INTRODUCTION TO NUTRITION Nutition ie a vtal component jo overall wellnece and health. Dict alfecte energy, well being and many disease states. There is a connection between lifetine nutritional habits end the risks of many chronic diseases such as cardio vascular diseases, diabetes, cancer. A well balanced diet can prevent such concitions and improve energy levele and over all health and wollnege. The basie of nutrtion ‘e FOOD Definition of term 1) Nubiton —is the study of ood in relation 1o heat, 2) Food isany eubstence when ingested or eaten nourishes the body. 3) Nutrient —is a chemival component needed by the body to provide energy. to build and repair tssues and to requlate life process. 4) Digestion — it is a mechanical and chemical breakdown of food into smaller components. 5) Absorplion — itis a process where the nutriants from foods ate absorb by the body into the bloodstreams. 6) Metabelism—is a chemical process of transforming foods into other substance to sustain lle 7) En2ymes —an organic catalyst that ate protein in nature and are produced by lving cells. ‘A catalysi speeds up or slows dovmn chemical reactions wihoutitsett undergoing change 8) Nutritional Staius —is the conditin of the body resulting irom the utiization of cessertial nutriens, 9) Calbrie —tuel potential a food. Cne calorie represents ihe amount o! heat requred toraise one iter of water one degree Celsius. 410) Malnutrition — It isthe concition of the body resuliing kom a lackaf one or mare cessertial nuiien's or due to excessive nutrient supply.‘The Digestive System Mouth: The digestive process begins in the mouth. Food is party broken down by the process of chewing and by the chemical action of salivary amylase (these ‘enzymes are produced by the salivary glands and break down starches into ‘smaller molecules), Qn the way to the stomach: Esophagus - After being chewed end swalowed, the food enters the ‘esophagus. Tho esophagus ‘© a long tubo that runs from the mouth to tho stomach. It uses rhylhmie, wave-lke muscle mavements (called peristalsis) to {force food {rom the throat into the stomach. This muscle movement gves us the bill to eat or drink even wien we'te upside-down. ‘Stomach ~ The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly gested and mixed with stomach acids is called chyme. ‘Small intestine — absorption happens in the small intestine. Sie (produced in the liver and stored in the gall blacder), parteatic enzymes, and other digestive ‘enzymes produced by the inner wall of the small intestine help in the breakdown of food, Large Intestine — Uncigesied food passes in the large intestine. In the large intestine, eeme of the water and electroltes (chemicale ike eedium) aro removed from the food.+ The end of the process — Solid waste is then stored in the rectum until it is excreted via the anus, ENZYMES ~ an organic catalyst that are protein in nature and are produced by Iving cells. ‘3 Groups of Digestive Enzymes: 1. Amylase — carbohydrate spliters 2. Lpase—fat epittars 3. Proteases —protein spliters PART | SECRETION | ENZYME | SUBSTRATE | PRODUCT [Saliva Piyalin (salivary | Cooked Dexirin and amylase) Carbohydrate | Maltose | Gastric hice Protein and | Branched chain | execs polypeptides | amino acids Mik Casein | Caleium Geseinate Long chain faty acs, glyeeral ‘Smalliniestine | Pancreatic Pancreatic —_| Branched chain | polypeptidealee (akaline) Bile (alkaline) Intestinal juice (succus centericus) Trypsin Pancreatic Lipase Pancteatic Amylase Aminopeptiéase: Intestinal pase amino acid Long chain fatty acids, glycerol cholesterol Dextiin and Maltose polypeptide ‘amino acide long chain fatty acide, alyoerides, cholesterol ‘amino acdls long chain faty acs, alycerides, cholesterol Dextin, lactose, sucrose, maltose Faciitates tat and Vit. A, D, E, K absorption Single chain amino acd Fatty acidsIsomaltase Ladiase Sucrece Large tniesiine maltose lactose Ghose Gucose, galactese Guicose, fructose Dgestbility of an average person CHO - 20% Protein— 92% Fats -95% Factors that affect digestion and absorpiion: (Crude fibers skn ard seed of fru Preparation and cooking Disease —iniestinal cancer, diathea ‘Surgery — gastrectomy Parasitism Presence of interfering substancePHYSIOLOGIC VALUE OF FOOD Food is good to eat when it ullls the ff. qualities: 4) tis nourishing ornutsitious 2) has satiaty value 3) Itis prepared under sanitary conditiens 4) Its palatabilly factors (color, aroma, flavor, texture) 5) Within the budge! and suitable te the occasion, Nutttion Classification 41) According to function 2) According to chemical nature 2) According to eseentiaity 4) Recording concentration Giassiicaton of Nutrien's, 1) Ascording to function: Function as energy giving, body buileing, body regulating 2) According to chemical properties: 4) Organic — protein, ipids, carbohydrates and vitamins ») Inorganic water & minerals 3) According to cancentraiion a) Macro nutrients ~ Carbohydrates, Proten, Fats ») Micro nutrienis ~ vitamins, Minerals & water BASIC TOOLS IN NUTRITION + Food Groups —group of foods thet have similar nutritoral properties and ig part of the hierarchy of the food pyramid, such as coreel group, milk ‘gtoup, meat and protein group, ult and vegetable group, fats and sweets groupand ‘The 3Main Food Groups: 1 Body-bullding foods - foods that supply good qualty proteins, some vitamins and minerals. 2. Energy foods - mestly of rice and other cereals, starches, sugars and fats ccontribule the bulk of Calories. 3, Regulating foods - composed of fults and vegetables that provide viamins ‘andiminerale, particulary asoorbe acid and pro vitamin A + Dietary Guidelines stratecies to promote appropriate diets and related health practioes to achieve the goal ct improving tne nutrtional condition. 10 Nutritional Guidelines For Filipinos 1. Eata variety of foods everyday. 2. Breast-feed infants exclusively from birth to 4-6 months and then, give appropriate foade while continuing breas!-feeding 8. Maintain children's normal growth through proper diet and monitor thet growth regulary. 4, Consume fish, lean meat, poultry or dried beans. 5. Eat more vegetables, fruit and roct crops. 6. Eat foods cooked in edible/cooking oll dally. 