HSI LIMERICK BUSINESS SCHOOL

Certificate in Diet and Nutrition

Paul Gough: Consultant Dietitian MINDI

Niamh Gough: Consultant Dietitian MINDI
COURSE OUTLINE

• Duration 9 weeks
• Every Tuesday from 18.30 – 20.30

• Weekly Topics
– Role of Dietitian
– Diet, Health and Disease
– Calculating Nutritional Requirements
– Concept of Healthy Eating
– The Balanced Diet and FAD Diets
– Meal Planning
– Basic Anatomy and Physiology
– Role of Exercise
– Achieving Behaviour Change and Goal Setting
– Macro and Micronutrients and Vitamin Supplementation
COURSE LECTURERS

• Paul Gough
– BSc Sport & Exercise Science
– PgD Nutrition and Dietetics
– 4 – 5 years clinical Experience
– Currently working with Danone Group
– Consultant Dietitian to Galway Senior GAA

• Niamh Gough
– BSc Nutritional Science
– PgD Nutrition and Dietetics
– 4 Years Clinical Experience in UK and Ireland
– Consultant Dietitian to Brothers of Charity Intellectual Disability Unit
ROLE OF DIETITIAN
• Registered Dietitians are the only qualified health professionals that assess,
diagnose and treat dietary problems

• The most up to date professionals on public health issues with regards to

nutrition, health and disease

• Translate scientific guidelines into practical advice and guidance to enable the
public to make appropriate lifestyle and food choices

• Statutorily regulated and governed by INDI to ensure work is off highest

standard

• Employment opportunities within HSE, private practice, industry, education,

research, sort, media and government

• The title dietitian can only be used by those appropriately trained professionals
and have registered with INDI
DIET, HEALTH AND DISEASE
DIET, HEALTH AND DISEASE

• Food is essential for health and survival. Without sufficient energy and
nutrients the body cannot function and with complete starvation life will only
be sustained for a matter of weeks

• Twentieth century really brought to light the role of nutrients in maintaining

health and the requirements of them to prevent deficiency leading to scurvy
and anaemia

• In more recent times it has become clear that diet can play major role in
development of serious preventable diseases, and also conditions causing
morbidity

• Increasingly acknowledged that ‘health’ is more than just absence of disease.

Good health requires both mental and physical well being leading to better
quality of life requiring various all round factors
Global Perspective

• There are major differences in the health problems of the poorer parts of the
world than those of affluent areas

• In less developed regions, famine and chronic under-nutrition remain a

constant threat along with death from infectious diseases. 98% of deaths in
children under 15 occur in developing world

• In developed countries, coronary heart disease and cancer have become the
leading causes of death, with diet and lifestyle being attributable factors,
hence preventable

• The consumption of energy-rich diets, high in saturated fat and low in fibre and
micronutrients, coupled with sedentary lifestyle and use of tobacco, influence
obesity, hypertension, hyperlipidaemia (high cholesterol) and diabetes
Diet and Health
A healthy diet has to fullfil 2 objectives:
• It must provide sufficient energy and nutrients to maintain normal
physiological functions and permit growth and replacement of body tissues
• It must offer the best protection against disease

Meeting the needs for energy and nutrients

Energy
- Most of this energy is derived from the metabolism of carbohydrate, fat and
protein, the amount of energy released being measured in kilocalories (kcal)
or kilojoules (kJ)
- Fat is the most energy-dense nutrient, providing 9 kcal per gram. Protein (4
kcal) and carbohydrate (3.75 kcal) each provide less than half this amount of
energy per gram. Providing 7 kcal per gram, alcohol is also a significant source
of energy to the diet.
- If insufficient energy is obtained from the diet, it will start to ‘cannibalize’ it’s
own tissues in order to meet energy needs, starting with fat stores and then
muscle and tissue supplies.
Carbohydrate, protein and fat

• Carbohydrate (sugars and starches) is rapidly broken down to glucose and is

the most readily available source of energy to the body.

