1. How long does it take for birthweight to triple?
    12 months
  2. How much does birth length increase in the first year?
  3. How long does it take for birth length to double?
    4 years
  4. Weight increases ________ per year until age 9 or 10.
    • 2-3 kg
    • 4 1/2 -6 1/2 #
  5. Height increases ________ per year from age 2 until puberty.
    • 6-8 cm
    • 2 1/2 -3 1/2 "
  6. Fat reaches a minumum between ages
    4 & 6
  7. adiposity reboun
    increase in body fatness in preparation for the pubertal growth spurt
  8. growth channels are not well established until after
    age 2
  9. stunted growth
    both height and weight are proportionally low
  10. primarily wasted
    • weight deficit exceeds the height deficit
    • can gain more than a child with stunted growth
    • ex. 20 g/kg/d
  11. important nutrients during catch up growth
    • vitamin A
    • iron
    • zinc
    • more protein & energy are needed during the initial period of catch-up growth
  12. When does catch up in linear growth peak?
    1 to 3 months after treatment starts
  13. What determines energy needs for kids?
    • BMR
    • rate of growth
    • energy expenditure of activity
  14. energy intake proportions
    • 45-60 or 65% kcals from CHO
    • 25-40% kcals from fat
    • 10-30 or 35% kcals from protein
  15. Children between 1 and 3 years are at high risk for
    • iron-deficiency anemia
    • most at risk: prolonged bottle feeding & Mexican-American children
  16. Most recent NHANES data suggests childhood (age 2-19 years) obesity prevalence of...
  17. childhood obesity definition
    >95th percentile
  18. high BMI in children
    • > 85th percentile
    • prevalence of 31.7%
  19. overweight & obesity prevalence in ages 2-5 years
    • 21.1% have high BMI
    • 10.4% are obese
  20. early adiposity rebound is associated with
    • overweight in adulthood
    • (rebound befor 5 1/2 as opposed to after 7)
  21. Explain the multi-faceted etiology for childhood obesity
  22. Describe 5 health risks and associated medical conditions related to childhood obesity
  23. Explain the screening factors for childhood obesity
  24. acanthosis nigricans
  25. Explain the difference in MNT goals for children (2-7 yrs and >7yrs with a BMI >95 %tile)
  26. Explain how to dose the nutritional needs of an obese child
    • 40-60% kcal from CHO
    • 25-40% kcal from fat
    • 10-35% kcal from protein
  27. desribe 3 strategies used when counseling obese children
  28. Describe some of the common dietary modifications used to treat obese children
  29. Describe 5 health risks and associated medical conditions related to obesity
  30. explain the complex issues around the non-biological and biological etiologies for obesity
  31. Explain the two types of weight signaling (GI and adiposity)
    • GI signal: CCK, GLP-1, PYY, Ghrelin(activated when stomach is empty) - short term
    • Adiposity Signal: insulin, leptin, adiponectin - long term
  32. Discuss the components of nutrition assessment that are particular to working with a person with obesity.
  33. Describe 5 behavioral and dietary modifications that could be used when working with someone who is obese.
  34. Review pharmaceutical management of obesity
  35. Explain the predictors of long-term weight loss management
  36. some basic counseling techniques for obese patients
  37. Describe the stages of breast development and the structure and function of the breast
  38. Explain the physiology of milk production and let-down
    • oxytocin - hormone of expulsion & "let down" - signals dopamine to release from receptors
    • prolactin - responsible for breast milk production
    • dopamine- inhibits prolactin from reaching receptors
    • prolactin receptors multiply in 1st 2 weeks after birth
  39. Explain the nutritional needs of a nursing mother
    500 kcal/d
  40. differences between breast milk and formula
    • breastmilk has >200 components/ fomula ~20
    • breastmilk changes as pregnancy progresses and during feeding, time of day, etc.
    • BF babies may need vitamin D
    • BREASTMILK: curds are small & soft, moves through GI tract quickly, helps to close holes in gut, lots of live immune factors / cells
  41. List and explain the benefits (both to infant and mother) of breastfeeding
  42. Decide your stand on iron fortification of breast milk and formula
    if placenta was allowed to remain until it stopped beating, Fe supplementation may be unnecessary; exogenous Fe overwhelms lactoferrin which inhibits bacteria & it's heavier & harder to absorb
  43. Breastfeeding reduces risk of...
    • acute otitis media
    • atopic dermatitis
    • GI infection
    • Lower respiratory infections hospitalization rate
    • asthma
    • overweight
    • DM (I & II)
    • childhood leukemia
  44. Know the recommendations for continued breastfeeding
    • WHO, AAP - exclusive for ~ 6 mo.
    • continued for 2+ yrs (WHO), 1+ yr (AAP & AAFMDs)
  45. Describe the reasons for failure to thrive while breastfeeding
    • poor let-down (stress, drugs, HTN, smoking)
    • poor production (hyperthyroidism, antihistamines, development of alveolar tissue, caffeine, illness, diet, fatigue)
    • high energy requirement
    • low net intake (vomiting & diarrhea, malabsorption, infection)
    • poor intake (poor suck, infrequent feeding)
  46. Explain the transfer of drugs into breastmilk
    affected by milk/plasma ratio, molecular weight of drug, protein binding & lipid solubilit of drug
  47. AN
  48. BN
  49. BED
  50. EDNOS
  51. Be able to assess and dose nutritional needs and complete a nutritional assessment of a patient who either has AN, BN or BED
  52. discuss how to deal with trigger foods when working with patients
  53. explain the MNT goals for a patient with AN.
  54. explain some of the meal behaviors seen in patients with eating disorders
  55. Describe where fuel is stored and how energy is metabolized.
    • Liver: Glycogen → Glucose / AAs (Liver glycogen ≈ 400
    • calories (100 g CHO))
    • Adipose Tissue: TG, FA (Adipose tissue ≈ 80,000 calories (8888.9g fat)
    • Blood: Glucose, FFA, Deaminated AAs
    • Muscle: ATP, PCr, Glycogen, IMTG, Carbons from AAs (Muscle glycogen ≈ 1,400 calories (375 g CHO))
    • (—Intramuscular Triglycerides (IMTG) ≈ 3,000 calories (333.3g fat))
  56. Explain the production of ATP
  57. Describe fuel utilization and the sources of energy during 4 hours of exercise
    • PCr - 10 seconds - Fast ATP - Short, quick, powerful
    • Carbs - 1-3 min without oxygen - >60 min with oxygen - Higher intensity
    • Fat - Long, requires oxygen - Slow ATP - Low intensity
  58. Describe how athletes can prevent “bonking” or “hitting the wall”
    prefuel with carbs
  59. Explain why each macronutrient is important and understand how to dose the nutritional needs of an athlete
    • CHO: —Pre: Meal 3-4 hours prior/Snack 30-60 min prior,
    • —During: 30-60 g/hr, —Post: 30-min recovery window (0.8-1.5 CHO/kg BW)