7. Consume mik, milk products and other calclum-rich foods such as small Fish end dark green lealy vegetables everyday. 8, Use iodized eat, ut avoid excessive intake of salty foods. 9. Eat clean and sale food. 10. For a healthy lifestyle and good nutrition, exercise regularly, do nat smoke ‘void drinking aleohelic beverages. st FOOD GUIDE PYRAMI FNRI (Foods & Nutition Research Institute)Animal foods, dried beans and nuts FOOD GUIDE PYRAMID (USDA) United States Dept. of AgricultureMyPyramid contains eight divisions. From left to right on the pyramid are sk food ‘groups: ins, recommending that at east half of grains consumed be as whole grains + Vegetables, emphasizing dark aren venetables. orange vegetables, and dry bems and peas + Enuite, emphasizing variety and deemphasizing fruit juices + Olle, tecommending fish, nut, and vegetables sources + Milk, a category that includes fluid milk and many other mik-besed products + Meat and bean: mphastuing low-fat and lean meals such as fish as well as, ‘more bears, peas, nuts, and seeds 4 RDA & REN. Recommended Dietary Allowance (RDA)- is the information of nutrient allowance for the maintenance of good health, A tool for assessing a dietary intake of the population group. This emphasize the amount of foods or diet RENI— Recommended Energy Nutrient Intake ‘Anew standard replacing DA, emphasizing on recommencing on the nutrients rather than food or diet This too} serve as a quide for designing nutriton and health intervention towards. ‘an improvement of the health of the Filipinos. Food Exchange List A classification or grouping of common foods in terms of equivalent amounts of Carbohydrates, Protein, Fat and Calories Te word exchange reiers to the fact that each item on a particular list in the porfin sted may be interchanged with any ather food item on the same ist. An ‘exchange can be explained as a substitution, choice, or serving,Nutritional Labeling Nutrition Fact Song sem tesce(tig) Primary means of communication between the Ssnngares Cantona? producer or manufacturer nthe consumer. 2 Components of Nutrtional Labeling 1 Nutrient Dederation—a standardedstatement ‘erlsting ofthe nutiont ortent of food 2. Nutrition Claim representation which statesor implies that afood has some particular nutitoral prepenents, & Nutrient density is 2 measure of the nutrienis a food provides compared to the ealories it provides. Foods law in calories and high in nutrients are nutiient dense, while foods high in calories and low in nutrients are nutient poor. References: hipwo fri dost gov phinder php 2eptan-cantandtask-vions hipulworee-s6.g0.can-aniabeletquetindex eagohp MACRO NUTRIENTS Macro nutrients - constiule the buk of the food we eal, they provide energy and ‘chemical buitding blocke for tieauoe. ‘3 Macro Nutvients: 1. Carbohydrates 2. Protein2. Fats CARBOHYDRATES = Majorsource of energy for thebody, = Consst of 60-100%! caries. = Leramof carbohydrates ‘contains Aeslvies. ‘athohyératesare made of carbon, hydrogen and oxygen with the general fo1mulaofC,(,0 cong Classification of Carbohydrates Simple Carbohydrates 1) Monosascharide — “simple sugar’, is tho simplost form of sugar. a) Glucose ~“blood sugar” b) Fructose - sweetest of simple sugar. Found in honey, fruits end vegetables. ©) Galactose ~ not found in free foods. Galactose is a result wien the lactose breakdown. ** Simple sugar are water soluble, and quickly absorb in the bloodstream "** 2) Disascharide - “double cugar’. Mado up of 2 monosaccharide. a) Sucrose — ordinary table sugar (glucose & fructose) b) Lacose — “milk sugar” (glucose & galactose) ) Maltose ~(malt sugar) is produced during the malting of cereals such as barky.3) Polysaccharide — “ complex sugar” ‘Composed of many molecules of simple sugar a) Starch ~ most important in human. They supply enesgy for longer period of tine. Examples: rice, wheat, corn, carrols and potatoes. Starches are nol water-soluble and require cigestive enzymes called amylases to break them part. b) Dextrins ~ formed by the breakdown of starch. obtained trom starch by the application of heat or acids and used mainly as adhesives and thickening agents. ‘) Cellulose — Non-cigesiible by humans. They lower the blood glicase level of people with diabetes. that is composed of glucose units, forms the main consituent of the cell wall in most plants, and Is important In the manutacture of numerous products, ‘such as paper, texties, pharmaceuticals 4) Pectin — Sources from fruits and are often used as a base for jellies ) Glycogen ~ “anal starch’ 1) Hericellulsse ~ also indgesibe, ound in agar, pectin, woody fibe's, leaves, stems. 4) Iruln — impertant medicine and nurehg as it provides test of renal function, Functions of Carbohydrates: 1) Main source of ene:gy for the body. 2) Protein sparing action 2) Necessary for normal fat metabolism 4) Cellulose stimulate peristaltic movement of the gastrointestinal tract. Absorb water to give bulk tothe intestines. 5) Lactose encourage the growth of beneficial bacteria, resulting in a laxative action, 6) Glucose is the soe soutce of energy in the brain. Proper functioning of the lissues Sources of Carbohydrates 1) Whole gains 2) Sweet potatoes & white potatoes. Bananas, diied fruits.2) Mik (lactose) 4) Sucar, sweets, honey, maple sugar “Empty Calories” - foods which do net contain any other nutrients except carbohydrates ‘Common Diseases: 4. Overweight 2. Diabetes 3. Tooth Decay 4. Depressed appetite 5. Fermentation causing gas formation 6. Cancer Deficiency 1)Kelosis ~ disease caused by lack of carbohydrates, in which the acid level of the body is raised 2\Protein_ Energy Malnutrition 2) Kwashiorkor — Protein Det b) Marasmus ~ Calorie Det. 3) Low Blood Sugar Level FATS or Lipids Fats, olls, and waxes belong to the group of naturally ocourring organic materials callod lipids. Lipids are those constituents of plants or ‘animals which are insoluble in water but solube in other organic solvents. 