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 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; eg. 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 Vit 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 portion s 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; 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

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 • 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 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

21. 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

22. 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

23. Determinants of Food Choice and Eating Patterns throughout Life

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

25. Components of Food • Carbohydrates • Proteins • Fats • Minerals • Vitamins • Water • Fibre (Roughage)

26. 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

27. Carbohydrates • Chemically carbohydrates are defined by their number of saccharide units in their structure • Monosaccharides • Disaccharides • Oligosaccharides • Polysaccharides

28. 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

29. Dietary Carbohydrates

30. Dietary Carbohydrates

31. 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

32. 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

33. Sources of Dietary Carbohydrate

34. 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

35. 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

36. Structure of Amino Acid

37. 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

38. Nonessential Amino Acids • -Alanine • -Asparagine • -Aspartic acid • -Cysteine • -Glutaminc acid • -Gluatmine • -Glycine • -Proline • -Serine • -Tyrosine Amino Acids Essential Amino Acids • -Phenylalanine • -Valine • -Threonine • -Tryptophan • -Isoleucine • -Methionine • -Histidine • -Arginine • -Leucine • -Lysine Conditionally essential Amino Acids -Cysteine -Glutamine -Tyrosine

39. 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

40. 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

41. 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.

42. Transport Proteins • Transport substances in the blood • Lipoproteins (transport lipids) • Hemoglobin ( transports oxygen and carbon dioxide) • Transports materials across cell membranes

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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

50. Trans Fatty Acids • Processed margarines contain significant amounts of trans fat • Same adverse affects as • saturated fatty acids