NUTR THRU LIFE: PREGNANCY – COMPREHENSIVE QUESTION SET WITH VERIFIED ANSWERS AND RATIONALES

1. Barriers to breastfeeding - ANSWER -inability to breastfeed -understaning benefits and misinformation -avaiblitiy to midwives and lactation consultants -lack of support -short maternity leave -pumping milk at work -lack of acceptance 2. colic - ANSWER Common disorder in babies, causing cramp abdominal pain soon after eating, crying and fussing -effects familial quality of life -no obvious casue 3. what is formula - ANSWER Intended as an effective substitute to breast milk and formulated to mimic the nutritional composition of breast milk 4. Recommended if women are not able to breast feed or after breast feeding has ended until 12 months cow based or soy base formula formula is ..... - ANSWER FDA regulated with lots of restrictions 5. how are human milk and formula different - ANSWER -HFC and mawtodextin instead of lactose -human milk oligosaccaride complexity hard to stimulate -lower quality protein and higher content- more body fat -bioactive compound not minced -cannot mimic fat globule composition and TG composition -mimic monounsaturated fat 6. gut microbriame differences in formula babies - ANSWER less stable microbiome, more complex microbiome, different microbe composition 7. formula risks - ANSWER short term- diarrhea, otitis media, respiratory tract infection, SIDS long term- obesity, athsma, cancer, diabetes if can't breast feed focus on good health with solids 8. formula safety - ANSWER •Prepare formula according to instructions. Do not change water to powder ratio. •all bottles and nipples and other feed equipment must be properly cleaned in warm soapy water or dish washer. For infants under 3 months equipment needs to be sterilized. •Wash hands when preparing formula. •Ideally prepare only amount for one feeding •Prepared formula should be consumed immediately or refrigerated. •Boil water from a safe source no prolonged boiling. One minute at a rolling boil is enough. •Throw away leftover in bottles. 9. why solids at 6 month mark - ANSWER -capacity to digest and absorb near adult level -Breast feeding alone is not sufficient anymore (amount, iron) -Incoming teeth: Carbohydrate consumption needs to start shift away from sucking and disaccharides -Psychosocial role of food needs to be considered. 10. (family meals by 12 months) 11. foods to start with - ANSWER iron fortified baby cereal -veggies and meats next -no added sugars or salts -no chunky foods that are choking hazard 12. why are mothers feeding solids too early - ANSWER wanting to improve sleep, enjoyment at meal times use food to calm, less awarenss about hunger cues 13. vegetarian eating patterns for babies - ANSWER -avoid high fiber diets -iron for CNS, no difference in first year but after first year more chance of anemia -protein is lower quality but most infants two fine -omega 3 difference but no signs of cognitive lack -supplament bitmin D 14. vegan moms - ANSWER vitamin B-12 content of milk os regulated by maternal intake -milk will lack B-12 -only in animal based foods -need b12 injections (through lactation) otherwise neurolocigan symptoms -vomitting, lethargy, failure to thrive, hypotonia, tremors, twitches 15. allergies or high risk infants - ANSWER -whey protein formula if can't breastfeed -intorduction to common allergens to eliminate them -keep house clean but not disinfected -exposure to farm animals and pets -omgea 3 as preventative effect 16. baby tooth decay - ANSWER child teeth are exposed to any liquid or food other than water for prolong period of time -sugars decay -giving baby juice or formula to camp down or fall asleep -switch to snippy cup after first year 17. anatomy of GI wall - ANSWER mucosa- IEC, lamina propria (connective tissue, thick muscle layer, subserosa and serosa 18. Gi funtion - ANSWER secretion digestion and absorption motility barrier, cellular immune system 19. intestinal epithelial layer - ANSWER •Enterocytes: Barrier function •Goblet cells: Mucus secretion •Other cells: Secreting antimicrobials, secretory IgA 20. lamina propria - ANSWER •Thin layer of connective tissue •Home to immune cells: T-cells, B-cells, macrophages 21. GI and microbiota - ANSWER keep in balance -tight junction of IEC maintains physical barrier -IEC receptors recognize microbe derived molecules -IEC and lamina communicate and IgA and antimicrobials secreted 22. microbiome vs microbiota - ANSWER Often used interchangeably those two are slightly different: The gut microbiome describes all microbes in the gut plus their genetic material while the gut microbiota are just the microbes. 