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NTD 3360 Exam 1 Study Guide Spring 2019 Study the content in the Review Questions at the end of each chapter to make sure you have a clear understanding of the chapter concepts. In addition, know the following content from the slides:

Chapter 1: Basic Nutrition ·

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What are the 6 categories of nutrients? - Carbs - Certain amino acids - Essential fatty acids - Vitamins - Minerals - Water What is the difference between an essential nutrient and a non-essential nutrient? - Essential nutrients must be obtained through the diet, non essential nutrients don’t have to be. What are the Principles of the Science of Nutrition? - Food is a basic need of humans - Foods provide energy(calories), nutrients and other substances needed for growth and health - Health problems related to malnutrition originate within cells - Poor nutrition can result from both inadequate and exercise levels of nutrient intake - Humans have adaptive mechanisms for managing fluctuations in food intake - Malnutrition can result from poor diets and from disease states, genetic factors, or combinations of these causes - Some groups of people are at higher risk of becoming inadequately nourished than others - Poor nutrition can influence the development of certain chronic diseases - Adequacy, variety, and balance are key characteristics of healthy dietary patterns - There are no good or bad foods What is the daily recommended intake range for carbohydrates, protein, and fat? - Fat: 20-35% of total calories - Carbohydrates: 45-65% of total calories - Proteins: 10-35% of total calories What are some examples of nutrition and health guidelines for Americans? - Myplate.gov: recommendations to promote health and reduce disease risks, example menus - USDA Food groups: veggies, grains, fruits, dairy, protein foods, planning tools - DASH: fruits, poultry, fish, nuts, WW, Lowfat dairy

Chapter 2: Preconception Nutrition · What are the Healthy People 2020 nutrition-related objectives for the nation for preconception? - Increase the proportion of women who are at a healthy weight prior to pregnancy by 10% - Reduce the proportion of women aged 18-44 who have impaired fecundity by 10%

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Reduce the proportion of men aged 18-44 years who have impaired fecundity by 10% Increase the proportion of women who didn't drink alcohol before pregnancy by 10% Reduce iron deficiency in childbearing age by 10% Increase the proportion of women of childbearing potential with intake of at least 400 mcg of folic acid from fortified foods or dietary supplements by 10% - Reduce the proportion of women of childbearing age potential who have low red cell folate concentrations by 10% - Increase the proportion of women delivering a live birth who received preconception care services and practiced key recommendations preconception behaviors by 10% · How does body fat impact fertility? - Excessive body fat means more likely to be subfertile - Excessive And inadequate levels of body fat are related to declines in fertility in women and men - Inadequate body fat and fertility: critical level of body fat is needed for reproductive functions · How does weight loss impact fertility in normal-weight men and women? - Weight loss past 10-15% of weight decreases estrogen. LH and FSH - Results in loss of periods, anovulatory cycles and short or absent luteal phases - Clomid doesn’t help until weight is gained · What specific nutrients can have an impact on fertility (and how - Ex: soy isoflavones are related to reduced sperm count in men and decreased fertility in women)? - Zinc: has an impair on normal functions - Iron: poor status is related to reduced fertility - Caffeine: conflicting research - Alcohol: increases testosterone levels, reduced sperm concentration, total sperm count and percentage of sperm with normal shape · Why is it important for pre-conceptional women to have normal folate status? What can they consume to make sure they have an adequate intake? - Important: reduced neural tube defects-50% - B vitamin and refined grain products such as white bread, grits, pasta, white rice · When is the periconceptional period? - Critical period! - 8-10 days after ovum is fertilized, implants into uterine wall. - 1 month before conception through 3 months after coneption · Know the concepts discussed in Table 2.6 (Periconceptional nutritional exposures that may disrupt fetal growth and development). - Underweight - Underweight increases the risk of maternal complications during pregnancy and delivery of small and early newborns - Obesity increases the risk of clinical complications during pregnancy and delivery of newborns with neural tube defects or excessive body fat -

Nutrient status

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Excessive vitamin A(retinol, retoni acid) increases the risk the fetus will develop facial and heart abnormalities High maternal blood levels of lead increase the risk of intellectual disability in the offspring Iodine deficiency in early pregnancy increases the risk that children will experience impaired mental and physical development Iron deficiency increases the risk for early delivery and development of iron deficiency in child within the first few years of life.

