ESSAYS DUE AT 5:35 PM IN CLASS ON 21 NOVEMBER 2013 –NOTHING CLINICAL AND NOTHING RELATING TO...

ESSAYS DUE AT 5:35 PM IN CLASS ON

21 NOVEMBER 2013 –NOTHING CLINICAL

AND NOTHING RELATING TO PATHOLOGY

NO DEFICIENCIES OR TOXICITIES

Final exam-120 multiple choice-120 marksfrom vitamins to end of course

-4 short answer questions-15 points each for a total of 60 points

covers whole course

-3 hours- 180 marks

•PLEASE SEE EXAM REGULATIONS

ON: faculty.cbu.ca/ebarre

Beta carotene-fat soluble

Lecture 10- 14 November 2013

This lecture is based largely on Chapter 7, 12, 14, 15,16 in Understanding Normal and Clinical Nutrition by Rolfes et al.

Lecture 10- 14 November 2013

Outline

Water -role in metabolism -role in metabolic regulation

Outline of lecture 10

Nutrition metabolism throughout the life cycle

Pregnancy and Lactation Infancy Early Childhood Adolescence Adulthood

More Detailed Comments

Water -role in metabolism

-carries nutrients and waste products throughout the body

-maintains structure of large molecules like proteins and glycogen

Water -role in metabolism

-participates in metabolic reactions- eg hydrolysis (eg protein catabolism), or product of metabolism (metabolic

sink)(eg when hydrogen joins with oxygen as part of electron transport chain processes)

-solvent (provides medium for reactions)

-regulation of body temperature -maintains blood volume

Water

-class exercise

-explain each role in metabolic regulation

Nutrition metabolism throughout the life cycle Pregnancy and Lactation

Pregnancy

foetal growth and development -folate supplementation -prevent neural tube defects -one month before conception- why?

Nutrition metabolism throughout the life cycle Pregnancy and Lactation Pregnancy foetal growth and development

folate supplementation -0.8 to 4 mg supplements -if have had previous neural

tube baby then 4 mg supplements may be recommended - require a prescription as high folate intake may mask pernicious anemia of a vitamin B12 deficiency

Nutrition metabolism throughout the life cycle Pregnancy and Lactation Pregnancy critical periods

-maternal anemia during critical growth period of placental growth alters pattern of blood vessel growth which may affect cardiovascular health of infant

Nutrition metabolism throughout the life cycle Pregnancy and Lactation Pregnancy

critical periods -infant beta cell development-poor

maternal nutrition during critical period of beta cell development (12 weeks gestation to 5 months post delivery) may cause diabetes particularly if person eats in overabundance in later life


weight prior to conception-underweight mother

-underweight mother leads to greater chance of a low birthweight infant especially if mother is unable to gain sufficient weight during the pregnancy


weight prior to conception-underweight mother

-as well rates of preterm births and infant deaths are higher for underweight women


weight prior to conception-overweight mother

overweight mother leads to greater chance of her experiencing gestational diabetes, hypertension and post-partum infections and of having a stillborn and/or other labour and delivery complications


weight prior to conception-overweight mother

-as well infants tend to be larger and have greater risk of poor health(including neural tube defects) and death than do normal weight infants

-never try to lose weight during pregnancy- lose appropriately pre-conception or post-delivery


weight gain during pregnancy

underweight 28-40 lbs correct weight 25-35 lbs overweight 15-25 lbs obese 15 lbs minimum


energy and nutrient needs during pregnancy energy add 100 kcal per day trimester 1

add 300 kcal per trimesters 2 and 3

pregnant teenagers, underweight and physically active women may require more


energy and nutrient needs during pregnancy

nutrient needs

fig 14-10

Fig. 14-10, p. 489



nutrient needs

carbohydate- ideally 250 or more grams per day and no less than 100 grams per day



nutrient needs

protein add 5 grams per day trimester 1 add 20 grams per day trimester 2 add 25 grams per day trimester 3



nutrient needs protein most people have enough protein

to begin with in their diet to meet these protein requirements



nutrient needs protein do NOT use high protein

supplements during pregnancy-chance of low birthweights, pre-term births and still borns



nutrient needs essential fatty acids linoleic and alpha-linolenic- brain

growth and development, visual acuity

fish oil supplements are not recommended -possibility of toxins and effect on pregnancy is not known



nutrient needs

-folate, B12, iron and zinc as well as

vitamin D and calcium require particular attention


common nutrition related concerns of

pregnancy

-nausea, constipation, haemorrhoids, heartburn, food cravings and aversions, non food-cravings (pica)


malnutrition and pregnancy -malnutrition can lead to reduced

fertility for males and females -malnutrition prior to pregnancy-

prevent placenta from developing properly with subsequent potential for physical and cognitive abnormalities on the part of the infant


infants birthweight -low- premature-can catch up -have

easier time catching up in growth development if their post-delivery nutrition is good