• Fat provides essential fatty acids necessary for the construction of cell
membranes

• Protein provides amino acids which are essential for the growth and
continuous replacement of body tissues and enzymes
Vitamins, minerals and trace elements
- Many different substances are required by the body for the operation of
enzyme systems, transport mechanisms, structural synthesis and
regulatory processes, however most are only required in very small or
trace amounts

Dietary fibre
• Dietary fibre helps to maintain normal bowel function, increases the
satiety value of a diet and may influence the absorption of nutrients and
their metabolic effectFluid
- Fluid is also a vital component of a healthy diet; without which survival
time is limited to a number of days
Conclusion to meet energy needs
There is now wide consensus that the type of diet which minimizes the risk of
chronic disease is one which:

• Has an energy content which is appropriate for bodyweight

• Contains small amounts of energy in the form of saturated fat. Most dietary
fat should be in the form of monounsaturated

• Contains a high amount of energy in the form of starchy carbohydrate

• Has a high fibre content in the form of cereal foods, fruits, vegetables and
pulses

• Low in sodium and high in potassium

• Is balanced overall i.e. decreasing saturated fat to preserve CV health should

not compromise iron or calcium intake
Dietary Targets for Health

Ideal Intake Current Intake Change Required

Total Fat <35% energy 40% energy Decrease by 12%
Saturated Fat 11% energy 17% energy Decrease by 35%
Mono Fat 13% energy 12% energy No change
Poly Fat 6.5% energy 6% energy No change
Total Carbohydrate 50% energy 44% energy Increase by 13%
Starches 33% energy 27% energy Increase by 22%
Sugars 11% energy 17% energy Decrease by 35%
Protein <15% energy 14% energy No increase
Fibre 18g per day 12g per day Increase by 50%
Salt 6g 9g Decrease by 33%
• Eating habits and meal patterns have altered over the years due to:
– Less time spent on shopping, preparing, cooking and eating traditional
meals
– More food is eaten in snack form
– Advances in food technology making microwave meals easy
– Population have become less physically active

Net result is that it has become easier to eat a diet which no longer balances
nutritional needs. Today’s diets tend to:

• Provide too much energy relative to energy needs due to decreased activity
and too much much energy dense, fat and sugar rich foods

• Lack of variety – People tend to eat their few chosen favourite foods

• Lack of fresh foods – Especially fruit and vegetables due to ready meals
Changes Needed to achieve Dietary Targets

• A 50% increase in the consumption of potatoes and bread

• Fruit and vegetable intake being doubled

• Full fat dairy products etc being replaced with low fat alternatives

• Saturated fat spreads and cooking fats being replaced by low fat
spreads or mono fat oils

• All meat being lean meat

• Consumption of 2 portions of oily fish per week and 50% reduction

in the consumption of junk food
Calculating Nutritional Requirements

• Learn to calculate approximate Basal Metabolic Rate (BMR)

• Adjust for stress or weight gain/loss

– If a person is stressed I is necessary to add a factor that estimates the
increased energy required due to disease process
– Or if an increase or decrease in energy stores is required, add or subtract
400 – 1000 kcals/day

• Add a combined factor for activity

SCHOFIELD EQUATIONS

Females (kcal/day) Males (kcal/day)

10-17yrs 13.4W+692 10-17yrs 17.7W+657

18-29yrs 14.8W+487 18-29yrs 15.1W+692
30-59yrs 8.3W+846 30-59yrs 11.5W+873
60-74yrs 9.2W+687 60-74yrs 11.9W+700
75+yrs 9.8W+624 75yrs+ 8.3W+820

To BMR add combined stress factor and activity Factor:

Surgery – 5-40% Bed bound immobile + 10%

Tumour – 0-20% Bed bound mobile/sitting + 15-20%
IBD – 0-10% Mobile on ward + 25%
Infection – 15-20% Mobile in community + 40%

Protein intakes generally 1 – 1.7 g/kg/bw

BODY MASS INDEX (BMI)

Used to express weight grades in adults and calculated using following equation:

BMI = Weight (kgs) <15 = severely underweight

Height (m2) 15-20 = Underweight
20-25 = Desirable weight range
25-30 = Overweight
30-40 = Very overweight
>40 = Severely overweight
EXAMPLE

