Required nutrients that the body cannot manufacture or produce in sufficient amounts but that are required in the diet
Dietary Reference Intakes (DRI)
Dietary intake standards
Six Categories of Nutrients
Main Function of Carbohydrates
A source of readily available energy
Most Common Monosaccharides
Most Common Disaccharides
Sucrose, Lactose, & Fiber
Protein in Foods Provides the Body with...
How are amino acids unlike carbohydrates & fats?
They contain nitrogen
How many essential amino acids are there?
How many calories per gram are in carbohydrates?
How many calories per gram are in protein?
How many calories per gram are in fat?
How many calories per gram are in alcohol?
What's the recommended intake of carbohydrates?
45-65% of calories
What's the recommended intake of protein?
10-35% of calories
What's the recommended intake of fat?
20-35% of calories
What are particularly good sources of protein?
Cholesterol & related compounds
Triglycerides Consist of
Functions of Fat
Precursors of cholesterol & sex hormones
Components of cell membranes
Vehicles for carrying certain vitamins
Suppliers of essential fatty acids
Essential Fatty Acids Include
Linoleic & Alpha-linoleic acids
Alpha-linoleic acid is the parent of...
The omega-3 fatty acid family
DHA & EPA
Found in fatty fish & human milk
Regular consumption of fish protects against
Stroke and high blood pressure
Plaque formation in arteries
2 Basic Types of Lipids (fats)
Unhealthy Fats Include
Water Soluble Vitamins Include
Fat-Soluble Vitamins Include
Vitamins A, D, E, & K
Do vitamins provide energy?
Do vitamins serve as structural components of the body?
Vitamins that Serve as Antioxidants
Fruits, veggies, nuts, seeds, & whole grains
Might partially account for lower rates of heart disease & cancer
Consist of single atoms
Carry a charge in solution
Unlike any other nutrients
Roles of Water
Excretion of waste
Products made with refined grains must use flours enriched with...
Individual-level nutrition assessment includes...
What assesments are generally used for individual diets?
Multiple 24-hour recalls
Anthropometric Assessment Measures...
Height & weight
For nutritionally at-risk population
Low income pregnant women, postpartum, & breastfeeding women
Low-income children under 5 years old
Every dollar invested in the Women, Infants, and Children (WIC) prenatal nutrition services saves ___ on Medicaid costs for infants during the first 2 years of life.
The (new) MyPyramid recommends the following number of servings per day for a 2,000 calorie diet
2 meat/meat substitute
Choose Foods that Limit the Intake of
2005 Dietary Guidelines Include Recommendations for...
Sodium & potassium
Food groups to encourage
Factors Contributing to Infertility in Females and/or Males
Infertility in Males May be Related to...
Low zinc status
Heavy metal exposure
Exposure to synthetic estrogens
Inadequate amounts very early in pregnancy can cause neural tube defects
It is recommended that women who may become pregnant consume
400 mcg of folic acid
No more than 5000 IU of vitamin A
Little or no alcoholic beverages
It is commonly recommended that women reduce their intake of ___ to decrease PMS symptoms.
What supplements appear to decrease symptoms of PMS?
High blood glucose levels during the first two months of pregnancy can cause
Glycemic Load (GL)
A measure of the extent to which blood glucose levels are raised by a specific amount of carbohydrate-containing food.
Characteristics of Polycystic Ovary Syndrome
Obesity or high levels of intra-abdominal fat
Excessive body hair
High blood levels of insulin, triglycerides, and
Phenylketonuria (PKU) in a pregnant woman often results in an infant with
Avoid eating gluten from wheat, rye, & barley
Small improvements in infant mortality in the past few decades in the United States are largely due to
Technological advances in medical care that save ill newborns
US Ranking on Infant Mortality Rates
Infants weighing ___ to ___ at birth are least likely to die
within the first year of life.
7 lb 12 oz ... 10 lb
Duration of Pregnancy
To provide the fetus with sufficient energy, nutrients, and oxygen for growth, the mother must first
Expand plasma volume
How much fetal growth is accomplished in the first half of pregnancy?
How much fetal growth is accomplished in the second half of pregnancy?
