Transcript Dietary Requirements for Different Client Groups

Dietary Requirements for Different
Client Groups
Lisa M. Hanna-Trainor
Learning Outcomes

Be aware that there are a range of different client groups

Identify different characteristics of the different client
groups

Knowledge of different components in different foods

Identify other factors that will affect food choice
Different Client Groups

Pregnant women

Infants, babies and toddlers

Primary school children

Adolescents

Adults

Older people

Vegetarians

Coeliac Disease

Diabetes

Food Intolerance
Nutrition through Life Cycle
Pregnant Women

Provide sufficient energy for pregnancy weight gain (developing
baby) Provide all essential nutrients for growth

Lifestyle - Avoid alcohol / smoking due to risk miscarriage / stillbirth

Regular non-strenuous exercise

400ug/day folic acid until week 12
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Adequate fibre to prevent constipation 25-35g/day

Increase fluid intake

Increased Energy – extra 200 calories/day during last 3mnths

Increased Iron intake – form red blood cells, babies iron
store laid down during pregnancy, last for 6mnths after birth
Pregnant Women

Essential fatty acid intake – important foetal brain development

Vitamin A – high intake not recommended, avoid liver and other
sources

Vitamin C – increased need, aids in absorption of iron

Vitamin D – increased need to aid calcium absorption, 10ug/day

Adequate Calcium – healthy diet should provide sufficient
calcium for mother and baby
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Should avoid soft cheeses, unpasteurised milk, raw eggs,
undercooked chicken, liver products
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Good personal / food hygiene important

Special nutritional considerations: teenagers, those with
learning disabilities, ethnic groups
Infants, Babies and Toddlers

Breast-feeding is optimum feeding for first 6mnths

Advantages for baby – lower risk of infection, protection against
allergens, provides correct mix and quantity of nutrients, baby only
takes what it needs

Advantages for mother – No preparation needed, help with weight
loss after birth, associated with lower risk of certain cancers; eg.
breast, ovarian

Vitamin A, C & D and calcium all important for infants
Infants, Babies and Toddlers

Some mums choose not to or are unable to breast feed

Bottle fed / infant formula – based on cows milk modified to mimic
the nutrient profile of breast milk

Various products available on market, SMA Gold and Aptamil
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Cow’s milk contains more protein, less fat, lactose and Vit A & C
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Weaning – transition on to a mixed diet, advised at 6mnths

Suggested introductory foods; pureed cooked vegetables and
pureed fruit
Pre-School / School Age
Children

Children between 1-4yrs have high energy and nutrient needs.
Variable appetite relating to fluctuations in growth rate
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Important nutrients include; Calcium and Vit. D, Fibre / NSP,
Iron and Fluoride
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Should avoid high fat, high salt and high sugar food
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From age 5, children should have a healthy balanced diet as per
Eatwell model
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Children’s families exert most influence over their eating and
physical activity habits
Eatwell Model
Primary School Children

Continually growing and developing physically, cognitively and
emotionally

Children continue to develop eating and exercise behaviours that
affect their current and future states of health

Although family exert most influence, other external influences
including; Teachers / Coaches, Friends, Media, Ethnic group /
religion, Special requirements. Need for Independence

Iron deficiency problematic – include iron rich foods eg. Meats,
fortified breakfast cereals (Vit. C to aid absorption)

