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1. What is metabolic programming?
2. What are some of the associations with childhood obesity?
3. What happens in animals when food intake is restricted early in development?
4. What does some evidence of early weight gain before 2 years of life indicate? (4)
1. Metabolic factors acting during critical periods of growth in pre- and postnatal development can induce lasting effects on health and disease risk later on.
2. Serious short/long-term adverse effects on quality of life, health, life expectancy, financial burdens, stigma, etc.
3. Permanent reduction of body size
4. Associated with later adverse health outcomes like hypertension, increased overweight, increased body fat deposition, and increased risk of diabetes
1. What is best overall predictor of overweight at school entry?
2. Who gains more wight - breastfed or formula fed infants?
3. Does duration of breastfeeding matter? ^
4. What are some mechanisms for why breastfeeding has protective effect? (3)
1. Weight gain in first 24 months of life
4. (1) Differences in feeding behavior (suckling pattern, frequency of meals, longer time intervals bt meals)
(2) Milk is variable in nutrient content from day to day unlike formula to fit child's needs
(3) Breastfeeding may enhance emotional bonding bt mother & infant
1. What are some of the nutrient composition diff bt breast milk and formula? (3)
2. What is the early protein hypothesis?
3. What are the implications of the above?
4. What is the INfant Formula Act of 1980?
1. Formulas has higher energy density, differences in protein supply, differences in nutrient content
2. High protein supply in postnatal period increases body fat by enhancing secretion of insulin and IGF-1 and decreasing HGH secretoin (less lipolysis)
3. High protein content of formula predisposes infants to increased obesity risk later on in life
4. Passed as a result of severe health consequences when artificial breast milk failed to include key vitamins and minerals in new formula
1. Difference in macronutrient composition bt human and formula milks?
2. How do amino acids differ bt the two? 4
3. What do nucleotides do? Can infants synthesize them de novo?
4. Why does whey:casein ratio bt breast milk and cow milk matter?
1. Protein content (30-40% casein and 60-70% whey, while bovine is 80% casein and 20% whey), oligosaccharides, lower in fat than formulas
2. Ratio of sulfa-containing AAs differ greatly between the two (cysteine & methionine) & lower aromatic AAs (phenylalanine), also BM has taurine while CM (Cow milk) doesn't.
3. Key roles in immune system, protein synthesis, microbiome, and absorption/metabolism of other nutrients. LIMITED ABILITY TO SYNTHESIZE
4. Increased whey allows for small, soft curds --> easily digested.
1. Why are long chain PUFAs so important for newborns (2) and where are they derived from (2)?
2. What are some other important factors found in BM?
3.How does infant take advantage of its mtoher's immune response through breast milk?
1. Important energy source --> critical for formation/functioning of nervous tissue and cognitive functioning. Derived from linoleic and linolenic acids.
2. Prostagalndins, EGF, etc.
3. Immunoglobulins - high [IgA] esp in colostrum, passive immunity, lymphocytes, macrophages, lactoferrin (iron), etc.
1. What AA is missing from cow milk and has to be added to formula?
2. Why is lactose necessary for newborn growth? (4)
3. How do glycoproteins directly decrease virulence of bacteria & viruses in newborn?
4. Name 3 functions of lipids in human infants?
2. Major energy source, enhances Ca2+ absorption, ready source of galactose for brain, important for CNS development
3. Prevents adhesion of pathogenic bacteria by acting as receptor analogues, competing with epithelial ligands for bacterial/viral binding.
4. (1) energy source (2) protects against viral infections and parasites (3) major substrates for somatic & CNS development
1. Describe 3 feeding reflexes in newborns
2. Describe a baby's growth rate from fertilization to one year. How does this relate to energy needs of an infant?
3. Why, evolutionarily speaking, is human breast milk diff in comp than cow's milk? (2)
1. (1) Rooting: stroke baby's cheek --> turns head towards stroked cheek and opens mouth to find nipple (2) Sucking: to permit feeding, a baby sucks when object is placed in mouth (3) Coordination of swallowing and breathing
2. 3x birthweight. Has greatest energy needs per ounce during this time.
3. Bc of human biped gait and brain size (1) Brain size increased to accommodate intelligent behaviors/language (2) biped gate altered structure of female pelvis from being rounder to wider.
Solution: deliver fetus at decreased levels of maturity
Adaptation: breast milk complements and offsets immaturity of newborn by secreting bioactive components, but cow milk lacks these factors bc there's no evolutionary pressure on cow to develop them.