-less than gestational age- have tougher time catching up in growth development even if their post-delivery nutrition is good


mothers age -adolescence- immaturity may lead

to poor food choices with subsequent foetal risk

-weight gain of 35

lbs for normal weight female


practices incompatible with pregnancy

alcohol and herbal supplements and nutraceuticals

Nutrition metabolism throughout the life cycle Pregnancy and Lactation Lactation

Nutrition during lactation

mother's nutrient needs energy additional 450 kcal per day consumed-

rest comes from fat stores built up during pregnancy

figure 14-10

Fig. 14-10, p. 489

Nutrition metabolism throughout the life cycle Infancy energy and nutrient needs energy

infants require about 100 kcal/kg/day

protein

inadequate-consequences

too much-stress kidneys and liver figure 15-2

Fig. 15-2, p. 517

Nutrition metabolism throughout the life cycle Infancy

breast milk lactose improves calcium

absorption

omega 3 fatty acids

figure 15-3

Fig. 15-3, p. 518

Nutrition metabolism throughout the life cycle Infancy infant formula nothing beats breast milk

soya formulas-avoids allergy issue found with some non-soya formulas

- good for lactose intolerance as there is no lactose in soya formulas

avoid goats milk-low in folate table 15-2 figure 15-4

Table 15-2, p. 519

Fig. 15-4, p. 521


special needs of pre-term infants poor absorption of calcium and lipid,

fat soluble vitamins, calcium, iron and zinc due to immature gut

solution-pre-term breast milk eg higher protein concentration than full term breast milk


introducing cow's milk not until 12 months of age poor iron content and it may cause

intestinal bleeding

cows milk is higher in calcium and lower in vitamin C-thus inhibiting iron absorption

type 1 diabetes issue-this is controversial


introducing solid foods

no earlier than 6 months

6-12 months

if not before end of first year there may be delayed growth


introducing solid foods6-12 months

iron fortified cereals, meat or meat alternatives such as legumes

-serve with vitamin C to improve iron absorption

-vitamin C rich foods include citrus fruit juices and chopped berries


introducing solid foods at one year-2-3.5 cups of milk

maximum to avoid displacement of iron rich foods plus give iron fortified cereals, fruits and vegetables to meet iron requirements

primary food in first 12 months ideally is breast milk


Early Childhood energy and nutrient needs energy

1 year 1000 kcal/day 3 years-1300 kcal/day 10 years-2000 kcal/day


Early Childhood energy and nutrient needs nutrient needs

protein-needs dictated by needs to maintain nitrogen balance, protein quality and added needs of growth

vitamins and minerals-met by 6 principles of dietary planning(adequacy, moderation, balance, variety, energy control and avoiding empty kcal foods)


Early Childhood

hunger and malnutrition in children glucose and iron are critical to brain

functioning and subsequently to the child's behaviour

adverse reactions to foods must meet nutrient needs of child

childhood obesity excess energy intake relative to energy

expenditure


Early Childhood

mealtimes at home -6 principles of good dietary planning

nutrition at school -pack lunches


Adolescence

energy and nutrient needs

energy-2000-4000 kcal/day activity levels males need more than females


Adolescence

nutrients vitamin D and calcium iron chronic diseases atherosclerosis type 2 diabetes hypertension


Adulthood

as we age in adulthood we reduce our metabolic rate- therefore need to

reduce caloric intake while meeting the 6 principles of good dietary planning that adequately address changing nutrient intake requirements


Adulthood

water- avoid dehydration-mobility and desire to consume water are issues here

protein- 0.8 g/kg/day

carbohydrate- increased fibre to offset constipation- also need more fluid


Adulthood

vitamin B12, vitamin D, calcium as well as

iron are among the nutrients of primary concern

vitamin B12 -bacterial overgrowth-in

stomach results in vitamin B12

consumption by bacteria vitamin D and calcium -a concern due to

reduced dairy intake as we age as well as the risk of osteoporosis


Adulthood

vitamin B12, vitamin D, calcium as well as

iron are among the nutrients of primary concern

iron- deficiency risk if low food energy

intakes-mobility and desire to consume food are issues here


Adulthood

nutrient-brain relationships-table 16-2

Table 16-2, p. 574

ESSAYS DUE AT 5:35 PM IN CLASS ON 21 NOVEMBER 2013 –NOTHING CLINICAL AND NOTHING RELATING TO...

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