23. gut microbiome functions - ANSWER •Assisting with digestion and metabolism •Production of vitamins (vitamin K and B12) •Production of short-chain fatty acids •Maintaining colon health •Maintaining the gut barrier •Regulating the development of the immune system •Regulation of the metabolism 24. gut microbiome dysbiosis related connected to - ANSWER T2D cvd LGCI obesity asthma anutoimmune conditions 25. most important phase of gut microbiome is.... - ANSWER first two weeks of life colonization, development, expansion, fluctuations pf diversity -immune system starts repelling new strains of bacteria after first two weeks 26. window of opportunity - ANSWER is a period of unstable gut microbiome during the first three years of life during which lifelong immune homeostasis is set up 27. gut microbiome increase in first weeks but is less diverse and step by step diversity increases 28. first three years setting up immune homeostasis - ANSWER Stimulation: After birth stimulation of gut epithelium takes place innate immune stimulation + gut closure 29. Immune tolerance follows until 3 months to allow beneficial bacteria to cultivate the gut and the immune system to learn 30. Declining immune tolerance: Immune system keeps learning until window closes around 2 to 3 years with declining immune tolerance to new bacteria strains 31. development of gut microbiota is multifactorial - ANSWER breast milk v formula vaginal v c section early solids and dietary pattern environment genetics 32. exclusively breastfeeding - ANSWER -high number of microbes (lactobacillus and bifidobacterium) -less diversity 33. how many toddlers eat fruits and veggies - ANSWER 1/3 34. fries don't equal veggies - ANSWER 71% said their child ate veggies 32% was only white potatoes 35. avoid added sugar until - ANSWER at least age of two most babies are eating sweets and drinking fruit juice 36. fruits and veggies 2-18 years - ANSWER fruit intake increasing fruit juice decreasing veggie intake is low 37. olfaction and taste - ANSWER thousands of epithelial cells picking up volatile substance while eating allowing for many flavors -trigeminal nerve fibers detect irritation like during or gag 38. tactile and auditory inputs when eating - ANSWER complex evaluation of foods, make decision to ingest or reject 39. third trimester and eating - ANSWER taste buds are Abel to detect taste and communicate with brain -olfactory bulb and receptors cells are functioning fetus drinks 1 l amniotic fluid per day 40. after birth and eating - ANSWER newborn sensitive to odor taste and flower stimuli -preference for sweet reject bitter then develop salty preference 41. sweet taste - ANSWER predominant in human milk sensory pleasure calming, lactose almost double in human milk 42. bitter - ANSWER infants initially reject 25 different receptors for bitter 43. PROP super taster- some veggies taste super bitter 44. salty - ANSWER prefer weak salty taste sweet and salty mix enhanced during growth spurts 45. taste change with age - ANSWER see preference declines during adolescence 46. bitter less pronounced 47. neophobia - ANSWER react new unfamiliar foods 48. picky eating - ANSWER eating inadequate food, reject familiar and unfamiliar foods, strong preferences 49. ARFID - ANSWER avoidant/restrictive food intake disorder -selective eating of only a few food nutrient deficiencies 50. picky eating risks - ANSWER late into to lumpy food pressure to eat decrease risk by providing fresh foods, eating same as child, early into to veggies 51. early flavor experience amniotic fluids - ANSWER volatile substance tradition to amniotic fluid infants recognize flavors they had in third trimester 52. breast milk and volatile flavor - ANSWER flavors transfer to breast milk infants recognize 53. exposure and dietary variety - ANSWER expose child 8-10 times with or without other foods variety of vegetables increase acceptability reduces picky eating 54. early exposure to fruits and veggies.... - ANSWER interacts with the plasticity of the chemosensory system shifting preference and acceptance for fruits and vegetables and avoid added sugars 55. recommendations - ANSWER milk and water not juice introduce variety of foods multiple times and ways offer 2-3 healthy snacks parent provide child decides 56. We assume that an infant grows adequately if: - ANSWER the infant grows along a centile between the 5nd and 95th centile 57. does not cross centiles over time. 58. What body composition changes happen during the first 6 months? - ANSWER Increase in body fat 59. Steep decline in body water stabilizing around 4 months 60. Infants are born with an immature renal system. The consequences of this renal immaturity are? - ANSWER -Inability to concentrate or dilute urine. -Feeding cow' milk will lead to dehydration. -Diluting formula-sometimes seen in poor families-will lead to hyponatremia a condition detrimental to the brain. 