1. Dietary Requirements for Different Client Groups
Lisa M. Hanna-Trainor

2. 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 2

3. Different Client Groups
Pregnant women
Infants, babies and toddlers
Primary school children
Adolescents
Adults
Older people
Vegetarians
Coeliac Disease
Diabetes
Food Intolerance 3

4. Nutrition through Life Cycle4

5. 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

6. 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 6 6

7. 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 7 7

8. 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 8 8

9. 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 9 9

10. Eatwell Model

11. 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 11 11

12. 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 12 12

13. 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)

14. 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

15. 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

16. 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

17. Vegetarians and Vegans

18. 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

19. 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)

20. 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

21. 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

22. 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

23. Determinants of Food Choice and Eating Patterns throughout Life

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

25. Components of Food Carbohydrates Proteins Fats Minerals Vitamins Water
Fibre (Roughage)

26. 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

27. Carbohydrates
Chemically carbohydrates are defined by their number of saccharide units in their structure
Monosaccharides
Disaccharides
Oligosaccharides
Polysaccharides

28. 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

29. Dietary Carbohydrates

30. Dietary Carbohydrates

31. 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

32. 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

33. Sources of Dietary Carbohydrate

34. 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

35. 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

36. Structure of Amino Acid

37. 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
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
nonessential amino acids

38. Amino Acids Essential Amino Nonessential Amino Acids Acids
-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

39. 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

40. 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

41. Immune Function / Fluid Balance
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.

42. Transport Proteins Transport substances in the blood
Lipoproteins (transport lipids)
Hemoglobin ( transports oxygen and carbon dioxide)
Transports materials across cell membranes

43. 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

44. 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

45. 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

46. Dietary Fats High energy component – 9 kcal per gram
Most important contain carbons
Whether a fat is saturated, monosaturated or polysaturated depends on the location of the double bond

47. 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

48. 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

49. 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

50. Trans Fatty Acids Processed margarines contain
significant amounts of trans fat
Same adverse affects as
saturated fatty acids

51. 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

52. 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

53. 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

54. 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

55. 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)

56. 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

57. 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)

58. 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

59. 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

60. 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

61. 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

62. B Vitamins

63. 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.

64. Minerals

65. 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

66. Discussion What nutrition do they provide?
What age group(s) are targeted?
Male or Female or both?
Anyone excluded?

67. Benecol Range
Benecol® is the only range of foods to contain Plant Stanol Ester, a unique cholesterol lowering ingredient. Plant Stanol Ester works with the body to significantly reduce 'bad' cholesterol by partially blocking its entry to the bloodstream

68. Pot Noodle

69. Quorn

70. Coke Zero

71. QUESTIONS: Dietary Requirements for Different Client Groups Lisa M
QUESTIONS: Dietary Requirements for Different Client Groups Lisa M. Hanna-Trainor Institute of Nursing Research University of Ulster 71