Nutritional needs of specific groups

1. Nutritional needs of specific groups Frances Meek and Alex White 29/06/2018 Food Science Face to Face

2. GCSE Food Preparation and Nutrition Students must demonstrate knowledge and understanding of: Recommended guidelines for a healthy diet How peoples’ nutritional needs change and how to plan a balanced diet for those life-stages, including for those with specific dietary needs The choices that people make about certain foods according to religion, culture, ethical belief or medical reason How to make informed choices about food and drink to achieve a varied and balanced diet, including awareness of portion sizes and costs

3. Level 3 Food science and Nutrition LO1 understand the importance of food safety LO2 understand properties of nutrients • AC2.1 explain how nutrients are structured • AC2.2 classify nutrients in foods • AC2.3 assess the impact of food production methods on nutritional value LO3 understand the relationship between nutrients and the human body • AC3.1 describe functions of nutrients in the human body • AC3.2 explain characteristics of unsatisfactory nutritional intake • AC3.3 analyse nutritional needs of specific groups • AC3.4 assess how different situations affect nutritional needs LO4 be able to plan nutritional requirements • AC4.1 evaluate fitness for purpose of diets • AC4.2 calculate nutritional requirements for given individuals LO5 be able to plan production of complex dishes LO6 be able to cook complex dishes Information and support also available from: www.nutrition.org.uk

4. Nutritional needs of specific groups Nutritional needs can vary depending on many things; Different life stages – childhood, adulthood, female (pre/postnatal, pre/post menopausal), later adulthood. Medical conditions – diabetes (type 1 or 2), hypercholesterolemia, anaemia, lactose intolerance, coeliac disease. Culture – religious beliefs, vegans/vegetarians, lifestyle choices.

5. Nutritional needs at different life stages

6. Task - starter Get into groups and select one of the cards with different life stages – Early childhood, Weaning, teenager, adult female (pre/postnatal, pre/post menopausal), later adulthood. Discuss one way in which nutritional needs may differ at the life stage selected. In the classroom: Ask the students to identify at least five ways nutritional needs may differ at the life stage.

7. Early childhood The Department of Health recommends exclusive breastfeeding for the first 6 months. Weaning or complimentary feeding should begin at around 6 months as; stores of essential nutrients such as iron need to be replenished and baby's increased requirements of these nutrients cannot be provided by milk alone. The aim of weaning is to gradually introduce your baby to a wide range of new tastes and textures. In the classroom: Weaning your baby from around 6 months Link: https://bit.ly/2Gezlsm

8. Weaning After 6 months of age, milk no longer fulfils all the baby’s needs for energy and nutrients. The baby must be given other foods in addition to breast milk or infant formula. This process is called weaning. Weaning too soon (before 4 months) can increase the risk of infections and allergies, as your baby's digestive system and kidneys are still developing. Solids must be semi-fluid and soft, since the baby has no teeth and cannot chew. Supplements of vitamins A, C and D in the form of drops are recommended for children aged from 6 months to 5 years. Cows’ milk is not suitable as a drink before 12 months of age

9. Childhood One in five children in Reception is overweight or obese (boys 23.2%, girls 22.1%) One in three children in Year 6 is overweight or obese (boys 36.0%, girls 32.4%) Children aged between 2 and 5 should gradually begin to follow the proportions illustrated in the Eatwell Guide. The Eatwell Guide does not apply to children under the age of 2, as their nutritional needs are different. Mean daily intakes of all micronutrients are above the RNIs (and only a small amount have intakes below LRNI) in children under 11 years. (National Child Measurement Programme 2016/17) In the classroom: Nutrition for toddlers Link: https://bit.ly/2geFZqB

10. Key messages of the Eatwell Guide Eat at least 5 portions of a variety of fruit and vegetables every day Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates; choosing wholegrain versions where possible Have some dairy or dairy alternatives (such as soya drinks); choosing lower fat and lower sugar options Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish every week, one of which should be oily) Choose unsaturated oils and spreads and eat in small amounts Drink 6-8 cups/glasses of fluid a day : https://bit.ly/1WsxtyK If consuming foods and drinks high in fat, salt or sugar have these less often and in small amounts