Alcohol - Increases the risk for fetal alcohol syndrome

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Diabetes - Poorly controlled blood glucose levels in early pregnancy increase the risk of fetal malformations, excessive infant size at birth and the baby developing diabetes later in life · What are the recommended dietary intake and healthy dietary patterns for preconceptional women? - 400 mcg of folic acid - More than 10,000 IU of vitamin A - Limit or omit alcohol containing beverages - Keep the DRI’s in mind - Nutrient dense foods: fish, poultry, lean meats, veggies, fruits, legumes, whole grains and whole grain products, oils and nuts

Chapter 3: Preconception Nutrition: Conditions and Interventions · Describe the female athlete triad and its impact on fertility. What is the intervention for this condition? - Chronic energy deficits combined with high levels of physical activity can put women at risk for female triad - Osteoporosis - Eating disorder - amenorrhea -

Treatment - Correction of negative energy balance - On restoration of ovulation and bone mass secretion - Get vitamin D, calcium and other supplements - Restoration of energy balance can reverse disruptions in reproductive hormones and bone formation · Why is an obese individual who does NOT have excess intra-abdominal fat and who has a healthy metabolic profile at decreased risk for infertility (compared with an obese individual who has excess intra-abdominal fat and who is NOT metabolically healthy)?

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Because the blood pressure, glucose intolerance, abnormal blood lipid levels or increased markers of inflammation and oxidative stress are at lower risk of diseases development than are in metabolically unhealthy individuals How does PCOS impact fertility? What is the nutritional management of PCOS? - Absence of periods - Outer layer of ovaries are thick - Insulin sensitivity increase - Insulin sensitizing drugs -

Diet recommendations - Lean proteins, whole grains, fruits and veggies, regular meals, nonfat dairy and low glycemic index carbs - Weight loss and exercise are recommended · Why is it important for pregnant women with PKU to follow a PKU diet? What is the likelihood that an infant born to a mom who did not treat her PKU during pregnancy will be impacted (and in what way)? - High levels of phenylalanine could impair nerve functions and interfere with amino acid transport - Levels in the first 8 weeks could lead to heart defects - 92% chance of mental retardation and 73% percent chance that infant will have microcephaly · What impact does celiac disease have on fertility? - Delayed sexual maturation - Loss of periods - Increased miscarriage risk - Short lactation - Low birth weight deliveries - Fetal growth restriction · What dietary supplements may be helpful to treat premenstrual syndrome? - Calcium, B6, chasteberry, antidepressants with SRI

Chapter 4: Nutrition During Pregnancy ·

What is a desirable birth weight? - 3500-4500 grams/ 7 lbs and 12 oz-10 lbs · What are the Healthy People 2020 nutrition-related objectives for the nation related to pregnant women and infants? - Reduce the rates of fetal and infant deaths - Reduce the rate of maternal mortality - Reduce low birthweight and very low birthweight - Reduce preterm births - Reduce the rate of fetal and infant deaths - Increase the proportion of pregnant women who receive early and adequate prenatal care - Refrain from alcohol - Increase the proportion of women who gain weight appropriately during pregnancy

