Dietary Requirements for Different Client Groups

1. Dietary Requirements for Different Client Groups Lisa M. Hanna-Trainor

2. 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

3. Different Client Groups Pregnant women Infants, babies and toddlers Primary school children Adolescents Adults Older people Vegetarians Coeliac Disease Diabetes Osteoporosis Food Intolerance

4. Nutrition through Life Cycle

5. 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 • 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

6. 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 Should avoid soft cheeses, unpasteurised milk, raw eggs, undercooked chicken, liver products Good personal / food hygiene important Special nutritional considerations: teenagers, those with learning disabilities, ethnic groups

7. 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; e.g. breast, ovarian Vitamin A, C & D and calcium all important for infants

8. 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 Cow’s milk contains more protein, less fat, lactose and Vitamin A & C Weaning – transition on to a mixed diet, advised at 6mnths Suggested introductory foods; pureed cooked vegetables and pureed fruit

9. Pre-School / School Age Children Children between 1-4yrs have high energy and nutrient needs. Variable appetite relating to fluctuations in growth rate Important nutrients include; Calcium and Vit. D, Fibre / NSP, Iron and Fluoride Should avoid high fat, high salt and high sugar food From age 5, children should have a healthy balanced diet as per Eatwell model Children’s families exert most influence over their eating and physical activity habits

10. Eatwell Model

11. 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 Calcium requirements should be met due to bone formation; prevention of osteoporosis

12. Adolescents Biological, psychosocial and cognitive changes affect nutritional status Rapid growth increases nutrient needs Need for independence, means take control over their food choices Conform to peer pressure Nutrient deficiencies common / health-compromising eating behaviours Need for calcium and Vitamin D to build bone density; Iron to prevent iron-deficiency anaemia; Zinc for essential mineral growth Watch intake of high salt, high sugar and fatty foods

13. 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 portions of fruit and vegetables daily • Maintain moderate protein intake • Limit salt to less 6g/day (FSA, 2010)

14. 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

15. 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; e.g. 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

16. 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

17. Vegetarians and Vegans

18. 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 (affects 1 in every 100) • Nutritional needs include; gluten-free diet, correct any nutritional deficiencies caused by poor absorption • Gluten free foods ranges available from supermarkets

19. 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)

20. Diabetes • Diet for people with diabetes is a balanced healthy diet, 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 • 2.8 million people in UK have diabetes • Over ¾ people with diabetes have type 2

21. Osteoporosis • Osteoporosis is a condition where the bones become thin and weak and break easily (frequently goes undiagnosed until a fracture occurs) • About 3 million people in UK have osteoporosis, and every year more than 230,000 fractures occur • 1 in 2 women and 1 in 5 men over the age of 50 will have a fracture as a result of the condition • Diagnosis through examination, blood checks, Dexa Scan (x-ray) • Treatment may include calcium and Vitamin D supplements (10 micrograms/day), variety of hormone treatments (HRT / SERMS)

22. Osteoporosis • Causes include: - Genetic predisposition (parents) - Age – Bone density is fixed in third decade of life (after that levels deplete) - Gender - affects Women after menopause (oestrogen levels fall) - Smoking – Increases risk - Heavy drinking (more than 3 units daily) - Low Body Weight (BMI <19) - Sedentary Lifestyle • Diet: Prevention is better – - Healthy balanced diet rich in Calcium (green leafy veg. dried fruit, tofu, yoghurt) (3servings per day) and Vitamin D (eggs, milk and oily fish) - Increase weight-bearing exercises / Maintain a healthy body weight - Get some Sun! / Quit Smoking / Reduce Alcohol consumption - Certain foods – (salt, fizzy drinks, caffeine) leech minerals from bones

23. 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

24. 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

25. Determinants of Food Choice and Eating Patterns throughout Life

26. Important Note You should target your product to a particular client group bearing in mind their specific dietary requirements