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NUTR 337 (6)
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Lactation Summary.doc

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Department
Nutrition and Dietetics
Course
NUTR 337
Professor
Stan Kubow
Semester
Winter

Description
Lactation Dietary Usual Requirement Reason Requirement Intake Energy EER+ Milk Energy Ouput -170kcal=0.8kg/mo wgt loss -Weight Loss= -calculation 0.67kcal/g milk has been used 1st6mo: EER+500-170 -Avg milk production (US): 0.78L/day 1st 6mo. and 0.6L/day 7-12mo. for in term infants 2nd 6mo: EER+400-0 -assumed weight stability reached 6mo postpartum -unlikely Thermic Effect from lactating major impact -activity pattern variable therefore not all will mobilize E from tissues-> avg. loss 0.8kg/mo (subcutaneous fat-> the unsubcutaneous fat actually increased); most E obtained from diet vs tissue stores Protein RDA RDA -Factorial approach: assumed that process of lactation does not alter the maintenance 0.8g/kg/d 1.1g/kg/day of protein or protein requirement AND that the protein and/or amino acid requirement is increased in +25g/day of additional proportion of milk production. protein (lost during -20-27% milk N is nonprotein- mainly urea (diversion of urea loss from urine + colonic lactation-reference body fermentation to milk) weight of 57kg) -total protein output+nonprotein N in milk= additional protein requirement- factor 6.25 -assumed cost of making protein for maintenance= growth and lactation= incremental CV=12% efficiency of N utilization of 0.47 -0.8+0.44g/kg/d rounded to lower 0.1=1.1g/kg/d EAR*124% N-6 Fatty AI 11g/day AI 13g/day -No evidence that dietary intervention has any effect on infant growth and Acids development->AI set based on median intake of lactating women without df. N-3 Fatty AI 1.1g/day AI -Studies show lower plasma and rbc lipid DHA levels in lactating women due to either Acids 1.3g/day declining status due to inadequate intake OR a normal physiological responses to the changes in endocrine status, lipoprotein and lipid metabolism or nutrient transfer that accompany pregnancy and lactation -Lack of evidence to determine requirement or need to increase from current median intake: AI based on median intakes of lactating women without df. -Small amount of EPA and DHA can contribute towards reversing df. -Fish oil supplements=increase mother milk and newborn DHA (almost all absorbed) Carbohydrates 130g/day RDA -Higher RQ and rates of CHO utilization have been reported- mammary gland 210g/day (increased) preferentially uses glucose 130%EAR -74g/L of lactose in human milk (need more precursors, ie glucose, either as glucose CV-15% or aas to prevent endogenous protein store use for glucose production-glycerol from fat stores can be used to but its use is limited). -EAR based on variation of glucose utilization by the brain. Dietary Usual Requirement Reason Requirement Intake Energy EER+ Milk Energy Ouput -170kcal=0.8kg/mo wgt loss -Weight Loss= -calculation 0.67kcal/g milk has been used 1st6mo: EER+500-170 -Avg milk production (US): 0.78L/day 1st 6mo. and 0.6L/day 7-12mo. for in term infants 2nd 6mo: EER+400-0 -assumed weight stability reached 6mo postpartum -unlikely Thermic Effect from lactating major impact -activity pattern variable therefore not all will mobilize E from tissues-> avg. loss 0.8kg/mo (subcutaneous fat-> the unsubcutaneous fat actually increased); most E obtained from diet vs tissue stores Protein RDA RDA -Factorial approach: assumed that process of lactation does not alter the maintenance 0.8g/kg/d 1.1g/kg/day of protein or protein requirement AND that the protein and/or amino acid requirement is increased in +25g/day of additional proportion of milk production. protein (lost during -20-27% milk N is