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

Identify other factors that will affect food choice

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

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 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

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 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

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

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

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

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)

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

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

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 Vegans

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 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)

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 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

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

Important Note

You should target your product to a

particular client group bearing in

mind their specific dietary

requirements

Components of Food

Carbohydrates

Proteins

Fats

Minerals

Vitamins

Water

Fibre (Roughage)

Carbohydrates

C = carbo H20 = 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

Carbohydrates

Chemically carbohydrates are defined by their number of saccharide

units in their structure

Monosaccharides

Disaccharides

Oligosaccharides

Polysaccharides

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 Carbohydrates

Dietary Carbohydrates

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

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

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

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

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

Essential AminoAcids

-Phenylalanine-Valine-Threonine-Tryptophan -Isoleucine-Methionine -Histidine-Arginine-Leucine-Lysine

Nonessential Amino Acids

-Alanine-Asparagine-Aspartic acid-Cysteine-Glutaminc acid-Gluatmine-Glycine-Proline-Serine-Tyrosine

Conditionally essential Amino Acids

-Cysteine -Glutamine -Tyrosine

Biological Functions of Protein

Used in body organs and soft tissues

Enormous functional diversityCell membrane structure and functionEnzymesHormones 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

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

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 substances in the blood

Lipoproteins (transport lipids)

Hemoglobin ( transports oxygen and carbon dioxide)

Transports materials across cell membranes

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

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

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

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

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

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

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

Processed margarines contain

significant amounts of trans fat

Same adverse affects as

saturated fatty acids

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

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

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

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

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)

Vitamins

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 C = Ascorbic Acid

Vitamin D = Calciferol

Vitamin E = Tocopherol,

tocotrienol

Vitamin K = Phylloquinone

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

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

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

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

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

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.

Minerals

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

What nutrition do they provide?

What age group(s) are targeted?

Male or Female or both?

Anyone excluded?

Benecol Range

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Pot Noodle

Quorn

Coke Zero

QUESTIONS:

Dietary Requirements for Different Client Groups

Lisa M. Hanna-TrainorInstitute of Nursing Research

University of Ulster