-
Essential Nutrients
Required nutrients that the body cannot manufacture or produce in sufficient amounts but that are required in the diet
-
Dietary Reference Intakes (DRI)
Dietary intake standards
-
Six Categories of Nutrients
- Carbohydrates
- Fats
- Protein
- Water
- Vitamins
- Minerals
-
Main Function of Carbohydrates
A source of readily available energy
-
Most Common Monosaccharides
-
Most Common Disaccharides
-
Complex Carbohydrates
- Polysaccharides
- Sucrose, Lactose, & Fiber
-
Protein in Foods Provides the Body with...
Amino acids
-
How are amino acids unlike carbohydrates & fats?
They contain nitrogen
-
How many essential amino acids are there?
9
-
How many calories per gram are in carbohydrates?
4
-
How many calories per gram are in protein?
4
-
How many calories per gram are in fat?
9
-
How many calories per gram are in alcohol?
7
-
What's the recommended intake of carbohydrates?
45-65% of calories
-
What's the recommended intake of protein?
10-35% of calories
-
What's the recommended intake of fat?
20-35% of calories
-
What are particularly good sources of protein?
- Animal products
- Dried beans
-
Lipids Include...
- Fats
- Oils
- Cholesterol & related compounds
-
-
Functions of Fat
- Precursors of cholesterol & sex hormones
- Components of cell membranes
- Vehicles for carrying certain vitamins
- Suppliers of essential fatty acids
-
Essential Fatty Acids Include
Linoleic & Alpha-linoleic acids
-
Alpha-linoleic acid is the parent of...
The omega-3 fatty acid family
-
DHA & EPA
- Fatty Acids
- Found in fatty fish & human milk
-
Regular consumption of fish protects against
- Irregular heartbeat
- Sudden death
- Stroke and high blood pressure
- Plaque formation in arteries
-
2 Basic Types of Lipids (fats)
-
Unhealthy Fats Include
- Trans fats
- Saturated fats
- Cholesterol
-
Water Soluble Vitamins Include
- B-Complex Vitamins
- Vitamin C
-
Fat-Soluble Vitamins Include
Vitamins A, D, E, & K
-
Do vitamins provide energy?
No
-
Do vitamins serve as structural components of the body?
No
-
Vitamins that Serve as Antioxidants
- Vitamin C
- Vitamin E
- Beta-carotene
-
Phytochemicals
- Fruits, veggies, nuts, seeds, & whole grains
- Might partially account for lower rates of heart disease & cancer
-
Minerals
- Consist of single atoms
- Carry a charge in solution
- Unlike any other nutrients
-
Roles of Water
- Energy transformations
- Excretion of waste
- Temperature regulation
-
Products made with refined grains must use flours enriched with...
- Thiamin
- Riboflavin
- Niacin
- Iron
-
Individual-level nutrition assessment includes...
- Anthropometric assessment
- Biochemical assessment
- Clinical/physical assessment
- Dietary assessment
-
What assesments are generally used for individual diets?
- Multiple 24-hour recalls
- Dietary history
-
Anthropometric Assessment Measures...
- Bone density
- Height & weight
-
WIC Program
- For nutritionally at-risk population
- Low income pregnant women, postpartum, & breastfeeding women
- Low-income children under 5 years old
-
Every dollar invested in the Women, Infants, and Children (WIC) prenatal nutrition services saves ___ on Medicaid costs for infants during the first 2 years of life.
$3.13
-
The (new) MyPyramid recommends the following number of servings per day for a 2,000 calorie diet
- 2 dairy
- 2 meat/meat substitute
- 2 fruit
- 3 vegetables
- 6 breads/cereals
-
Choose Foods that Limit the Intake of
- Saturated Fat
- Trans Fat
- Cholesterol
-
2005 Dietary Guidelines Include Recommendations for...
- Physical activity
- Carbohydrates
- Sodium & potassium
- Food groups to encourage
-
Factors Contributing to Infertility in Females and/or Males
- Beta-Carotene Intake
- Caffeine Intake
- Alcohol Intake
-
Infertility in Males May be Related to...
- Low zinc status
- Alcohol intake
- Heavy metal exposure
- Exposure to synthetic estrogens
-
Folate
Inadequate amounts very early in pregnancy can cause neural tube defects
-
It is recommended that women who may become pregnant consume
- 400 mcg of folic acid
- No more than 5000 IU of vitamin A
- Little or no alcoholic beverages
-
It is commonly recommended that women reduce their intake of ___ to decrease PMS symptoms.
