NUTRITION DURING THE FIRST YEAR OF LIFE

1. NUTRITION DURING THE FIRST YEAR OF LIFE

2. BREAST FEEDING Definition: Breastfeeding is infant`s nutrition during the first 4 – 6 months of life with human milk only. Methods: • breast feeding • bottle feeding with human pumped milk • with teaspoon • gavage

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4. BREAST FEEDING The mechanism of milk secretion:Endocrine factor: - estrogens, - placental lactogen hormone.Nervous factor

5. The mechanism of milk secretion Endocrine factor:  Prolactin controls the beginning and milk secretion.  In pregnancy: actual ↑ ↑ ↑ h estrogen inhibits prolactin.  After removal of the placenta: ↓ ↓ → h estrogen prolactin acts freely → lactation.  Estrogens through pituitary hormones (mamogeni factors 1 and 2) determine changes in the mammary gland lactation.

6. The mechanism of milk secretion Factor Nervous  - reflex act by excitations from the nipple and areola   - contribute to the formation and maintenance of milk secretion.

7. HUMAN MILK COMPOSITION Mammary gland secretion: - colostrum - transitional milk, - mature milk.Colostrum: - lactation within 5 days after birth - opaque yellow liquid, - Ig richer in protein than human milk and mature.

8. Colostrum Protein - varies between 27-41 g / l - diminishes as soon as the milk flow.Immunoglobulins: - initially very high, which decrease during the first days after birth. - 90% of total Ig are IgA (Ac polio Anticoli, antistaphylococcal, anticoxakie).   Action from colostrum (resistant to digestive enzymes) + Ac secreted by the gut destroy pathogens in the digestive tract → high degree of local immunity.

9. Colostrum Colostrum is adapted to the needs of the newborn in the first days of life, with increased quantities of: - lactoferrin - secretory IgA, - protein bound vitamin B12 - zinc - lipase, alpha-amylase, phosphatase, protease inhibitors - taurine

10. Colostrum Carbohydrates: - total of 55-60 g / l - proportion of lactose is small (37 g / l) - oligosaccharides (23g / l), promotes implantation of the newborn intestine of the Bacillus bifidus.

11. Colostrum Total lipids: - initial 30g / l, in conjunction with low activity of intestinal lipase n.b then increase their level - unsaturated fatty acids are essential especially those in large quantities and have a role in nervous system development.

12. Colostrum Mineral salts: - the amount of 3.9 g / l - the Na, P, Ca, Fe, Zn, Cu more in line with that of protein.Vitamins A, E, C, B12 are well represented in colostrum compared with mature milk.Caloric value = 58 kcal/100ml.

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14. Transitional milk • on the 6th and 10th postpartum, although biochemical and immunological changes continue until one month; -  decreases the protein, mineral salts, pH,-  increase the level of lipids and lactose.

15. Mature human milk (h.m.) Water - 87%.Total Protein - 10g / l:  4g / l casein  6g / l of whey protein (lactalbumin and lactoglobulin)   Human milk is a milk type albumin.

16. Mature human milk Human casein:  - mammary gland synthesis of amino acids in the blood  three fractions (alpha, beta and kappa)  - kappa - casein has a role in colonization of the intestinal bifidus Bacilus in breastfed infant.

17. Mature human milk Proteins in whey:  Alfalactalbumina - contains lactosintetaza, an enzyme involved in lactose synthesis;   Lactoferrin - glycoprotein capable of reversibly bind iron milk → Fe absorption in the intestines and stomach. - iron chelator → bacteriostatic action. - additional factor of protection against intestinal pathogens, with IgAs, Lactobacilus lysozyme and bifidus.

18. Mature human milk Proteins in whey:- Betalactoglobulina milk is absent → human milk are nealergizant.- serum albumin → ligand role for folate, vit. B12, tyrosine, zinc. Immunoglobulins: IgAs - agglutinate of food antigens, bacterial enterotoxins and viruses, blocking their adhesion to epithelial surfaces,- Ac containing anti E. coli, Shigella, Salmonella, Klebsiella, Coxackie, Echo, polio virus, hepatitis B and measles virus.