2Most concentrated form of eneray Comtains 9 cabries pergram fat Itie recommended 15-25%6ta\ in the diet ‘The basie unit of fat is called “Walyeeride”, which consist of moleccie of glycerol attached to the fatty acids ‘9 Forms Fatty Acids 1) Saturated Fats ~ Shown to raise blood cholestera. + Considered the most “dangerous’ type of fat that lead to raise blood cholesterol may lead to coronary heart disease + Difficult to metabelize causing weight gein Sources: butter, lerd, meat, cheese, eggs, coconut oll chocolate, cakes, cookies 2| Monounsaturated fats —lower level of “bad” cholesterol Sources: Vegetable oll, peanut, soybean, corn, oliveoll, canola oil 4) Polyunsaturated Fats ~ Lower levele of total cholesterol Classes: 1) Omega 3 - have a postive effect on reducing mortality trom cardovascular disease, Reduced blood clotting tendancy and reduced bined pressure 2) Omega 6 ~ ‘Lindleic acid’ polyunsaturated fatty acid > lowers cholesterol levels in the blood and helps in the prevention ot heart decease, > Sources of Polyunsaturated fate : unrefined saiflower, com, sesame, soybean, ‘sunflower ol, seeds, nuts, dark oreen vegetables.Fatly Acid Composition of Common Food Fals (OL ———* POLYUNSAT. MGNOUNSAT. [TOTAL | SATURATED | FA Fr UNSAT. FA RA (Safflower OF 75% fa 80H Suniiewor Oi 20% 10% Com Oi "ae 13% ‘Soybean Ol 23% 14% Gatior'seed OF 52% 18% 26% ‘Canola Oi 39% 5% 1% Oive oF 74% 13% Poanut Oil 30% 17% Margarine O1 18% 19% Palin Oil 9% 49% CocorutOr 2% 36% ‘Shortening 14% “31% "ANIMAL FAT Tuna fat 37% 2% Chicken fat 21% 30% Beet fat 4% 50% Butter tat % 52% are 11% 40% Funetions: 1) Important source of caloriesto provide a continuous suoply i energy. 2) Protein sparing 8) Maintain the constent blood temperature 4) Cushions vital organs such askidney against injury 5) Facilitates the absorption of fat soluble vitamins (ADEK) 6) Provides satlely and delays onset on hunger.7) Contributes flavor end palatabiliy tothe diet Cholesterot Cholesterol is a mejor component of all cell membranes, It is tequred {or synthesis of ‘sex hormones, bie acids, and vitamin D. Its also a precursor al the steroid hormones. > Cholesterol is also mace in the body and is teken also thru foods > Bul Cholestera is 2 major factor in the development of hean diseases > Daily intake should net exceed 200 mg./day ‘Source of Dietary Cholesterol + Richest: egg yok, fsh roes, mayonnaise and shelltish Moderate : Fal on meat, duck, goase, cold cuts, whole miks, cream, ice cream, ‘chease, butter and most commercially made cakes, biscuits and pastries. + Poor : All ish and fish canned in vegetable cil, very lean meats, pouttry without ‘skin, skimmed mik, low fat yoghurt and cottage cheese, Cholesterol free = All vegetables, and vegeiable cils, fut [including avocados: andolives}, nuts, rice, egg white and sugar Vocabularies: Lipid — Any of a group of orcanic compounds, including the fats, oils, waxes, sterol, land trigycerdes, that re Insoluble in water but soluble In nonpolar organic solvents, ate oily fo the touch. Fat - Any of various soft, solid, or semisolid organic compounds constituting the esters of alyoerol and fatty acids and their associated organic groups. (Oil is [quid at room temperature soluble in various organic solvents such as ether but notin water Cholesterol —is a foi of fat in animal origin that is a factor in the development of heart disease,Transfats- fatty acids that are produced when polyunsaturated oil are hydrogenated to make them more sold. Thus raise the level of bload cholesterol Hydrogenated fats — unsaturated oll undergone hydrogenation to make them more ‘solid and less resistant to heat Low Density Lipoprotein (LDL) - A complex of lipids and proteins, with greater ‘amounts of lipid than protein, that transports cholesterol in the blood. High levels are: ‘associated with an increased risk of atherosclerass and coronary heart disease. High Density Lipoprotein (HDL) - A complex o! lipids and proieins in approximately ‘equal amounts that functions 2s a transporter of cholesterol in the blood. High levels are associated with a decreased riskof atherosclerosis and coronary heart disease. 10 Foods High Transfats ‘Spreads —mayonnaise, margarine, butler Package foods —cake mixes, biscuits Soups — noodle soups Fas! foods ~ Medonalis, Kentucky Fried Chicken 1 2 3. %, 5. Frozen foods — frazen pies, pizza, breaded lish sticks, breaded chicken 6. Baked goods — cupcakes 7. Gookies & cakes 8. Donuts 9. Cream Filled cookies 1 10.Chins & Crackers Sources of Fat 4) Animal Fais ~ fat from meat, fish, poultry, milk, mik products and egge. 2) Vagetable Fate - margarine, seed ard vegetable oll, nute 3) Visible Fats —butter, cream, margerine, lard, fsh liver cls, pork fat 4) Invisible Fats ~ cheeses, olives, cakes, nuts, pastries Diseases: 41) Heart Disease 2) Cancer2) Obesiy PROTEIN + Known as the building blocks of the body + Itcontains the elements of carbon, hydrogen, oxygen and nitrogen . + Protein is made up of amine acids which ie the basic component of protein san AMINO ACIDS ‘Amino acids are known as the building blocks of protein. They perlorm many Important functions such as: bullling cels, protecting he body {rom viruses or bacteria, repairing damaged tissue and cairying oxygen throughout the body There are 20 diferent amino aciis. Amino acids are linked together to form peplides, which are small chains of amino acids. The peptides are then linked together to form larger proteins. ‘There ave thousands of different proteins that eamy out a large number of jabs in the: human body. Even though so many different proteins are at work in your bedy, you don't have to worry about consuming each individual protein from the foods you eal Your body wil meke those proteins. All you need to do is to make sure your body has a healthy supply of all 20 ol the different amina acid "building blocks.” Having enough of those amino acids is easy because your body can make 11 of them trom other ‘compounds already in your Dody. That leaves eight amino acids thet you must get trom your diet rrTypes of Amino Acids 41) Essential Amino Acids are those thal are necessary for good health but cannet be produced by the body and so mustbe supplied in the diet Ex. Leueire Isoleucine Lysine, Valine. Typtophan, Phenylalanine, Mathicnine Serine 2) Non-Essential Amino Acids ~are those that are produced by the body so not as necessary in the diet Ex. Asparte Acid Tyrosine Glycine cysteine Arginine Glutamic Acid Hisiidine Glutamine Alanine Asparagine Proline ‘Complete and Incomplete Protein + Complete contain all essential