    • Protein: Current Reference intake =—0.8 g/kg/day, Endurance athletes = —1.2-1.4 g/kg/day
    • Resistance athletes = —1.6-1.7 g/kg/day, —In practice: Max 2g/kg (155g protein/170# athlete)

    FAT: Rx: 20-30% kcals from, Not <15%
  60. State the position of the American Dietetic Association, Dietitians of Canada and the American College of Sport’s Medicine on working with nutrition and athletic performance.
  61. State the position of the American College of Sports Medicine on exercise and fluid replacement
    • ACSM daily fluid rx:
    • WOMEN 91 fl. oz. (~3 L)
    • MEN 125 fl. oz. (~4 L)
  62. Describe the guidelines for adequate hydration and the consequences of inadequate fluid intake to an athlete
  63. Explain the five assessment measures for athlete iron status
  64. Discuss the biochemical framework for iron status
  65. Recommend key education points for a dietitian working with an athlete who is at risk or has been diagnosed with anemia
  66. is anemia a diagnosis or a symptom
  67. Who is affected by anemia?
  68. Anemia
    • deficiency in size or number of erythrocytes or amount of
    • hemoglobin they contain

    Limits exchange of oxygen and CO2 between blood and tissue cells
  69. Iron Deficiency Anemia
    Characterized by the production of small (microcytic) erythrocytes and diminished level of circulating hemoglobin

    Last stage of iron deficiency

    Represents the end point of a long period of iron deprivation
  70. Stages of Iron Depletion and Deficiency
    • Depletion
    • Stage I—early negative iron balance
    • Stage II—severe iron depletion

    • Deficiency
    • Stage III—inadequate body iron, dysfunction and disease
    • Stage IV—iron deficiency anemia
  71. Progressive Stages of Iron Deficiency
    6 different measured used to evaluate stages
    1.Quantity of serum or plasma ferritin

