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Diet requirements for different client groups. Sally Ison Senior Community Dietitian. 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

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Diet requirements for different client groups l.jpg

Diet requirements for different client groups

Sally Ison

Senior Community Dietitian


Learning outcomes l.jpg
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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Maternal

Babies and toddlers

Primary school children

Adolescents

Adults

Older people

Vegetarians

Coeliac

Diabetics

Food intolerant

Some Client Groups……..



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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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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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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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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

Labeling Rules


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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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H

H

O

OH

H

N

C

C

H

Side chain

(R)

Central carbon

Acid group

Amino group

Structure of amino acid

  • Different side chains make different amino acids


Amino acids l.jpg

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

Amino Acids

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

Immune function (antibodies)


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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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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 - <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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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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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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Minerals

  • Essential minerals

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


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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

Minerals


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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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TYPICAL VALUES

per slice

per 100g

Energy

118KJ

1305KJ

28Kcal

308Kcal

Protein

0.8g

8.5g

Carbohydrate

5.9g

65.0g

(of which sugars)

0.2g

2.5g

Fat

0.1g

1.5g

(of which saturates)

trace

0.3g

Fibre

1.7g

18.5g

Sodium

trace

0.4g

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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Nutritional Information

Fat

Fibre

of which sugars

of which saturates

Protein

Carbohydrate

Energy (kj/kcal)

Sodium

1.4g

9.8g

3.6g

0.6g

14.2g

825/197

13.0g

4.0g

4.0g

0.6g

1.4g

3.6g

14.2g

13.0g

825/197

9.8g

Per 100g

Per Fillet

Ingredients

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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(Typical values per 100 ml):Energy 118 kJ (28 kcal)

Protein – Trace

Carbohydrate 6.4g

Fat – Nil

Niacin 0.93 mg (5.2% RDA)

Vit B6 0.10 mg (5.2% RDA)

Vit B12 0.05mg ((5.2% RDA)

Pantothenic Acid 0.31 mg (5.2% RDA)

Each 330 ml pack provides 17% RDA of the vitamins listed.

Typical mineral values per 100 ml: Sodium 50 mg, Potassium 8.8 mg, Calcium 2.0 mg, Magnesium 0.6 mg.


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Actimel

Nutritional information Typical values per 100g:Energy kJ (kcal) 349/83

Protein 2.8g

Carbohydrate 14.3gFat 1.6g

Contains milk

Suitable for vegetarians and coeliacs




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