Diet requirements for different client groups

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Diet requirements for different client groups

• Sally Ison
• Senior Community Dietitian

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Learning Outcomes

• Be aware that there is a range of different
  client groups
• Identify different characteristics of different
  client groups
• Knowledge of different components in different
  foods
• Identify other factors that will affect their
  product choice

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Some Client Groups..

• Maternal
• Babies and toddlers
• Primary school children
• Adolescents
• Adults

• Older people
• Vegetarians
• Coeliac
• Diabetics
• Food intolerant

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Nutrition through Life Cycle
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Pregnancy

• Provide sufficient calories to support weight
  gain
• Provide all essential nutrients
• 400ug/day folic acid
• Fibre 25 35 g/day
• Iron
• Increase fluid intake

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Pregnancy

• Lifestyle changes alcohol, smoking, caffeine
• Salt to taste
• Vitamin A
• Vitamin D
• Calcium

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Breast Feeding
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Formula Feeding

• Some Mums choose not to or are unable to breast
  feed
• Formula Milks
• Using human milk as the nutritional standard,
  formula manufacturers follow a basic recipe that
  includes proteins, fats, carbohydrates, vitamins,
  minerals and water

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Formula Milk
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Child and Preadolescent Nutrition

• Children continue to grow and develop physically,
  cognitively and emotionally during the middle
  childhood and preadolescent years
• Children continue to develop eating and physical
  activity behaviors that affect their current and
  future states of health
• Childrens families continue to exert the most
  influence over their eating and physical activity
  habits

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Child and Preadolescent Nutrition

• External influences
• Teachers
• Coaches
• Peers
• Media
• Independence

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Dietary Recommendations

• Iron inclusion of iron-rich foods including
  meats, fortified breakfast cereals, and dry beans
  ( vitamin C for absorption)
• Fibre Age 5 grams per day may prevent
  adulthood disease fresh fruit and veg whole
  grain breads and cereals
• Fat Use high fat esp saturated fat sparingly
  fat intakes lt20 are not recommended for
  children need calories, EFA, FSV

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Dietary Recommendations

• Calcium 800mg 4-8 yrs 1300mg 9-18 yrs bone
  formation prevention of osteoporosis low-fat
  dairy products
• Fluids esp. during exercise
• Soft drinks increased consumption with age
  overweight children

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Products
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Adolescents

• Biological, psychosocial and cognitive changes
  affect nutritional status
• Rapid growth increases nutrient needs
• Desire for independence may cause adoption of
  health-compromising eating behaviours

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Adolescents

• Common belief that the adolescent diet is
  nutritionally inadequate is this true?
• Getting taller!
• Getting heavier!
• Energy surplus Reduced Activity
• Micronutrient deficiency?

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Adults

• Early 21-39 yrs
• Midlife 40-59 yrs
• Old age 60 yrs
• Need to develop beneficial nutritional and
  lifestyle choices to support physical and mental
  health and well-being in old age

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Adults

• Growth and maturation are complete by early
  adulthood
• Focus now on maintaining physical status,
  strength and avoidance of excessive weight gain
• Reduce fat intake to 30 or less limit saturated
  fats to less than 10 limit cholesterol to 300
  mg daily

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Adults

• 5 or more serving of vegetables and fruits per
  day
• Maintain moderate protein intake
• Balance food intake and physical activity to
  maintain normal weight
• Limit salt intake less than 6 grams

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Adults

• Limit alcohol intake less than 2-3 units per day
  for women 3-4 for men with 2-3 alcohol free days
  in the week
• Maintain adequate calcium
• Avoid taking vitamin and mineral supplements in
  excess of RDA

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Elderly

• Main age related body changes
• Decrease in muscle mass
• Slower uptake of vitamin A
• Decline in immune function
• Reduced skin synthesis of vitamin D
• Decreased vitamin B6 utilisation
• Decreased absorption of certain vitamins and
  minerals
• Recommendations for specific nutrients change
  with age

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Elderly

• Some nutrients are of particular importance in
  older adults e.g fibre, protein, saturated fat,
  vitamin D, vitamin B12, vitamin A, Iron, vitamin
  E, folate, calcium, magnesium and zinc