amino acid in sufficient quantities to supply the body's need Sources: proteins trom animals + Incomplete ~ those deficient in one or more essential amine acids, Sources : Plant (grains, legumes, seeds and nuts Functions of Proteins 41) Used in repairing worn out body tissue 2) Source of heat and energy 3) Contrioute to numerous essential body secretions (mucus, milk, sperm cells) 4) Keeping tics and pH balanced in the boay 5) Play a lerge ‘ole in the resisiance of the body to diseases 66) Contributing to enzyme activity thal promotes chemical reactions in the body 7). Signaling cells what to do and when todo it8) Transporting substances around the body 9). Serving as buiding blocks for hormone production 10) Helping biood clot 41) Serving as structural compenenis that give our body parts their shapes ‘Sources Complete Protein 4. Meat —beet, pork, lamb 2. Poultry — chicken, turkey, duck 3. Fish 4. Dalty Products ~ mik, yogurt, cheese Incomplete Protein Grans ~beans, com, oats, pasta, whole grain breads, Legumes, seeds & nuls ~ sesame seed, sunfower seed, peas, rice, peanuts, ‘eashew \Vagetables — Brocell ‘Common Diseases 1) Heart Disease 2) Cancer (prostate, pancreas, kidney, breast and colon) 3) Osteonerosis 4) Wegnt contrat 5) Kidney Diseases 6) Ketoss Protein ~ Eneray MalnutritionMICRO NUTRIENTS: VITAMINS & MINERALS VITAMINS + Complex organic compound to regulate tody procoseos and maineain body Hesse + "Vieamin’ comes fromthe Latin word "Va? rmesninglfe, “amine” means nitrogen compourd. + Vitamins do not give the boay energy. + Therefore, we cannot ncrease our physial ‘apicity by taking eatra vitamins + Vitamins do nat have calorie vale ‘Vitamins Terminologies, Precursor or Provilainins ~ these are compounds that can be changed to the active viamine Ex. Carotene are precursors to Vit. A Preformed Vitamins ~ naturally occurring vitamins that are inactive form and ready for iis biological use. Ex. Animal eaurcoe ‘Avitaminosis severe lack f vitamins Ex. Avitaminoss A leads to night bindness Hypervitaminosis— “wari toxicity" ‘excassive accumulation of vitamins in the body Vitamin Malnutrition —“too much or too litle” NOMENCLATURE OF VITAMINS VITAMIN NOMENCLATURE1 2) 3) 4) 5 Vitamin A Ratinal D | Calcferol E | Tosopherot K | Phyllaquinone VitarinBi | Thamine 82 _| Riboilavin 83 | Niacin Ba | Paninorenic Aeid 36 | Pyiidoxine | Bian Bi2 | Cyanocobaiamin WLC | Ascorbic Acid FAT SOLUBLE VITAMINS (Vit. ADEK) FAT Soluble Vitemine - can be absorbed in the presence of fat & stored in the body. Fat Soluble vitamins generaly have pre curso's or pro vitamins ‘They can be stored in the bedy, deticiencies ave slow to develop. Not absolutely needed daily from food cources Stable especially in daily cooking + Vit. A Retinol) FUNCTIONS Vision Cycle — necessary component of visual purple (hedopsie), a pigment to make adjustments to ight and dark Necessary material for maintenance of epithelial tissues. Growth & Bone Development ~ Reproducton — necessary for normal reproduction and lactation Aatioxidant Food Sources 241) Animal Sources — liver, yalk, milk, butler, cheese, fish, elame, tahong 2) Plant sources - deep green and yellow vegetables and frutts DALY DOSAGE: Male ~ 1000 microgram, Female -800 microgram Deficiency & Toxicity Vitamin A (Retinal) Deficiency + Night blindness + ye lesions Retarded growh + Lower resistance to infections + Faulty skeletal & dental development Skin Lesions Toxeily + Lver damage + Miki dermatiis + Thickening of the skin and peeling off + Course sparse hair + Hypercarotenimia (narmeess orange appearance 4 VIT. D (Calciferol) Functions 41) Absorption of Calcium & Phosphorus 2) Essential or normal growth development. Food Sources 4) Synthesie with eunlight (10 mineiday) z2) cod liver fish, halbut [lype ol flatfsh], salmon, sardine, 29g yolk 3) Forlfied Vit. A products Deficiency + Tetany (abnormal musele twitehing and cramps. + Rickels (defective bones, retarded growth) + Osteomalasia (saitening of the bones} Toxicity + Sone formation on kidney Deminetalisation of the bene + Polyutia + Weight Loss + Hypercalcemia + Vit. E (Tocopherol) Functions 1. Maintenance of colular membrane 2. Anti oxidant Food Sources ‘Whole grain nuts, seeds, graen and leafy vagatables, polyunsaturatad fate + No toxicity . this nutrient cannot be stored to a large extend in the body 4 Vit. K ( Phylloquinone) Functions Aids in blood clotting and bone mineralization Food Sources Green leaty vegetables, soy beans + DeficiencyHemmarhage diseases Toxicity Vomiting Aburrinuna Hemolysis FY ‘Anti oxidant - Any substance thal rectces oxidative damage (damage due to ‘oxygen) such 2s that caused by tree radicals Free Radieas - are highly reactive cemicals that altack molecules by capturing ‘eectrons and thus modfying chemical structures PHYTOCHEMICAL - natural bioactive compound found in plant foods that works: with nutiients and cietary liber to protect against disease WATER SOLUBLE VITAMINS Water soluble vitamins are B-complex group and Vit. C Dissolve In wale’ and are not siored, they are eliminated in urine, so we need ‘continuous supply of this vitamins in the diet everyday. Water-soluble vitamine are easily destroyed or washed out during foad storage or preparation, To reduce vitamin loss, retrigerale tresh produce, Keep mik and grains away {rom strong light, and use the cooking waier fram vegetables to prepare coupe. + Vitamin C (Ascorbic Acid) Functions: Maintenance of bones, teeth, connective tissue.certilages ‘Absorption of Calcium, ron and Folacin Production of brain hormones, immune factors4. Antioxidant Deficiency: 1. Bleeding gums, scurvy, anemia 2. jin! pain, increase resistance to inlections, 2. rough skin, hair loss, loose teeth Toxicity Diarrhea, bloating, cramps, formation of Kdney stones: FOOD SOURCES Citrus tuts, Brocoll, sirawoerries, potatoes, mangoes, papaya, red and green bell pepper, Dari green vegelables 4 Vitamin B1 (Thiamine) Functions 1, Helps release energy trom foods, 2. Promotes normal appetite 3. Important in funetion of nervous eyeiem Deticiency Mental contusion; muscle weakress 2. wasting; edama: impaired growth: bariber Toxicity (none) None Food Sources ork. liver. whole grains. lean meats + Vit. B2 (Riboflavin) Functions4. Hels release energy from foods; 2. Promotes good vision, healthy skin Deficiency Cracks at comers of mouth; 2. Dermatiisaround nose and lips; 3. Eyes senstive to light. Toxicity (none) Food Sources 1. Lver, mik, dark green vegetables, whole and 2. enriches gran products, eggs + Vit. B3 (Niacin) Functions 41. Energy production from foods; 2, Aids digestion, promotes normal appetite; 3. Promoies healthy skin, nerves Deficiency 1. Skin disorders; diarrhea: weakness 2. mental confusion; initailiy. 