nonprotein- mainly urea (diversion of urea loss from urine + colonic lactation-reference body fermentation to milk) weight of 57kg) -total protein output+nonprotein N in milk= additional protein requirement- factor 6.25 -assumed cost of making protein for maintenance= growth and lactation= incremental CV=12% efficiency of N utilization of 0.47 -0.8+0.44g/kg/d rounded to lower 0.1=1.1g/kg/d EAR*124% N-6 Fatty AI 11g/day AI 13g/day -No evidence that dietary intervention has any effect on infant growth and Acids development->AI set based on median intake of lactating women without df. Dietary Fiber AI 29g/day No evidence of beneficial effects of extra fiber in reducing the risk of CHD than that of 14g/1000kc (2066kcal*14g/1000kcal) nonpregnant women. al Water AI AI -No evidence to suggest that renal function and hydration status are different during 2.3-2.9L 3.8L/day lactation- AI based on median total water intakes -nonpregnant needs + water content of avg. milk output during 1st 6mo. (0.78Lmilk*87%=0.68L)=2.9, 3.4 and 3.6L (14-18, 19-30 and 31-50yr) Electrolyte Usual Requirement Requirement Reason Potassium AI AI -Av. 0.4g/d in milk during first 6 mo of lactation. ♂♀4.7g/d 5.1g/d -Efficiency of conversion of dietary K to milk almost 100%. Sodium AI AI -No evidence to suggest that sodium requirements of lactating women ♂♀sedentary 1.5g/d 1.5mg (65mmol)/d and differ. (>if active with no UL) 2.3g (65mmol)/d chloride -0.12mg/d is secreted daily in human milk in first 6 months. -Chloride set to be equimolar to sodium. Dietary Usual Requirement Reason Requirement Intake Energy EER+ Milk Energy Ouput -170kcal=0.8kg/mo wgt loss -Weight Loss= -calculation 0.67kcal/g milk has been used 1st6mo: EER+500-170 -Avg milk production (US): 0.78L/day 1st 6mo. and 0.6L/day 7-12mo. for in term infants 2nd 6mo: EER+400-0 -assumed weight stability reached 6mo postpartum -unlikely Thermic Effect from lactating major impact -activity pattern variable therefore not all will mobilize E from tissues-> avg. loss 0.8kg/mo (subcutaneous fat-> the unsubcutaneous fat actually increased); most E obtained from diet vs tissue stores Protein RDA RDA -Factorial approach: assumed that process of lactation does not alter the maintenance 0.8g/kg/d 1.1g/kg/day of protein or protein requirement AND that the protein and/or amino acid requirement is increased in +25g/day of additional proportion of milk production. protein (lost during -20-27% milk N is nonprotein- mainly urea (diversion of urea loss from urine + colonic lactation-reference body fermentation to milk) weight of 57kg) -total protein output+nonprotein N in milk= additional protein requirement- factor 6.25 -assumed cost of making protein for maintenance= growth and lactation= incremental CV=12% efficiency of N utilization of 0.47 -0.8+0.44g/kg/d rounded to lower 0.1=1.1g/kg/d EAR*124% N-6 Fatty AI 11g/day AI 13g/day -No evidence that dietary intervention has any effect on infant growth and Acids development->AI set based on median intake of lactating women without df. Thiamin RDA RDA -Assumed 0.16mg transferred into milk/d (if milk production is 0.78L) + (B1) ♀ >19yr 1.1mg/d 1.4mg 0.1mg to cover energy cost of milk production. -10% diff sexes based on E CV 10% -Needs may be slightly dec. if BF older infants eating solid foods due to utilization and size difference. dec. volume of milk prod. Riboflavin RDA RDA -0.3mg transferred in milk/d->add 0.4mg due to 70% efficiency to use (B2) ♀>19yr 1.1mg/d 1.6mg/d riboflavin for milk production by mother. CV 10% -If BF more than 1 infant, may require more. -If BF older infants who are eating solid foods need dec. in proportion to lower volume of milk production. Niacin (B3) RDA RDA -Estimated 1.4mg of preformed niacin is secreted daily during lactation ♀♂>19yr 16mg/d 17mg/d +1mg to cover energy expenditure involved in milk production. CV 15% (due to -Not expected to be enough to feed more than 1 infant. efficiency of converting tryptophan to niacin) Dietary Usual Requirement Reason Requirement Intake Energy EER+ Milk Energy Ouput -170kcal=0.8kg/mo wgt loss -Weight Loss= -calculation 0.67kcal/g milk has been used 1st6mo: EER+500-170 -Avg milk production (US): 0.78L/day 1st 6mo. and 0.6L/day 7-12mo. for in term infants 2nd 6mo: EER+400-0 -assumed weight stability reached 6mo postpartum -unlikely Thermic Effect from lactating major impact -activity pattern variable therefore not all will mobilize E from tissues-> avg. loss 0.8kg/mo (subcutaneous fat-> the unsubcutaneous fat actually increased); most E obtained from diet vs tissue stores Protein RDA RDA -Factorial approach: assumed that process of lactation does not alter the maintenance 0.8g/kg/d 1.1g/kg/day of protein or protein requirement AND that the protein and/or amino acid requirement is increased in +25g/day of additional proportion of milk production. protein (lost during -20-27% milk N is nonprotein- mainly urea (diversion of urea loss from urine + colonic lactation-reference body fermentation to milk) weight of 57kg) -total protein output+nonprotein N in milk= additional protein requirement- factor 6.25 -assumed cost of making protein for maintenance= growth and lactation= incremental CV=12% efficiency of N utilization of 0.47 -0.8+0.44g/kg/d rounded to lower 0.1=1.1g/kg/d EAR*124% N-6 Fatty AI 11g/day AI 13g/day -No evidence that dietary intervention has any effect on infant growth and Acids development->AI set based on median intake of lactating women without df. Vitamin B6 RDA RDA -0.13mg/L in milk and need to consume 5x that amount to get this ♂♀ 19-50yr 1.3mg/d 2mg/d much. CV 10% -Evidence that low maternal intakes can lead to compromised B6 status in infants. Biotin AI AI -To cover # secreted in milk. No distinction made for the stage of ♂♀>19yr 30Ug/d 35Ug/d lactation or age. Folate RDA RDA -EAR based on folate to be secreted in milk + to maintain status ♂♀>19yr 400Ug/d 500Ug/d -Extra need=0.78L (milk volume)*85Ug/L (folate in milk)*2(50% Aging not associated with red. CV 10% bioavailability correction factor)=133Ug/d (+320Ug EAR) ability to use folate -Women who partially BF need less. Folate from supplements or fortified foods in addition to dietary folate is recommended for women capable of becoming pregnant. Dietary Usual Requirement Reason Requirement Intake Energy EER+ Milk Energy Ouput -170kcal=0.8kg/mo wgt loss -Weight Loss= -calculation 0.67kcal/g milk has been used 1st6mo: EER+500-170 -Avg milk production (US): 0.78L/day 1st 6mo. and 0.6L/day 7-12mo. for in term infants 2nd 6mo: EER+400-0 -assumed weight stability reached 6mo postpartum -unlikely Thermic Effect from lactating major impact -activity pattern variable therefore not all will mobilize E from tissues-> avg. loss 0.8kg/mo (subcutaneous fat-> the unsubcutaneous fat actually increased); most E obtained from diet vs tissue stores Protein RDA RDA -Factorial approach: assumed that process of lactation does not alter the maintenance 0.8g/kg/d 1.1g/kg/day of protein or protein requirement AND that the protein and/or amino acid requirement is increased in +25g/day of additional proportion of milk production. protein (lost during -20-27% milk N is nonprotein- mainly urea (diversion of urea loss from urine + colonic lactation-reference body fermentation to milk) weight of 57kg) -total protein output+nonprotein N in milk= additional protein requirement- factor 6.25 -assumed cost of making protein for maintenance= growth and lactation= incremental CV=12% efficiency of N utilization of 0.47 -0.8+0.44g/kg/d rounded to lower 0.1=1.1g/kg/d EAR*124% N-6 Fatty AI 11g/day AI 13g/day -No