19. Mature human milk Ig G and Ig M:- small quantities in milk,- serum Ig does not differ structurally.Enzymes in human milk - a role in:- digestion of milk components- antibiotic protection.Lysozyme:- contribute to lysis of intestinal bacteria,- enhances antibody formation.

20. Mature human milk - Enzymes Lipases have a role in digestion of human milk triglycerides.Alfaamilaza:- catalyzes the hydrolysis of starch into maltose- pancreatic and intestinal amylase offset deficit in the infant.Proteases and protease inhibitors:- greater amount compared with cow's milk- catalyzes the hydrolysis of proteins.

21. Mature human milk Amino acids:taurine - a role in absorption of lipids and brain development. Human milk proteins are absorbed and used by the infant with optimal efficiency.No physical or chemical process does not allow for similar proteins in human milk.

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23. Mature human milk Carbohydrates - 70 g / l: - lactose (beta-lactose - 60 g / l) - a source of galactose(cerebrozidelor composition of the brain); - oligosaccharides (10 g / l) - role in the defense of non-specific antibiotic (promotes intestinal colonization with Lactobacilus bifidus).

24. Mature human milk Lactobacilus bifidus - roles: - causes acidification of the intestinal environment → inhibits the growth of pathogens - anemic and antirickets (promotes absorption of Fe, Ca, vit. D and lipid) - synthesis of vitamins B and K.

25. Mature human milk Lipids: 36 - 40 g / lfatty acids (FA), mono and polyunsaturated fats (oleic acid, palmitoleic and linoleic)  -over half of the total FA h.m.  - role in CNS maturation in the newborn periodtriglycerides - report equally between unsaturated and saturated FA.

26. Mature human milk Cholesterol and lecithin:  large quantities h.m. than c.m.The presence of lipase in human milk: - facilitates lipid hydrolysis - FA promote rapid release of usable energy metabolism.

27. Mature human milk Mineral salts and trace elements:- content four times lower than c.m., less influenced by maternal dietary intake, being provided by maternal stores. - thus, if sufficient phosphorus and calcium are the mother's diet, they are obtained through its mobilization from bone deposits.

28. Mature human milk Sodium: → low amount of renal function overloading is avoided.Calcium four times and phosphorus 6-7 times less than the c.m., but the Ca : P = 2 : 1 is favorable for their proper use.Iron: - amount of two times higher in h.m. - intestinal absorption and incorporation into the hemoglobin molecule is much higher in infants breastfed.

29. Mature human milk Vitamins:soluble (A, D, E, K)soluble (C, folic acid, vitamin complex. B)  - varying proportions, in relation to food intake.  - a balanced diet of the mother provides adequate intake of these vitamins, except vitamin D.

30. Mature human milk The amount of vitamin D in human milk does not provide even if your baby needs a proper sun exposure, but is higher than that of cow's milk, which explains the lower incidence of rickets in infants breastfed.The energy value of h.m. mature = 65-68 kcal/100ml.

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32. Factors of human milk 1. Antiinfectious protection factors: - immunological - biological - provide protection against infectious agents from the environment until the baby develops its own immunity. breastfed infants versus artificially fed infants: -low rate of hospitalization-low incidence of respiratory infections, diarrhea, a rash, etc. sites.

33. Factors of human milkAntiinfectious protection factors Cellular factors (macrophages, neutrophils, Ly B and T):  anti-infective role in maternal mammary gland and infant's digestive tract (protects against enterocolitisulceronecrotics).Immunoglobulins - IgAs: - opsonizant role, - mobilize and agglutinate bacteria, viruses and antigens of food,  Ly stimulates the formation of intestinal mucosal IgA in the infant.

34. Factors of human milkAntiinfectious protection factors Lactoferrin - bacteriostatic role.Lysozyme - a role in combination with complement and antimicrobial IgAs, which potentiates the action.Lactoperoxidase - bactericidal action against germs like Pseudomonas, E. coli, Salmonella, Streptococcus.

35. Factors of human milkAntiinfectious protection factors Mucin - prevent adhesion of germs and rotaviruses to the surface of intestine.C3 and C4 fractions of complement - role in chemoattraction of phagocytes and intracellular incorporation of particles.Bifidogens factors (glycoproteins and oligosaccharides) - role in promoting growth of Lactobacilusbifidus in the intestine of breastfed infant.