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Vegetarian and Vegans

• In general vegetarians have a well balanced diet
• Lower mortality from some chronic diseases
• Vegetarians are more likely to be health
  conscious and alter other aspects of their diet
  and lifestyle

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Coeliac

• Coeliacs Disease is a reaction to gluten, which
  causes damage to the lining of the small
  intestine, thereby reducing an individuals
  ability to absorb enough nutrients for their
  needs. Gluten is found in wheat and some other
  cereals
• 250,000 diagnosed with coeliac disease in UK
• 500,000 undiagnosed in UK

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Coeliac

• The Gluten Free Food and Drink Directory ("The
  Food List")

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Diabetics

• 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 diabetes develops if the body is unable to
  produce any insulin
• Type 2 diabetes develops when the body can still
  make some insulin, but not enough, or when the
  insulin that is produced does not work effectively

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Diabetics

• The diet for people with diabetes is a balanced
  healthy diet, the same kind that is recommended
  for the rest of the 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

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Food intolerance

• Food allergy and food intolerance are both types
  of food sensitivity
• Food intolerance doesnt involve the immune
  system and is generally not life-threatening. But
  if someone eats a food they are intolerant to,
  this could make them feel ill or affect their
  long-term health
• Essential to examine the label on any pre-packed
  food

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Labeling Rules

• Peanuts
• nuts such as 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
• sulphur dioxide and sulphites (preservatives used
  in some foods and drinks) at levels above 10mg
  per kg or per litre

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Components of food in human diet

• Carbohydrates
• Proteins
• Fats
• Minerals
• Vitamins
• Water
• Roughage

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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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Carbohydrates

• C carbo   H2O hydrate
• Basic formula (CH2O)n
• All carbohydrates are converted to glucose and
  absorbed into the blood
• Glucose - vital fuel n 6  C6 H12 O6

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Carbohydrates

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

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Dietary Carbohydrates

• Originate from plants CO2 H2O
  Photosynthesis
• Living animals have carbohydrates but this
  dissipates rapidly on death
• Not all carbohydrates are digestible
• 1 gram of carbohydrate 4 kcal
• Starches and sugars are main sources of dietary
  carbohydrate

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Dietary sugars

• Intrinsic sugars those present within intact
  cells e.g. Sugars in fruit
• Non-milk extrinsic sugars present in a free and
  readily absorbable state e.g. sucrose

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Requirement and intake

• Total carbohydrate should provide 50 energy
• Non-milk extrinsic sugars should not exceed 11
  energy intake
• Starches, intrinsic and milk sugars should
  contribute to 39 energy intake

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Sources of dietary Carbohydrates
Starches
Intrinsic Sugars
Milk Sugars
NMES
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Restriction of Carbohydrate intake

• Atkins Diet
• Low carbohydrate
• Ketongenesis
• GI diet
• The glycaemic effect of 50g of a particular food
  in relation to 50g glucose
• Encourages low GI foods

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Protein

• Protein amino acidamino acidamino acidamino
  acid
• Made of 20 different amino acids bonded together
  in different sequences to form many SPECIFIC
  proteins
• Twenty amino acids are important in nutrition

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Amino Acid

• Side chain of an amino acid determines its
  properties (R group)
• 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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Amino Acid

• L-forms proteins and biological systems
• D-forms bacteria (not mammals)
• D-forms slowly absorbed in digestion
• Amino acids can be positively or negatively
  charged according to the pH of the environment
• The polarity of the amino acid indicates how the
  amino acid will be incorporated into proteins

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Classification of amino acids

• Essential 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 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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Structure of amino acid

• Different side chains make different amino acids

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Amino Acids

• Essential (10)
• Phenylalanine
• Valine
• Threonine
• Tryptophan
• Isoleucine
• Methionine
• Histidine
• Arginine
• Leucine
• Lysine

• Nonessential (10)
• Alanine
• Asparagine
• Aspartic acid
• Cysteine
• Glutaminc acid
• Gluatmine
• Glycine
• Proline
• Serine
• Tyrosine

• Conditionally essential (3)
• Cysteine
• Glutamine
• Tyrosine

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Primary structure of a protein

