G&D 2

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G&D 2
2013-10-22 12:46:12

Lectures 3 & 4 & 5
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  1. 1. In developing countries, what is one of the main causes of multiple micronutrient deficiencies?

    2. Deficits of what major micronutrients have been found to contribute to abnormal development/pregnancy outcomes in real world settings? 3,2,2,1
    1. Poor quality diet (inadequate intake of animal source foods - ASF). Women in wealthy countries who avoid meat/milk are at higher risk of micronutrient depletion too

    2. Folate, iron, iodine deficiencies, as well as B vitamins, vitamin D. More research is needed for maternal vitamin A and Zn status. Evidence is accumulating that maternal antioxidant status is important too.
  2. 1. Why are some micronutrient deficiences of particular concern during lactation and which nutrients are they? 7

    2. What strategies can increase maternal intake of multiple micronutrients (3)

    3. What happens to [DHA] in maternal plasma during pregnancy?

    4. What has omega 3 fatty acids been proven effective in maternal health? (2)

    5. What has evidence shown about required intake of omega 3 FA?
    1. Maternal micronutrient deficiencies during lactation can lead to insufficient amounts in breast milk --> infant deficiency. Priority nutrients are B1, B2, B6, B12, vitamin A, and Iodine, Iron

    2. (1) improve dietary quality (2) provision of micronutrient-rich foods (3) provide multiple mironutrient supplements - easiest.

    3. Increases by ~40% in 1st and 2nd trimester, then depletes as demand of fetus increases in 3rd trimester.

    Breastfeeding - [DHA] rapidly decreases and returns after weaning. IF baby is bottle-fed [DHA] soon after delivery returns to pre-pregnancy level

    4. Preeclampsia and postpartum depression

    5. It's not high enough and may be important for pregnancy and postpartum period
  3. 1. What are the roles of vitamin D in pregnant women? (3)

    1.5 what are roles of vitamin D in general? (6)

    2. Roles of folic acid in pregnant women/infants? 7

    2.5. Recommended RDA for non-pregnant, pregnant, and lactating women?

    3. What are some reasons we might think that recommending supplements to pregnant women would not be effective in making them healthy? (2)

    4. Is there standardize rec for dietary supplements during lactation?

    5. What is IOM's rec for lactating women to obtain the necessary nutrients?

    6. Dietary sources of vitamin D?

    7. Who is at risk for Vitamin D def? (5)

    8. What are consequences of deficiency? (3)
    1. Enhance bone mineralization in offspring & mother, immune function, lowers rates of preeclampsia

    1.5. (1) Ca2+ homeostasis (bone, kidney intestines), (2) brain development, (3) regulates cell prolif/diff, (4) immune function, (5) gene expression/transcription, (6) hormone secretion

    2. (1) DNA synthesis/cell division - esp for RBCs (esp during periods of rapid growth & development) (2) prevents neural tube defects, (3) lowers maternal anemia, (4) lowers preeclampsia, (5) lower BW rates, (6) uterus growth/maternal blood volume (7) methionine synthesis for DNA/RNA/protein/PL methylation for epigenetic changes in infants.

    May cause macrocyctic anemia in adults

    2.5. Non-pregnant: 400, Lactating: 500 micrograms, pregnant - 600 micrograms

    3. Diets vary so its difficult to measure effectiveness of supplements independently; supplements may not be taken at right time to support beneficial development

    4. No

    5. Varied diet rather than taking supplements

    6. Cod liver oil, fatty fish, fortified foods

    7. Dark skinned people, people who live in the North, obese, fat malabsorbers, gastric bypassers

    8. Rickets/bone/mineral def in new borns, osteomalacia in mom
  4. 1. What is general folate status in non-pregnant women in US? What has been done to address this and why?

    2. How does folate def affect infant? When is it usually done? Order in which it affects races?

    3. What are sources of B12? Why does deficiency take years to develop?

    4. Causes of B12 deficiency? 5
    1. More than 75% of non-pregnant women don't get enough. Dietary advice is not effective, so food fortification mandated in 1998.

    2. Neural tube defects (anencephaly, spina bifida) - closure is usually complete 28 days after fertilization before pregnancy is realized. Highest in hispanics, whites, then blacks.

    3. Animal tissues (meat, seafood, eggs, dairy products). Because it's stored in liver which  has 6-7 year supply.

    4. Malabsorption (celiac/chron's disase, gastric bypass, decreased stomach acid), low intake in vegetarians/vegans, infection with h. pylori, metformin, nitric oxide
  5. 1. Consequences of B12 def in pregnancy and breastfeeding?

