Question 1: Mrs Smith has recently given birth and intends to breastfeed her bab

Question

Question 1:

Mrs Smith has recently given birth and intends to breastfeed her baby. During pregnancy she gained an extra 2.2kg of adipose tissue. Assuming that (i) during breastfeeding over a period of 16 weeks she loses all of this extra adipose tissue, (ii) that she produces 700ml of milk per day, (iii) the energy content of the milk is 2.8kJ/ml, (iv) the additional cost of lactation (cost of synthesizing the milk) is 0.25MJ/day and (v) that 1g of adipose tissue yields 39.1kJ of energy, calculate the following
1) The total energy content (in kJ) of the milk over the 16 week period?
2) The additional energy cost of lactation (in MJ) during the 16 week period?
3) The total energy requirement (in MJ) of lactation during the 16 week period (give to 1 d.p)?
4) How much extra energy (in MJ/day) must come from her diet (give to 2 d.p)?

Question 2: This continues from question 1

If she were to obtain 45% of this extra energy from starch, 10% from glucose, 30% from fat and 15% from protein, calculate how many grams per day extra of each she would have to eat (1 d.p.)
Starch 17.3 kJ/g
Glucose 15.4 kJ/g
Fat 37.1 kJ/g
Protein 15.9 kJ/g
Assume the metabolizable energy (ME) values shown above:
1) Starch
2) Glucose
3) Fat
4) Protein

Question 3:

A 28 year old man (weight 85kg) was involved in a road traffic accident and sustained multiple fractures of his limbs and ribs. He remains in hospital (i.e. he is bed-bound/ immobile) for 10 days. His energy requirements have been calculated to be 1.3 x BMR (remaining constant throughout the 10 day period).
Assuming that BMR (MJ/day) = 0.063xBW + 2.896
1) Calculate his daily energy requirements (2 d.p)
2) What are the units?

Question 4: This continues from question 3

In fact, during this period he is anorexic and can only tolerate 5MJ/day. He is taking in 7g of N per day but excreting 8g of N per day in his urine. Assuming that (i)protein contributes 1/5 of the mass of lean tissue, (ii) the protein to nitrogen ratio is 6.25 (i.e. approximately 1/6.25 mass of protein is nitrogen) and (iii) 1g of body protein yields 17.7KJ, calculate
1) How much energy (kJ) he loses in the form of protein over the 10 day period (to 2 d.p)
2) The loss of lean body tissue (in grams) over this period.

Question 5: This continues from question 3,4

Assuming that there is no overall change in glycogen levels, and that 1g of adipose tissue triacyglycerol yields 39.1kJ, calculate
1) The total energy deficit (MJ) over the 10 days (to 1 d.p.).
2) How much body fat (Kg) he loses over the 10 days (to 3 d.p).

Explanation / Answer

The purpose of this research was two-fold. Study 1 aimed to confirm that tibial bone strength and geometry were compromised in the mdx mouse model of DMD, and Study 2 explored the efficacy of vibration in mdx mice to initiate bone formation. In Study 1, tibias from mdx and wildtype mice (n=8 and 7) were excised and 66 sequential mCT (Scanco Medical) images at the midshaft were assessed for total cross-sectional area (CSA, mm 2 ), cross-sectional moment of inertia (CSMI, mm 4 ) and volumetric bone density (vBMD, mg/cm 3 ). Bone strength was assessed by 3-point bending (Mecmesin) at the midshaft by assessing ultimate load (UL, N) and stiffness (N/mm). In the second study, mdx mice were vibrated for 7 days (15min/d at 45Hz) at accelerations of 0g (sham), 0.5g or 1g (n=6 each). Plasma osteocalcin (OC) levels were measured and RNA isolated from tibias were analyzed with an osteogenic gene array (SABiosciences). Independent t-tests were used in Study1 and one-way ANOVAs for Study 2; significance was set at P,0.05. Three-point bending results confirmed that mdx bones were compromised, as indicated by ~17% reductions in UL and stiffness. These decrements were attributed to mdx mice having smaller CSA and CSMI (14 and 25%, respectively), rather than altered vBMD (P=0.32). Vibration exposure in mdx mice elevated OC levels by 48% in the 1.0g group compared to sham. Upregulated gene expression was only apparent in mice vibrated at 0.5g and these genes were predominately associated with chondrogenesis (i.e. collagen X and XI, Integrin alpha2, and Sox9). These data establish that mdx mice are a suitable model to research methods aimed at improving skeletal health and decreasing fracture risk. Furthermore, these data suggest that vibration has potential to improve dystrophic bone; however, further studies are warranted to optimize vibration parameters to elicit the greatest benefit. ............................................................................ It sounds like you were seen by a very inexperienced dietitian. Registered dietitians are trained to create personalized meal plans. The one you saw definitely didn't do that! If you go to see another one, ask to see a dietitian who is also a certified diabetes educator (CDE). That may help as CDE's specialize in diabetes care. You may also find my second book helpful, Diabetes on Your OWN Terms. It helps you choose the treatment options, including meal plans, that fit your personal needs. ..................................................................................... It appears to be a near-universal finding that troops under-eat on operations when rationing is by CRP. When nutrient intake is less than ideal, the nutritional status of a subject prior to the period of low nutrient intake itself becomes a determinant of subsequent nutritional status. There is evidence from the military scientific literature (both Australian and overseas) that young service people are entering military service with suboptimal nutritional status. The potential for this to impact adversely on health and performance can only be overcome by improvements in nutritional quality of diet during service. This implies a strong need for both availability of highly-nutritious food and guidance to ADF members on appropriate food selections to maximise nutritional status. DSTO has conducted studies to determine the energy expenditure (and therefore nutritional requirements) of (predominantly male) ADF members across a wide range of land-based, and a smaller range of sea-based military activities. These results are summarised in Tables 1 and 2 of the present report. Knowledge gaps can be filled by conducting research on ADF groups not previously studied. There is also scope for resuming the development of an expert system that will allow commanders to determine the food and water needed to sustain troops in particular operational situations. It is concluded that for the purposes of setting nutritional standards, the ADF can be divided into four population groups—adult males, adult females, adolescent males and adolescent females. Further, adult male ADF occupations can be conveniently assigned to five distinct categories of energy expenditure, while four categories apply to occupations involving adult females and adolescents.

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