Physiological changes during pregnancy
Increased concentrations of blood cholesterol
Relaxed gastrointestinal tract muscle tone
Functions of the Placenta
Hormone and enzyme production
Nutrient and gas exchange between the mother and
Removal of waste products from the fetus
First Organ to Develop in Humans
Preprogrammed time periods during development when cells, organs, and tissues are formed and functions established.
Can deficits or excesses in nutrients supplied to the fetus during critical periods can produce lifelong defects in organ function?
About how long after birth do cells of the central nervous system continue to multiply?
"Small for gestational age" (SGA)
Weight is less than the 10th percentile
What are disproportionatel small infants at greater risk for in the adult years?
About how much of the total weight gained during pregnancy is comprised by the fetus?
Increased need for energy in pregnancy averages how many calories per day?
Do artificial sweetners have any association with birth defects?
No. Therefore, they should not be avoided during pregnancy.
How much alcohol should pregnant women drink daily?
The recommended protein intake for pregnancy is an additional ___ grams per day for females aged 14 and older.
Overall, the incidence of iron deficiency is ___ in vegetarian as compared to non-vegetarian pregnant women.
Inadequate availability of folate between 21 and 27 days after conception can...
Interrupt normal cell differentiation
Cause neural tube defects
Approximately what percent of women enter pregnancy with iron deficiency?
What are normal declines in hemoglobin level during pregnancy generally a result of?
Dilution effects of increased plasma volume
Which is lower: absorption of iron from multimineral supplments, or absorption from supplements containing only iron?
Absorption of iron from multimineral supplements
Should sodium intake be restricted during pregnancy to minimize edema?
How many cups of coffee is it safe to drink per day while pregnant?
Up to 4
Compulsion to eat non-food substances
Consequences of Pica
The only supplement routinely recommended for pregnant women
Should pregnant women avoid exercising until after the baby is born?
Has been shown to reduce the severity of nausea in many women
The second leading cause of maternal mortality in the US
Symptoms of Preeclampsia/Eclampsia
Deficits in prostacyclin relative to thromboxane
Increased blood pressure
Platelet aggregation and blood coagulation
Who is the risk of developing hypertension associated with preeclampsia higher in?
Women who were born small for gestational age
What supplements during gestation show promise in reducing oxidative damage caused by preeclampsia?
Vitamin C & Vitamin E
Approximately what percent of pregnant women develop gestational diabetes?
Consequences of Gestational Diabetes
Increased risk for preeclampsia
Diets for Women with Gestational Diabetes
Relatively low in carbohydrates
High in fats
Approximately what percent of children with HIV/AIDS are infected during pregnancy or delivery?
Approximately what percent of children are infected with HIV/AIDS during breastfeeding?
Most commonly observed eating disorder among pregnant women in the US
Risks Associated with Adolescent Pregnancy
Foods which have been changed to make them better for one's diet.
Example: Orange juice with added vitamin C (nutrients added)
Example: Lactose-free milk (harmful parts removed)
"The Fetus is Not a Parasite"
The fetus doesn't take whatever it needs
from its mother at its mother's expense. The fetus will
sacrifice its own deficiency for the mother.
Example: If the mother really needed iron, the baby would not take it from the mother.
"Nutrition Programming" of Genes
It's the changes that can occur in a fetus that program what certain genes do. If
certain nutrients are exposed to the fetus, the function of genes can
actually change, and diseases can be prevented later in the child's
Foods that could provide a total of approximately 20-25 grams of protein for a meal for a pregnant woman consuming a lacto-ovo vegetarian diet.
2 tortillas - 6 grams of protein
1 oz. cheese - 7 grams of protein
1/2 cup refried beans - 7 grams of protein
Plays a specific role in human milk production
Plays a specific role in human milk let down
Acts on the uterus, causing it to contract, seal blood vessels, & shrink in size
The first milk
Contains compounds for immune protection
What's the difference in calorie consumption between infants who are breastfed vs. those who drink formula?
Those who are breastfed consume fewer calories
Lipids Content in Human Milk
Lipids provide about half the calories of human milk
Fatty Acid Profile
Breast milk component that varies with the mother's diet
The dominant carbohydrate in human milk
Early consumption of ___ through breast milk appears to be related to lower ___ later in life.
