1. Meal palnning
Dr M. Altamimi

2. Nutrition During Lactation
Key Nutrition Concepts: 1 Human milk is the best food for newborn infants for the first year of life or longer. 2 Maternal diet does not significantly alter the protein, carbohydrate, fat, and major mineral composition of breast milk, but it does alter the fatty acid profile and the amounts of some vitamins and trace minerals.

3. 3 When maternal diet is inadequate, the quality of milk is preserved over the quantity for the majority of nutrients. 4 nutritionist should encourage breastfeeding over any kinds of formula milk for the benefits of mums ad babies.

4. Lactation Physiology
The functional units of the mammary gland are the alveoli.
Each alveolus is composed of a cluster of cells (secretory cells) with a duct in the center, whose job it is to secrete milk.
Very similar to a bunch of grapes.
Myoepithelial cells surround the secretory cells.
Myoepithelial cells can contract under the influence of oxy-tocinand cause milk to be ejected into the ducts

5. Lactogenesis
Breast milk production, or lactogenesis, is classically described as occurring in three stages:
Lactogenesis I.
During the first stage of milk production, milk begins to form, and the lactose and protein content of milk increase.
This stage extends through the first few days postpartum.

6. Lactogenesis II.
This stage begins 2–5 days post-partum and is marked by increased blood flow to the mammary gland.
Significant changes in both the milk composition and the quantity of milk that can be produced occur over the first 10 days of the baby’s life.
Very important period of lactation in terms of building good immune system for the babies.

7. Lactogenesis III.
This stage of breast milk production begins about 10 days after birth and is the stage in which the milk composition becomes stable.
Generally talking human milk never has been the same after this period, the main reason is to suit the baby needs of nutrients not only in their quantities but also in their functional composition.

8. Human Milk Composition
H Milk is the only food needed by the majority of healthy infants for the first 6 months.
Human milk composition is changeable over a single feeding, over a day, age of infant and gestation and delivery.
human milk is complex.
Hundreds of components of human milk have been identified, and their nutritive and non-nutritive roles are under investigation.

9. Colostrum:
is a thick, often yellow fluid produced during lactogenesis II (days 1–3 after infant birth). Infants may drink only 2 to 10 mL (1.5–2 tsp) of colostrum per feeding in the first 2–3 days.
Higher in protein and lower in carbohydrate and fat than mature milk.
Secretory immunoglobulin A and lactoferrin are the primary proteins.

10. Water
Breast milk is isotonic with plasma. This biological design of milk means that babies do not need water or other fluids to be hydrated.
Energy
Human milk provides approximately 0.65 kcal/mL, although the energy content varies with its fat composition.
Infants who are breastfed are thinner for their weight at 8–11 months than infants fed formula milk, but these differences disappear by 12–23 months of age.

12. Effect of Maternal Diet on Fat Composition
The fatty acid profile of human milk varies with the diet of the mother.
When diets rich in polyunsaturated fats are consumed, more polyunsaturated fatty acids are present in the milk.
DHA: Milk DHA levels are increased by maternal supplementation.

13. Trans Fatty Acids Trans fatty acids stemming from the mother’s diet are present in human milk.
Cholesterol: Breastfed infants have higher intakes of cholesterol and higher levels of serum cholesterol than infants fed FM.
Early consumption of cholesterol through breast milk appears to be related to lower blood cholesterol levels later in life.

14. Protein: The concentration of proteins synthesized in the breast are more affected by the age of the infant (time since delivery) than maternal diet and maternal serum proteins.
It looks like that mammary gland select amino acids from serum depending on infants life stage.
Example:
Glutamine is a free a. a in the milk its percent is increasing over the first 3 months what ever the diet’s composition of protein is.
Glutamine is very important nutrient to digestive system to make ready to solid food.

15. Think about glutamine
Where can you find more food allergy in breast fed babies or formula fed babies?
Explain.

16. Milk Carbohydrates:
Lactose is the dominant carbohydrate in human milk. Lactose enhances calcium absorption.
Oligosaccharides contribute calories at low osmolality, stimulate the growth of bifidus bacteria in the gut, and inhibit the growth of E. coli and other potentially harmful bacteria.
Over 130 different oligosaccharides are present as functional ingredients of human milk.

17. Vitamin K Vitamin K is present in human milk at levels of 2.3 μg/dL.
Approximately 5% of breastfed infants are at risk for vitamin K deficiency based on vitamin K- dependent clotting factors. There are cases of vitamin K deficiency among exclusively breastfed infants who did not receive vitamin K at birth.
Vitamin B12 and Folic Acid: their content in milk is less influenced by maternal intake of these vitamins than are the other water-soluble vitamins.