3. Pellagra Toxicity ‘Abnormal lver function: 2. Nausea’ intabiity Food Sources Lver, fish, poultry, meat, peanuts, 2. whole and enriched gran products. 4 Vit. BS (Panthotenic Acid) Functions 4. Invelvad in energy production2. ads in formation of hormones Deficiency Uncommon due to avalabilily h mos! foods; faligue; nausea, abdominal cramps; cifcuty sleeping. Toxicity (none) Food Sources Liver, kidney, meats, egg yok, whole grains, legumes 4 Vit. BG (Pyrido: ) Functions ‘Adds in proten metabolism, absorption; ‘Aids in red bed cell oration; Holpe body use fat. Deficiency Skin disorders, dermatits Cracks at comers of mouth; Initabitty; anomia; kidney stones; Nausea: smooth tongue. + B8 (Biotin) Functions Halps release energy from carbohydrates Aids in fat synthesis Deficiency Fatigue; lossof appetite, nausea, vomiting; Depression; muscle pains: anemia. Toxicity none Food Sources Liver, kidney, egg yolk, milk, Frosh vegetables& Vit. B12 - Phylloquinone Function: Synthesis of red blocd cells, Detilency- Anemia, tatgue, sore longue Food Sources ~ all arimal products Minerals, What isa mineral? Minerals are elements that ere not organic needed by the body in relatively small Amounts to help regulate body process and maintain issue structure + Minerals do not broken down during digestion nor destroyed by heat or light. Trace and Major Minerals + Trace Minerals — minerals that are raquited in our let 2t amounts less than 100 mgitay. + Major Minerals - minerals that are required in our diet at amounts greater than 100 mg/day. Primary Roles: + Metabolic heat ‘Anti oxidant + Blood heath + Bone health + Beatrotyte balance Major Minerals: 4) Caleium, 2) Phosphorus 3) Magnesium 4) Potassium5) Sodium: 6) Chloride Trace Mnerals: 4) tron 2) ledine 3) Zine 4) Flouride 5) Selenum 6) Manganese 7) Chromium, Major Minerale ‘Wineral_ | Symbol Function jency | Food Sources Calcum Ga | Maintenance of bones and Osteoporosis, | Dalry producs, teeth convulsion, | green ely muscle spasm | veg, fish with bones Phosphorus Ph | Bone growth Mik,cereal, all foods Magnesum Mg | Muscle contraction, ‘Green veg.sea Bone & tooth structure ‘oods, legumes Sedum Na |Bedy fluid @ acid base | Hypertension, | Salt, processed balance edema ‘oods Potassium K Body Tid balance ‘Allwnle foods Chloride GI Body Fluid Balance ‘Salt, processed food‘Trace Minerals Mineral Symbal | Fureton Deftieney | Food Sources Tron Fe [Red BloadCalisincture on def.) Dark green anemia bealy vegetables, Iver, tegumes iedne 7 Thyroid Rormone | Goiter Seafoods, development incized sale Energy metebelism Ze [2a] Fetal development, wound Whole — grain, haaling meat egg Fuoride FI | Teeth maintenance Denial caries | Fortiied water, tea, fish tones oiter lodine deficiency Angular stomaitis Vi. C deficiency ) Rickets Vit. D deficiency aWATER + Most important nutritional constituent iswater + The major comporent of the body is wator + 80-70% water + Water has no nutrtional values ‘and no calories + Water is necessary to ransport nutien's, + regulate body temperature + Remove waste materials + Participate in chemical reaction & energy production Recommended to drinkat least 8 classes aday Ir trying io toose weight 12-15 glasses a day is recommended Anigh inteke of water aids in fat loss Caffeine & alechol are both diuretics. Large iniake of water is recommended Hangover are generally cause by the dehydration action by alcohol Matcha bottle of beer with 2 glass of water io lessen the intensity of hangover Vital Element, second only to oxygen Vital every day Things that dehydrate ~ Aging process Sweat from exercics| ~ Medications. ~ Caffeine ‘Good general ule: for each glass o! beverage with caffeine that you consume, dink one exira glass of water. (Other Benetits ~ Helos utilize stored fet for enevay 2Helps body recover quicker afier exercise ‘Aids healing process when you have been ill Reference: Detary Guidolires. Htn/Mealthyeatna sfoalecom/recommendad anount percan-carbohvdrales per ey-7287 Mind hiro. vestrng com arin} 2088-noemal-carbohyeraieitake-par day hipulwava selina siroie oduthandoutelmacrenctint Hm htpu/alntiments Bogspel.com/20'3/0abarbotydrale delicency denser hitp/hwows med heath ne Proteir Deficiency: Diseases ht hipulwova2sioncemag orgicontet2968878'901 aberaet ference: htp//wwa-utiton arguW/heathyivingheathyeatingatsugar hin! Basie Nuttin & Dia Thoraghy by Mava Lourdes C. Caudal, AND. Ideal Weight, Total Energy Requirement,Body Mass Index Basal Metabolism —the amount of energy required by an individual in the resting stale. for such functions as breathing and cculation ofthe blood, Basal Metabolic Rate ~ the minimum caloric requirement needed to sustain lie in a resting ineividual. It can be looked at as being the amount of energy (measured in calories) expended by the body to remain in bed asleep all day. Factors that affect BAR 1.Genetics. Some people are born with faster motabolisms; come with slower metabolsms, 2. Gender. Men have a greaier muscle mass ard a lower body fat percentage. This means they have ahigher basal metabolic rate. 3. Age. BMR reduces with age. After 20 years, it drops about 2 per cont, per decade. 24, Weight. The heavier your weight, the higher your BMR. Example: the metabolic rate of obese women is 25 percenthigher than the metabolic rate of thn women. '5. Body Surface Area. This is @ reflection of your height and weight. The greater your Body Surface Area factor, the higher your BMA. Tall, thin people have higher SMA. If {you compare a tall person with a short person o equal weight, then if they both follow a diet calorie-controlled to maintain the weight of the taller person, the shorter person may {gain up fo 15 pounds in a year. 6. Body Fat Percentage. The lower your bedy fat percentage, the higher your BMA. ‘The lower body fat peroantage in the male body is one reason why men genarally have a 10-15% faster BMR than women. 