Dietary Requirements for Different Client Groups

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Dietary Requirements for Different Client Groups

• Lisa M. Hanna-Trainor

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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

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Different Client Groups

• Pregnant women
• Infants, babies and toddlers
• Primary school children
• Adolescents
• Adults
• Older people
• Vegetarians
• Coeliac Disease
• Diabetes
• Food Intolerance

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Nutrition through Life Cycle

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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

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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

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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

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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
• Cows 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

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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
• Childrens families exert most influence over
  their eating and physical activity habits

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Eatwell Model
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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

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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

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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)

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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

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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

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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

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Vegetarians and Vegans
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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 individuals 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

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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 doesnt
  work effectively (treated by diet alone, or diet
  and tablets)

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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

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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 doesnt 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

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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

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Determinants of Food Choice and Eating Patterns
throughout Life
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Important Note

• You should target your product to a particular
  client group bearing in mind their specific
  dietary requirements

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Components of Food

• Carbohydrates
• Proteins
• Fats
• Minerals
• Vitamins
• Water
• Fibre (Roughage)

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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

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Carbohydrates

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

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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

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Dietary Carbohydrates
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Dietary Carbohydrates
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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

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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) lt60

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Sources of Dietary Carbohydrate
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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

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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

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Structure of Amino Acid
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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

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Amino Acids

• Essential Amino
• Acids
• -Phenylalanine
• -Valine
• -Threonine
• -Tryptophan
• -Isoleucine
• -Methionine
• -Histidine
• -Arginine
• -Leucine
• -Lysine

Nonessential Amino Acids -Alanine -Asparagine -As
partic acid -Cysteine -Glutaminc
acid -Gluatmine -Glycine -Proline -Serine -Tyrosin
e
Conditionally essential Amino Acids
-Cysteine -Glutamine -Tyrosine
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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

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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

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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.

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Transport Proteins

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

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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

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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

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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
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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

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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

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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

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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

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Trans Fatty Acids

• Processed margarines contain
• significant amounts of trans fat
• Same adverse affects as
• saturated fatty acids

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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

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Dietary Fat Requirements

• Less than 35 of energy intake should come from
  fats
• lt11 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)
• lt2 Trans fats
• May need higher intakes of n-3

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Low or Reduced Fat Foods

• Reduced fat at least 25 less fat than the
  standard product
• Low fat food lt3g fat/100g or 100ml
• Fat free lt0.15g fat/100g or 100ml

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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 cant 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

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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)

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Vitamins

• Vitamin C Ascorbic Acid
• Vitamin D Calciferol
• Vitamin E Tocopherol, tocotrienol
• Vitamin K Phylloquinone

• Vitamin A Retinol, retinaldehyde, retonoic acid
  (performed) and carotenoids (provitamin A)
• Vitamin B1 Thiamin
• Vitamin B2 Riboflavin
• Vitamin B6 Pyridoxine, pyridoxal, pyridoxamine
• Vitamin B12 Cobalamin

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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
  (mothers poor diet) elderly, schoolchildren
  (poor veg. intake)

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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

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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

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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

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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

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B Vitamins
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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.

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Minerals
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Water

• Adults are 60-70 water
• Functions - Maintain the health and integrity of
  every cell in the body.
• Help eliminate by-products of the bodys
  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

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Discussion

• What nutrition do they provide?
• What age group(s) are targeted?
• Male or Female or both?
• Anyone excluded?

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Benecol Range
Benecol is the only range of foods to contain
Plant Stanol Ester, a unique cholesterol lowering
ingredient. Plant Stanol Ester works with the
body to significantly reduce 'bad' cholesterol by
partially blocking its entry to the bloodstream
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Pot Noodle
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Quorn
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Coke Zero
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QUESTIONS Dietary Requirements for Different
Client GroupsLisa M. Hanna-TrainorInstitute
of Nursing ResearchUniversity of Ulster