Constipation problematic – fibre and fluids encouraged, eg. Fruit
and vegetables, wholegrain breads and cereals
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Calcium requirements should be met due to bone formation;
prevention of osteoporosis
Adolescents
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Biological, psychosocial and cognitive changes affect nutritional
status
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Rapid growth increases nutrient needs
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Need for independence, means take control over their food choices
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Conform to peer pressure
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Nutrient deficiencies common / health-compromising eating
behaviours
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Need for calcium and Vitamin D to build bone density; Iron to
prevent iron-deficiency anaemia; Zinc for essential mineral growth
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Watch intake of high salt, high sugar and fatty foods
Adults
 Early = 21-39 yrs
Midlife = 40-59 yrs
Old Age = 60+ yrs
 Important to develop beneficial nutritional and lifestyle choices to
support physical and mental health and well-being in old age
 Reduce fat intake to 30% or less; limit saturated fats to less than 10%;
limit cholesterol to 300mg/day
 Five or more portion s of fruit and vegetables daily
 Maintain moderate protein intake
 Limit salt to less 6g/day (FSA, 2010)
Adults
 Limit alcohol intake; 2-3 units/day for women; 3-4units/day for men,
with 2-3 alcohol free days in the week
 Vitamin and mineral supplements in excess of RDA not advised
 Balance food intake and physical activity to maintain normal weight
 Main health issues; obesity, inactivity, high cholesterol, high blood
pressure, prevention of diseases eg. CVD, cancer
 Younger adults more unhealthy than older adults
 Low income = Poorer diet
Older People
 Some nutrients are of particular importance in older people; fibre
(constipation), calcium and Vitamin D (fractures), Vitamin B12 and
Iron (anaemia)
 Some specific nutrients may be needed in increased amounts for
individuals; eg. Protein and zinc (wound healing)
 Ill health and ageing process impacts on nutrition
 Main age-related body changes; decrease in muscle mass, slower
uptake of vitamin A, decline in immune function, decreased
absorption of certain vitamins and minerals
Vegetarians and Vegans
 Number of different types of vegetarian
 In general they have a well balanced diet
 Suffer from less chronic diseases
 Vegetarians are more likely to be ‘health conscious’ and alter other
aspects of their diet and lifestyle
 Should be eating; 3 or 4 servings of cereal grains, 4 or 5 servings
of fruit and vegetables, 2 or 3 servings pulses, nuts and seeds, 2
servings of dairy, eggs or soya products, small amount of
vegetable oil
Vegetarians and Vegans
Coeliac
 Coeliac disease is a reaction to protein in food known as gluten.
Lifelong inflammatory condition of gastro-intestine tract that affects
small intestine; reduces an individual’s ability to absorb enough
nutrients for their needs
 250,000 diagnosed with coeliac disease in UK, however 500,000
undiagnosed
 Nutritional needs include; gluten-free diet, correct any nutritional
deficiencies caused by poor absorption
 Gluten free foods ranges available from supermarkets
Diabetes
 Diabetes mellitus is a condition in which the amount of glucose (sugar)
in the blood is too high because the body cannot use it properly
 Type 1 – Insulin dependent; develops if the body is unable to produce
any insulin (treated by insulin injections and diet)
 Type 2 – Non-insulin dependent; develops when body can still
produce some insulin, but not enough, or when insulin that is
produced doesn’t work effectively (treated by diet alone, or diet and
tablets)
Diabetes
 Diet for people with diabetes is a balanced healthy die, the same kind
that is recommended for rest of population
- low in fat, sugar and salt