11. Eatwell Guide resources EatwellGuide short videos https://bit.ly/2cxIHla Making better choices with the EatwellGuide podcast https://bit.ly/2cCNQbw Eatwell Guide PPT, worksheets, posters and food cards https://bit.ly/2bZTCIp Eatwell Challenge interactive game https://bit.ly/2K2ApCB Healthy eating loop game

12. Teenagers Eating a healthy, varied diet and keeping active will be good for teenagers’ health. Your teenage years are a time of rapid growth and development, and the requirements for some nutrients, like calcium and phosphorus, is fairly high. Boys need more protein and energy than girls for growth. Girls need more iron than boys to replace menstrual losses. There are also a significant proportion of teenagers not meeting the micronutrient requirements, with many having intakes below the LRNI, lower reference nutrient intake. Food route resources https://bit.ly/2bZTCIp

13. Teenagers 15% of 11-18 boys and 39% of 11-18 girls have low blood levels of vitamin D (below 25nmol/L2). Evidence of anaemia, 9% of 11-18 years and 5% of 19-64 years below threshold both for Hb and plasma ferritin. Low blood levels of some vitamins (e.g. folate NDNS years 7 and 8 (2018)

14. Adults 26% of adults were obese and a further 40% of men and 30% of women were overweight (Health Survey England, 2016). In the classroom: Obesity mind map Link: https://bit.ly/2thWHJf NDNS years 7 and 8 (2018)

15. Nutrition pre/post natal Pre conception Women are advised to take a folic acid supplement (400 µg), which should be continued with until the 12th week of pregnancy to reduce the risk of the baby being born with a neural tube defect. The mother should aim to be of healthy weight; achieving a healthy bodyweight may increase her chances of conceiving. In the classroom: Nutrition – trying for a baby Link: https://bit.ly/2ylBi7L

16. Pregnancy During pregnancy, some extra nutrients are needed (mainly in the last three months) to: help the development of the uterus, placenta and other tissues; meet the needs of the growing foetus; lay down stores of nutrients and energy (as fat) for the growth of the foetus and in the mother for lactation. This equates to an extra 200 kcal/day during the third trimester only. In the classroom: Nutrition in pregnancy Link: https://bit.ly/1T6W9xA

17. What not to eat when pregnant Pâté (all types), Raw or undercooked meat Fish liver oil and liver contain vitamin A, which can harm your baby. Shark, marlin and swordfish, as they can contain high levels of mercury. Other fish is great for your baby’s health and development but should be limited to no more than two portions of oily fish and certain non-oily fish. Alcohol should be avoided during pregnancy and caffeine should be limited (to around 200mg per day). Caffeine – do not consume over 200mg/day. Raw shellfish or raw or lightly cooked wild fish Some types of cheeses, such as soft blue cheeses. Avoid raw or lightly cooked eggs that are; UK non-lion eggs, eggs from outside the UK or non hen eggs. https://bit.ly/2oSNWmP NHS Choices

18. Breastfeeding When breastfeeding it is recommended to follow a healthy, varied diet as depicted in the Eatwell Guide. Pregnant and breastfeeding women should aim to restrict their caffeine intake to less than 200mg a day While breastfeeding, women should have no more than two portions (140g each) of oily fish a week. Breastfeeding women should not drink more than one or two units of alcohol, more than once or twice a week when breastfeeding. Breastfeeding can have health benefits for both the baby and mother (such as reducing the risk of breast cancer).

19. Later life Our risk of chronic conditions such as heart disease, cancer and dementia increases as we age. Older people may eat less for different reasons, for example: difficulty in chewing and swallowing; dental problems; changes in sense of smell and taste; difficulty in shopping, preparing and cooking food; living alone; financial problems and illness. Older adults are advised to stay active and follow the basic principles of the Eatwell Guide. For older adults who find it difficult to eat enough, some healthy eating advice such as avoiding full fat dairy products may not apply. In the classroom: CVD brace map Link: https://bit.ly/2t9G5Eh Bone health circle map Link: https://bit.ly/2JZagEt Tips for healthy ageing Link: https://bit.ly/2M53pds

20. Medical conditions

21. Treasure hunt – active learning In the classroom: Nutrition treasure hunt Link: https://bit.ly/2JSXzPP Worksheet https://bit.ly/2M5QKa9