Cholesterol / Blood cholesterol
Docosahexaenoic Acid (DHA)
In breast milk, it's associated w/ developmental advantages (ie- higher IQ scores)
Protein & Breast Milk
Lower content in breast milk than other types of milk, making it easier for the kidneys to handle
Vitamin B6 & Breast Feeding
Of the water soluble vitamins, it's the most likely to be deficient in human milk since it reflects maternal intake
Minerals in Human Milk
Many are highly available for absorption
Breast Feeding & Return of Fertility
Return of fertility (through monthly ovulation) is often delayed in breastfeeding women
Secretory Immunoglobulin A
The predominant immunoglobulin in human milk
Breastfeeding may Reduce the Risk of...
Inflammatory bowel disease
Rate of accumulation of milk in the breast
Related to infant demand
Infants fed cow's milk before six months of life suffer
nutritionally significant losses of ___ via intestinal blood loss.
The U.S. Surgeon General recommends human-milk feeding exclusively for how many months?
How many times a day is it normal for a newborn to feed?
All infants in the US receive a supplement injection of what at birth?
When should infants be fed?
When signs of hunger are displayed
Should be given daily to exclusively breastfed infants starting within the first 2 months of life
What percent of their body weight do newborns usually lose in the first week postpartum?
Up to 7%
How many extra calories per day should lactating women consume in the first six months postpartum?
Modest Protein-Calorie Malnutrition
Results in reduced volume of milk, but usually does not compromise the composition of the milk
Common Barriers/Obstacles to Breastfeeding
Early hospital discharge
Lack of broad societal support
Commercial promotion of infant formul
How many daily feedings are generally needed for women to continue making milk?
A bacterial infection of the breast
Most commonly found in breastfeeding women
What's the single most common medical isue health care providers face in managing breastfeeding patients?
Physician's Desk Reference (PDR)
Not a good reference for info about drugs & breastfeeding
One of only a few medications that is thought to be contraindicated to breastfeeding
Is alcohol considered to be "usually compatible with breastfeeding?"
Should women who smoke still breastfeed?
Breastfeeding & Caffeine
It's recommended that women who are breastfeeding consume caffeine in moderation
Is breastfeeding the preferred choice even though environmental contaminants do exist in breastmilk?
Protection from ___ is one of the most important benefits of breastfeeding for the infant
Are HIV-infected women in developing countries advised to breastfeed their infants if they do not have access to safe and affordable replacement feeding?
How many days can human milk that is freshly expressed into a closed container be stored in the refrigerator?
4 Benefits of Breastfeeding for the Mother
Delays in the return of fertility through monthly ovulation, creating delays between pregnancies
Increased bonding with their baby
Lower risk of breast and ovarian cancer
Breastfeeding increases production of oxytocin, which stimulates uterine contractions
5 Benefits of Breastfeeding for the Infant
Meets nutritional needs of the infant without any extra added food or water
Provides high amounts of essential fatty acids
The amount of protein in human milk meets the baby's needs without harming the kidneys
It forms an easily digestible curd
DHA helps the central nervous system develop to its full potential
Daily food plan for a pregnant woman consuming
2,400 calories, as indicted by her MyPyramid food plan.
8 ounces of grains
3 cups vegetables
2 cups fruits
3 cups milk
6.5 ounces meat & beans
7 teaspoons oil
3 Prental Strategies to Encourage Breastfeeding
Provide education to new and expecting mothers.
Nurses and doctors in the hospital could encourage
it before discharging mother and baby
Providing support to the mother after discharge to encourage that she continue breastfeeding
Major Factor in the Prevalence of US Infant Mortality
At birth, which nutrients can the healthy newborn's digestive system is sufficently mature to digest?
What's the average caloric need of breastfed infants in the first five months of life?
108 cal per kg of body weight
What is the specific recommended intake level of fats for infants?
There is none
Should cholesterol intake be limited in infants?
Short & Medium Chain Fats
Found in breast milk
More readily utilized than long chain fats
Long Chain Fats
Found in some infant formulas
Not as readily utilized as short & medium chain fats
Metabolic Rates in Infancy versus Later in Life
Flouride Levels in Breastmilk
Should salt be added to infants' food to maintain adequate sodium intake?
When is it recommended that screening for lead poisoning start?
When do healthy newborns double their birthweight?
When do healthy newborns triple their birthweight?