61. How can a mother tell if an infant is ready for solids - ANSWER Suck and swallow reflex reflex disappears. -Infant is between 4 and 6 months old. -Infant can sit up for some time. 62. How is milk produced? Order the steps: - ANSWER 1. sucking stimulates nerve impulses in nipples 2. nerve impasses travel from receptors to pituitary glands and release prolactin and oxytocin 3. prolactin stimulate milk production while oxytocin stimulates milk ejection refelx 4. milk starts flowing 63. Which of the following statements about breast milk production are correct? - ANSWER -Milk production varies from woman to women and is determined by the frequency of pumping or the infant suckling. -Breast milk production increases rapidly after 2 - 3 days. -The composition of breast milk changes over time. 64. lipids in milk - ANSWER main energy source providing building blocks, promoting maturation of GI tract, have antimicrobial properties 65. casein in milk - ANSWER amino acid source 66. whey protein in milk - ANSWER bioactive compounds protecting GI tract from microbes encountered by the mother 67. oligosaccharides in milk - ANSWER bioactive compounds acting as probiotics, protecting GI system, promote immune system maturation 68. non protein nitrogen in milk - ANSWER building block for non essential amino acids and potential bioactive function 69. lactose in milk - ANSWER energy source 70. Formula fed infants have a higher risk for: - ANSWER -Diarrhea, otitis media and respiratory tract infections -Higher fat mass at the end of the first year -Childhood obesity -Allergic conditions such as atopic dermatitis, asthma and food allergies -SIDS 71. Everybody can formulate, produce and sell supplements in the USA as long as the ingredients used are similar to foods and nutrients. The USDA will only step in when negative side effects of the supplement are reported. 72. What prevents Americans from producing their own specialty formula, and sell and market it? - ANSWER -Formulas are FDA regulated -The producer must demonstrate that infants grow and develop comparably to breast fed infants. -Companies must adhere to nutrient content requirements. -Ongoing safety and quality control reported to the FDA is required. -Adequate protein quality needs to be demonstrated. 73. Which of the following food safety guidelines when preparing formula for infants under 3 month is incorrect? - ANSWER -Bottles, nipples and other feeding equipment must be washed with warm soapy water before re-using. -Tap water needs to be boiled, but no longer than 30 minutes. Filtered water can be used without boiling. -Leftover formula in bottles can be fed with 2 hours if refrigerated immediately. 74. Which of the following statements are true for the average American infant and toddler? - ANSWER 2/3 of infants (age 6 to 12 month)s don't eat vegetables. Only 1/4 of the parents with toddlers between 12 and 18 month adhered to the recommendation of no sweets before 2 years. Only about one third of infants age 6 to 12 month were fed fruits as recommended. 75. Which of the following statements about added sugar consumption in infants and toddlers is true? - ANSWER The main sources for added sugar in infants is sweetened yogurt. 76. The average intake of added sugar during the toddler years is almost 6 teaspoon per day. 77. African-American toddlers have the highest added sugar intake of all US race groups. 78. sweet - ANSWER energy 79. intensely bitter - ANSWER toxic 80. salty - ANSWER sodium chloride 81. sour - ANSWER vitamin c 82. savory - ANSWER amino acids 83. mildly mitter - ANSWER phytochemicals 84. Newborns have a taste preference for - ANSWER sweet 85. Which of the following statement(s) about bitter taste in infants is/are true? - ANSWER -Bitter can be mask by sweet taste -Initially infants reject bitter but bitter taste perception is modifiable -Some infants and children have an enhanced bitter perception because they are PROP super tasters -There are 25 different taste receptors for bitter 86. flavor is - ANSWER The combined sensation of taste, olfaction and the somatosensory system. 