22. Treasure hunt - answers

23. Resources Resources to demonstrate knowledge and understanding of the major diet related health risks. Seven pupil worksheets to challenge and encourage independent thinking: Obesity mind map; Cardiovascular disease brace map; Bone health circle map; Dental health circle map; Iron deficiency anaemia circle map; Diabetes (type 1 & 2) Venn diagram; Ignorance logging worksheet. https://bit.ly/2lDnfm7

24. Culture

25. Religious beliefs Around the world, people choose to eat or avoid certain foods depending on their religious belief. These include: to communicate with God (e.g. saying thanks and blessing); to demonstrate faith through following religious rites concerning diets; to develop discipline through fasting. In the classroom: Religion and food choice PPTs, worksheets and Kahoot quiz Link: https://bit.ly/2mRU0fG International food culture and religion Link: https://bit.ly/2MFMcIr

26. Religion and food choices quiz Open the link below on the main screen and log onto kahoot.it on your tablet or smartphone. You can then enter the code (that will come up on the main screen when you start the game). You can then play along with the quiz choosing the multiple choice answers that correspond with the questions on the main screen. There will then be a leaderboard of the scores after each question and at the end. https://play.kahoot.it/#/?quizId=59753993-0d7b-44e3-9067-f8efa5f64feb

27. Religious beliefs

28. Vegetarians, vegans and other social concerns Human welfare and fair trading, where growers or producers in developing countries are paid a good minimum price to cover their costs, can be a high concern for some people. Animal welfare can also be a concern for some people. This can affect the choice between caged or free-range hens, or ‘dolphin friendly’ tuna. In the UK there are a growing number of people following plant based diets. These can include vegetarians and vegans.

29. Vegetarianism and veganism At least 3.25% of the population, around 1.68 million people, are either vegetarian or vegan (542,000 vegans). Almost 4 in 10 (38%) Britons have bought vegetarian or meat-free food. 35% of people in Britain identify as semi-vegetarian (Mintel). 350% increase in vegans in the UK in the last 10 years. 41% of all vegans are in the 15-34 age category. In the classroom: Factors affecting food choice PPT Link: https://bit.ly/2JrJcxm FAQ Vegan diets – strengths and challenges Link: https://bit.ly/2LAAwoX I dine on iodine blog: Link: https://bit.ly/2EZrdiY Vegan Society

30. Healthy eating for vegetarians and vegans Well planned vegetarian and vegan diets can be nutritious and healthy, they should still be based on the Eatwell Guide. There are some nutrients of which it is likely they will come from different sources than in most diets. For example; protein, iron, calcium, vitamin B12 and omega-3 fatty acids. It is important to remember that removing meat from a diet alone is no guarantee of a healthier diet. An ‘all or nothing’ approach to meat isn’t required

31. Consumer awareness • Being a prudent and critical consumer • Food price and food choice PPT • Food provenance – red meat • Red Tractor Food route up to 14 Food route 16+

32. BNF support and resources Food a fact of life http://www.foodafactoflife.org.uk BNF Blogs BNF Talks British Nutrition Foundation https://www.nutrition.org.uk/

33. BNF online courses The following courses are online now: Catering for health; Complementary feeding and obesity; The science of dietary fibre and digestive health; Allergies – reducing the risk in early life; Food labelling and health claims; An introduction to healthy eating and nutrition; Exploring nutrition and health; Teaching food in primary – what, how and why • England, Scotland, Wales and Northern Ireland available now. www.nutrition.training

34. Useful sources of information Scientific Advisory Committee on Nutrition (SACN) https://www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition NHS Choices (Consumer) • Eatwellhttp://www.nhs.uk/Livewell/Goodfood/Pages/eatwell-plate.aspx • Information http://www.nhs.uk/livewell/healthy-eating/Pages/Healthyeating.aspx The Eatwell Guide, Public Health England https://www.gov.uk/government/publications/the-eatwell-guide National Diet and Nutrition Survey (NDNS) https://www.gov.uk/government/collections/national-diet-and-nutrition-survey Food Standards Agency (Allergens) https://www.food.gov.uk/science/allergy-intolerance FDF Food labelling toolkit http://www.fdf.org.uk/corporate_pubs/Food_Drink_Labelling_toolkit.pdf DEFRA Pocket Book (Food statistics) https://www.gov.uk/government/collections/food-statistics-pocketbook DEFRA Family food statistics (food and drink purchases in the UK) https://www.gov.uk/government/collections/family-food-statistics