- plenty of fruit and vegetables
- meals based on starchy foods, such as bread, potatoes, cereals,
pasta and rice
 1.4 million people in UK have diabetes
 Over ¾ people with diabetes have type 2
Food Intolerance (FI)
 Food allergy and food intolerance are both types of food sensitivity
 Food allergy is when body identifies food as foreign substance and triggers
abnormal reaction in immune system
 Food intolerance doesn’t involve the immune system and is generally not
life-threatening. But if someone eats a food that they are intolerant to, this
could make them feel ill or affect their long-term health
 Signs (FI) include; headache, swelling, vomiting, diarrhoea, skin disorders
 FI Caused by; milk, eggs, nuts, fish/shellfish, wheat/flour, chocolate,
artificial colours, pork/bacon, chicken, cheese
 Essential to examine the label on any pre-packed food
Food Intolerance – Labelling
Rules
 Peanuts
 Nuts Eg. almonds, hazelnuts, walnuts, Brazil nuts, cashews, pecans, pistachios and
macadamia nuts
 Eggs
 Milk
 Crustaceans (including prawns, crabs and lobsters)
Fish
 Sesame seeds
 Cereals containing gluten (including wheat, rye, barley and oats)
 Soya
 Celery
 Mustard
Determinants of Food Choice and
Eating Patterns throughout Life
Important Note
You should target your product to a
particular client group bearing in
mind their specific dietary
requirements
Components of Food
 Carbohydrates
 Proteins
 Fats
 Minerals
 Vitamins
 Water
 Fibre (Roughage)
Carbohydrates
 C = carbo H20 = hydrate
 Basic formula (CH20)n
 All Carbohydrates are converted to glucose and absorbed into the
blood
 Glucose – vital fuel: n = 6 C6 H12 O6
 CHO have a reciprocal relationship with fat
↑ CHO → ↓ Fat
Carbohydrates
 Chemically carbohydrates are defined by their number of saccharide
units in their structure
Monosaccharides
Disaccharides
Oligosaccharides
Polysaccharides
Dietary Carbohydrates
 Originate from plants – CO2 + H2O – Photosynthesis
 Not all carbohydrates are digestible
 1 gram of carbohydrate = 4kcal
 In our diet, starches and sugars are main sources of dietary
carbohydrate
 Function of Carbohydrate – supply energy, protein sparing, prevents
ketosis – breakdown fatty acids
Dietary Carbohydrates
Dietary Carbohydrates
Dietary Sugars
 Intrinsic sugars: sugars which are incorporated within intact plant cell
walls; eg. fruit and vegetables
 Extrinsic sugars: refined sugars; eg. Fruit juices, honey and milk
 Non-milk extrinsic sugars: sugars are present in a free and readily
absorbable state eg. sucrose
Requirement and Intake
 Total carbohydrate should provide up to 50% energy
 Non-milk extrinsic sugars should not exceed 11% energy intake
 Starches, intrinsic and milk sugars should contribute to 39% energy
intake
 Certain diets promote restricted intake of carbohydrates
Atkins Diet – low carbohydrate diet
GI Diet – Encourages foods with low glycaemic index (GI) <60
Sources of Dietary
Carbohydrate
Protein
 Contains carbon, hydrogen, oxygen and nitrogen
 Protein regulates and maintains body functions; structural (skeleton,
connective tissues), protective (tears, mucus), transport (plasma
proteins and hormones) and enzymatic (protein synthesis)
 Protein are made up of 20 different amino acids bonded together in
different sequences to form may SPECIFIC proteins
 Twenty amino acids are important in nutrition
Amino Acid
 All amino acids have an acid group and an amino group attached to a
carbon atom
 The rest of the amino acid is represented by R and is different for every
amino acid
 The carbon to which the carboxyl is attached is the alpha-carbon
 Amino acids have 4 different groups around the alpha carbon resulting
in optically active L or D isomers or enantiomers
Structure of Amino Acid
Classification of Amino Acid
 Essential (indispensable) Amino Acid
- One that the body is unable to make or can only make in inadequate
quantities
- Need to be consumed from the diet
- 8-10 essential amino acids
 Nonessential (dispensable) Amino Acid
- One that the body can make in large enough quantities (Made from