1. Does breastfeeding reduce BMI in older children? How much of an effect is seen?
2. What are ways breast milk interacts with immune system? (2)
3. Which has more lactose - breast milk or cow milk? Why is this important?
1. Yes, 7% in BMI
2. Colostrum and breast milk neutralize propensity toward excessive inflammation and contain many immunological substances. Allows for proliferation of bifidobacteria.
3. breast milk - major energy source for brain.
1. What nutrients should be considered to be added in BM and why? (3)
2. What are considerations to keep in mind while weaning?
3. What should complementary foods at 6 months be rich in?
4. What should be avoided?
1. Zinc (high in colostrum but low later on), fluoride, vitamin D - should be supplemented
2. Introduce foods one at a time, with rice/cereal/veggies introduced first.
3. Vit A, copper, IRON, zinc, B1, B3, and should be diverse to provide new taste/sensory experiences
4. Popcorn, juice, honey, grapes, hard candy, gum, hot dog pieces, etc.
1. What factors (scores) was higher child adiposity associated with?
1. Lower "pressure to eat" and higher "restriction" scores.
1. What is "pressure to eat?"
2. What are restrictive feeding practices?
3. What does 'pressure to eat' predict for maternal feeding practices?
4. What is Satter's Division of Responsibility intervention? Parent - 4, Child - 2
1. The push for higher overall consumption or just "healthy foodS" - promotes eating beyond satiety teaching children to ignore satiety cues.
2. Restrictive feeding - limits child's intake of unhealthy/snack foods. Children will consume more of previously restricted food than they would have otherwise.
3. Food avoidance behaviors
4. Parent is responsible for providing/serving food on a regular schedule, deciding when and where. Child is to decide whether to eat and how much.
1. What are some of the major macro/micronutrients that toddlers need? (6)
1. Protein, Iron (Vit C for Iron absorption), Calcium (vit D for absorption), and monopolyunsaturated fat for brain growth.
1. What are the core physiological needs for healthy growth in toddlers? (5)
1. (1) Neuroendocrine cues
(2) neurological/neuronal response
(3) reward systems (brain)
(4) recognition of tastes and odors
(5) diff organs systems functioning
What are the physiological and neurodevelopmental milestones related to eating in young children?
Neurodevelopmental (4 major ones)
Timeline 16-20 weeks, 18-24 weeks, 34-37 weeks, birth, 6-8 months, 10-12 months (6)
Physiological - sympathetic nervous system, parasympathetic nervous system (3 cranial nerves to send signals to digestive system)
Neurodevelopmental: (1) gross motor skills (2) fine motor skills (3) control level arousal (4) sensory ability
- 16-20 --> amniotic fluid
- 18-24 suckling
- 34-37 coordinated suck and swallow
- birth - rooting reflex
- 6-8 months - sit, head control, closes lips over cup
- 10-12 pincer grasp
What are the determinants of food pref and eating behaviors in children?
1. Genetic - 4
2. Environment - 4
3. Family/parents - 1
Genetic (sweetness, avoid bitterness)
Environment - physical activity, access to food/portion size, media, culture
When should children be able to:
1. Self feed?
2. drink from a cup?
3. Precise up and down tongue movements
4. Circular jaw rotatoin/grinding?
What are recommendations surrounding cup use/juice in children?
- 1. 8-18 months
- 2. 9-12 months
- 3. 18-24 months
- 4. 24-26 months
(1) No bottle bc prolonged use increases caloric intake, results in failure to thrive/obesity, iron deficiency, caviies
(2) Juice should not be had before 6 months of age - no fiber, results in diarrhea, dental cavities, overweight and underweight.
1. Which 2 agencies have established growth standards for children?
2. What is the AAP? What do they recommend in how to use these standards? Why?
1. CDC and WHO
2. American Academy of Pediatrics - use WHO from 0-24 months and CDC standards from 2-19 years old.
BC WHO growth charts were done using exclusively breastfed infants and CDC is recommended after age 2 since WHO growth charts go until age 5.
1. What are factors that children do and things that parents do that can disrupt self-regulated eating of infants?
- Child (4), parent (3)
2. At 1 year of age, what type of modifications are happening with regard to diet and eating? (4)
1. Child-temperament (slowness, emotional eating, fussiness, can't tell satiety response)
2. Parent - feeding styles (food as reward, restriction, pressure to eat)
- 2. (1) Eating skills and experiences (2) food from diff food groups (3) intro of veggies and fruits (4) serving size.
1. What types of foods and how much should a toddler 1-3 y/o be eating?
2. What triggers growth hormone release? Physiologic - 5, Pathologic - 4
3. What inhibits growth hormone release?
Physiologic - 6, pathologic - 4
1. Fat content of a toddler's diet from 1-3 years old sould be 30-40% of energy intake, all 5 food groups every day, decreases to 25-35% fat at 4 years.