7. Diet. Starvation or serious abrupt calorie-reduction can dramatically reduce BMR by Up to 30 percent.Restrictive low-calorie weight loss diets may cause your BMA to drop as much as 20%. 8. Sleep —BMR falls 10-15% below waking levels. 9, Endocrine Glands ~ male sex hormones increase the BMIR 10-15% 10. Fever ~ increase 7% for each degree rise the body temperalure above 98.6 F COMPUTATION: 1.BMR N. in Ibs. X 10.9 (male) 9.8 (female) Example : 125 Ibs. x 9.8 = 1,225 Gal, 2. BMI = 1s a measure of body fat based on height and weight BMI = weight (ka) AT g = 47kq = 20.25 = 20kaim: {Normal (nt-meters), — (1.524)(1524) 232 %a.paw ‘A. (TANHAUSSER’S METHOD) FOR ADULT DBW = (Ht cm —100)~ 107% Ex, 83* = (63 inches x2.54) = (160.92 ~ 100) = (60.02- 9.002 (10%) = 54 kg. Note: (+ /-) 10% of the value within the range of DBW B.infants: (0-6 months) 2) DAW «birth weight (gms)e(age in mons.x 600) Note: ithe weight is not knowin, use 3000 gms, Example: 4 month od intant DBW = 3000 + (4 x 600) = 3000 + 2400 5400 ams or 5.4ka. b) DBW = (age in months = 2) +3 Ex: DBW = (4:2) +9=2+9 = Sig DBW (Children) =( No. of yrs. X 2) + 8 Ex 7 yrold 1 grader DEW= (712)s8 = 1468 2 ka, 4.TER = DRWx activity level Ex 53° student = 54 x 35 = 1,890 Cal 4) Infants= DBW x 120 Cale/kg. Ex 4 month old infant TER = 5.4 kg. x 120 Cals/kg = 648 or 650 Cals.2| Children = 1000 + (100 x age in yrs.) Ex.7 yr. oid child TER = 1000 +(100 x7} 1000 + 700 =1700 Cas. 2) Adult = DBW x activity level Ex. 893" student » 64 x 35 1,860 Cal. ‘CONVERSIO! HT, 1M = 12inches 1ig.-22 be Vinch =2.540n 100¢m = 1 meter fACTIIYLEVEL: ss—<—sSSSCid Badrest =27.5 (hospital patients) Sadentary = 30 (secretary, clerk, typist administrator, cashier, bankteller) Light = 35 | teacher, nurse, student Lab. Tech, house wie with maid) Moderate = 40 (housewife wo maid, vendor, mechanic, jeepney & car diver) Heavy = 45 (farmer. laborer. cargador, laborer. coal miner. fisherman, heavy eqpt.optr ) BMI LEVEL: ‘Cbeoe = above 20 ‘Overweight = 27-30 Normal = 18.5 ~ 27 Under weight = below 13 36Reference: ‘According WHO (2014 votives from hip/aope.who.inibmiinéexjep?ntioPage-into 3m) ‘According a Caudal Mara Lourdes C., BND Basie Nuiton and Die herapy Raviced Elton psge 10. 4, DIET PRESCRIPTION: Step 1 : Get the DBW of the patient Step 2: Compute hiner TER (based o1 his occupation/actvity) Step 3: Identity his percentage requirement (based on histher health condition ordietary Requirement Step 4: Distribution of TER on CHO, PRO, FATS. TER x% CHO TER x % PRO TER x % FAT | Percentage Ditribuion CHO 50.70% 60% (everede) PRO 10% (infaricntaren) 40-18% (adoloscontadut) Fat 20-25% (ult) 30-35% (children) Step 5: Gram distibuton % CHO /4 (fuel value) = _gm. a%2PRO/ 4 (fuelvalue) = __gm %FAT/9((uel value) = __gm. Step 5 : Meal Distioution COMPOSITION OF FOOD EXCHANGE LIST LST [FOOD | MEASURE CHO [PRO [FAT | CAL TR |Vaga T 6 raw, we e|- |= - 6 IB | VegB | cooked 3 Yee raw & cooked | Fruit varies 0 |- - 0 m1 _| Wik Fullream | Varies we js |t0 | 170 LowFat |4tablospoen [12/8 |, 125 Skimmed [4 tablespoon = [12/8 - 80 WV | Rice Varies (2 | 700 V__| Meat LowFat | Varies - |e |t a Medium Fat - [a |e 86 High Fat - | jis |rze vi | Fat Tp. - 3 6 vit | Sugar T teaspoon) s | = 20 FOOD DISTRIBUTION Example: 336g 849. 62g 2240 UIST | FOOD | MEASURE | CHO PRO [FAT [CAL ia Vega [3 : : F aeiB Weg z 1 Fruit |S 0 5 E 200 Wr wk 7 3 5 1B ‘sub:71 (986. 71)H265 265/28 = 11 v/Rie [i080 tO Sub: 28 (at 28)=56 (9818) 7 v Meat |7 sae 602 sub: 47 (6 4716 (1865)=3 vi Fat 15 15 vir Sugar [4 © | 80 at eg t90 MEAL DISTRIBUTION FOOD | BFAST | LUNCH | DINNER’ [AWSNAGK| PW ENAOK Vogh 7 7 VeoB 1 1 1 RUT 7 T 7 T 7 MLK 7 RICE 2 2 2 z 2WEAT 2 7 7 IF it FAT 1 T a | SUGAR T T ft Pe NUTRITIONAL ASSESSMENT ‘What is Nutritional Assessment? is an in-depth evaluation of beth abjective and subjective data related to an individual's food and nutrient intake, lifestyle, and medial _ history ‘Aims of Nutritional Assessment 1. To identity certain specitic nutrtional problem. 2. To map out magnitude and geographical distribution of malnutrition 3. To determine ecological factors responsible for malnutrition, Methods of Assessment Direct Assessment — based on physical sign a) Diet Hisiory — This method evaluates the primery factor of nutitional inadequacy. 'b| Physical Method or Anthropometric Taking weight & height data (c) Medical History ~ record of the person's pastillnesses 4) Clinical Examination ~ physieal signs associated with malnutiition | Biochemical Tests — blood plasma. tissue biopsy, urinalysis, B. Indirect Aceoesment — use of deta, eialetice end ether information. Includes: food consumption, eating practices41) Vital Statisties - a) age specitic mortaity — no. of death/age and sex arcu ‘ave. population of the same age ) Infant Nottalty Rate ~ no. of deaths below 1 yr. ‘over the number of live biths (©) Maternal Morality Rate — no. of deaths among women due to pregnancy, labor/ total ive bith ¢) Morbidity Rate ~ no. of reported cases of a given disease present ai a given Jime per 100,000 population 2. Conditioning Infections — dierrhea, meesies, tb 2, Foed Balance Sheet ~ rough estimate of food supplies available for consumption Dietary Survey ~24 hr. food recall Cultural and anthropological influences Socio economic factors population, family, education Focd production - Health and educational services @yvoas Methods of Assessing Dietary Intake: 24 Hr. Recall — recall ofall what he/she had eaten within 24 hrs. Food Frequency Questionnaire . Diet History Itie more complete than the twe pravious method. it contains tha following: Economic ( incame, amount of money for food) Physical Actvity occupation, exercise, sleep) Ethnic & Cultural Backg ound (religion, educ) Homelife & Meal Pattems (no per household, person who does the cooking, type of house) Sas‘Appetite (good, poor) allergies, intolerances, focd avoidance DentalOral health Gastrointestinal (heartburn, darchea, constpation) SVN NN Chronic Diseases ¥ Medication 4, Food Diary ~The subject & asked lo write dovm everything that he eats for ‘a coriain ime. It could be 3 days, two