HLSC 2P21 Nutrition Through Lifespan (LEC 8 Notes) PDF

HLSC 2P21-Nutrition Through the Lifespan: pregnancy, lactation and stages of life **LEC 8 notes** Final exam  - 50 multiple choice  - And 5 long answer questions WITH OPTION OF CHOICE FROM 8 QUESTION - Total 100 marks  Nutrition  - All people need the same nutrients, they just require...

HLSC 2P21-Nutrition Through the Lifespan: pregnancy, lactation and stages of life **LEC 8 notes** Final exam  - 50 multiple choice  - And 5 long answer questions WITH OPTION OF CHOICE FROM 8 QUESTION - Total 100 marks  Nutrition  - All people need the same nutrients, they just require them in different amounts at different times. Nutrition in stages - Prior to pregnancy  - During pregnancy  - After pregnancy  - mother  - child (lactation)  - Childhood  - Adulthood  - Elderly/Aging Maternal Nutrition and Pregnancy Nutrition prior to pregnancy - Body provides the environment for growth and development of the child - Many habits influence fertility - - - Healthy body weight  - Preconception weight  - influence or exacerbate maternal health  - strongly correlated to fetal growth and health  - affect infant health - Underweight women  - low-birth weight babies  - preterm births  - increased risk of disabilities, impaired development and mortality  - Increase weight before and during - Overweight or obese women  - maternal complications (hypertension, gestational diabetes)  - complications of delivery (premature)  - infant complications (neural tube defects, congenital defects)  - Decrease weight before [not] during Physical activity  - Benefit to everyone  - Need to be or become physically active before pregnancy  - Dietary requirements should reflect amount of physical activity Adequate and balanced diet - Need to start pregnancy on an "even keel"   - Malnutrition (deficit) will affect mother and baby  - Target specific nutrients that may be limited in the diet (e.g. folate -- talk about later) Fetal development - Critical period - Embryonic period  - [rapid developmental stage  ] - most vulnerable to adverse influences with nutrition (critical periods) Critical periods and nutrition - Folate  - protein metabolism and [DNA synthesis ] - RDA  - 400 µg/day  - 600 µg/day if pregnant  - taken throughout first trimester  - supplements and fortification (1.7 times more bioavailable) in addition to dietary intake DFE (dietary folate equivalents) = food folate + (1.7 x supplemental folic acid) - Genes can be turned on or off  - epigenetics  - pattern of gene expression regulated by modifications to DNA (e.g., methylation, histone modification, micro-RNA) - Fetal programming   - fetal genes can be turned on or off with maternal nutrients - Agouti model or "fat yellow" gene is silenced with diet ***Nutrition during pregnancy *** - The most important modifiable variable increasing the chances of a mature healthy newborn  - Proper nutrition to support  - maternal changes (e.g., uterus, blood volume, breasts)  - fetal development  - In addition to proper diet, body adapts to maximize absorption and minimize loss  - Numbers aren\'t important  - Focus on what\'s changing or not changing  - Understanding the full change of what's increase or decrease (don\'t look at the scale simply whats increased or decreased) ***Macronutrients*** - Energy (increase)  - improve nutrient density  - placenta and fetal growth and development  - maternal needs  - Protein (increase)  - not much of a problem in North America  - build muscles, organs, skin, etc. of growing fetus  - Carbohydrate (increase)  - quality (more complex, less simple)  - fuel the developing fetal brain and spare protein for growth  - Lipid (no change)  - decrease SFA   - increase essential fatty acids (linoleic and linolenic)  - include DHA for fetal brain and neural growth and development - North america we consume more than enough protein in our diets  - Focusing on quality  ***Cell growth and blood production*** - Folate (increase)  - DNA, RNA, and rapid cell division  - reduced risk of neural tube defects  - supplement recommended  - Vitamin B12 (increase)  - increased absorption efficiency  - DNA, RNA, rapid cell division - activate folate  - Vitamin C (increase)  - collagen formation and amino acid metabolism  - antioxidant  - Vitamin A (increase)  - development of retinal pigments and aids in protein synthesis and rapid cell division  - do not supplement (preformed vitamin A; teratogen) - There are situations where health canada recommends supplementation when there are risks present of malnutrition  - Vitamin A is not advised to be taken in supplement form during pregancy  Cell growth and blood production - Iron (increase)  - DNA, RNA, rapid cell