    2. What is seen in children of B12 def mothers? (2)

    3. What is the physiological basis for brain effectst?
    1. Failure to thrive, reduced brain growth, megaloblastic anemia, BW, developmental delay, reduced appetite, lethargy/irritability

    2. Insulin resistance & lower test scores

    3. Demyelination and atrophy of fetal/infant brain.
  6. 1. What are uses of iron in the body? (3)

    2. Which cells require it?

    3. What are consequences of def in Pregnancy? 5

    4. What is important about iron and breastfeeding? (4)
    1. Basic metabolism, RBC development, mitochondrial actions (every cell requires it!)

    2. ALL

    3. (1) Reduced work capacity, (2) preterm babies, (3) reduced Hb --> reduced newborn iron stores, (4) delayed infant motor function, (5) mental function

    4. (1) Components of breast milk increases fe absorption in infant (2) Breast milk Fe is unavailable to microorganisms preventing infection (3) Complementary foods after 6 mos should be high in iron (4) Fe fortified formula needed if used in the first year
  7. 1. What is the #1 nutritional def in the world?
    1. Iron
  8. 1. How is iodine used in body? For what? (3)

    2. What is iodine important for during pregnancy? (4)

    3. What is iodine important for during breastfeeding? (2) Not good question
    1. To create thyroid hormone (increases 50% in pregnancy) --> for controlling (1) metabolic activity (2) regulating protein synthesis (3) regulating enzyme activity

    2. (1) Skeleton/CNS development in fetus and child (2) Fetus depends on maternal T3 early in pregnancy before thyroid develops (3) Fetus's own T3 synthesis (4) lack of iodine can lead to cretinism (mental deficiency, squint, deaf/mutism, hypothyroidism, stunted growth)

    3. Needed for infant's optimal development AND BF of child with athyroidism can prevent metnal defects until detection
  9. Type I vs. Type II conditioning

    1. Other names? (3,2)
    2. What is it?
    3. Is learner active or passive?
    4. Is it visceral or cognitive?
    5. Which requires more effort? Which requires more time?

    6. How is it regulated?

    7. Is it easily suppressed/modified/ignored once learned?

    8. Examples?

    1. Classical/pavlovian/enteroceptive conditioning vs. operant/instrumental

    2. Behavioral response to a stimulus conditioned over time; behavioral response conditioned over time through controlled stimulus (reward/punishment)

    3. Passive; active; Visceral vs. cognitive

    4. Automatic/fast does not require brain; requires considerable effort

    5. Type II

    6. Type I is NOT under direct subject control (co-regulation), while Type II is self-regulated and self-controlled

    7. Type II is easily suppressed/modified/ignored once learned.

    8. Pavlov's dogs (neural stimulus + unconditioned stimulus --> conditioned response) vs. association formed between behavior and consequences of behavior through punishment/rewards
  10. 1. What is NICU routine? What type of conditioning is it for the child? (2)

    2. What does this type of conditioning lead to? (3)

    3. What happens when a depressed mother approaches the infant? (1-->3) What is this similar to in a normal mother?

    4. What are proposed mechanisms for the relationship of neonatal intensive care unit (NICU) admission & negative outcomes later on in life? (4)
    1. 1 hr stressful procedures, 2 hours alone --> >300 3-hour cycles for the average NICU baby; Type I/Pavlonian + Adverse conditioning

    2. Emotional, behavioral, and physiological disorders

    3. Right brain activation --> withdrawal, anxiety, phobias. Similar to activation when a normal mother DEPARTS

    4. Infant needy --> stressful contact w/ depressed mother --> no calming --> continued --> leading to anxious baby.
  11. 1. What is the family nurture intervention? (FNI) Design

    2. What was the intervention? (1-->4)

    3. What were the results? 5
    1. Design: RCT in high acuity NICU, blind assessment of infant health and development.

    2. Facilitated calming cycle practice! Odor exchange during separation, comfort-touch with vocal soothing, skin-skin holding, feeding, etc. Repeated calming sessions.