18. Minerals in Human Milk: Mineral content in milk is related to the growth rate of the offspring.
With the exception of magnesium, the concentration of min-erals decreases over the first 4 months postpartum.
This reduced load on the kidneys is considered a significant benefit of human milk.

19. Maternal Diet Nutrition Assessment of Breastfeeding Women:
Attention should be paid to appropriate maternal energy intake to achieve or maintain ideal or healthy target maternal body weight.
Specific foods that may be related to infant colic symptoms may need to be avoided.
Nutrition intervention may include a plan for adjusting energy intake to promote appropriate maternal weight change, education regarding milk production mechanisms and appropriate maternal feeding.

21. Energy and Nutrient Needs
The DRIs for normal-weight lactating women assume that the energy spent for milk production is 500 cal per day in the first 6 months and 400 cal afterward.
However, a single recommendation for energy for lactating women could never address all of the individual ways that women meet their energy needs, mainly due to weight loss (0.8 kg/month), physical activities, infant needs.

22. Vitamin and Mineral Intakes
well-nourished breastfeeding women do not need routine vitamin or mineral supplementation.
Instead, supplementation should target specific nutritional needs of individual women.
Supplementation strategies should take into account how nutrients are secreted into human milk and the potential for nutrient–nutrient interactions in mothers and their infants.
For example, women who avoid dairy products completely should use calcium (1200 mg) and vitamin D (10 μg) supplements.

23. Fluids
There is no evidence that increasing fluid intake will in-crease milk production or that a short-term fluid deficit results in a decrease in milk production.
Fluid demands rise during breastfeeding, however, so women should drink fluids to thirst.
Therefore, women are advised to drink enough fluids to keep their urine pale yellow.

24. Infant Colic
Infant colic is defined as crying for more than three hours a day when the cause is not a medical problem.
It is widely believed that components of maternal diet are related to infant colic.
An observational trial suggested that a mother’s consumption of cow’s milk, onions, cabbage, broccoli, and chocolate were associated with greater likelihood of colic in the infant.

25. A randomized trial assessing maternal avoidance of cow’s milk, eggs, peanuts, tree nuts, wheat, soy, and fish resulted in a reduction in colic symptoms of their infants in the first 6 weeks of life.

26. Cabbage Leaves
Many believe that cabbage leaves (either cool or at room temperature) reduce discomfort and swelling associated with engorgement, although it is not known how the effects are mediated.
In recent randomized trials, cabbage leaves and gel packs were equally effective in the treatment of engorgement, as were cabbage extract and a placebo cream.
Raw leaves are applied directly to the breast until they wilt, which is approximately 20 minutes.
Cabbage leaves should be used only 2–3 times per 24 hours to prevent reduction in milk supply

28. Infant Nutrition Key Nutrition Concepts:
1 The dynamic growth experienced in infancy is the most rapid of any age. Inadequate nutrition in infancy, however, leads to consequences that may be lifelong, harming both future growth and future development.
2 Progression in feeding skills expresses important developmental steps in infancy that signal growth and nutrition status.

29. 3 Nutrient requirements of term newborns have to be modified for preterm infants. Knowing the needs of newborn infants who are ill or smaller than normal results in greater understanding of the complex nutritional needs of all newborns and infants. 4 Changing feeding practices, such as the care of infants outside the home and the early introduction of foods, markedly affects nutritional status of infants.

30. Standard Newborn Growth Assessment:
Newborn health status is assessed by various indicators of growth and development taken right after birth.
Indicators include birth weight, length, and head circumference for gestational age.
small for gestational age (SGA):means the newborn’s birth weight falls below the 10th percentile of weight for gestational age.
Infants above the 90th percentile are considered large for gestational age (LGA). Those in between are appropriate for gestational age (AGA).

31. Infant Development
Monitoring infants’ nutritional status requires an understanding of their overall development.
Motor Development:
Motor development reflects an infant’s ability to control voluntary muscle movement. There are several models for describing infant development, but none provide a complete description and explanation of the rapid advances in motor skills achieved during infancy

32. Some important gross motor

33. Motor development influences both the ability of the infant to feed and the amount of calories expended in the activity.
An example of how motor development affects feeding is the ability to sit in a high chair.
Only when an infant has achieved the motor development of head control and sitting balance and certain reflexes have disappeared can oral feeding with a spoon be achieved

34. Example of reflexes