Caffeine
-
What supplements appear to decrease symptoms of PMS?
- Vitamin B6
- Calcium
- Magnesium
-
High blood glucose levels during the first two months of pregnancy can cause
Congenital abnormalities
-
Glycemic Load (GL)
A measure of the extent to which blood glucose levels are raised by a specific amount of carbohydrate-containing food.
-
Characteristics of Polycystic Ovary Syndrome
- Infertility
- Obesity or high levels of intra-abdominal fat
- Excessive body hair
- High blood levels of insulin, triglycerides, and
- androgens
-
Phenylketonuria (PKU) in a pregnant woman often results in an infant with
Mental retardation
-
Celiac Disease
Avoid eating gluten from wheat, rye, & barley
-
Small improvements in infant mortality in the past few decades in the United States are largely due to
Technological advances in medical care that save ill newborns
-
US Ranking on Infant Mortality Rates
27th
-
Infants weighing ___ to ___ at birth are least likely to die
within the first year of life.
7 lb 12 oz ... 10 lb
-
Duration of Pregnancy
40 weeks
-
To provide the fetus with sufficient energy, nutrients, and oxygen for growth, the mother must first
Expand plasma volume
-
How much fetal growth is accomplished in the first half of pregnancy?
10%
-
How much fetal growth is accomplished in the second half of pregnancy?
90%
-
Physiological changes during pregnancy
- Suppressed immunity
- Increased concentrations of blood cholesterol
- Relaxed gastrointestinal tract muscle tone
-
Functions of the Placenta
-
Hormone and enzyme production
- Nutrient and gas exchange between the mother and
- fetus
- Removal of waste products from the fetus
-
First Organ to Develop in Humans
Brain
-
Critical Periods
Preprogrammed time periods during development when cells, organs, and tissues are formed and functions established.
-
Can deficits or excesses in nutrients supplied to the fetus during critical periods can produce lifelong defects in organ function?
Yes
-
About how long after birth do cells of the central nervous system continue to multiply?
2 years
-
"Small for gestational age" (SGA)
Weight is less than the 10th percentile
-
What are disproportionatel small infants at greater risk for in the adult years?
Chronic Disease
-
About how much of the total weight gained during pregnancy is comprised by the fetus?
One-third
-
Increased need for energy in pregnancy averages how many calories per day?
300
-
Do artificial sweetners have any association with birth defects?
No. Therefore, they should not be avoided during pregnancy.
-
How much alcohol should pregnant women drink daily?
None
-
The recommended protein intake for pregnancy is an additional ___ grams per day for females aged 14 and older.
25
-
Overall, the incidence of iron deficiency is ___ in vegetarian as compared to non-vegetarian pregnant women.
The same
-
Inadequate availability of folate between 21 and 27 days after conception can...
- Interrupt normal cell differentiation
- Cause neural tube defects
-
Approximately what percent of women enter pregnancy with iron deficiency?
12%
-
What are normal declines in hemoglobin level during pregnancy generally a result of?
Dilution effects of increased plasma volume
-
Which is lower: absorption of iron from multimineral supplments, or absorption from supplements containing only iron?
Absorption of iron from multimineral supplements
-
Should sodium intake be restricted during pregnancy to minimize edema?
No
-
How many cups of coffee is it safe to drink per day while pregnant?
Up to 4
-
Pica
Compulsion to eat non-food substances
-
Consequences of Pica
- Lead poisoning
- Intestinal obstruction
- Parasitic infection
-
Iron
The only supplement routinely recommended for pregnant women
-
Should pregnant women avoid exercising until after the baby is born?
No
-
Vitamin B6
Has been shown to reduce the severity of nausea in many women
-
Hypertensive Disorders
The second leading cause of maternal mortality in the US
-
Symptoms of Preeclampsia/Eclampsia
- Deficits in prostacyclin relative to thromboxane
- Increased blood pressure
- Platelet aggregation and blood coagulation
-
Who is the risk of developing hypertension associated with preeclampsia higher in?
Women who were born small for gestational age
-
What supplements during gestation show promise in reducing oxidative damage caused by preeclampsia?