Dietary Fiber Recommendations for Infants
There are none
The National Center for Chronic Disease Prevention and Health Promotion infant growth charts show...
Weight for age
Length for age
Head circumference for age
Is the rate of weight gain during infancy predictive of further growth patterns after infancy?
How do you assess an infant's readiness to begin eating from a spoon?
Ability to keep head upright and sit with little support
Ability to move tongue from side to side without moving head
What's the recommended age for weaning the infant from the breast or bottle to a drinking cup?
An infant who is weaned from breastfeeding too soon may...
Plateau in weight because of a decrease in total calorie intake
Become constipated from a decrease in fluid intake
First Food Generally Recommended for Infants
Baby cereal (iron-fortified)
Many foods eaten by other family members are appropriate foods for infants who are...
Unsafe Foods for Infants
Uncut stringy meats
Breast milk or formula generally provides adequate water for healthy infants for how long?
The first 4-6 months
The American Academy of Pediatrics Juice Recommendations
Not introduced into the diet before 6 months of age
Never at bedtime
Infants learn food preferences largely based on...
Their experiences with foods
If an infant's mother is a vegan, the infant may need what supplements?
Which supplement may be needed if the infant is not exposed to adequate sunlight?
Failure to Thrive (FTT)
A condition in infants
A calorie deficit is suspected
Research in infants who have long-term and severe iron-deficiency anemia suggests inadequate iron contributes to...
Long-term learning delays
The use of a bottle containing formula or juice to calm a baby enough to sleep may set the infant up for...
Dental caries (cavities)
Is the ingredient in a specialized formula given to infants with suspected protein intolerance
Infants born before 37 weeks gestation
The overall U.S. infant mortality rate has _____ between 1980 and 2002.
When are extra calories needed for infants?
Recovery from surgery
Medium-Chain Fatty Acids
Fats that may be given to infants who are sick or recovering
Body Composition of Preterm Infants
Not the same as that of term infants, in part because these infants have missed part of the third trimester, when fat is added rapidly.
The interaction of a chronic condition with development
Preterm babies with immature immunological systems are prone to infection, so every effort is made to assure that...
Their feedings don't become contaminated
What is the recommended source of nutrition for preterm infants?
Since folic acid has been added as a supplement in grains and flours...
Rates of spina bifida and related conditions have declined 26%
Maple Syrup Urine Disease
A genetic condition
Supplements Recommended for Breastfed Babies
Fluoride supplements are recommended if the family lives in a place that does not provide fluoridated water
Elemental iron (at 3 mg per kg body weight of the infant) may be prescribed if the mother was anemic during pregnancy
Vitamin B12 may be prescribed if the mother is a vegan
Vitamin D supplements may be needed if the infant is not exposed to adequate amounts of sunlight."
Recommendations for use of Cow's Milk During Infancy
Not to be used
Iron-deficiency anemia has been linked to early introduction of whole cow's milk.
Modifications in Dietary Protein That may be Needed for
Infants at Risk Due to Specific Health Conditions
Forms of protein in which amino acids are in short chains (ie- hydroloyzed proteins), or single amino acids
Genetic condition in which the child's 22nd chromosome has a small deletion
Can cause many difficulties in the child's heart health, calcium balance, and immune system as well as affect their speech and learning abilities
Occurs in one of every 4,000 births.
If the child has short stature, heart malformations, heart surgery, and resulting feeding problems, then nutrition intervention may be necessary.
2004 Poverty Rate for Children Under 6 Years Old
Children btw 1-3 y/o
Children btw 3-5 y/o
Appetite & Normal Growth in Toddlers
Decrease in appetite is normal for toddlers
Body mass index is predictive of body fat for children over how many years of age?
BMI in Pediatrics
Goal is to strive for a BMI-for-age, instead of a specific BMI like you would for adults
For toddlers and preschoolers, a BMI of what indicates risk of being overweight?
Greater than or equal to the 85th percentile, but less than the 95th percentile
Sign of independence
Usually complete by 12-14 months
At about what age do children have a refined pincer grasp?
Snacks & Toddlers
Snacks are vital in meeting the child's nutritional needs
Children & Self-Regulation
Children can self-regulate
BUT that doesn't meant they will consume a well-balanced diet
Recommendations for Feeding Toddlers
Serve child-size portions
Serve simple, unmixed foods
Avoid strongly flavored foods\
Don't allow the child to eat & drink indiscriminately btw meals & snacks
How many exposures might it take before a child accepts a new food?