• It is the sequence of amino acids that makes each
  protein different from the next
• Dipeptide 2 amino acids
• Tripeptide 3 amino acids
• Polypeptide many amino acids
• Most proteins have many 100 amino acids

aa
aa
aa
aa
aa
aa
Peptide Bonds
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Secondary structure

• Alignment of polypeptides as a right-hand alpha
  helix
• Stabilized by hydrogen bonds between carboxyl
  (CO) and imido (NH) groups

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Tertiary structure

• Three dimensional folding and coiling of
  polypeptide into globular 3-D structure
• Caused by additional chemical interactions among
  side chains
• Disulfide bonds

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Quaternary structure

• Interactive folding of several polypeptide chains
  together to form a single functional protein
• Functional proteins also might incorporate
  minerals or other nonprotein components
• Final shape and components determine function of
  protein

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Nutritional importance of proteins

• Nutritional value of dietary proteins is
  determined mainly by its primary structure (i.e.
  amino acid composition)
• Tertiary structure can influence protein
  digestibility
• Globular proteins are generally more easily
  digested than filamentous proteins such as
  collagen, elastin and keratin

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Protein synthesis and amino acids

• Protein synthesis cannot proceed without an
  adequate supply of all amino acids, which
  contribute to the primary structure of that
  protein

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Amino acids and protein quality

• The ability of a specific dietary protein to
  supply amino acids in the relative amounts
  required for protein synthesis by body tissues is
  defined as biological value
• Influenced mainly by essential amino acid
  composition
• Is not fixed, but varies with the needs of
  different species, physiological and nutritional
  states

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Biological functions of proteins

• Principal organic chemical constituents of body
  organs and soft tissues
• Enormous functional diversity
• Cell membrane structure and function
• Enzymes
• Hormones and other chemical messengers
• Immune factors (antibodies)
• Fluid balance
• Acid-base balance
• Transport
• Source of energy and glucose

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Structural and mechanical

• Collagen
• Bone and skin
• Keratin
• Hair and nails
• Motor proteins
• Make muscles work!

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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
• Example
• Digestion
• Salivary amylase

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Hormones

• Chemical messengers that are made in one part of
  the body but act on cells in other parts of the
  body
• Note that "steroid hormones" are not proteins!
• Examples
• Insulin
• CCK
• Some reproductive hormones

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Immune function (antibodies)

• Antibodies are proteins that attack and
  inactivate bacteria and viruses that cause
  infection

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Fluid balance

• Proteins in the blood help maintain appropriate
  fluid levels in the vascular system
• Fluid is forced into tissue spaces by blood
  pressure generated by pumping action of the heart
• Fluid returns to blood because of osmotic
  pressure

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Transport proteins

• Transport substances in the blood
• Lipoproteins (transport lipids)
• Hemoglobin (transports oxygen and carbon dioxide)
• Transport 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 excess protein occurs
• Some amino acids converted to glucose which is
  converted to fat

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Sources of Protein
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Fats

• Distributed universally among all cells of the
  body
• Fuel for cells
• Essential fatty acids
• Carrier of fat soluble vitamins
• Protective layer around organs
• Cell membranes
• Hormone synthesis

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Fat and fatty acids
Triacylglycerols
Glycoglycerolipids
Waxes
Sterols
Phospholipids
Sphingolipids
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Dietary fats

• High energy component 9 kcal per gram
• Most important contain 16-18 carbons
• Saturated
• Monounsaturated
• Polyunsaturated

Depends on location of the double bond
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Fatty acids
Carboxyl group
Saturated
Unsaturated
Cis
Methyl Group
Trans
Polyunsaturated
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Saturated fatty acids

• Only single bonds
• High melting temperature
• Solid at room temperature
• Chemically stable
• Animal fats and their products
• May enhance arthrosclerosis and cardiovascular
  disease

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Monounsaturated fatty acids

• Contain one double bond
• Usually liquid at room temperature
• Olive oil
• Rapeseed oil
• Nuts
• Seeds
• Most beneficial type of fatty acid
• Lower LDL cholesterol
• Less lipid peroxidation than PUFA

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Polyunsaturated fatty acids

• Contain 2 or more double bonds
• Liquid at room temperature
• Susceptible to oxidation
• Omega 3 and 6