Vitamin C & Vitamin E
-
Approximately what percent of pregnant women develop gestational diabetes?
3-7%
-
Consequences of Gestational Diabetes
- Stillbirth
- Increased risk for preeclampsia
- Infant macrosomia
-
Diets for Women with Gestational Diabetes
- Relatively low in carbohydrates
- High in fats
-
Approximately what percent of children with HIV/AIDS are infected during pregnancy or delivery?
20%
-
Approximately what percent of children are infected with HIV/AIDS during breastfeeding?
14-21%
-
Bulimia Nervosa
Most commonly observed eating disorder among pregnant women in the US
-
Risks Associated with Adolescent Pregnancy
- Low birthweight
- Iron-deficiency anemia
- Preeclampsia
- Perinatal death
-
Functional Foods
- Foods which have been changed to make them better for one's diet.
- Example: Orange juice with added vitamin C (nutrients added)
- Example: Lactose-free milk (harmful parts removed)
-
"The Fetus is Not a Parasite"
- The fetus doesn't take whatever it needs
- from its mother at its mother's expense. The fetus will
- sacrifice its own deficiency for the mother.
- Example: If the mother really needed iron, the baby would not take it from the mother.
-
"Nutrition Programming" of Genes
- It's the changes that can occur in a fetus that program what certain genes do. If
- certain nutrients are exposed to the fetus, the function of genes can
- actually change, and diseases can be prevented later in the child's
- life.
-
Foods that could provide a total of approximately 20-25 grams of protein for a meal for a pregnant woman consuming a lacto-ovo vegetarian diet.
- 2 tortillas - 6 grams of protein
- 1 oz. cheese - 7 grams of protein
- 1/2 cup refried beans - 7 grams of protein
-
Prolactin
Plays a specific role in human milk production
-
Oxytocin
- Plays a specific role in human milk let down
- Acts on the uterus, causing it to contract, seal blood vessels, & shrink in size
-
Colostrum
- The first milk
- Contains compounds for immune protection
-
What's the difference in calorie consumption between infants who are breastfed vs. those who drink formula?
Those who are breastfed consume fewer calories
-
Lipids Content in Human Milk
Lipids provide about half the calories of human milk
-
Fatty Acid Profile
Breast milk component that varies with the mother's diet
-
Lactose
The dominant carbohydrate in human milk
-
Early consumption of ___ through breast milk appears to be related to lower ___ later in life.
Cholesterol / Blood cholesterol
-
Docosahexaenoic Acid (DHA)
In breast milk, it's associated w/ developmental advantages (ie- higher IQ scores)
-
Protein & Breast Milk
Lower content in breast milk than other types of milk, making it easier for the kidneys to handle
-
Vitamin B6 & Breast Feeding
Of the water soluble vitamins, it's the most likely to be deficient in human milk since it reflects maternal intake
-
Minerals in Human Milk
Many are highly available for absorption
-
Breast Feeding & Return of Fertility
Return of fertility (through monthly ovulation) is often delayed in breastfeeding women
-
Secretory Immunoglobulin A
The predominant immunoglobulin in human milk
-
Breastfeeding may Reduce the Risk of...
- Celiac disease
- Inflammatory bowel disease
- Neuroblastoma
-
Milk Synthesis
- Rate of accumulation of milk in the breast
- Related to infant demand
-
Infants fed cow's milk before six months of life suffer
nutritionally significant losses of ___ via intestinal blood loss.
Iron
-
The U.S. Surgeon General recommends human-milk feeding exclusively for how many months?
6
-
How many times a day is it normal for a newborn to feed?
10-12
-
All infants in the US receive a supplement injection of what at birth?
Vitamin K
-
When should infants be fed?
When signs of hunger are displayed
-
Vitamin D
Should be given daily to exclusively breastfed infants starting within the first 2 months of life
-
What percent of their body weight do newborns usually lose in the first week postpartum?
Up to 7%
-
How many extra calories per day should lactating women consume in the first six months postpartum?
500
-
Modest Protein-Calorie Malnutrition
Results in reduced volume of milk, but usually does not compromise the composition of the milk
-
Common Barriers/Obstacles to Breastfeeding
- Embarrassment
- Early hospital discharge
- Lack of broad societal support
- Commercial promotion of infant formul
-
How many daily feedings are generally needed for women to continue making milk?