36. Factors of human milk 2. Modulators of growth factors:- stimulates growth of mammary gland- acting on the baby's organs.Epidermal growth factor (epidermal GrowthFactor - EGF) and insulin-like growth factor (Insulin-like growth factor: IGF-1) - role in the maturation of the gastrointestinal tract.

37. Factors of human milkModulators of growth factors Nervous growth factor - essential for the development of sympathetic neurons and sensory cells.B-cell stimulating factor - role in the proliferation of Ly B and production of immunoglobulins.Taurine - improves fat absorption and promotes intestinal colonization of Lactobacilusbifidus.

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39. Other qualities of human milk - is always fresh and available (immediately available); - does not involve special training (breast care is required); - is the ideal temperature; - is aseptically; - not cause allergies or intolerance; - has an optimum power distribution, the total energy being supplied by fat (55%), carbohydrates (38%) and protein (7%).

40. Evolution of milk secretion "Anger milk" = colostrum transformation in transition milk and then mature h.m.Clinical Manifestations:turgescence of mammary glands ± pain, local hyperthermia,  fever, headache, tachycardia.Paraclinical: leukocytosis with lymphocytosis and eosinophilia.

41. Evolution of milk secretion "Psychosis lactation" = mental status changes that mayup to manic states - depression.- these phenomena disappear spontaneously in most cases.- mothers rarely requires admission to psychiatric hospitals.

42. Evolution of milk secretion Maximum intensity of milk secretion: - between day 15 and 3 months after birth; - may take a year or more, if stimulated by sucking or squeezing the breast.Composition of human milk varies: - according to the stages of lactation - after the time of day (diurnal variations / nocturnal) - from one breast to another, - the same breast over the meal.

43. Evolution of milk secretion At the same table at the end of meal milk (“hindmilk “) is richer in fat and protein than that of the beginning of the meal ("foremilk"), so it's hearty and nourishing.Administration only h.m. after the age of 6 months is not sufficient quantity and quality for infant development.

44. Factors influencing lactation -age: young women → more abundant milk secretion;-  parity: primiparous lactation to be installed with a delay of several days; - kinds of birth: interventions from birth (cesarean, forceps, perineorafie) by trauma and postoperative diet are important factors in milk secretion inhibitors; - feeding, resting, graded exercise and especially psychological factor contributing to maintaining a good milk secretion;

45. Milk secretion Stimulation of milk secretion: - sucking - mammary gland drained, - ensuring physical comfort of the mother.Agalactic: extremely rare.Hipogalactic: more common in primiparous, the intellectual, women who do not comply with resting.Spontaneous flow of milk secretion: this may be a sign of hipogalactic.

46. Benefits of breast feeding Benefits for children: - optimal growth and physical development - h.m. has all the nutrients needed, in quantities and proportions ideal for a child's needs and maximum bioavailability; - mother - child bonding - solid and sustainable with long-term consequences of child mental health.

47. Benefits of breast feedingBenefits for children low morbidity by:-  much lower risk of malnutrition, acute diarrheal diseases, intestinal parasites, dental disease (caries, malocclusion, periodontal disease); - incidence lower than 50% of the malignant process during 0-16 years; - respiratory and ENT pathology rarer and less serious;

48. Benefits of breast feedingBenefits for children low morbidity by:  - allergic asthma and different more rare and mild forms;  - diabetes mellitus and risk of sudden death in infants less than 2-3 times;  -urinary infections 5 times more rare in the first 6 months of life; - protective role against hypertension and ateromatosis.

49. Benefits of breast feeding Benefits for the mother: - affective (psycho-emotional)  - direct physical contact (skin to skin ") parent - child positive emotional reactions → ↓ risk of abuse, neglect or mistreatment of children and ↓ risk of postpartum depression;

50. Benefits of breast feedingBenefits for the mother - contraception → tasks spacing → effects on reproductive health of the mother; - decreases the risk of breast cancer, ovary cancer; - a lower incidence of osteoporosis is whether breast lasted more than nine months.