8 to 10
Restriction & Desirability of Food (Young Children)
Restricting access to a certain food might increase desirability
Protein & Children's Diets
Adequate in both the usual American diet, as well as vegetarian diet
Coercive Practices & Getting a Child to Eat
Shouldn't be used (ie- "clean your plate, children are starving in Africa")
Common in children
Especially ages 9-18 months
Most common in Mexican American children
Milk & Children Ages 1-5
No more than 24 ounces a day b/c of low iron content
What's a primary cause of dental decay?
Habitual use of a bottle with milk or fruit juice at bedtime or throughout the day.
What do diets adequate in iron & calcium seem to protect against?
High blood lead levels
In 1998, how may people lived in households where at least some members experienced hunger due to lack of food?
10 million people
More than 1/3 were children
High Blood Lead Levels
Approx. 2.2% of children ages 1-5 have them
Overweight Children Ages 2-5
BMI greater than or equal to 95th percentile
13.9% of children ages 3-5
Treatment of Obesity Ages 2-7 (w/ no Secondary Complications of Obesity)
Maintain weight while gaining height
#1 Cause of Death in the US Today
Children who have high LDL-cholesterol should restrict saturated fat to less than what percent of calories per day?
Children who have high LDL-cholesterol should restrict dietary cholesterol to less than what amoung of mg per day?
Good, Non-Meat Sources of Iron
Dried peas & beans
Fortified breakfast cereals
How soon can low-fat dairy products be used?
After 2 years of age
What is the estimated percentage of children ages 2-8 who consume less than their DRI for calcium?
Approximately what percent of children ages 2-5 years old consume soft drinks?
What supplement should children on vegan diets receive or eat food supplemented with?
Children in part-day childcare programs (4-7 hours daily) should receive food that provides at least how much of their daily calorie & nutrient needs?
Children w/ Developmental Delays-- Feeding Behaviors
May have feeding behaviors that are younger than their current chronological age
Dietary Recommendations for Autism
The same as for any other child of the same age who has feeding problems.
Which health problem results in more emergency room visits for children under 5 years of age as compared to older children?
Preterm Babies in Toddlerhood
More likely as toddlers to have breathing problems than other toddlers
Estimated to be present in 2-8% of children
What Improves the Intellectual Functioning of a Child with Down Syndrome?
What are some food allergies that may result in anaphylaxis for some children is
5 Practical Applications of Child Feeding Research
Serve child-size portions
Serve food in an attractive way
Don't allow children to eat & drink indiscriminately between meals & snacks
Don't serve strongly flavored vegetables
Don't force the child to stay at the table until they have finished "x" amount of food
Guidelines Recommended for Vegetarian Diets of Young Children
Allow the child to eat several times a day
Avoid serving the child bran and an excessive amount of bulky foods
Include in the diet some sources of energy-dense foods
Include enough fat (at least 30% of total calories) and a source of omega-3 fatty acids; Include sources of Vitamin B12,Vitamin D, and calcium in the diet, or supplement if required
Source of Vitamin B12
Fortified breakfast cereal
Source of Vitamin D
Fortified soy milk
Source of Zinc
Source of Omega-3 Fatty Acids
Source of Calcium
Potential problem of excessive fluid intake in toddlers and preschoolers with chronic conditions. What are the recommendations, and what are the risks if recommendations are not followed?
Toddlers & preschoolers w/ chronic conditions are more likely to excessively consume fluids b/c it's often easier for their families to get these children to drink to try to get them to grow.
The recommended juice intake for all children ages 1-6 is 4 to 6 fluid ounces.
If these recommendations are not followed, gastrointestinal problems may be created, or children might have a smaller stature and lower bone density. For those children who have chronic conditions, the impact of consuming excessive fluids could be even greater.
Meal Plan for a Preschooler with Celiac Disease
Breakfast: Soy milk, Grapefruit, Oats (as long as they are not contaminated w/ gluten from wheat mixed in)
Snack: Banana, Orange Juice
Lunch: Chicken (w/ no wheat flour for thickening, if processed), Green beans, Apple