments
support adolescents through puberty:
recognize changes and self-worth
teach that thin does not equal
better athletic performance
encourage healthy attitudes from:
high risk pregnancies due to:
types of immaturity
physical, psychological, emotional
time from onset of menstruation
gynecological age
if gynecological age is <______ years, indicates greater risk
less time from completion of puberty means:
less nutrient stores
increased bleeding, anemia, difficult labor & delivery, (cephalopelvic disproportion), pregnancy-induced HTN, infections, psychological/social development (education, economic future), increased mortality (2.5 times greater)
risks to adolescent mother
increased parinatal and neonatal mortality, low birth wt, risk of premature birth, risk of birth defects, life with parents who have poor parenting skills, life with one parent only, living below the poverty line
risks to the baby of an adolescent mother
age distribution in america, life expectancy, classification of the elderly
demographics/characteristics of aging
social security, demand on health care system, increases health care costs
social implications of trends in aging
1. heart disease
2. cancer
3. stroke
top 3 causes of death
decreased replacement of lost tissue, fewer parietel cells in stomach lining -> decreased HCL (decreased absorption of Fe, Ca, Zn, vit B6, B12, folate), food safety implications, decreased efficiency of hormonal enzymatic, neural communication
aging cells... decreased cell division
decreased brain, decreased blood flow to brain, decreased neurotransmitter synthesis
CNS in elderly
decreased cardiac output (increased peripheral resistance, decreased heart efficiency), decreased oxygen delivery to tissues, increased BP
cardiovascular system in elderly
decreased senses of taste and smell, loss of teeth, decreased sense of thirst, decreased saliva, so swallowing can be difficult, digestion of micronutrients is generally normal, nausea, diarrhea, constipation (low fiber, fluid, exercise, anxiety, use of
GI tract in elderly
loss of nephrons, lowered cardiac output, decreased GFR, decreased sensitivity to hormonal regulation (ADH)
aging organs... kidneys
decreased clearance of toxins and wastes, decreased ability to concentrate urine, increased risk of dehydration, glucose, plasma proteins, water-soluble vitamines less efficiently reabsorbed
caused from agind kidneys
decreased gas exchange in the lungs, decreased homeostatic adjustments (stress, temp changes, glucose tolerance in slower), decreased LBM and muscle mass
effects of aging on the body
decreased BMR
kcals in aging
need 1 g/kg bw to maintain nitrogen balance, need adequate kcals to spare protein
protein in aging
14 g/1000 kcal, for disease prevention
fiber in aging, also need water
decreased ability to synthesize from skin
vit D
elderly men need more to maintain body pool
vit C
RDA is increased to levels maintain serum & RBC
Vit B6
10-30% of elderly have decreased absorption (pernicious anemia)
vit B12
decreased absorption (UL set to prevent masking of vit B12 deficiency)
absorption decreased (after menopause, women's need also decreases)
decreased absorption, impaired vit D status
impaired insulin sensitivity
chromium deficiency
decreased taste acuity, decreased wound healing, decreased immune function
zinc deficiency
impaired Ca status, loss of estrogen protection for bones so now bone is reabsorbed faster than it is replaced
chromium status, overweight -> insulin resistance, low physical activity
glucose tolerance in elderly
increased fat & cholesterol, increased BP, increased homocysteine
heart disease
can interfere with nutrient intake, absorption, metabolism, excretion in elderly
can interfere with drug absorption, distribution, metabolism, excretion in elderly
loss of stimulation of appetitie, decreased degestion/absorption via: decreased HCL, chelation, competition for binding sites, damage to GI tract; prevent conversion to active form, antagonists decrease fxn, affect need via metabolism and/or excretion
drugs can interfere with nutrients in elderly
influnece rate/extent of absorption (chelation), alter distribution via availability of plasma proteins (decreased protein -> more drug freely circulating), influence rate of metabolism, influence rate of excretion
nutrients can interfere with drugs in elderly
vit K vs Coumadin, caffeine cs tranquilizers
antacids and minderals, antacids + citrus = increased absorption of Al, tetracycline and calcium, antibiotics and vit K
absorption problems with drug-nutrient interactions
asprin -> Fe loss, diuretics, laxatives -> electolyte loss, diarrhea
nutrient loss in drug-nutrient interactions
MAOI's + tyramine = increased BP
trigger toxicity in drug-nutrient interactions
digoxin, chemotherapy drugs -> anorexia, nausea; anticonvulsants increase need for vit D
side effects of drug-nutrient interactions
nutrients as drugs taken in:
tolerance decreases with age, depletion of nutrient stores, poor nutrient intake, risk of hypoglycemia in diabetes
system effects of alcohol in the elderly
term of synthetic form (supplements and food fortification)
folic acid
term for naturally occuring form found in foods, generic term
generic term
active form of folate
cell growth and division, (DNA synthesis), formation of heme, formation of choline (involves homocysteine to methionine conversion)
homocysteine to methionine conversion (regenerates active THF), synthesis of myelin sheath of nerves
vit B12
deficiency causes megaloblastic anemia
deficiency causes megaloblastic anemia + neurological damage = pernicious anemia
vit B12
conversion of homocystein to methionine converts:
inactive THF to active THF
active THF concerted to:
form needed in DNA synthesis
stomach acidity, intrinsic factor, special proteins from the stomach needed for:
absorption of vit B12
1 DFE =
1 mcg food folate
1 mcg food folate =
.6 mcg synthetic folic acid
.6 mcg synthetic folic acid =
.5 mcg synthetic folic acid taken on empty stomach
two supplements better absorbed in their synthetic forms
folic acid and B12
RDA for vit B12
2.4 mcg/day

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