87. Taste is malleable, Which of the following are recommended strategies to increase acceptance of vegetables in children? - ANSWER -Trying a new food 8 - 10 times consecutively -Eating a healthy plant-based diet during pregnancy and breast feeding. -Trying new foods 8-10 times consecutively in a combination with other foods. -Avoiding added sugar until age 2. -Offering a variety of healthy foods with the introduction of solids at 6 month. 88. Volatile compounds are: - ANSWER -cause food odor. -set free during chewing travelling up retro-nasally. -released during digestion, absorbed and distribute in body fluids. -are excreted in urine or exhaled. -Some volatile compounds are transferred into amniotic fluid and breastmilk. 89. Which of the following life events are crucial for the development of a healthy gut microbiome? - ANSWER Mode of delivery Type of milk fed during first 6 months Timing of the introduction of solids Shift to family meals Weaning 90. Why is it so important to breast feed when it comes to the development of the gut microbiome? Bioactive compounds in human milk: - ANSWER -Promote the development of specific bacteria (Lactobacillus and bifidobacteria) that are essential for the education of the immune system. -Such as oligosaccarides can only be digested by specific bacteria or a group of bacteria. This contributes to developing a healthy gut microbiome. -Such as the probiotics lactobacillus, bifidobacterium, enterococcus help establish a large but less diverse microbiome during the first 6 months 91. average birth weight in US - ANSWER 7.5 pounds 92. birth weight compared to parent wight - ANSWER correlated 93. large mom larger baby 94. US birth weight is... - ANSWER declining -declign gestational length -LGA decreaed -SGA increased 95. all infants will lose about.... of their birth weight - ANSWER 10% 96. failure to thrive is - ANSWER if tech infant loses more than 10% of birth wight or does not gain the wight back by the 2 week mark 97. how do we know if a baby grows well - ANSWER infant grow between 5th and 95th percentiles 98. remains mostly on centile line after first month 99. well baby visits - ANSWER every two-3 months until age 2 than ever year -test length -weight -head circumference -WHO growth chart 100. infants growth is tracked to.... - ANSWER determine adequacy of nutrition and health 101. children grow rapidly in the first tow years and reach about half adult height between ages.... - ANSWER 2 and 4 -growth in spurts after first year 102. during the first 5 years.....changes profoundly - ANSWER body composition 103. all newborns - ANSWER lose 10% of body wight after birth -mostly extracellular water -weight regained after 10-14 days 104. 0-6 months - ANSWER steep decrease in body water steep increase in body fat 105. GI system in newborn - ANSWER -limited enzyme secretion and synthesis making it hard to fat and carbs -grwoth spurt during first 24h after birth -microial colonization after birth -maturation promoted by components in breast milk 106. renal system in newborns - ANSWER immature -newborns cannot dilute or concentration their urine -high solute load= dehydration (cow milk) -low solute load=hyponatermia (diluted formula) (water would not exit and would flow into brain cells) 107. new born immune system - ANSWER -functionally different -commensal microbiota-colonization during vaginal delivery, diet and environment -major shift in firs year and stabilizes for metabolism 108. GI anatomical development - ANSWER frost 20 weeks of gestation 109. third trimeter-length and surface increases 110. GI mobility - ANSWER peristalsis after 29-30 weeks mobility mature at 40 weeks suck and swallowing at 32 weeks 111. GI digestion - ANSWER limited lipase, and bile acids limited amylase and lactase maturation due to exposure to feeding 112. barrier function GI - ANSWER established after birth by microbe colonization of the colon 113. microbiome GI - ANSWER starts with delivery colonization driven by milk type and environment 114. growth spurt - ANSWER Burts of GI development after first feed -motility development is slower than maturation of digestion 115. renal system - ANSWER high solute load lead to dehydration since infants cannot concentrate urine in first four months -additional liquids lead to over hydration both can harm brain 116. integrated rooting, sucking, swallow, and gag reflex - ANSWER birth to 4 month 117. voluntary suck and swallow - ANSWER 5-6 month 118. phasic bite reflex - ANSWER 1-6 month 119. hand on bottle - ANSWER 2-5 month q 120. hold bottle - ANSWER 6 month 121. drinks from hand held cup - ANSWER 5-6 moth 122. tongue thrust and gag refelx - ANSWER 1-4 month 123. circular chewing - ANSWER phasic bite wanes 124. 9-12 month 125. for solid foods 126. food types for age - ANSWER 6 month- purees 127. 