PROTEIN DIGESTION AND ABSORPTION
FACTOR
ACTIVITY (% of adult)
Gastric digestion
HCl
Pepsin
<30%
<10%
Pancreatic digestion
Trypsinogen
10-60%
Chymotrypsinogen
Procarboxypeptidase
10-60%
10-60%
Enterokinase
10%
Intestinal digestion and absorption
Peptidases (brush border and cytosol)
Amino acid transport
Macromolecule absorption
>100%
>100%
>100%
CARBOHYDRATE DIGESTION AND ABSORPTION
FACTOR
Intraluminal digestion
Salivary-amylase
Pancreatic-amylase
ACTIVITY (% of adult)
10%
1%
Intestinal digestion and absorption
Lactase
Sucrase-isomaltase
Glucoamylase
Monosaccharide absorption
>100%
100%
50-100%
<100%
Comparison of human milk and cow's milk
Human milk
cow's milk
70
88
12
4.5
7.0
67
88
12
3.5
5.0
Protein (total) (g/dL)
Casein (g/dL)
Whey (g/dL)
a-lactalbumin
ß-lactoglobulin
Lactoferrin
Serum albumin
Lysosym
Immunoglobulins
Others
Whey/ casein
0.90
0.25
0.65
0.25
0.17
0.05
0.05
0.10
0.03
70/30
3.30
2.70
0.60
0.12
0.30
Trace
0.04
Trace
0.07
0.09
20/80
Total mineral (g/dL)
Calcium (mg/dL)
Phosphorus (mg/dL)
Calcium / Phosphorus
Sodium (mEq/L)
0.21
34
15
2/1
7
0.80
130
110
1/1
25
Oral solute load (mOsm/L)
Renal solute load (mOsm/L)
250
80
263
220
Energy (kcal)
Water (%)
Solids (%)
Lipid (g/dL)
Lactose (g/dL)
Absolute contraindications of breast feeding
* Galactosemia
* Anticancer drugs
*Antithyroid drugs
* HIV infection
* Herpetic breast infections
* Psychos
* Heavy metal poisoning (lead, mercury, arsenic etc)
Relative contraindications of breast feeding
(Infant can be breastfed after vaccination and/or drug therapy)



Active tuberculosis
Active hepatitis B
Malaria
Pseudo-contraindications of breast feeding






Hepatitis B carrier state
Cesarean delivery (sectio)
Ordinary infections (Pneumonia, common cold, diarrhea etc)
Mother's milk jaundice
Mastitis
Routine drugs (antibiotics, analgesics etc)
HANDICAPS OF COW'S MILK

High renal solute load of cow's milk lead dehydration if it is given undiluted
Dilution rates;
1st month: 1part milk : 1 part water
2nd month: 2 parts milk : 1 part water
3rd month: 3 parts milk : 1 part water
Over 3rd month: no dilution

Low vitamin C content

Low iron content
Risks of early and late weaning
Risks of early weaning ( <4-6 months)
Short term complications
-
Malnutrition
Diarrhea and other infections
Food allergy
Methemoglobinemia (nitrated foods)
Long term complications
Obesity
Atherosclerosis
Hypertension
Risks of late weaning ( >4-6 months)
Malnutrition
Iron deficiency
Refusing solid foods
What is weaning?
The term weaning means to accustom and it describes the process by which the
infant gradually becomes accustomed to the full adult diet.
During the weaning period the child's diet changes from "milk" alone to the one
based the regular family foods.
Weaning is a dangerous time for infants. It is well known that there is a higher
rate of infection (diarrhea, pneumonia etc) than that any other period in life.
This is because the diet changes from clean breast milk, which contains antiinfective factors, to foods, which are often prepared, stored and fed unhygienic
ways.
Malnutrition is more common during this transitional period, because families
 May not be aware of the special needs of the infant
 May not know how to prepare weaning foods from the foods that are available
locally
 May be too poor to provide sufficient food nutritious foods.
When weaning should begin?
Breast milk, on its own is sufficient for most infants until four to six months of
age.
How to introduce complementary foods?
 Give the food after the breast feed
 Wait a few days until the infant is used to one food before introducing a new
one.
 Use a spoon to feed the infant.
 Gradually increase the amounts of food offered.


Do not force the infant to eat and not to worry if he (she) spits out the food.
Once a new food is accepted give it fairly frequently so that it becomes
familiar.
NUTRITION OF AN INFANT 6-12 MONTHS OF AGE
Cow's milk
Yogurt
Cheese
Pudding
Vegetables
(purees)
Fruits
(purees)
Breast milk
Cereals
(rice , wheat,
maize, "tarhana")
Legumes
(lentil, beans)
Legumes
Mashed meat
Mashed chicken
Egg yolk