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
- peristalsis
- physiological (normal) anemia of pregnancy, due to increase in the blood volume during pregnancy
- hemodilution
- volume of packed red blood cells (RBC)
- hematocrit
- protein to which oxygen bind in RBC
- hemoglobin
- 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
- 29-31%
- hematocrit
- 10-11 g/dl
- hemoglobin
- 200-325 mg/dl
- cholesterol
- 3 mcg/dl
- folacin
- >40 mcg/dl
- iron
- 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:
- glucose
- fat becomes more important for:
- mother
- decreases because of relatice lack of amino acids
- gluconeogenesis
- more is stored for future needs, including lactation
- fat
- 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
- estrogen
- supports fetal growth, anchors fetus to uterus, site of hormone synthesis, suppress immune rejection, exchange of oxygen, nutrients, and waste materials
- placenta
- mother and fetal blood supplies are always:
- seperate
- O2, CO2, fatty acids, fat-soluble vitamins, electrolytes
- simple (passive) diffusion
- CHO
- facillitated diffusion
- amino acids, water-soluble vitamins, minerals
- active transport
- immunoglobulin G
- pinocytosis
- (2 weeks) rapid cell division, early placenta, implantation of fertilized ovum
- blastogenesis
- (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
- folate
- tetrahydrofolate
- 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
- 400
- folate RDA for pregnancy
- 600
- 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
- twins
- recommended gain: 35-45
- deficiency in pregnancy is the number one preventable cause of mental retardation
- iodine
- 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
- prolactin
- stimulates let down and promotes uterine contractions
- oxytocin
- 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
- 1-2
- 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
- protein
- adolescents need for sexual maturation, bioavailability increases
- Zinc
- Adolescents need .5g/kg bw; keep <35 g total
- Fiber
- 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
- vegetarians
- plant foods that are a complete protein:
- soy and amaranth
- animal sources NOT a complete protein:
- gelatin
- 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:
- multidisciplinary
- 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
- water
- a performance and a health risk
- dehydration
- replace _ cps of water for ever lb lost in sweat
- 2
- +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
- energy
- Boys: maintain _
- linear growth
- girls: Maintain_
- mentruation
- 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
- supplements
-
disordered eating
amenorrhea
low bone density
(anemia) - 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:
- coaches
- high risk pregnancies due to:
- immaturity
- types of immaturity
- physical, psychological, emotional
- time from onset of menstruation
- gynecological age
- if gynecological age is <______ years, indicates greater risk
- 2
- 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
- young-old:
- 65-74
- old-old:
- 75-84
- oldest-old:
- 85+
- 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)
- folacin
- absorption decreased (after menopause, women's need also decreases)
- iron
- decreased absorption, impaired vit D status
- Calcium
- 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
- osteoporosis
- 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
- drugs
- can interfere with drug absorption, distribution, metabolism, excretion in elderly
- nutrients
- 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
- antagonism
- 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:
- megadoses
- 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
- folate
- generic term
- folacin
- active form of folate
- THF
- cell growth and division, (DNA synthesis), formation of heme, formation of choline (involves homocysteine to methionine conversion)
- folate
- homocysteine to methionine conversion (regenerates active THF), synthesis of myelin sheath of nerves
- vit B12
- deficiency causes megaloblastic anemia
- folate
- 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