- 2. Growth Hormone Triggers:
- Physiologic - exercise, stress, slow wave sleep, low glucose levels, fasting
Pathologic - ILs, low protein, T1D, liver cirrhosis
- 3. Inhibition of Growth Hormone Release
- Physiologic - hyperglycemia, high FFA, high GH, high IGF, REM sleep, age
Pathologic - LDopa, obesity, hypo/hyperthyroidism
1. What are major actions of growth hormone? LOTS adipose, bone, muscle
1. Adipose tissue - Acute insulin-like activities (protein/lipo/glycogenesis), AA uptake and metabolism,
- Bone - osteoclast differentiation, osteoblast activity, increases bone mass, stimulates epiphyseal growth
Muscle - increased AA transport, N retention, lean tissue, energy expenditure.
What are major actions of insulin-like growth factors (IGF-1)?
How do the levels of IGF-1 differ over time in boys and girls?
Insulin-like activity, promote sulphation of cartilage, stimulate DNA synthesis, and cell multiplication.
IGF is lower in infancy when growing is fastest, highest in adolesence and decreases (age/sex dependent)
Boys increased rate of IGF (start at 5) as opposed to girls (start immediately until puberty)
What does thyroid hormone do? (5)
- 1. Increase O2 consumption
- 2. Increase # of mitochondria/mit protiens
- 3. Increased ribosomal proteins and nuclear incorporation of RNA
- 4. Important for skeletal maturation
- 5. Necessary in fetus & infant for axonal and nerve cell body growth in CNS.
What do glucocorticoid hormones do? (6)
- 1. Inhibit DNA synthesis in liver, heart, skeletal muscle, kidney
- 2. Inhibit cell proliferation
- 3. Inhibit enzymes
- 4. Acutely enhance growth hormone release
- 5. Chronically inhibits GH release
- 6. Antagonizes growth hormone action
What are the general actions of sex hormones? What actions do estradiol & testosterone share? (3) For what actions are they opposites? (1)
- Minimal impact on growth prior to puberty. Basically, (1) enhances GH secretion and (2) IGF-1 production and (3) increases skeletal maturation (linear bone growth and epiphyseal fusion and bone mineral)
Opposites: subcutaneous fat (estrogen increases)
Testosterone increases muscle, energy expenditure, decreases visceral fat
Estrogen determines bone mass accretion - regulates timing of growth spurts.
What is a growth chart and why do we use them?
Limitations to using growth charts?
Used to predict growth trajectory relative to "average" population. Can be used to determine unhealthy growth patterns.
Limitations - data for growth trajectories are collected from specific cohort that's not necessarily the same ethnically, SES, etc.
How should a person's upper:lower segment change as they age?
What about arm span and height?
1. Upper: lower segment should decrease (birth - 1.7, post-puberty - 0.9).
2. Arm span catches up to height
- Child - span < height
- Adolescent span = height
- Adult - span > height
1. What are the target height equations for boys and girls? What is the standard deviation?
2. Describe DXA. Advantages & Disadvantages
3. Describe BIA advantages & disadvantages
4. Skin-folds/anthropometry (same)
- 1. Boy = (sum of parental heights + 13 cm)/2
- Girl = (sum of parental heights - 13 cm)/2
2SD for target height = +/- 10 cm
2. Exponential attenuation of absorbed photons at 2 energy levels resolving tissues into bone, lean mass, and fat mass. Advanatages
- validated against carcass analysis in pigs, limitations
- susceptible to measurement bias
(measures of electrical resistance in body) Advantages
: cross validated with TBW, DXA, and TBW. Limitations
: estimates TBW which must be converted to fat-free mass. Precision may be less than skin folds.
- 4. Skin-folds/anthropometry (uses multli-compartmental model of body comp with sum of skinfolds to predict total fat mass). Advantages - easy to use, appropriate for population-based studies, inexpensive.
- Limitations - sensitive to inter-user variability
Describe the diff in bone mineral content, lean body mass, and % body fat in boys and girls under age 24.
Bone mineral content - tend to have higher mineral content than girls after puberty, both increase at same age, but higher in boys
Lean body mass - girls increase lean body mass at early age maxing at 15. Boys increase rapidly around puberty and then increase to a max much higher than girls
% body fat - boys maintain a level average of ~10% at all times. Girls continually increase body fat % as they age.
What are limitations to measuring skeletal maturation? (3)
- 1. Subject to interobserver variation
- 2. Current US standard developed on American white children bt 1931-1942
- 3. Based on normal children - relevance to pathological conditions is unclear.
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