Whole family nutrition, heart health & meal planning:

focus on differing needs and limited budget

Ruth CharlesConsultant Paediatric Dietitian

Ballinderry Clinic, St. Francis Hospital, Mullingar, Co. Westmeath.www.nutrikids.ie

Ruth Charles MINDI

Life ages and stages

Ruth Charles MINDI

Stage Key drivers for nutrition Nutrition related issues Key nutrients

Infant0-12 months

Growth: linear and weight gainBone HealthBlood Health

AnaemiaFood refusal

CaloriesIron Calcium Vitamin D

FibreToddler1-4

Family DietIndependencePhysical activity

Food refusalDental health

Child5-13

Linear GrowthPeersSport & hobbies

Overweight & obesity Calorie quality

Teen14-18

Growth spurtPubertyMenstruationBone Health

Fad diets ImbalanceDrugs and alcoholRole models +/-

Calorie qualityIronCalcium and Vitamin D

Adult18-51

Weight:heightWaist circumferencePregnancy & lactationPhysical activity

OverweightMetabolic SyndromeIrritable bowel syndromeCancerStrokeCoronary Heart Disease

Calorie qualityFolic acidCalcium and Vitamin D

Over 51 Muscle mass declinesBMR dropsAnorexiaPhysical activity

OsteoporosisFractures

Calorie qualityCalcium and Vitamin D

Ruth Charles MINDI

Nutrient requirements Ireland Infants

NEW RECOMMENDATION Vitamin D3 supplement: Children 0-1 year: 5µg/200 i.u.

Ruth Charles MINDI

Nutrient requirements Ireland

Ruth Charles MINDI

Ruth Charles MINDI

Ruth Charles MINDI

Ruth Charles MINDI

Ruth Charles MINDI

Ruth Charles MINDI

Ruth Charles MINDI

Food refusal• Common• Learned behaviour that’s repeated if the desired result is obtained• Keep trying! 10-15 new food exposures required before acceptance• Do you eat the food? Be a good role model.• Eating at the same time. Eating new foods

together. Sitting together at the table.

Ruth Charles MINDI

Iron deficiency AnaemiaAdults: Red meat 2-3 times a week

Infants & children: Include red meat in the weaning diet from 6 months onwardsAvoid giving tea Avoid too much formula/milk (>6oomls reduces appetite for other food)

Follow on infant formulae

Ruth Charles MINDI

Bone health: Calcium (Phosphorus)

• Dairy: 3-5 servings per day for children. 5 servings a day for teenagers. Pregnant/breastfeeding women 3 servings.

• Serving= glass of milk (1/3 pint or 189 ml), 1 pot of yogurt or a matchbox-sized (1oz) piece of cheese.

• There is relatively no difference in the calcium content between full fat, low-fat and skimmed milk.

Ruth Charles MINDI

Bone health Vitamin DActive form cholecalciferol D3 needed.

Non Food sources:5–30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back

Dietary sources: Most margarinesSome fortified brands of soya milks, yogurts and desserts – check the labelA few fortified breakfast cereals – check the labelDried skimmed milkFortified yoghurtsEggsOily fish: mackerel, herring, tuna, salmon

Ruth Charles MINDI

Dental Health

The facts

Report of the National Taskforce on Obesity 2005 : 1 in 5 children were overweight

Growing Up in Ireland - Overweight and Obesity Among 9-Year-Olds 2011370,000 Irish Children are Obese.

Girls BoysOverweight Obese Overweight Obese

11.6% 13% 10.5% 9.2%

1 in 4 nine year olds are overweight/obese.

This number increases by 10,000 annually.

The World Health Organization (WHO 1998) report shows that the prevalence of both adult and childhood obesity has reached epidemic proportions worldwide.

Ruth Charles MINDI

The changing shape of Irish children

Ruth Charles MINDI

1 2 3 4 5 6 7 8 9 100123456789

10

Blood glucoseInsulin

What is the Metabolic syndrome?