2
-
Mastitis
- A bacterial infection of the breast
- Most commonly found in breastfeeding women
-
What's the single most common medical isue health care providers face in managing breastfeeding patients?
Medication use
-
Physician's Desk Reference (PDR)
Not a good reference for info about drugs & breastfeeding
-
Antineoplastic Agents
One of only a few medications that is thought to be contraindicated to breastfeeding
-
Is alcohol considered to be "usually compatible with breastfeeding?"
Yes
-
Should women who smoke still breastfeed?
Yes
-
Breastfeeding & Caffeine
It's recommended that women who are breastfeeding consume caffeine in moderation
-
Is breastfeeding the preferred choice even though environmental contaminants do exist in breastmilk?
Overwhelmingly, yes.
-
Protection from ___ is one of the most important benefits of breastfeeding for the infant
Allergic diseases
-
Are HIV-infected women in developing countries advised to breastfeed their infants if they do not have access to safe and affordable replacement feeding?
Yes
-
How many days can human milk that is freshly expressed into a closed container be stored in the refrigerator?
3-5 days
-
4 Benefits of Breastfeeding for the Mother
- Delays in the return of fertility through monthly ovulation, creating delays between pregnancies
- Increased bonding with their baby
- Lower risk of breast and ovarian cancer
- Breastfeeding increases production of oxytocin, which stimulates uterine contractions
-
5 Benefits of Breastfeeding for the Infant
- Meets nutritional needs of the infant without any extra added food or water
- Provides high amounts of essential fatty acids
- The amount of protein in human milk meets the baby's needs without harming the kidneys
- It forms an easily digestible curd
- DHA helps the central nervous system develop to its full potential
-
Daily food plan for a pregnant woman consuming
2,400 calories, as indicted by her MyPyramid food plan.
- 8 ounces of grains
- 3 cups vegetables
- 2 cups fruits
- 3 cups milk
- 6.5 ounces meat & beans
- 7 teaspoons oil
-
3 Prental Strategies to Encourage Breastfeeding
- Provide education to new and expecting mothers.
- Nurses and doctors in the hospital could encourage
- it before discharging mother and baby
- Providing support to the mother after discharge to encourage that she continue breastfeeding
-
Major Factor in the Prevalence of US Infant Mortality
Infant birthweight
-
At birth, which nutrients can the healthy newborn's digestive system is sufficently mature to digest?
- Fats
- Proteins
- Simple sugars
-
What's the average caloric need of breastfed infants in the first five months of life?
108 cal per kg of body weight
-
What is the specific recommended intake level of fats for infants?
There is none
-
Should cholesterol intake be limited in infants?
No.
-
Short & Medium Chain Fats
- Found in breast milk
- More readily utilized than long chain fats
-
Long Chain Fats
- Found in some infant formulas
- Not as readily utilized as short & medium chain fats
-
Metabolic Rates in Infancy versus Later in Life
High
-
Flouride Levels in Breastmilk
Low
-
Should salt be added to infants' food to maintain adequate sodium intake?
No
-
When is it recommended that screening for lead poisoning start?
9-12 months
-
When do healthy newborns double their birthweight?
4-6 months
-
When do healthy newborns triple their birthweight?
1 year
-
Dietary Fiber Recommendations for Infants
There are none
-
The National Center for Chronic Disease Prevention and Health Promotion infant growth charts show...
- Weight for age
- Length for age
- Head circumference for age
-
Is the rate of weight gain during infancy predictive of further growth patterns after infancy?
No
-
How do you assess an infant's readiness to begin eating from a spoon?
- Ability to keep head upright and sit with little support
- Ability to move tongue from side to side without moving head
-
What's the recommended age for weaning the infant from the breast or bottle to a drinking cup?
12-24 months
-
An infant who is weaned from breastfeeding too soon may...
- Plateau in weight because of a decrease in total calorie intake
- Become constipated from a decrease in fluid intake
-
First Food Generally Recommended for Infants
Baby cereal (iron-fortified)
-
Many foods eaten by other family members are appropriate foods for infants who are...
9-12 months
-
Unsafe Foods for Infants
- Popcorn
- Raisins
- Uncut stringy meats
- Raw apples
-
Breast milk or formula generally provides adequate water for healthy infants for how long?