· What is happening during the maternal anabolic and catabolic phases of pregnancy? When do each of these stages occur during pregnancy? (hint: table 4.6) - Anabolic: first half of pregnancy (0-20 weeks) - Increased levels of anabolic hormones - Decreased exercise tolerance - Increased appetite, food intake (positive caloric balance) - Buildup of fat, nutrient and liver glycogen sres - Blood volume expansion, increased cardiac output - Catabolic: second half of pregnancy (20+) weeks - Increased levels of catabolic hormones - Increased appetite and food intake decline somewhat near term - Accelerated fasting metabolism - Mobilization of fat and nutrient stores - Increased production and blood levels of glucose, triglycerides, and fatty acids, decreased liver glycogen stores · How and why does carbohydrate metabolism change during pregnancy? Are there any differences between CHO metabolism in early pregnancy vs. late pregnancy? What is the diabetogenic effect of pregnancy? - Promotes availability of glucose to fetus - Early: high estrogen and progesterone stimulate insulin which increases the glucose conversion to glycogen and fat - Late: HcS and prolactin inhibit conversion of glucose to glycogen and fat · How do protein, fat, and mineral metabolism change during pregnancy? · Is the fetus a parasite? Why or why not? (hint: “in general, nutrients will first be used to support…and next for…before they become available at optimal levels for…” - No, it is first used for maternal needs, then placenta, then fetal needs · What are critical periods of growth and development (be able to define/describe)? - When cellular acquisition of 1 or more characteristics or functions different from that of original cell - Critical periods: preprogrammed periods during embryonic and fetal development when specific cells, organs, and tissues are formed and integrated or functional levels are established. - Hyperplasia: increase in cell multiplication - Determined by noting times during gestation when DNA content of specific organs and tissues increase sharply. -

Hyperplasia and hypertrophy: cell multiplication continues at a lower rate after critical periods of cell multiplication is accompanied by increases in sizes of cells Hypertrophy: cells continue to get protein and lipids, functional levels continue to grow in sophistication but cells no longer multiply. Maturation: stabilization of cell number and size, happens after tissues and organs are fully developed later in life.

· Know the newborn weight classifications. Be able to differentiate between dSGA and pSGA. - SGA: small for gestational age - dSGA: disproportionately small for gestational age: skinny, wrinkly, small waist circumference - PsGA: proportionately small for gestational age: look small but well proportioned - Exhibit fewer health problems - Poor catch up growth -

AGA: appropriate for gestational age: LGA: large for gestational age: greater than 90th percentile - Related to poorly controlled diabetes, · What maternal nutritional factors impact the risk for preterm delivery? - Increased levels of cholesterol, triglycerides, or free fatty acids and elevated levels of markers of inflammation and oxidative stress · What are pregnancy weight gain recommendations? (Table 4.16 and rate of weight gain) - Underweight: 28-40 lb - Less than 0.5 per week in 2nd half and 0.75 lb per week in 3rd trimester - Normal weight: 25-35 lb - Overweight: 15-25 lb - Less than 0.5 lb per week - Obese: 11-20 lb - Twin pregnancy: 25-54 lb · How do energy and nutrient needs during pregnancy compare to needs for women who are not pregnant? - Energy requirements change during pregnancy because its due to protein and fat synthesis and expanding amount of metabolically active tissues. · Why do iron needs increase substantially during pregnancy? What are the maternal and fetal risks of iron deficiency during pregnancy? - Because women require about 1000 mg(1 g) of additional iron for pregnancy - 300 mg for fetus and placenta - 250 mg lost at delivery - 450 used to increase red blood cell mass · Would you recommend a sodium restriction for a pregnant woman to help with edema or high blood pressure? Why or why not? - No because inadequate sodium can complicate pregnancy and cause a negative outcome · Should a pregnant woman drink coffee? (not just a “yes” or “no”…be able to defend your answer!) - Yes, as long as its in moderate amounts. 3 cups don’t pose a risk · What are the basics of a good diet for normal pregnancy? - Provide sufficient calories to support appropriate rates of weight gain - Myplate recommendations

- Provide all essential nutrients at recommended levels of intake from diet - Include 600 mcg folate, of which 400 mcg is folic acid - Provide 28 g (sufficient) fiber a day - Include 9 cups of fluid daily - Include salt “to taste” - No alcohol - Satisfying and enjoyable foods · Are vegan and vegetarian diets recommended during pregnancy? What nutrients are of concern? - Vegetarian - Make sure you’re getting enough B12, D, calcium, iron, zinc and omega 3 fatty acids. -