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Polyunsaturated fatty acids

• Anti-inflammatory
• Brain development
• Eyes

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Trans Fatty acids

• Double bonds may be cis or trans
• Cis both on same side
• Trans facing each other
• Most naturally occurring dietary fat is cis
• Processed margarines contain significant amounts
  of trans
• Same adverse affects as SFA

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Cholesterol

• Wax like substance
• Belongs to steroid family
• Cholesterol is essential to life required for
  synthesis of bile acids, steroid hormones and
  vitamin D

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Dietary fat requirements

• Total fat - lt35
• SFA lt11
• MUFA 13
• N-6 PUFA 6.5
• N-3 PUFA 0.2g/day (minimum)
• Trans Fats - lt2
• May need higher intakes of n-3

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Sources of fat
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Low or reduced fat foods

• Reduced fat at least 25 less fat than the
  standard product
• Low fat food lt3 fat/100g or 100ml
• Fat free lt0.15g fat/100g or 100ml

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Vitamins

• Vitamins are essential nutrients in the
  maintenance of normal health and metabolic
  integrity
• Obtained from food because your body can't make
  them from scratch (organic compounds)
• 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 and these
  are thus known as water-soluble

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VitaminsThe "letter" vitamins sometimes go by
different names. These include

• Vitamin A retinol, retinaldehyde, retinoic acid
  (preformed) and carotenoids (provitamin A)
• Vitamin B1 thiaminVitamin B2
  riboflavinVitamin B6 pyridoxine, pyridoxal,
  pyridoxamineVitamin B12 cobalamin

• Vitamin C ascorbic acid
• Vitamin D calciferol
• Vitamin E tocopherol, tocotrienol
• Vitamin K phylloquinone

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Vitamin A

• Growth
• Vision
• Regulation of gene expression
• Tissue differentiation

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Vitamin D

• Calcium absorption
• Gene expression
• Bone health
• Healthy immune system

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Vitamin E

• Antioxidant
• vegetables oils, nuts, seeds, most green leafy
  vegetables and a variety of fish

Vitamin K

• Blood clotting
• green leafy vegetables, soya bean, rapeseed,
  cottonseed and olive oils

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Vitamin C

• Antioxidant
• Prevents scurvy
• Iron absorption

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B Vitamins

• B1 thiamin required for the central nervous
  system (beri beri)
• B2 riboflavin energy
• B6 coenzyme protein metabolism and steroid
  hormone regulation
• B12 pernicious anaemia

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B vitamins
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Minerals

• Essential minerals
• calcium, phosphorus, magnesium, iron, zinc,
  fluoride, iodine, selenium, copper, manganese,
  chromium, molybdenum, sodium, potassium, chloride

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Minerals

• Calcium bone health dairy products
• Zinc immune system fish, meat, rice
• Iron blood, energy meat, fish, cereals
• Sodium and chloride regulation of osmotic and
  electolyte balance - salt

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Water

• Adults are 60-70 water
• Recommended intakes
• 12 cups/day for males
• 9 cups/day for females
• 75 from fluids 25 from foods
• Dietary sources
• Best are water and nonalcoholic beverages
• Alcoholic beverages increase water loss through
  urine

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Examples - discussion

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

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RYVITA
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Wholemeal Rye, Salt.CONTAINS Gluten, may
contain traces of sesame seeds      Made from
only natural ingredients      No artificial
colourings or preservatives      Only 28
Calories per slice      High in fibre     
Low in fat
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Quorn Fillet (69)rehydrated free range egg
white, onion, textured wheat protein (wheat
protein, wheat starch), flavourings, milk
proteins, tapioca starch, gelling agent
pectin, breadcrumb (wheat flour, yeast, salt),
batter (maize flour, wheat flour, wheat starch,
hydrogenated palm oil, raising agents di-sodium
diphosphate, sodium bicarbonate salt, skimmed
milk powder, dextrose, whey powder, wheat
gluten, rice flour, rapeseed oil), sunflower
oil. Contains Egg, Gluten, Milk Wheat
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Actimel

• Nutritional information Typical values per
  100gEnergy kJ (kcal) 349/83
• Protein 2.8g
• Carbohydrate 14.3gFat 1.6g
• Contains milk
• Suitable for vegetarians and coeliacs

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Crisps
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QUESTIONS