The first 4-6 months
-
The American Academy of Pediatrics Juice Recommendations
- Not introduced into the diet before 6 months of age
- Never at bedtime
-
Infants learn food preferences largely based on...
Their experiences with foods
-
If an infant's mother is a vegan, the infant may need what supplements?
Vitamin B12
-
Which supplement may be needed if the infant is not exposed to adequate sunlight?
Vitamin D
-
Failure to Thrive (FTT)
- A condition in infants
- A calorie deficit is suspected
-
Research in infants who have long-term and severe iron-deficiency anemia suggests inadequate iron contributes to...
Long-term learning delays
-
The use of a bottle containing formula or juice to calm a baby enough to sleep may set the infant up for...
Dental caries (cavities)
-
Hydrolyzed Protein
Is the ingredient in a specialized formula given to infants with suspected protein intolerance
-
Preterm Birth
Infants born before 37 weeks gestation
-
The overall U.S. infant mortality rate has _____ between 1980 and 2002.
Decreased 45%
-
When are extra calories needed for infants?
- Infections
- Difficulty breathing
- Recovery from surgery
-
Medium-Chain Fatty Acids
Fats that may be given to infants who are sick or recovering
-
Body Composition of Preterm Infants
Not the same as that of term infants, in part because these infants have missed part of the third trimester, when fat is added rapidly.
-
Developmental Delay
The interaction of a chronic condition with development
-
Preterm babies with immature immunological systems are prone to infection, so every effort is made to assure that...
Their feedings don't become contaminated
-
What is the recommended source of nutrition for preterm infants?
Breast milk
-
Since folic acid has been added as a supplement in grains and flours...
Rates of spina bifida and related conditions have declined 26%
-
Maple Syrup Urine Disease
A genetic condition
-
Supplements Recommended for Breastfed Babies
- Fluoride supplements are recommended if the family lives in a place that does not provide fluoridated water
- Elemental iron (at 3 mg per kg body weight of the infant) may be prescribed if the mother was anemic during pregnancy
- Vitamin B12 may be prescribed if the mother is a vegan
- Vitamin D supplements may be needed if the infant is not exposed to adequate amounts of sunlight."
-
Recommendations for use of Cow's Milk During Infancy
- Not to be used
- Iron-deficiency anemia has been linked to early introduction of whole cow's milk.
-
Modifications in Dietary Protein That may be Needed for
Infants at Risk Due to Specific Health Conditions
Forms of protein in which amino acids are in short chains (ie- hydroloyzed proteins), or single amino acids
-
DiGeorge Syndrome
- Genetic condition in which the child's 22nd chromosome has a small deletion
- Can cause many difficulties in the child's heart health, calcium balance, and immune system as well as affect their speech and learning abilities
- Occurs in one of every 4,000 births.
- If the child has short stature, heart malformations, heart surgery, and resulting feeding problems, then nutrition intervention may be necessary.
-
2004 Poverty Rate for Children Under 6 Years Old
21%
-
Toddlers
Children btw 1-3 y/o
-
Preschoolers
Children btw 3-5 y/o
-
Appetite & Normal Growth in Toddlers
Decrease in appetite is normal for toddlers
-
Body mass index is predictive of body fat for children over how many years of age?
2
-
BMI in Pediatrics
Goal is to strive for a BMI-for-age, instead of a specific BMI like you would for adults
-
For toddlers and preschoolers, a BMI of what indicates risk of being overweight?
Greater than or equal to the 85th percentile, but less than the 95th percentile
-
Weaning
- Sign of independence
- Usually complete by 12-14 months
-
At about what age do children have a refined pincer grasp?
12 months
-
Snacks & Toddlers
Snacks are vital in meeting the child's nutritional needs
-
Children & Self-Regulation
- Children can self-regulate
- BUT that doesn't meant they will consume a well-balanced diet
-
Recommendations for Feeding Toddlers
- Serve child-size portions
- Serve simple, unmixed foods
- Avoid strongly flavored foods\
- Don't allow the child to eat & drink indiscriminately btw meals & snacks
-
How many exposures might it take before a child accepts a new food?