35. Thank you for joining us today For further information, go to: www.nutrition.org.uk or www.foodafactoflife.org.uk Frances Meek: f.meek@nutrition.org.uk Alex White: a.white@nutrition.org.uk Why not follow us on twitter? @BNFevents @Foodafactoflife

36. Extra information on medical conditions

37. Diabetes Type 1 diabetes The body does not produce insulin, as pancreatic cells which normally produce insulin are missing or damaged, so blood glucose levels remain high. Treated by daily injections of insulin. Type 2 diabetes The body produces insulin in the pancreas, but it is insufficient to control blood glucose effectively. This is often because the body tissues are resistant to the action of insulin. Type 2 diabetes can be controlled or improved by diet.

38. Type 2 diabetes Most people with newly diagnosed type 2 diabetes are overweight or obese. Prevention includes following a healthy varied diet, taking more physical activity, maintaining a healthy weight (BMI 18.5-25 kg/m2) and avoiding weight gain (>5kg) in adult life. • Diet modification and physical activity help patients to control blood glucose levels and also to help overweight patients to lose weight. • People with type 2 diabetes should still follow the basic principles of the Eatwell Guide.

39. Iron deficiency anaemia Why iron is important: essential for the formation of haemoglobin in red blood cells; haemoglobin binds oxygen and transports it around the body. essential component in many enzyme reactions and has an important role in the immune system. required for normal energy metabolism and for the metabolism of drugs and foreign substances that need to be removed from the body. A lack of dietary iron depletes iron stores in the body and this can eventually lead to iron deficiency anaemia. Dietary iron is found in two basic forms; haem iron (from animal sources) or non-haem iron (from plant sources). Haem iron is the most bioavailable form of iron.

40. Iron deficiency anaemia More than 2 billion people worldwide suffer from iron deficiency anaemia, making it the most common nutritional deficiency condition. Teenage girls and women of childbearing age need more iron than males of the same age making them at increased risk of deficiency. Symptoms can include: tiredness and lack of energy; shortness of breath; noticeable heartbeats (heart palpitations) or pale skin. Iron deficiency anaemia is usually tested by a full blood count (FBC) test.

41. Sources of iron Although meat is the most bioavailable source of iron, other good sources of iron include: pulses, such as beans, lentils and peas nuts dried fruit, such as raisins dark-green vegetables, such as watercress, broccoli and spring greens wholegrains, such as brown rice and brown bread cereals fortified with iron

42. Coeliac Disease Coeliac disease is an autoimmune disease caused by an allergic reaction to gluten. About 1% of the population are estimated to have coeliac disease. There is no evidence that the true prevalence of wheat intolerance is on the increase. There is no reason to cut out gluten in the absence of a gluten related disorder. Cutting out gluten unnecessarily may have negative effects on the balance of the diet e.g. lack of wholegrain foods. Coeliac disease is more difficult to clinically diagnose if a person has eliminated gluten from their diet

43. Lactose intolerance Lactose intolerance is a common digestive problem where the body is unable to digest lactose. This isn't the same as a milk or dairy allergy. Symptoms include flatulence (wind), diarrhoea, bloated stomach, stomach cramps and pains and feeling sick. Advice to control the symptoms is to limit lactose containing foods and drinks including milk and some dairy products. • People with lactose intolerance can often still consume small amounts of lactose without experiencing any problems.

44. Hypercholesterolemia Hypercholesterolemia is the presence of high levels of cholesterol in the blood. It can be caused by an unhealthy diet, lack of exercise or physical activity, drinking excessive amounts of alcohol and smoking. Hypercholesterolemia may also be due to genetic factors. It increases the risk of; narrowing of the arteries (atherosclerosis), heart attack, stroke and peripheral arterial disease (PAD). Blood cholesterol levels are measured with a simple blood test. To lower cholesterol it is important to follow the basic principles of the Eatwell Guide and avoids foods high in saturated fat and choose unsaturated oils and spreads.