1. 60 year old female, no medical history and is mobile in community, weighs 75kg
and height is 1.50m. Calculate BMI, and nutritional requirements for weight
maintenance.
CONCEPT OF HEALTHY EATING

There are eight basic guidelines for a healthy diet:

1. Enjoy your food – Eating should be a pleasant aspect of life. Healthy eating does
not mean that some foods are banned but it involves getting the correct balance

2. Eat a Variety – The greater the variety then the more likely it will be that the diet
contains the wide variety of nutrients to be balanced

3. Eat the right amount – Obesity causes many health problems. Eating the correct
diet and combining with physical activity helps maintain correct body shape

4. Eat plenty of starchy foods – Many people have bad conceptions of starchy
foods being fattening. However in correct volumes they contain essential
nutrients such as B vitamins and fibre without too much energy or fat and are
inexpensive
5. Eat plenty of fruit and vegetables – These foods are the major sources of
vitamins, minerals, fibre and antioxidants. Aim for 5 per day

6. Limit fat intake – Eating too much fat can cause obesity and high cholesterol
leading to heart disease. Choose mono fats and low fat alternatives

7. Limit sugary foods and drinks – Fine as occasional treats but too many will
cause the diet to be too high in energy and low in essential nutrients

8. Drink alcohol sensibly – Modest amounts are no harmful to most people and
may even have health benefits. Limits are 21-28 units for men and 14-21 units
per week for females.
Balance of Good Health

• Ireland like many countries use a food pyramid as a conceptual guide to dietary
balance

• Each sector of the pyramid represents one of the five food groups to show the
types and proportions of foods in a well balanced and healthy diet with
healthier foods at the base of the pyramid

• Some countries also use a divided plate model as a visual guide to healthy
eating

• Important to remember that different people need different amounts of food

so a serving is a relative amount rather than a quantified one e.g a young adult
will require a bigger portion than a small child or elderly citizen

• The point is the proportion of foods in the diet should remain the same
Important messages conveyed by plate and pyramid model

• It attempts to change the traditional perception that a meal has to be centred

around protein rich foods such as meat, fish but instead starchy foods and fruit
and vegetables

• Healthy eating does not mean that some foods must be eaten while others are
banned. It is a case of finding the correct balance

• A healthy diet has plenty of scope for flexibility and should not be confined to
the same foods every day

• Overall dietary balance is important. No food contains every single nutrient

required so people need to eat a mixture of foods to obtain them all. The
balance of this mixture will determine health
Advantages of Balance of Good Health Model

• It is flexible enough to be applicable to all age groups from toddlers to elderly

people and all levels of energy and nutrient requirements

• It can be used to assess dietary adequacy. Comparing the proportion of food

groups in an individuals diet with the recommended proportion can indicate
the liklihood of nutritional problems

• It can be used as a basis for dietary modification. The mismatch between the
actual and ideal proportion of food groups in an individuals diet reveals the
type of dietary changes that need to be made

• Food choice guidance can be targeted towards individual needs or desired

therapeutic objectives e.g. a person who is overweight can be encouraged to
make low fat choice where as a person who has a small appetite can be
directed towards nutrient dense foods. Similarly for constipated and CVD
patients
FOOD PYRAMID
PLATE MODEL
Guidance on Food choices in Balance of Good Health

Breads, Cereals and Potatoes

• As discussed many people perceive these foods to be fattening and need to be

reassured. They provide bulk without too much energy

• There energy content only increases significantly when fat is added to them
e.g. butter on bread

• Addition of fat should be discouraged. The opposite may apply to people

requiring weight gain advice

• Wholemeal, wholegrain rice, bread and pasta should be encouraged o increase

fibre intake and provide dietary satiety

• Aim for 4-6 portions daily

Fruit and Vegetables

• In practice most people need to double their fruit and veg intake as these
foods provide the widest variety of vitamins and minerals

• Aim for at least 5 portions per day as a rule of thumb

• One portion would equate to an average apple, large slice of melon, glass of
fruit juice, two serving spoons of green or root veg, 3 serving spoons of peas
or sweetcorn