weeks 5, Cbservation of food intake — most accurate but most time consuming It requires knowing the amount and kind of food presented and the record of the amount actually eaten MALNUTRITION Malnutrition Itie the condtion of the body resulting from a lack af ane oF more cessertial nutrien's or due to excessive nutrient supply. Reference: Basic Nutition & Dist Theraphy by Maria Lourdes ©. Gaudal, AND. 2 Conditions of Nutritional Status 1) Optimum or Good Nutrition — body has adequate supply of essential nutrients for growth & heath 2) Malnutrition — A condition o! the body resulting from a lack of one or more: nutrients oF it may be dua to an excessive nultiont eupply creating toxe or harmful effects Forms of Malnutrition 1. Under nutrition — reeulting fo inadequate quantity of food, over an extended pperind of time (kwashirkor, marasmus) 22. Specific Deticiency ~ resuiting from @ ralative ar absolute lack of an individual rutient (jion defciency) 3. Over nutrition —resultng from the consumption of an excessive quantity of toca, calorie excess (obesity) 4. Imbalance — resulting from 2 disproportion among essential nutrients, with or with out absolute deficiency of any nutrient ‘Types of Malnutrition 1. Aeute Malnutrition. related to present state nutrition ex. Loss of weight 2, Chronic Malnutrition ~ related to the past state of nuttin 9. Primary Malnutrition ~ caused by lack ot unavailabilily of food (dietary ‘malnutriion) 4. Secondary Malnutrition - caused by certain conditioning factors other than food alone Nutritional Deficiencies 1) Primary Factor- refers to faulty diet a Poverty b. Ignorance Poor food Habits Limited food suppy Poor distribution of foods Cultural Taboos ¢. Low level of education h. Urbanization i Infectous diseases / parasitem 2. Secondary Factors: 4) Iniertere with normal digestion a1 3. 4. 1 2. a 4 5. Gastrointestinal disorder Lack of appetite Poor teeth Lack of digestive enzymes 'b) Factors that interlete with absorption Diarrhea ‘Mal absorption Syndrome Intestinal Surgery Laxative Parasitism Factors that affect metabolism & ulilization in the cells 1) Liver diseases 2) Malignancy 3) Some drugs 4) Alcohoism 5) Toxins 6) Diabetes Melitus Pathogenesis of Nutritional Deficiency Primary (Dielaty) Nutritional inadequacy tissue cepletion (loss of weight) 4 biochemieal changes (aboratary) ‘ Tunctonal sympioms ( symptorrs appear) ' ‘anatomical lesions (physical signs )Effects of Malnutrition 1. Increase susceptbility to infections 2. Inhibits mental development 2. Impases heavy sacial and economic burdans Prevention &Treatment of Malnutrition Prevention: 4) Increase economic stability 2) Educate the people 3) Practice good sanitation and hygiene 4) Inerease food production 5) Eatbalance diet 6) Exerose 7) Social Awareness (thin is not ‘in’) FOOD & DRUG INTERACTION Introduction Mecications, both prescription and over-the-counter, are used every day to treat acute and chronic illness. Research and technology constantly improve the drugs we have available and intioduce new ones. Medicatons ean help people live healt lives for a prolonged period. Although medicines are prescribed often, itis important to realize that they must stl be used with caution Foods, and the rutients they conlain, cen interact with medeations we take. This can ‘cauce unwanted effects. A food/arug interaction aceure when a food, or one of ite components, interferes with the way a drug is used in the body. A dlug/nutrient Interaction occurs when a drug aifects the use ol a nutrientin the body. %Risk Factors Fisk for food/crug and druginutrient interactions can be affected by many factors such ‘as: + age + gender + medical histery + body composition + hutitional status + number of medications used How Drugs React in the Body In order io understand foodidrug and cruginutrient interactions, its important to Understand how drugs work in the body. There are four stages of drug acton for medicines taken by mouth: ‘Stage 1. The drug dissolves into a useable loin in the stomach. ‘Stage 2. The drug ie absorbed into the blood and trangperted to ite cite of action. ‘Stage 3. The body responds to the drug and the drug performs a function. ‘Stage 4. The drug is excreted fromthe body either by the kidney or the liver, or both. Not al medications are taken by mouth. Stil, they are all transporied lo the site of action Effects of druginutient and food'drug interactions vary accarding to: + type of medication + form of drug (oll, liquid, ete: + dosage + site of absorption (mouth, stomach, intestine) + route of administration (ora, intravenous, et)Definitions Absorption: the passage of substances fom the Gi tract into the blood Exeretion: removal of drugs or nutrients from the body. Intravenous: within the blood Nutritional status: nutrlion-elaied health ‘Transport: movement of a substance fiom one eite in the body to another. Food/Drug Interactions Foods can interfere with the stages of drug action in a number of ways. The most ‘common effect ie for foods to interiore with drug absorption. Thie ean make a drug lose: effective because less gels into the blood and to the siteof action, Second, nutrients or other chemicals in foods can affect how a drug is used 1 the body. Third, excretion of diugs fram the body may be affected by foods, nutrients, or ober substances. ‘With some drugs, i's imporiant to avod taking food and medication together because the food can make the drug lese effective. For other druge, i may be good to take the dug vith food to prevent stomach ination ‘Atcohol can effect meny medications. Always check with your pharmacist about possible ettects of alcoholon your medication, Grapetrun Juice and Drugs Grapefruit juice containe @ compound thal inoteaces the abeorplion af eome drugs. Thie ‘can enhance thet effects. This compound is not found in other citrus juices. Is best to not take medications with grepetrult julce. Drink it at leas! twe hours away from when you take your medication. if you often drink grapetrut juice, talk with your pharmaciet or docter belore changing your routine. Drug/NutrientinteractionsItis also possible for drugs to interfere with a person's nutritional status. Some drugs Interfere with the absorption of a nutient, Other crugs