•Your body becomes resistant to its own Insulin•Your own Insulin becomes ineffective

1 2 3 4 5 60

1

2

3

4

5

6

7

8

9

Blood glucoseInsulin

Ruth Charles MINDI

Waist circumference >37”M, >32”F

Ruth Charles MINDI

Mixing a high with a low GI food reduces the overall GI

Low glycaemic index High glycaemic index

Ruth Charles MINDI

Heart Health

Ruth Charles MINDI

Heart Health

Risk factors

• Male• Family History

• Smoker• Stress• Blood pressure• LDL cholesterol• Weight• Cardiovascular fitness

Ruth Charles MINDI

Making sense of cholesterol and triglycerides

Ruth Charles MINDI

What are “omega” fats?

Cannot be made by the bodyMust be eaten: omega 3 & 6

Reduced risk of coronary heart disease: Reduce the stickiness of bloodThin the bloodProtect blood vessel wallsReduce TriglyceridesReduce InflammationMaintain healthy bone joints

Ruth Charles MINDI

Ruth Charles MINDI

How healthy is your bowel?

What colour is normal?

What’s normal ?

Foods for gut and bowel health

Ruth Charles MINDI

Ruth Charles MINDI

Are you getting enough to drink?

WaterMilkPure JuiceDiluted squash

(Alcohol)(Tea/Coffee)(Fizzy drinks)

Ruth Charles MINDI

Where are we getting our calories from?

Ireland 2012

Carbohydrate (mainly high sugar/refined) Fat (mainly sat-urated)Alcohol

Ireland 1970

Carbohydrate (mainly natural high fibre sources)Fat (mainly natural sources from dairy and meat)Alcohol

Ruth Charles MINDI

Calorie quality: carbohydrate

Ruth Charles MINDI

Calorie quality: Fat• Saturated

• Polyunsaturated/• Monounsaturated• Oily fish 2-3 times per

week.

Ruth Charles MINDI

Calorie quality: alcohol

Low risk weekly guidelines for adults are:up to 14 standard drinks (980 kcals)in a week for women, andup to 21 standard drinks (1470kcals) in a week for men.

1SD=70calories

Ruth Charles MINDI

Ruth Charles MINDI

At least one hour of moderate intensity every day

Ruth Charles MINDI

Common recurring themes A role in

More wholemeal, wholegrain, oats Bowel health, Cholesterol reductionSatisfying hunger, Low glycaemic index

More seasonal multicoloured fruit and vegetables. Natural antioxidants: cancer and heart healthSoluble fibre for bowel health, Water soluble vitamins, Low glycaemic indexValue for money

More fish especially oily sources Omega fats for heart health

Choose lean red meat cuts Haem iron for blood health

More pulses, nuts, seeds Fibre for bowel health, Good source of protein and minerals, Low glycaemic index

More fresh home cooked foodBasic cooking skills

Weight management, Low fat cooking methods, Reduced saltLife skills, Value for money

More water Hydration, Dental health, Satisfying hunger

Dairy is good Bone health, Low glycaemic index, Dental health.Good source of protein. Value for money.

Physical activity Agility, co-ordination, mood, heart health, weight management

Ruth Charles MINDI

Common recurring themes A role in

Less top shelf food pyramid1-2 per week

Improved: Weight management, Heart Health &Dental healthCost of living

Less processed food, ready meals, takeaways. Reducing salt intake, Improved Weight management & Heart HealthCost of living

Less added sugar, less added salt Dental health, glycaemic index,Blood pressure

Alcohol in moderation Improved Weight management & Heart Health & general healthCost of living

Learn to read food labels Making better food choices

Ruth Charles MINDI

Ruth Charles MINDI

Free resources

• www.healthpromotion.ie• www.irishheart.ie/media/pub/kids/on_the_go

_booklet_final.pdf• www.littlesteps.eu• www.fooddudes.ie• www.indi.ie• www.mabs.ie

www.nutrikids.ie

Thank you