Vegan: - Get enough protein with legumes, grains, find things in grocery stores. · Are multivitamins routinely recommended during pregnancy? Why or why not? Are there any exceptions? - Nutrient needs should be met by well balanced diet - Multivitamins Used if indicated by need - Iron is considered the exception: for vegans, iron deficiency anemia, diagnosed with other nutrient deficiencies -

Little evidence supporting safety and effectiveness of many dietary supplements

· What food safety recommendations would you give to a pregnant woman to avoid foodborne illness (specifically to prevent listeriosis and toxoplasmosis)? - Listeria - No raw or smoked fish, oysters, unpasteurized or soft cheeses, raw or undercooked meat, or unpasteurized milk - Lunch meats, hot dogs, and processed meats need to be stored correctly and heated thoroughly. - Toxoplasma gondii: - Wash fruits - Don’t change cat liter · Is it okay for a pregnant woman to start an exercise program or continue an existing one? - For most, yes. - Beginning a program may help fetal growth - Do 20-30 mins. - Switching To non weight bearing exercises is better toward end of pregnancy · What is the recommended nutritional management of nausea/vomiting, heartburn, and constipation? - Nausea

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Continue weight gain, separate liquids and food intake, avoid trigger food, select well tolerated foods - B6, diclegis, ginger Heartburn - Ingest small meals frequently - Don’t go to bed with full stomach - Avoid foods that trigger heartburn Constipation - 30 g/day fiber - Drink water with fiber - No laxatives

Chapter 5: Nutrition During Pregnancy: Conditions and Interventions · What are the nutritional recommendations and interventions during pregnancy for: obesity, hypertension, preeclampsia, diabetes (type 1, type 2, gestational), HIV/AIDS, and eating disorders? - Obesity - Meet nutrient needs - Consume a variety of foods - Physical actiity - Maintain appropriate rates of weight gain: weight loss isn’t recommended. -

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Hypertension - Monitored diet Preeclampsia - Recommended weight gain - Moderate-intensity exercise - Consume basic food recommendations - Adequate fiber intake - 5 or more servings of colorful veggies and fruits daily - Use of multivitamin/minerals if needed - Adequate calcium and vitamin D status Type 1 diabetes - Control blood glucose levels - Caloric and nutrional adequacy of diet - Achieve recommended weight gain - Careful home monitoring of glucose levels and dietary intake, exercise and insulin dose Gestational diabetes - Follow up after pregnancy - Interpret blood glucose and urinary ketone results - Monitor weight gain - Develop exercise and diet plan - Assess dietary and exercise habits. HIV/AIDS

- 5.18 Eating disorder - Eating disorder specialist! - Appropriate weight gain - Improve nutritional status - Behavioral changes · What are risk factors for gestational diabetes? How is it diagnosed? How can it be prevented? - Excess body fat - Unhealthful diets - Low physical activity levels Diagnosed - Look at page Prevented - Decrease insulin resistance prior to pregnancy - Increase physical activity - Reduce excessive weight and obesity · What are the weight gain recommendations for multifetal pregnancies (total and rate, twins and triplets)? - Twins - 5-7 lbs first trimester, then 1-2 lbs per week - Triplets - About 50 pounds - 1.5 lbs per week starting out as early as possible · What are the best practice recommendations for nutrition during multifetal pregnancy? - Look at table 5.17 -

· What are some risks associated with adolescent pregnancy? Why is nutrition so important for adolescents during pregnancy? What are nutritional recommendations for pregnant adolescents? - Risks - Low birthweight - Perinatal death - C section - Head too large for birth canal - Preeclampsia - Iron deficient anemia - Delayed educational achievement - Poverty - Poor diet quality -

Recommendations - More calories

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- Calcium at 1300 mg per day, 300 higher than adult women - Vitamin D - Nutrition counseling and services Important to teens because they are still growing. They gain more maternal fat tissue during the last trimester and retain more weight after birth than non adolescent women....