Dietary requirements for different client groups
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Dietary Requirements for Different Client Groups. Lisa M. Hanna-Trainor. 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

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Dietary requirements for different client groups

Dietary Requirements for Different Client Groups

Lisa M. Hanna-Trainor


Learning outcomes

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


Different client groups

Different Client Groups

Pregnant women

Infants, babies and toddlers

Primary school children

Adolescents

Adults

Older people

Vegetarians

Coeliac Disease

Diabetes

Food Intolerance


Nutrition through life cycle

Nutrition through Life Cycle


Pregnant women

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


Pregnant women1

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


Infants babies and toddlers

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


Infants babies and toddlers1

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

Cow’s 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


Pre school school age children

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

Children’s families exert most influence over their eating and physical activity habits


Eatwell model

Eatwell Model


Primary school children

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


Adolescents

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


Adults

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)


Adults1

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


Older people

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


Vegetarians and vegans

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


Vegetarians and vegans1

Vegetarians and Vegans


Coeliac

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 individual’s 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


Diabetes

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 doesn’t work effectively (treated by diet alone, or diet and tablets)


Diabetes1

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


Food intolerance fi

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 doesn’t 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


Food intolerance labelling rules

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


Determinants of food choice and eating patterns throughout life

Determinants of Food Choice and Eating Patterns throughout Life


Important note

Important Note

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


Components of food

Components of Food

  • Carbohydrates

  • Proteins

  • Fats

  • Minerals

  • Vitamins

  • Water

  • Fibre (Roughage)


Carbohydrates

Carbohydrates

  • C = carboH20 = 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


Carbohydrates1

Carbohydrates

  • Chemically carbohydrates are defined by their number of saccharide units in their structure

    • Monosaccharides

    • Disaccharides

    • Oligosaccharides

    • Polysaccharides


Dietary carbohydrates

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


Dietary carbohydrates1

Dietary Carbohydrates


Dietary carbohydrates2

Dietary Carbohydrates


Dietary sugars

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


Requirement and intake

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) <60


Sources of dietary carbohydrate

Sources of Dietary Carbohydrate


Protein

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


Amino acid

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


Structure of amino acid

Structure of Amino Acid


Classification of amino acid

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


Amino acids

  • Nonessential Amino Acids

    • -Alanine

    • -Asparagine

    • -Aspartic acid

    • -Cysteine

    • -Glutaminc acid

    • -Gluatmine

    • -Glycine

    • -Proline

    • -Serine

    • -Tyrosine

Amino Acids

Essential Amino

Acids

  • -Phenylalanine

  • -Valine

  • -Threonine

  • -Tryptophan

  • -Isoleucine

  • -Methionine

  • -Histidine

  • -Arginine

  • -Leucine

  • -Lysine

Conditionally essential Amino Acids

-Cysteine

-Glutamine

-Tyrosine


Biological functions of protein

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


Enzymes hormones

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


Immune function fluid balance

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.


Transport proteins

Transport Proteins

  • Transport substances in the blood

    • Lipoproteins (transport lipids)

    • Hemoglobin ( transports oxygen and carbon dioxide)

  • Transports materials across cell membranes


Source of energy

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


Dietary requirements for different client groups

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


Fat and fatty acids

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


Dietary fats

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


Saturated fatty acids

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


Monounsaturated fatty acids

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


Polyunsaturated fatty acids

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


Trans fatty acids

Trans Fatty Acids

  • Processed margarines contain

    significant amounts of trans fat

  • Same adverse affects as

  • saturated fatty acids


Cholesterol

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


Dietary fat requirements

Dietary Fat Requirements

  • Less than 35% of energy intake should come from fats

    • <11% 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)

    • <2% Trans fats

    • May need higher intakes of n-3


Low or reduced fat foods

Low or Reduced Fat Foods

  • Reduced fat = at least 25% less fat than the standard product

  • Low fat food = <3g fat/100g or 100ml

  • Fat free = <0.15g fat/100g or 100ml


Vitamins

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 can’t 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


Vitamins1

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)


Vitamins2

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


Vitamin a

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 (mother’s poor diet) elderly, schoolchildren (poor veg. intake)


Vitamin d

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


Vitamin e

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


Vitamin k

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


Vitamin c

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


B vitamins

B Vitamins


Minerals

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.


Minerals1

Minerals


Water

Water

  • Adults are 60-70% water

  • Functions - Maintain the health and integrity of every cell in the body.

    Help eliminate by-products of the body’s 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


Discussion

Discussion

  • What nutrition do they provide?

  • What age group(s) are targeted?

  • Male or Female or both?

  • Anyone excluded?


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Dietary requirements for different client groups

QUESTIONS:Dietary Requirements for Different Client GroupsLisa M. Hanna-TrainorInstitute of Nursing ResearchUniversity of Ulster


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