affect the body's use and/or ‘excretion of nutrients, especially vitamins and minerals. less of a nutrient is available te the body because of these effects, this may leas to a nutrient deficiency. Sometimes drugs affect nutrional status by incteasing or decteasing appetite. This affects the amount of food (and nutients) consumed. Some specific examples of iug/nutient interactions are given in Table 2 ‘The Different Groups of Medicines Drugs are grouped into classes based on linesses for whieh they are prescribed. They ‘ean also be grouped in other ways, such as their chemical make-up oF actions in the: body. Different foods can interact with moce than one class of drugs. ‘Table 3 isa lis of 14 drug classes and the uses for each. f you take medication in one of these classes, be aware of potential foodicrug and drug! nutrient interactions. If you arer't sure which classes your medicines fall into, ask your doctor or pharmacis! Analgesic Analgesics are drugs that relieve pain. Anelgesies often cause stomach initation. W's a {good idea to take analgotice, like asprin, with food. A full eiomach lowere the tiek for ‘stomach irritation, Antacid, Acid Blocker Antacids neutralize siomach acid, and acid blockers teduce stomach acid production Long term use of these drugs may lead to certain nutrent deticences. This is because ‘stomach acid is Important in the digestion andlor absorption of nutients. ‘Older people produce lees stomach acid, which loads to low absorption of vitamin B se Regular use of antacids or acid blockers lowers vitamn B 42 absorption even more. Vitamin 8 2 supplements maybe needed in this situation @Antibiotic Antibiotics are used to treat bacteral infections There are many different types of antibiotics. Some antibiotics decrease the synthesis of vitamin K by the bacteria normally found in our intestines. Vitamin K is important for normal blood clotting, Tetracycline antibiotics bind to calcium found in day products. This cen decrease the absorption ofthe antibtic. ‘Other diuge like penicillin and erythromyein are most effective when taken on an ‘empty stomach. This is because they may be partialy destroyed by stomach acid when ‘taken with food. However, food can reduce the chance ot stomach itaton tram these itmaybe tolerated better by children who ate sensitive to volume, are at high risk for aspiration, or have reflux. > coniinucus feeding can be administered at night, so it willnot interfere with dayiime actiitios. > conlinucus feeding increases energy eficiency, allowing more calories to be Used for growth. This can be important ior severely mainourisned children. > when feedings are delivered continuously, stool output is reduced which may be ‘consideration ifthe child suffers fom chronic diavthoea. Disadvantages o! contiruous feeding include: ¥ the childie “ied” to the leeding equipment during the feed, although feedings can be scheduled for night time and naptime feedhgs. ¥ In some counties continuous teedng is more expensive because of the ‘e08! of the pump and additional feeding supplies which may be necessary. a chilk’s medication needs to be considered as continuous leeding may interfere with serum concentration of some drugs. Bolus Feedings Bolus feedings alow for more mobilty than continuous drip feedings because thete are breaks in tne feedings, allowing the patlent io be free from the TF apparatus for activities such as physical therapy.oinee (5 Jes. Bolus feedings are usuelly delivered four io eight tines per day, with each feeding lasthg about 15 to 30 minutes. ADVANTAGES ‘The advantages of bolus feedings over continuous diip feeding are that: + bolus feedings are more similar to a normal feeding patter, ¥ more converient, + less expensive if a pump is nol needed ¥ bolus feeding ellows Feedom of movement for the patient, sothe chidis not tetheredto a feeding bag. DISADVANTAGES: ‘The disedvantages of bolus leedings are that + they are aspirated more easly than continuous drip feedings, + in some children, they may cause bloating, cramping, nausea. and diarrhoea itmay not be practical to bolis feed a child when the volume of formula @ child needs Is large or requires that the chid needs to be fe¢ around the clock. Combination ‘A.combination of continuous crip (at night) and bolus feedings (during the day) can be Used. 2‘What is combination feeding? “Combination or mixed feeding refer to when a beby is both breastfed and botle-fed,” Gray tells us. Youtl probably stumble on phiases like complementary feeding ot ‘supplementary feeding in your research. k's al the same thing! ‘What factors might make me choose combination feeding? “There are many reasons a mother rright choose to use mixed faeds,” Gray answers. “Separation from baby (such as returning to work), low milk supply (a mother wanis to breastleed but doesn't have enough mik for exclusive breastfeeding), higher order ‘multiples [when you have twins or triple's and can’t produce enough mik for both], and desire for partner to help with feeding” are all understandable reasons. Whatare the risks of combination feeding? + Here's where we sit youdawn and give ya some hard tuths. “Inducing anything other than breast mik forthe fist six morths of fe can open up the: baby's immature immune system an gastrointestinal tract io inflammation, ines, and disease,” Gray informs. + Too much bottl-leeding can also have an effect on a mother's production, “Intwoducing formula during the first 6 weeks (when a woman's body is, ‘establishing te milk supply), or having too many feeds a day away from the breast can cause a mother's supoly to decrease —sometimes te the point of weaning. + Secondly, "ifbabiee are inreduced to an artificial tea! before breastfeeding ie well established’ they might star to prefer the bots over breast. A bottle releases formula without stopping until the bottles empty, whereas "a baby at the breast ‘must euck-suek-cuck to have a let-dewn which lasts a minute or two and than there's @ pause before another let-down.” References: htpusie.mathostiends.om/ndax sho%page=contnuous dip feeds ntp:/stematthewstiends.o;gindoxphppage-bols toed hpu/worsoleminins.o.uklbabytist-yesrleverything you-need-to-hnow abou combiraton orm feadina yourtieby-s43¢242 hil B