    3. Treatment group had more (1) powerful brain function in frontal polar region of brain --> at 18 months better (2) cognitive ability, (3) language skills and (4) motor skills. (5) Moms were significantly less depressed at 4 months.
  12. Interoceptive conditoning

    1. Type?
    2. Does it require brain?
    3. What does it do?
    4. What is an example of this?
    5. What is FNI theory?
    6. Where else may it be effective?
    • 1. Type I
    • 2. No, takes place independently of brain
    • 3. Conditions emotional responses to visceral stimuli
    • 4. FNI in the NICU - takes Type I to effectively "counter condition"
    • 5. FNI theory - enteroceptive conditoning is the most effective in overcoming emotional disorders
    • 6. Eating disorders
  13. 1. What types of preclinical work has been done to investigate the role of the gut in type I conditioning? (4)
    1. Combined secretin & oxytocin reduces cytokines in rat colitis

    2. Oxytocin receptor may be associated with and decrease with weaning

    3. Oxytocinergic regulation of GI motility, inflammation, permeability, and mucosal maintenance in mice

    4. Expression and developmental regulation of OT and OTR in the enteric nervous system and epithelium.
  14. 1. What are the 5 ways that increased energy needed for milk production can be obtained or reduced?

    2. Why is increasing exercise during lactation often not successful in increasing weight loss? (1)

    3. What are 3 difficulties that can occur in early breastfeeding acting as obstacles to success? (3)

    4. Aside from inverted nipples, what other factors are associated with suboptimal breastfeeding behavior (SIBB) from infants?  6

    5. What is estimated increase in postneonatal mortality of infants who were never breastfed compared to those EVER breastfed? Why is this likely to be an underestimate?
    1. (1) Increased dietary energy intake (2) Use maternal fat stores (3) decreasing energy expenditure (4) improving efficiency of energy use for energy-requiring processes, like basal metabolism/thermal effect of food/improving efficiency of milk synthesis (5) reducing amount of milk produced

    2. Increased energy intake

    3. Sore nipples, difficulty of latching, delayed onset of lactation

    4. (1) Flat/inverted nipples (2) C-section delivery (3) use of non- breast milk fluids in 1st 48 hours (4) Any pacifier use in first 72 hours (5) birth weight <3.6 kg (6) high maternal BMI (7) first time mothers

    5. 27% higher - because those who ever breastfed includes people who initiated, stopped, only had to do it once.
  15. 1. What are 3 medical conditions reduced by breastfeeding?

    2. Why is sterile formula not sufficient for preventing infectious disease in infants? 5
    1. T1DM, obesity, childhood asthma, childhood leukemia, SIDS etc

    2. Sterile formula doesn't contain immunolgoical substances that breast milk has like, (1) secretory IgA (2) Lysozymes (3) macrophages (4) lymphocytes (5) B12 binding protein
  16. 1. Many proteins in human milk have multiple functions. Give example (2)
    2. Some people suggest that in areas where mothers are poorly nourished, breastfeeding should be discouraged. Why or why not?

    3. 2 major hormones controlling lactation?
    1. Taurine levels - aid in fat digestion (bile salts), NT in brain/retina, etc).

    2. Lactoferrin - enhances iron absorption in blood and decreases ferric iron in gut + works with lysozyme to destroy bad bacteria

    2. NO, bc dirty water --> diarrhea. BF increases mother-infant bonding, reduces mother's risk of ovarian/breast cancer, hip fractures, reduces future health issues. Can still give child good sustenance

    3. Prolactin and oxytocin
  17. 1. What is the best way to promote increased milk production? (4)

    2. How is child's cognitive function affected by breastfeeding? What factors improve this relationship?

    3. Name 2 major health risks that are reduced in adults who were breastfed?

    4. How long should a child be breastfed? What factors should be considered in making this recommendation?

    5. What is a baby friendly initiative? When are most common times for mothers to give up on breastfeeding? What happens in hospital that may discourage breastfeeding?
    1. (1) Decrease activity (2) increase food intake (3) increase efficiency - way you're sitting during bfing (4) mobilizing fat stores

    2. Dose-response relationship. Omega-3 fatty acids

    3. Diabetes (Type I and II), obesity, ulcerative colitis.

    4. 6 months - whether child is pre-term, available foods, etc.

    5. Ten Steps to Successful Breastfeeding, National Breastfeeding Hotline, etc.


    Given formula, given pacifier, etc. Babies are taken away
  18. 1. What is colostrum? When doe sit come out? What is it rich in?

    2. What are some concerns with bottle feeding early on? (2)

    3. How can a mother tell if nursing is happening normally?
    1. Colostrum is mammary secretion during late pregnancy and 3-5 days postpartum. Nutrient/vitamin/immune substance rich. Rich in protein, less carbs and lipids.

    2. Suckling of infant becomes different with bottle vs. nipple, bonding between mother and infant decreases

    3. If baby is gaining weight, if baby is pooping, if baby is swallowing (3)