evidence that dietary intervention has any effect on infant growth and Acids development->AI set based on median intake of lactating women without df. Vitamin RDA RDA -Avg. 0.33Ug/d secreted in milk in first 6 mo and 0.25Ug/d in second B12 ♂♀>19yr 2.4ug 2.8Ug/d 6mo. CV 10% -EAR=0.33Ug+2Ug=2.4Ug->1.2EAR=RDA=2.8Ug/d -Low [B12] in human milk occurs in 2 situations related to inadequate intake: when mother is a strict vegetarian and in developing countries where the usual consumption of animal products is low. Choline AI AI -Mechanisms to conserve maternal choline status not ided and large ♀>19yr 425mg/d 650mg/d about secreted in human milk. -Assumed avg. milk volume 0.78L/d and avg. 156mg/L of choline. Pantothenic AI AI -Inc. content in milk with inc. intake of vitamin and, at intakes of 5- acid ♂♀>19yr 5mg/d 7mg/d 6mg/d, blood levels are lower in lactating women at 3 mo postpartum and at 6 wks postpartum than for control women who had not been pregnant. -No evidence intakes are inadequate to support function during lactation. -1.7mg secreted in milk. Dietary Usual Requirement Reason Requirement Intake Energy EER+ Milk Energy Ouput -170kcal=0.8kg/mo wgt loss -Weight Loss= -calculation 0.67kcal/g milk has been used 1st6mo: EER+500-170 -Avg milk production (US): 0.78L/day 1st 6mo. and 0.6L/day 7-12mo. for in term infants 2nd 6mo: EER+400-0 -assumed weight stability reached 6mo postpartum -unlikely Thermic Effect from lactating major impact -activity pattern variable therefore not all will mobilize E from tissues-> avg. loss 0.8kg/mo (subcutaneous fat-> the unsubcutaneous fat actually increased); most E obtained from diet vs tissue stores Protein RDA RDA -Factorial approach: assumed that process of lactation does not alter the maintenance 0.8g/kg/d 1.1g/kg/day of protein or protein requirement AND that the protein and/or amino acid requirement is increased in +25g/day of additional proportion of milk production. protein (lost during -20-27% milk N is nonprotein- mainly urea (diversion of urea loss from urine + colonic lactation-reference body fermentation to milk) weight of 57kg) -total protein output+nonprotein N in milk= additional protein requirement- factor 6.25 -assumed cost of making protein for maintenance= growth and lactation= incremental CV=12% efficiency of N utilization of 0.47 -0.8+0.44g/kg/d rounded to lower 0.1=1.1g/kg/d EAR*124% N-6 Fatty AI 11g/day AI 13g/day -No evidence that dietary intervention has any effect on infant growth and Acids development->AI set based on median intake of lactating women without df. Vitamin E ♂♀ 15mg/d of 2R RDA -Estimated 4mg avg. secreted daily in milk in first 6 mo. stereoisomeric forms ɑ- 19mg/d of ɑ-tocopherol -EAR=(12mg+4)1.2=19mg tocopherol=RRR-, -Median intake reported for lactating women is 8.4mg/d but estimates of RSR-,RRS-,RSS (30mg/d of all CV 10% vit. E intake are underreported and vit. E df in infants receiving human rac-ɑ-tocopherol milk is extremely rare-> supplementation unnecessary. Vitamin C RDA RDA -Avg. 40mg/d produced in milk in 1st 6 mo. ♀>19yr 75mg/d 14-18yr 115mg/d -Vit C content dec. with length of lactation and milk volume dec. with 19yr + 120mg/d addition of solid foods, but EAR does not dec. for longer periods of CV 10% lactation. Vitamin A RDA RDA -Human milk fed infants consume on avg. 400Ug/d of vit. A in first 6 mo. ♀>19yr 700Ug/d 14-18yr 1200Ug RAE/d -Rounded to nearest 100Ug of Retinol activity equivalents19yr + 1300Ug RAE/d (RAE) CV 20%->1.4EAR Dietary Usual Requirement Reason Requirement Intake Energy EER+ Milk Energy Ouput -170kcal=0.8kg/mo wgt loss -Weight Loss= -calculation 0.67kcal/g milk has been used 1st6mo: EER+500-170 -Avg milk production (US): 0.78L/day 1st 6mo. and 0.6L/day 7-12mo. for in te
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