division, blood  - fetal iron storage during last trimester  - maternal affects rather than fetal  - supplement recommended  - Zinc (increase)  - DNA, RNA, rapid cell division  - both maternal and fetal development  - Iodine (increase)  - thyroid development  - Water (increase)  - increased blood volume  - maintain amniotic fluid ***Bone development*** - Vitamin D (no change) - important for calcium homeostasis (bone development) - due to recent changes (DRI 3X higher than before), more emphasis on rich sources - concern is around deficiency - Calcium (no change) - very important for bone development - absorption doubles during pregnancy due to elevated vitamin D *Supplements* - Not strictly necessary but used to avoid nutritionally related pregnancy complications (e.g. folate and iron) - Supplement [NOT] substitute ***Malnutrition and pregnancy*** - During pregnancy (fetal development)  - growth impairments  - birth defects  - premature birth   - low-birth weight  - Age - adolescents (still growing)  - energy and macronutrients  - calcium (supplement to achieve RDA)  - iron (supplement due to high risk of anemia)  - older women  - [calcium] (supplement to avoid osteoporosis)  - diet-induced hypertension and diabetes - Vegan diet  - in addition to protein, other nutrient challenges  - well planned diet with prenatal supplements are recommended ***Nutrition after pregnancy *** - Postpartum  - re-establish energy stores  - recovery (especially if surgery was required)  - Lactation/breastfeeding  - added energy to pass on to child  ***Nutrients during lactation*** - Needs higher than pregnancy! - energy into milk production - energy and nutrients into milk itself - estimated at 700-800 kcal per day - Energy (increase) - under the total needs for milk production to assist in losing weight gained during pregnancy - Protein (no change) - remain elevated - Carbohydrate (increase) - used to make lactose in milk - Lipids (no change) - linoleic and α-linolenic acid needs not much different from pregnancy - precursors for DHA and AA - growth and development of nervous system - development of retinas - Folate (decrease)  - critical periods of development are complete but folate still higher than pre-pregnancy  - Vitamin B12 (increase)  - support energy metabolism  - Vitamin C & A (increase)  - antioxidant  - Iron (decrease)  - iron stores (infant)  - not a significant component of breast milk  - postpartum amenorrhea (maternal) - Calcium (no change)  - enhanced calcium bioavailability  - some demineralization of bones (returns after lactation ends)  - exception is age (supplement)  - Vitamin D (no change) - not a significant component of breast milk  - contribute to calcium bioavailability  - Iodine (increase)   - thyroid hormones  - Water (increase)  - protect against dehydration (milk is 90% water) ***Nutrition for someone else *** - Assumption that the mother is well nourished  - Change focus to child and their needs  - first year  - 0-6 months (exclusively breast milk or formula)  - 6-12 months (breast milk/formula and introduction of solids ***Infancy*** - Fast growth  - more than doubles in first 5-6 months  - almost triples in first year  - High metabolic rate   - \~100 kcal/kg body wt/day (\~40 for adults) - Nutrient needs  - based on mean intakes of healthy, full-term infants fed breast milk  - breast milk/formula for first 6 months  - breast milk/formula and solids for second 6 months  - World Health Organization position statement states that "Mean intakes of human milk provide [sufficient energy] and [protein] to meet mean [nutritional requirements] during the [first 6 months] of infancy. ***Infancy nutrients *** - Infant biological and physiological characteristics  1. 2. 3. - Energy  - \~100 kcal/kg body weight/day (1)  - energy dense food  - Fat (35-50%)  - most of the energy (1)  - Protein (5-10%)  - most essential  - basic building block of all body tissues  - less stress on kidneys (2) - Carbohydrates (40-50%)  - energy for all cells, especially brain (3)  - brain larger in infants, use \~60% of daily carbohydrate intake ***Infancy nutrition***  - Water (more)  - critical, more so for infants  - proportionally lose more water (evaporation) (3)  - immature kidneys (inefficient in concentrating urine) (2)   - \~150 ml/kg body weight  - breast milk/formula sufficient  First 6 months  - Highlighted some of what breast milk provides  - Concerns  - Too high amounts of protein will cause stress on the kidney - High amounts of sodium double  - Little to no trace amounts of iron Breast milk  - More easily digested  - More feedings (every 2-3 hours)  - Provides the optimal energy-nutrient composition for growing infant! - Fat (55%)  - linoleic and linolenic fatty acids (essential)  - arachidonic and docosahexaenoic acids  - retinal and brain development  - Carbohydrates (39%)  - lactose  - enhances calcium absorption  - Protein (6%)  - alpha-lactalbumin  - optimal for growth and development - Vitamins  - plentiful for all vitamins  - exceptions  - vitamin K (supplement with a single dose at birth)  - vitamin D (supplement)  - Minerals  - calcium content optimal  - low iron but high bioavailability  - high bioavailability for zinc  - low sodium  - optimal fluoride Breast milk -- Immunological protection - Colostrum  - produced for the first 2-3 days  - serum with antibodies and white blood cells  - "kick start" immune system  - bifidus factor - optimal for Lactobacillus bifidus growth (healthy gut)  - lactoferrin - iron-binding protein to promote iron absorption  - lactadherin - prevents virus that causes infant diarrhea  - growth factor - development and maintenance of GI tract  - lipase and other enzymes - protect against infection - Infant formula - Try to mimic breast milk ***Preterm infants*** - incomplete development (GI tract): impares nutrient digestion and absorption - fat-soluble vitamins  - essential fatty acids, specifically AA, EPA and DHA  - Calcium, iron,zinc  - low-birth weight  - limited nutrient stores (fat and iron) - Preterm breast milk  - higher concentrations of proteins  - lower volume  - may be fortified with supplements  - Supports growth and development rates similar to in utero Introduction of other foods - Nutrient needs met first by breast milk/formula (6-12 months) - Solids → important for nutrition and development  - supplemental nutrients - timing suitable to physical and metabolic handling  \*\*\* pay attention to the need for Iron - Breast milk is low in iron, high in bioavailability  - Supplement this with iron fortified cereals  - This is why you don\'t introduce cow\'s milk until later because calcium impares bioavailability  ***Introduction of other foods*** - Supplemental nutrients - Iron - limiting at 4-6 months with breast feeding - iron-fortified cereals (supplement) - vitamin C - help absorb iron - Vitamin C enhances iron bioavailability  Childhood nutrition - Energy intake - depends on growth and physical activity - total increases with age - needs per kg body weight declines gradually - Carbohydrate - brain dependent on glucose - after 1 year of age, same as adults (45-65% of energy) - complex over simple - limit fruit juice to 150-200 ml/day during years 1-6 (lacks soluble fibre and can increase blood glucose) - Fibre  - relative to their energy intake (14 g fibre/1000 kcal energy expended -- same as adults)  - at a [minimum], total fibre = age + 5g  - look to whole grain cereals and breads and fresh fruit and vegetables - Protein  - gradual increase as kidneys and liver develop  - maintain nitrogen balance  - 1-3 years - 1.1 g/kg body wt/day or \~13 g  - 4-13 - 0.95 g/kg body wt/day or \~19 g  - Canada's Food Guide can contain between 16-24 g of protein (or more) - Lipids  - essential fatty acids similar to adults (5-10% for linoleic, 0.6-1.2% for linolenic)  - remains high from 2-3 years  - 30-40% of energy  - important source of energy and for developing neural system  - closer to adults from 4-13  - 25-35% of energy  - begin introduction of lower fat products (e.g. 2% instead of homogenized) - Vitamins and minerals concerns around  - vitamins A, C, and E -- fruit and vegetables - Calcium → milk and alternatives  - Iron - Vitamins and minerals concerns around  - vitamins A, C, and E - fruit and vegetables  - calcium -- milk and alternatives  - Cow's milk only after 1st year -- Why?  - poor source of iron  - higher in calcium, lower in vitamin C (decrease iron absorption - milk anemia)  - may cause GI tract distress  - high protein content (stress kidneys)  - Dairy important after 1st year -- bone health - Iron  - iron-deficiency anemia most common nutrient deficiency in young children  - unique situation - Water  - increase with age (1.5 ml/kcal expended)  - kidneys are maturing and lose less through evaporation  - Increase dependent on activity and environment ***Childhood malnutrition*** *BREAKFAST* - Skipping breakfast  - short attention span  - poor performance  Q. How is this translated? - Glucose homeostasis  - brain relatively same as adults  - liver smaller  - overnight fast results in very low blood glucose in children and "starving" brain - Cannot learn effectively due to not providing the brain with the proper fuel  *VEGAN DIETS * - Vegan diets : Potential challenges  - potentially low in protein, iron, zinc, and vitamin B12 (complementary proteins and iron, zinc, and B12 fortified cereals)  - low in