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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 Children’s 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 <20% 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 Coeliac’s Disease is a reaction to gluten, which causes damage to the lining of the small intestine, thereby reducing an individual’s 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 doesn’t 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 acid+amino acid+amino acid+amino 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 (C=O) 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 Sterols Waxes Sphingolipids Triacylglycerols Phospholipids Glycoglycerolipids

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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 Saturated Trans Cis Unsaturated Polyunsaturated Methyl Group Carboxyl group

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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 - <35% SFA <11% MUFA 13% N-6 PUFA – 6.5 % N-3 PUFA – 0.2g/day (minimum) Trans Fats - <2% 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 = <3% fat/100g or 100ml Fat free = <0.15g 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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Vitamins The "letter" vitamins sometimes go by different names. These include: Vitamin A = retinol, retinaldehyde, retinoic acid (preformed) and carotenoids (provitamin A) Vitamin B1 = thiamin Vitamin B2 = riboflavin Vitamin B6 = pyridoxine, pyridoxal, pyridoxamine Vitamin 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 100g: Energy kJ (kcal) 349/83 Protein 2.8g Carbohydrate 14.3g Fat 1.6g Contains milk Suitable for vegetarians and coeliacs

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