essential amino acids)
- Not necessary to consume these in the diet
- 10-12 nonessential amino acids
Amino Acids
Essential Amino
Acids
-Phenylalanine
-Valine
-Threonine
-Tryptophan
-Isoleucine
-Methionine
-Histidine
-Arginine
-Leucine
-Lysine
Nonessential
Amino Acids
-Alanine
-Asparagine
-Aspartic acid
-Cysteine
-Glutaminc
acid
-Gluatmine
-Glycine
-Proline
-Serine
-Tyrosine
Conditionally
essential Amino
Acids
-Cysteine
-Glutamine
-Tyrosine
Biological Functions of Protein
 Used in body organs and soft tissues
 Enormous functional diversity
Cell membrane structure and function
Enzymes
Hormones and other chemical messengers
 Immune factors (antibodies)
 Fluid Balance
 Transport
 Source of energy
 Structural and Mechanical – Collagen in bone and skin; Keratin in hair
and nails; Motor proteins, which make muscles work
Enzymes / Hormones
 Enzymes
Proteins that catalyze (speed up) chemical reactions without being
used up or destroyed in the process
Anabolic (putting things together) and catabolic (breaking things
down) functions Eg. Digestion – salivary amylase
 Hormones
Chemical messages that are made in one part of the body but act
on cells in other parts of the body Eg. Insulin, some reproductive
hormones
Immune Function /
Fluid Balance
 Immune Function
Antibodies are proteins that attack
and inactivate bacteria and viruses
that cause infection
 Fluid Balance
Proteins in the blood help to maintain
appropriate fluid levels in the vascular system.
Fluid is forced into tissue spaces by blood
pressure generated by pumping action of
heart.
Transport Proteins
 Transport substances in the blood
Lipoproteins (transport lipids)
Hemoglobin ( transports oxygen and carbon dioxide)
 Transports materials across cell membranes
Source of Energy
 Proteins are the last to be used for energy
Occurs in starvation and low carbohydrate diets
 When the body has excess protein stores, some amino acids are
converted and stored as fat in body
 Sources of protein
Fats
 Functions include;
 Provide energy
 Efficient storage of energy (adipose tissue)
 Insulation
 Essential nutrients required for; metabolic and physiological
processes, structural and functional integrity of cell membranes
 Control body temperature
 Physical protection to internal organs
Transport fat soluble vitamins
Flavour and mouth feel
Fat and Fatty Acids
 Simplest form – composed of a chain of carbons with hydrogen atoms
attached, methyl group and a carboxylic group
Methyl group
Acid group
Double Bond
Dietary Fats
 High energy component – 9 kcal per gram
 Most important contain 16-18 carbons
 Whether a fat is saturated, monosaturated or polysaturated depends
on the location of the double bond
Saturated Fatty Acids
 Only single bonds
 High melting temperature
 Solid at room temperature
 Chemically stable
 Examples include animal fats and
their products
 Linked with risk of cardiovascular
disease
Monounsaturated Fatty Acids
 Contain one double bond
 Usually liquid at room temperature
 Examples include olive oil, rapeseed
Oil, nuts and seeds
 Most beneficial type of fatty acid
Lower LDL cholesterol
Polyunsaturated Fatty Acids
 Contain 2 or more double bonds
 Liquid at room temperature
 Susceptible to oxidation
 Omega 3 and 6
 Polyunsaturated fatty acids are
needed in brain development
Trans Fatty Acids
 Processed margarines contain
significant amounts of trans fat
 Same adverse affects as
 saturated fatty acids
Cholesterol
 Wax like substance
 Produced by the liver
 Belongs to steroid family
 Important to limit dietary
cholesterol
 Cholesterol is essential to life
required for synthesis of bile acids,
steroid hormones and vitamin D
Dietary Fat Requirements
 Less than 35% of energy intake should come from fats
<11% from Saturated fatty acids
13% Monounsaturated fatty acids
6.5% N-6 Polyunsaturated fatty acids (PUFA)
0.2g/day minimum N-3 Polyunsaturated fatty acids (PUFA)
<2% Trans fats
May need higher intakes of n-3
Low or Reduced Fat Foods
 Reduced fat = at least 25% less fat than the standard product