    2.Quantity of serum or plasma iron

    3.Quantity of total circulating transferrin

    4.Percent saturation of circulating transferrin

    5.Percent saturation of ferritin with iron

    6.Quantity of soluble serum transferrin receptor (STFR)
  72. Symptoms of Iron Deficiency
    • Decreased work performance and exercise tolerance
    • Fatigue, anorexia, and pica
    • Abnormal cognitive development in children
    • Growth abnormalities, epithelial disorders, reduced gastric
    • acidity
    • Koilonychia - spoon-shaped nails
    • Reduced immunocompetence
    • If severe, cardiovascular and respiratory changes
  73. Tests for Iron Deficiency
    • Most sensitive: serum ferritin and transferrin saturation
    • Zinc protoporphyrin/heme ratio: affected by other factors
    • Total iron binding capacity (TIBC) declines and serum ferritin levels rise in chronic disease unrelated to
    • iron
    • Hemoglobin alone is an unsuitable diagnostic tool
  74. Hemochromatosis
    • A genetically determined form of iron overload that results
    • in progressive hepatic, pancreatic, cardiac, and other organ damage

    • MNT
    • Ingest less heme iron and more nonheme iron
    • Avoid alcohol and vitamin C supplements
    • Avoid highly fortified foods
    • Avoid iron supplements
  75. Iron Toxicity (types)
    • Thalassemias
    • Sideroblastic anemia
    • Chronic hemolytic anemia
    • Aplastic anemia
    • Ineffective erythropoiesis
    • Transfusional iron overload
    • Porphyria cutanea tarda
    • Alcoholic cirrhosis
  76. Megaloblastic Anemias
    • Disturbed synthesis of DNA results in morphologic and
    • functional changes in erythrocytes, leukocytes and platelets in blood and bone
    • marrow
    • Usually caused by folic acid or vitamin B12 deficiency or both
  77. pernicious anemia
    A macrocytic, megaloblastic anemia caused by a deficiency of vitamin B12, secondary to lack of intrinsic factor (IF) or other causes

    • Stage I: early negative vitamin B12 balance
    • Stage II: vitamin B12 depletion
    • Stage III: damaged metabolism: vitamin B12 deficient erythropoiesis
    • Stage IV: clinical damage including vitamin B12 deficiency anemia
    • Pernicious anemia: numbness in hands and feet; poor muscular
    • coordination; poor memory; hallucinations
    • May be irreversible if severe
  78. Stages of Folate Depletion and Deficiency
    • Stage I: early negative folate balance (serum depletion)
    • Stage II: negative folate balance (cell depletion)
    • Stage III: damaged folate metabolism with folate-deficient erythropoiesis
    • Stage IV: clinical folate deficiency anemia: elevated MCV and anemia
  79. Nutritional Anemias
    • Pernicious (B12 deficiency) anemia (megaloblastic)
    • Folate deficiency anemia (megaloblastic)
    • Copper deficiency anemia
    • Anemia of protein-energy malnutrition
    • Sideroblastic (pyridoxine-responsive) anemia
    • Vitamin E–responsive (hemolytic) anemia
  80. Sideroblastic Anemia
    • Microcytic, hypochromic form
    • Inherited defect of heme synthesis enzyme
    • Buildup of immature sideroblasts; hence the name
    • B6 is essential; must replace 25 to 100 times the RDA; may need lifelong replacement
  81. Hemolytic Anemia
    • Oxidative damage to cells; lysis occurs
    • Vitamin E is an antioxidant that seems to be protective
    • This anemia can occur in newborns, especially preemies
  82. nonnutritional anemias
    • Sports anemia (hypochromic microcytic transient anemia)
    • Anemia of pregnancy
    • Anemia of inflammation, infection, or malignancy (anemia of
    • chronic disease)
    • Sickle cell anemia
    • Thalassemias
  83. sports anemia
    • Transient problem of blood volume and dilution
    • Consume iron-rich foods; adequate protein; avoid tea, coffee, antacids, H2-blockers, and tetracycline
    • No need for iron supplements unless true deficiency based on CBC, serum ferritin level, serum iron level, TIBC, and 5
    • saturation of iron-binding capacity
  84. sickle cell anemia
    • Pain management
    • Keep body oxygenated; exchange transfusion if needed
    • Do not mistake for iron deficiency anemia; iron supplements
    • may cause excessive iron stores
    • Zinc supplements may be useful
    • Encourage adequate intake, avoid supplements that contain
    • iron, avoid alcohol, adequate fluid, diet low in absorbable iron
  85. thalassemia
    • Severe inherited anemias due to defective globin formation in hemoglobin
    • Microcytic hypochromic and short-lived red blood cells
    • Mostly in Mediterranean region
    • Damage due to iron accumulation in tissues and oxidative
    • damage
    • Require transfusions and chelation therapy to stay alive
    • Malnutrition is common
Card Set
obesity, eating disorders, anemias, breastfeeding