8 to 10
-
Restriction & Desirability of Food (Young Children)
Restricting access to a certain food might increase desirability
-
Protein & Children's Diets
Adequate in both the usual American diet, as well as vegetarian diet
-
Coercive Practices & Getting a Child to Eat
Shouldn't be used (ie- "clean your plate, children are starving in Africa")
-
Iron Deficiency
- Common in children
- Especially ages 9-18 months
- Most common in Mexican American children
-
Milk & Children Ages 1-5
No more than 24 ounces a day b/c of low iron content
-
What's a primary cause of dental decay?
Habitual use of a bottle with milk or fruit juice at bedtime or throughout the day.
-
What do diets adequate in iron & calcium seem to protect against?
High blood lead levels
-
In 1998, how may people lived in households where at least some members experienced hunger due to lack of food?
- 10 million people
- More than 1/3 were children
-
High Blood Lead Levels
Approx. 2.2% of children ages 1-5 have them
-
Overweight Children Ages 2-5
- BMI greater than or equal to 95th percentile
- 13.9% of children ages 3-5
-
Treatment of Obesity Ages 2-7 (w/ no Secondary Complications of Obesity)
Maintain weight while gaining height
-
#1 Cause of Death in the US Today
Heart disease
-
Children who have high LDL-cholesterol should restrict saturated fat to less than what percent of calories per day?
7%
-
Children who have high LDL-cholesterol should restrict dietary cholesterol to less than what amoung of mg per day?
200 mg
-
Good, Non-Meat Sources of Iron
- Dried peas & beans
- Fortified breakfast cereals
-
How soon can low-fat dairy products be used?
After 2 years of age
-
What is the estimated percentage of children ages 2-8 who consume less than their DRI for calcium?
21%
-
Approximately what percent of children ages 2-5 years old consume soft drinks?
50%
-
What supplement should children on vegan diets receive or eat food supplemented with?
Vitamin B12
-
Children in part-day childcare programs (4-7 hours daily) should receive food that provides at least how much of their daily calorie & nutrient needs?
Two thirds
-
Children w/ Developmental Delays-- Feeding Behaviors
May have feeding behaviors that are younger than their current chronological age
-
Dietary Recommendations for Autism
The same as for any other child of the same age who has feeding problems.
-
Which health problem results in more emergency room visits for children under 5 years of age as compared to older children?
Asthma
-
Preterm Babies in Toddlerhood
More likely as toddlers to have breathing problems than other toddlers
-
Food Allergies
Estimated to be present in 2-8% of children
-
What Improves the Intellectual Functioning of a Child with Down Syndrome?
Nothing
-
What are some food allergies that may result in anaphylaxis for some children is
-
5 Practical Applications of Child Feeding Research
- Serve child-size portions
- Serve food in an attractive way
- Don't allow children to eat & drink indiscriminately between meals & snacks
- Don't serve strongly flavored vegetables
- Don't force the child to stay at the table until they have finished "x" amount of food
-
Guidelines Recommended for Vegetarian Diets of Young Children
- Allow the child to eat several times a day
- Avoid serving the child bran and an excessive amount of bulky foods
- Include in the diet some sources of energy-dense foods
- Include enough fat (at least 30% of total calories) and a source of omega-3 fatty acids; Include sources of Vitamin B12,Vitamin D, and calcium in the diet, or supplement if required
-
Source of Vitamin B12
Fortified breakfast cereal
-
Source of Vitamin D
Fortified soy milk
-
-
Source of Omega-3 Fatty Acids
Canola oil
-
Source of Calcium
Broccoli
-
Potential problem of excessive fluid intake in toddlers and preschoolers with chronic conditions. What are the recommendations, and what are the risks if recommendations are not followed?
- Toddlers & preschoolers w/ chronic conditions are more likely to excessively consume fluids b/c it's often easier for their families to get these children to drink to try to get them to grow.
- The recommended juice intake for all children ages 1-6 is 4 to 6 fluid ounces.
- If these recommendations are not followed, gastrointestinal problems may be created, or children might have a smaller stature and lower bone density. For those children who have chronic conditions, the impact of consuming excessive fluids could be even greater.
-
Meal Plan for a Preschooler with Celiac Disease
- Breakfast: Soy milk, Grapefruit, Oats (as long as they are not contaminated w/ gluten from wheat mixed in)
- Snack: Banana, Orange Juice
- Lunch: Chicken (w/ no wheat flour for thickening, if processed), Green beans, Apple
- Snack: Raw carrots
- Dinner: Fish, Corn, english pea
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