 Low fat food = <3g fat/100g or 100ml
 Fat free = <0.15g fat/100g or 100ml
Vitamins
 Essential organic substances, they yield no energy, but facilitate
energy-yielding chemical reactions
 Essential nutrients in maintenance of normal health
 Obtained from food because the body can’t make them
 You need only small amounts (micronutrients) because the body uses
them without breaking them down, unlike what happens to
carbohydrates and other macronutrients
Vitamins
 13 compounds have been classified as vitamins
 Vitamins A, D, E, and K, the four fat-soluble vitamins, tend to
accumulate in the body
 Vitamin C and the eight B vitamins (biotin, folate, niacin, pantothenic
acid, riboflavin, thiamin, vitamin B6, and vitamin B12) dissolve in water,
so excess amounts are excreted (water-soluble vitamins)
Vitamins
 Vitamin A = Retinol,
retinaldehyde, retonoic acid
(performed) and carotenoids
(provitamin A)
 Vitamin B1 = Thiamin
 Vitamin C = Ascorbic Acid
 Vitamin D = Calciferol
 Vitamin E = Tocopherol,
tocotrienol
Vitamin B2 = Riboflavin
Vitamin B6 = Pyridoxine,
pyridoxal, pyridoxamine
Vitamin B12 = Cobalamin
 Vitamin K = Phylloquinone
Vitamin A
 Function – Promote Vision and Growth, prevent drying of skin and eyes
 Food Sources – Performed (Liver, fish oils, fortified milk and eggs)
Proformed (Dark leafy green, yellow orange
vegetables & fruits
 Deficiency – Cause night blindness, skin changes and nutritional
anaemia
 Those at risk – Urban poor, breast fed infants (mother’s poor diet)
elderly, schoolchildren (poor veg. intake)
Vitamin D
 Function – Calcium absorption, regulate bone metabolism, healthy
immune system
 Food Sources – Herring, eel, salmon, tuna, milk, some fortified cereals,
pork sausage, egg yolk (sunlight)
 Deficiency – Rickets in children, Osteomalacia in adults
 Those at risk – Elderly (stay indoors) People living in Northern Climate,
People with fat malabsorption
Vitamin E
 Function – Antioxidant, protects cells from attacks by free radicals, role
in iron metabolism
 Food Sources – Vegetable oils, nuts, seeds, green leafy vegetables
and a variety of fish
 Deficiency – Nerve degeneration
 Those at risk – Premature infants, smokers, people with fat
malabsorption
Vitamin K
 Function – Role in coagulation process (blood-clotting)
 Food Sources – Liver, green leafy vegetables, broccoli, peas and
green beans
 Deficiency – Bleeding disorders, fractures
 Those at risk – People taking antibiotics for long periods
Vitamin C
 Function – Aids in calcium / iron absorption, immune functions
 Food Sources – Citrus fruits, potatoes, green peppers, cauliflower,
broccoli, strawberries
 Deficiency – Scurvy, fatigue, bleeding gums and joints
 Those at risk – Infants, elderly, alcoholics, smokers
B Vitamins
Minerals
 The major minerals present in the body include sodium, potassium,
chloride, calcium, magnesium, phosphorus, and sulfur.
 Trace minerals are present (and required) in very small amounts in the
body. The most important trace minerals are iron, zinc, copper,
chromium, fluoride, iodine, selenium and manganese.
Minerals
Water
 Adults are 60-70% water
 Functions - Maintain the health and integrity of every cell in the body.
Help eliminate by-products of the body’s metabolism, excess
electrolytes (sodium & potassium). Regulate body temperature through
sweating.
 Dehydration occurs when the water content of the body is too low. This
is easily fixed by increasing fluid intake. Symptoms of dehydration
include headaches, lethargy, mood changes and slow responses, dry
nasal passages, dry or cracked lips, dark-coloured urine, weakness,
tiredness, confusion and hallucinations.
 Recommended intake depends on age, hot environment etc. Averages
between 6-10 cups/day
Discussion
 What nutrition do they provide?
 What age group(s) are targeted?
 Male or Female or both?
 Anyone excluded?
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QUESTIONS:
Dietary Requirements for Different Client Groups
Lisa M. Hanna-Trainor
Institute of Nursing Research
University of Ulster