calcium and vitamin D (supplement or fortified fruit juices)  - too much fiber (inhibit iron and zinc absorption and early satiety)  - safe but needs extra attention *CHILDHOOD OBESITY * - Childhood obesity  - Obesity based on body-mass index (BMI)  - weight (kg)/height (m)2  - adults  - 25-30, overweight -  \>30, obeseity - not as clear cut for children - Cannot base obesity off BMI, have to be based off population  - More difficult to assign in terms of healthyness   - Attempts made to quantify obesity risks in childhood and adolescence  - A significant contributor to the population - Nutrition and physical activity may be a contributing factor - Childhood obesity  - genetics  - less physical activity/ more time inactive  - poor nutrition choices - Three main nutritional factors  1. total energy intake  2. nutrient density  3. fat content  - Food choices: can depend on access  - at home  - at school  - in the community  - in the media  - Ways to overcome this  - Education - ***Physical activity and children/youth*** - Identify 4 main contributors 1. 2. 3. 4.  ***Increase physical activity*** - Children 5-11  - at least 60 min of moderate to vigorous physical activity per day  - vigorous activity at least 3 days per week  - strengthening activities at least 3 days per week ***Decrease physical inactivity*** - Children/Adolescence 10-16  - too much screen time!  - recommended amount is less than 2 hours per day  - Limit sedentary activity → strong correlation with health  - active transport to and from school  - active play after school ---\-\-\-\-\--\>  - active family time before bed ***Adolescent nutrition*** - Starts at 10-11 for females and 12-13 for males - Lasts for \~2.5 years (puberty) - Many more added confounding factors - growth and development - social stresses - make more choices Energy need second only to pregnancy and lactation ----\>  - Dependent on  - growth rate  - body composition  - physical activity - Macronutrients and water - similar to adults  - Micronutrients - similar to adults with a few exceptions  - iron  - vitamin A  - vitamin D  - Calcium - Iron  - increased muscle mass in males  - replace the blood loss during menstruation in females - Vitamin A  - support rapid growth and development  - adequate amounts through 5-9 servings of fruit and vegetables - Vitamin D  - enhanced vitamin D activation  - Calcium  - - Promote bone growth and important to achieve optimal peak bone density ***Calcium and vitamin D:*** - Canada's Food Guide does not have food groups -- NO dairy or alternatives BUT dairy isn't discouraged - Dairy was synonymous with bone health - Osteoporosis Canada identifies other food sources of calcium (green vegetables, canned fish, nuts, fortified foods) and vitamin D (oily fish, fortified foods) -  If we don\'t consume the proper nutrients to establish peek bone density, we increase our risk for osteoporosis  ***Increase physical activity*** - Youth 12-17  - at least 60 min of moderate to vigorous physical activity per day  - vigorous activity at least 3 days per week  - strengthening activities at least 3 days per week - Target  - Active transport  - Active play  - Active family time  ***Decrease physical inactivity*** - Youth 12-17  - limit screen time to no more than 2 hours per day  - limit sedentary activity ***Getting older:*** 1. Healthy  2. Physically active   3. Independent  4. Live longer ***Physiological changes*** - Immune system  - declines   - compounded by malnutrition  - Body weight  - Organ systems  - Digestive  - Renal (reduced capacity to concentrate urine)  - Reproductive  - menopause ***Body weight *** - Body composition  - Natural and take place with aging  - can t stop the process but hopefully can slow it - relative increase in fat  - absolute decrease in bone (osteoporosis) and muscle (sarcopenia) mass Digestive - GI tract  - dysphagia (difficulty swallowing) and changes in sensory perception  - intestinal wall loses strength and elasticity  - hormone secretion changes - GI tract (cont')  - vitamin B12 -------\>  - Absorption depend son and requires  1. 2. 3.  - Inflammation in the stomach results in a thinning of the stomach wall  ***Menopause*** - Cessation of menstruation  - Slow Decline in estrogen and progesterone  - Exacerbates osteoporotic occurrence and effects - Because estrogen is protective of the bone  - Loss of estrogen = bone loss Longevity - Aging is inevitable  - slow the process  - ease the transition  - Improved quality of life  - Goal of healthy aging  - Prolong Healthspan -- "Length of time in one's life where one is in optimal health" Q. How can we live longer and healthier?  - We maintain our optimal health span and drop off  the last few years (optimal) ***Nutrition and longevity *** Contributing factors - Healthy habits  - good sleep  - not smoking  - healthy body weight  - not using alcohol or in moderation  - physical activity  - nutrition ***Physical activity*** - Promote similar activities as other adults  - cardiorespiratory (endurance)  - flexibility  - strength and balance (musculoskeletal) - Intensity is subjective to the individual but accumulation and time is the same  ***Nutritional needs*** - Clustered into two groups (chronologic age)  - 51-70  - \>70  - Setting standards is difficult (biologic age)  - individual differences more pronounced with age  - chronic changes to diet need to be addressed  \*\*\*While the DRI values are based on chronological age, biological age might preside our nutritional requirements ' - Water  - total body water decreases with age  - renal capacity to concentrate urine decreases  - still very much essential  - recommendations similar to younger adults  - Energy  - need decrease \~5% per decade  - lower activity and basal metabolic rate  - no room for low nutrient density foods - Protein  - remains constant despite decreased energy (0.8 g/kg body wt/day)  - obtain from low-calorie, highprotein sources  - support immune system and fend off sarcopenia  - Carbohydrate and fibre  - protect protein from being converted  - complex carbohydrates with high fibre - Bmi is only good for an individual until about age 65 - after that it doesn\'t matter  - Lipids  - not too high (risk of cancer, CV disease, etc...)    →  - not too low (risk of nutrient deficiencies and weight loss) - Osteoporosis  - decrease in bone density   Healthy bone thin bone  (trabecular) FOCUS ON  - - - Looking at the serving size within populations  - Focusing on diary and the corresponding impacts of its intakes  - Vitamin D (increased)  - deficiency due to  - less consumption of vitamin D-fortified milk  - reduced capacity to synthesize vitamin D  - important to minimize bone loss  - Calcium (increased)  - utmost importance to ward off osteoporosis  - use calcium-fortified juices and [supplements ] - Vitamins B12  - low levels of stomach acid  - B12 deficiency due to atrophic gastritis  - look to fortified foods or [supplements]  - Iron  - iron needs decrease for postmenopausal women  - deficiency [may] arise with  - malnutrition  - chronic blood loss  - poor iron absorption SUMMARY   - What needs to be targeted from a supplementation perspective  - Highlight situations in which a diet can not meet supplemental demands and fortifications that are necessary  Sample "long answer" questions  1. Identify 5 nutrients that differ during lactation compared to pregnancy and state why they would differ. - 10 points here for 10 marks  - Questions on exam will be out of 10 marks 2. Compared to other life stages, infants are unique from a biological and physiological perspective. It is this uniqueness that speaks to their nutrient requirements. Identify the three main biological/physiological characteristics of [infants], a respective nutrient for each main characteristic that requires special attention, and why these nutrients are associated with said characteristic.  - Pay attention to this one he said  - Talking about infants  - Identify 3 main biological/physiological characteristics of [infants] a. [Have a higher energy need ] - b. [immature digestive tracts and kidneys ] c. [small size] - Connect nutrients of each of these situations that are unique  - These require special attention  - A nutrient for each,  - THIS WILL BE ON THE FINAL FUCKING STUDY IT  3. List a water-soluble vitamin, a fat-soluble vitamin, and a mineral and identify the important role each nutrient plays during a given life stage (e.g. infancy, childhood, adolescence) - Water soluble vitamins remember   - Fat Soluble vitamin  - Mineral  - Remember we get a choice of 5/8 questions on the exam. Within these questions we also get choices in how we answer - Remember one for each stage  - Multiple different combinations NOT JUST ONE ANSWER  4. You are working part time at a retirement facility that caters to men and women over the age of 60. You have been asked to look at the diets of these residents and provide feedback to the kitchen staff. List five (5) nutrients/nutritional factors that you plan to discuss with the kitchen staff, highlighting the importance of each of these points. - 5 nutrients to be listed and 5 listed importance of eahc of the listed nutrients  - This is 10 marks total  - PAY ATTENTION TO THE QUESTIONS. HE MAY RESTRICT OUR APPROACH. MAY NOT WANT TO HEAR ABOUT SUPPLEMENTATION OR FORTIFICATION. MAY ONLY BE ASKED ABOUT NATURAL FOODS. Vice versa. Maybe what they\'re recommended for