9-12-soft chunky 128. 12-sof chewed foods 129. feeding recommendations - ANSWER exclusive breast feeding first 6 months -solids not before end of 4th month -solids without salt 130. preparation for lactation - ANSWER 1. increasing progesterone. stimulate growth of milk producing glands and inhibits lactation during pregnancy 2. estrogen stimulate growth of milk ducts 3. prolactin rise and regulates milk production 4. sucking start milk flow, progesterone levels fall 131. how is milk produced - ANSWER prolactin- milk production in. glands oxytocin- contraction of milk glands releasing milk based on sucking feeding Avery 1-3 hours in first 5 days for good production 132. feeding after birth driven by reflexes - ANSWER rooting- max at 60 minutes after birth 133. suck and swallow relfex- strong at 45 minute -feeding within first hour of birth 134. milk production - ANSWER varies women to women 135. increases rapidly after 2-3 days 136. continues to increase during first months 137. milk composition first 5 days - ANSWER colostrum 138. more immunological than nutritional - bioactive compounds 139. immunoglobulins, lactoferin, oligosaccaride, sytokins, lysosomes, growth factors, nutritional factors (lower in lactose and fat) 140. milk composition after 5 days - ANSWER colostrum gradually replaces by transitional milk which transitions into mature milk around 14 days 141. -starts providing nutrition along with immunological 142. composition changes in one feeding - ANSWER foremilk- watery, lactose rich, longer between two feeding less fat 143. hind milk- lower lactose higher fat 144. diurnal variation- peak fat content of milk during midmorning low fat over night 145. lipids - ANSWER -main energy 146. -easily digested 147. -brain development 148. -antimicrobial 149. maturation of GI tracts 150. protein - ANSWER lowest of all mammilian milk 151. casein-amino acid source suspended in micelles 152. whey- Water soluble bioactive compounds 153. muffins- part of fat globule 154. carbs - ANSWER highest of all mammalian milk 155. lactose- energy source 156. oligosaccharides- indigeitbles bioactive compounds 157. non protein nitrogen - ANSWER use for non essential amino acids 158. bioactive substances immune function 159. immunoglobulins and antimicrobials - ANSWER -anitbodies in human milk target infectious agents encountered but he mother during perinatal period since they are most likely encountered by infant 160. -slgA- Main immunoglobulin in human milk, protecting from invasive pathogens at mucosal surface by immobilizing pathogens, preventing adhesion to epithelium and neutralize toxins 161. slgG-Main immunoglobulin in the human serum. Might be absorbed during first days by the newborn before gut closure. 162. lactoferrin-some lipids, other proteins and non-protein nitrogen act as anti-microbials. 163. -decline reflect gut closure over first few days 164. bioactive compound sin human milk - ANSWER oligosaccharides 165. HMO 166. Indigestible prebiotics promote a beneficial bacteria composition including Bifidobacterium and lactobacillus 167. -feeding and promoting unique gut microbiome 168. -antimicrobial- act as •anti-adhesives blocking attachments of pathogens and therefore prevent proliferation of pathogens 169. -alter epithelial cell gene expression and immune system promoting gut barrier development 170. HMOs - ANSWER oligosaccaride comp determined by moms genes 171. bacteria need specific enzyme to digest HMO 172. benefits of breast feeding for mother - ANSWER •Rapid shrinking of the uterus and reduced blood loss post partum 173. •Less blood loss due to suppression of menstruation as long as breastfeeding continues through night 174. •Faster return to pre-pregnancy weight due to substantial increased energy needs 175. •Decreased risk for breast, endometrial and ovarian cancer (negatively correlated with total months of breastfeeding) 176. •Convenient, less missed work, environmentally friendly 177. (additional energy of 640kcal needed per day) 178. when breastfeeding is not perfect - ANSWER Vitamin deficiency or deficient intake by the mother is reflected in the breast milk and can lead to deficiency in the infant. 179. Some viral diseases such as HIV or Hepatitis B can be transmitted via breast milk (antibodies provide some protection but not enough) 180. vitmin b-12 for vegan mothers 181. vitamin k single injection after birth 182. daily vitamin d drops to avid rickets 183. breast feeding initiation rate - ANSWER high at 82% but need support to continue 184. 60% of infants breast fed through 6 month 185. 24% infants only breast fed through 6 month