• Processed foods with only a small amount of vegetables would not count

• Again avoid adding fat too vegetables

• Low fat yoghurt can be a good addition to fruit as dessert

Milk and Dairy Products

• Healthy adults should choose reduced-fat or low fat varieties. Important to

emphasise that these products contain the same amounts of calcium, protein
as full fat equivalents but significantly less fat

• As they are lower in fat they are lower in fat soluble vitamins such as vitamin A
and D and low fat products should not be used for young children

• Hard and other full fat cheeses have a high fat and energy content and should
be used sparingly by those who need to reduce their energy intake

• Butter and cream are almost exclusively comprised of fat and are classified as
fat rich foods and not included in this group
Meat, Fish and Alternatives

• Important aspect of healthy diet but should not form the basis of meals

• Meat – Meat and meat products contribute a high proportion of fat to the
average diet, but lean meat itself contains relatively little fat.

• Lean meat is also a concentrated source of protein and micronutrients in

particular iron

• Good idea to trim fat off before cooking and avid consumption of visible fat

• Poultry – This is commonly assumed to contain less fat than red meat but it
only applies to the white meat eaten without skin

• Dark meat e.g chicken legs are high in fat

Fish – Irish population needs to significantly increase consumption of fish

• Oily fish are an important part of a cardioprotective diet as they contain omega
3 fatty acids

• Should aim to consume 2-3 portions per week and oily fish is also one of the few
dietary sources of vitamin D

• Eggs – Although eggs contain dietary cholesterol, this is not a significant concern
unless taken in large quantities

• Save to eat one egg per day even with high cholesterol

• Pulses – Good source of fibre, minerals and trace elements and provide a
valuable source of protein particularly for vegetarians
Fat Rich and Sugar Rich Foods

• These foods are not devoid of nutrients and in some diets particularly
adolescents, they may account for a significant portion of micronutrient intake

• Unrealistic to expect people to avoid these foods completely and can be used
sparingly to complete healthy diet

• Main point to get across is that these foods can provide a lot of fat and sugars
relative to the amount of valuable nutrients to health

• Products which are low/reduced in fat, sugar, energy or salt may be useful
alternatives. However be aware of the meaning of reduced as this could mean
that the product still contains relatively high amounts

• Choose low fat margarine instead of butter and use olive oil instead of butter
lard for cooking
GUIDE TO FOOD LABELLING

Per 100g A ‘lot’ is A ‘little’ is

Total fat More than 20g Less than 3g
Saturates More than 5g Less than 1g
Fibre More than 3g Less than 0.5g
Sodium More than 0.5g Less than 0.1g

Men Women
Energy 2500 kcals 2000 kcals
Fat 95g 70g
Saturates 30g 20g
Fibre 20g 16g
Sodium 2.5g 2g
BARRIERS TO ACHIEVE HEALTHY DIET

• Achieving permanent beneficial change in an individuals dietary habits is

notoriously difficult

• In order to do so, the many influences on dietary behaviour have to be

considered and will be covered in detail later on in the course

Some barriers include:

1. Lack of perception of the need to change – 70% of people already regard their
diet as healthy and not in need of further change

2. Negative attitudes towards healthy eating – Known that people who had not
changed their dietary habits were more likely to believe that healthy foods
were just another fashion and they were less likely to care about what they ate
3. Lack of time – Busy lifestyles an irregular work patterns are often cited as
barriers to healthy eating

4. Problems with taste and acceptability – People may feel that healthy eating is
less enjoyable or that it requires them to give up all favourite foods

5. Cost – Healthy eating is often perceived to be expensive because it is

associated as it is associated with costly foods such as lean meat, fish and
fresh fruit. People often overlook that the basis of a healthy diet are pasta,
bread, rice which are inexpensive
Conclusion

• Achieving healthy eating requires far more than dispensing dietary advice

• Helping and providing solution to overcome barriers should be identified

• Role of dietitian/nutritionist is to educate on healthy eating and ask not tell the
client what they feel is possible and guide them to how it can be done

• Advice given needs to be individualised taking into account social, economic

and lifestyle factors

• Targets for change should be positive (stressing what people can rather than
cannot do).

• All GOALS set should be SMART (covered at later date in goal setting)

• New initiatives to target high risk groups such as young, low income smokers