Nutrition across life course

Question 1

Define macronutrients

Answer 1

nutrients your body needs in large amounts

Question 2

Define micronutrients

Answer 2

nutrients your body needs in small amounts

Question 3

What are the 6 different classes of nutrients? Which are micronutrients and macronutrients?

Answer 3

Macronutrients:
1. Carbohydrates
2. Proteins
3. Lipids

Micronutrients:
4. Minerals
5. Vitamins

6. Water

Question 4

What are the stages of the lifecycle?

Answer 4

1. Preconception
2. Pregnancy
3. Lactation
4. Infancy- breastfeeding
5. Childhood
6. Adolescence
7. Adulthood

Question 5

What is the importance of nutrition during preconception?

Answer 5

Weight-loss:
- Severe weight loss has an impact on ovulation.

Body fat:
- Body fat must be 22% of body weight to maintain ovulation.
- Prolonged malnutrition can result in amenorrhoea (absence of menstruation).

Obesity:
- Obesity can also inhibit ovulation.

Nutrition can also have an impact on sperm quality!

Question 6

What is the importance of nutrition during pregnancy (weight, protein, vitamins)?

Answer 6

1. Weight:
   Over course of pregnancy, there should be approx weight gain of 12.5kg, consisting of:
   - 2.5 kg body weight
   - 3.5 kg infant weight
   - 6.5 kg placental weight
2. Protein:
   - Additional 6g/day to 51g in total.
3. Vitamins:
   - Folate - lack of folic acid associated w/ neural tube defects. Women who become pregnant should supplement with 0.4 mg folic acid a day for first 12 weeks.
   - Vitamin A - increment of 100 mg to 800 mg/day.
   - Vitamin D - 10 mg/day.
   - Vitamin C - increase by 10 mg/day to 50 mg/day in 3rd trimester.
   - Iron - 14.8 g/day with no increase needed unless iron was low to start with.

Question 7

What is the importance of nutrition during lactation? What to avoid?

Answer 7

1. Mineral:
   - Calcium - at least 1200 mg/day - the body will maintain breastmilk quantity & quality at the expense of the mother’s stores. A lack of calcium has long term impacts on bones.
2. Dehydration
   - Fluids need to be replaced - 2 L/day

Things to avoid:
- Alcohol - in large quantities
- Caffeine - in large quantities
- Strong tasting or highly spiced food - can alter taste of milk which may cause baby distress

Question 8

What is the importance of nutrition during breastfeeding?

Answer 8

Breastfeeding
- Encouraged to do this for at least 4 months.
- Milk should provide all the baby’s fat content needs.
- Infant formulae based on cow’s milk & modified to mimic breast milk can be used.

Babies need more of:
- Protein
- Iron
- Calcium
^per kg of body weight

Question 9

What is the importance of nutrition during breastfeeding?

Answer 9

Breastfeeding
- Encouraged to do this for at least 4 months.
- Milk should provide all the baby’s fat content needs.
- Infant formulae based on cow’s milk & modified to mimic breast milk can be used.

Babies need more of:
- Protein
- Iron
- Calcium
^per kg of body weight

Question 10

What is the importance of nutrition during childhood?

Answer 10

Free sugars: 19g

Protein: 19g (4-9yrs old), 34g (9-13yrs old)

Fat: 30-35% of diet, from mono or polyunsaturated fats

Carbohydrates: 50-60% of diet

Question 11

What is the importance of nutrition during adolescence?

Answer 11

Free sugars: 24g

Protein: 52g (boys), 46g (girls)

Fat: 25-30% of diet, from mono or polyunsaturated fats

Carbohydrates: 50-60% of diet

Question 12

What is the importance of nutrition during adulthood? What is the importance of protein?

Answer 12

1. Free sugars: 30g
2. Protein:
   - 55g/d males
   - 45g/day females

Importance of protein:
- A high protein diet is associated with greater weight loss & preservation of lean mass.
- Greater fat mass loss.
- Protein has a satiety effect - the feeling of fullness.
- 1.2-1.6g/kg/day - can help to loose & maintain the weight loss

3. Fat:
   - Total fat <35% food energy
   - saturated fat (no double bond)<11% food energy
   - linoleic and linolenic acids >1%
   and 0.2% food energy
   - Long chain omega-3 polyunsaturated fatty acids > 450mg/d
   - The more polyunsaturated fats (double bonds) in the diet, the lower the risk of coronary heart disease.

Sources of omega-3 fats fatty acids & importance:
- Good for cardiovascular health & brain health
- e.g. EPA & DHA - main ones in the diet
- sources: oily fish - herring, mackerel, salmon, fresh tuna not canned, marine microalgae (vegan)
- 450mg a day

4. Carbohydrate:
   - Carbohydrate >50% food energy
   - Free sugars <5% food energy
   - Free sugars are all simple sugars (glucose, fructose, maltose etc) except lactose
   - Wholegrain diet reduces risk of cardiovascular risk
   - Poor quality carbs are worse than fats.
   - Poor quality = white bread, white rice, potatoes.
   - Low carbohydrate diet is most effective in weight loss maintenance.

High quality carbs= have all the bran & germ layer= whole grain
- The more processed the grain, the more the germ & bran is removed.
- The more processed the carb = the larger the peak of blood glucose.

Question 13

What are the effects of excessive carbohydrate intake?

Answer 13

• Weight gain
• High blood sugar levels
• High triglycerides & low HDL Cholesterol levels

Question 14

What are the effects of excessive protein intake?

Answer 14

• Organ damage due to build up of amino acids, insulin & ammonia
• Upset stomach
• Abnormal stools
• Weight gain
• Bad breath

Question 15

What are the effects of excessive lipid intake?

Answer 15

• cardiovascular complications
• Obesity
• Increased risk of arthritis, some cancers & diabetes
• Lipid deposition

Question 16

What are the effects of excessive vitamin intake?

Answer 16

Vitamin A: Nausea, Loss of appetite, Headache, Dry & itchy skin

Vitamin B: itchiness, stomach problems and headaches and may trigger liver damage, erectile dysfunction, ulcers and diabetes

Vitamin C: Diarrhoea, headaches & kidney stones (long-term)

Vitamin D: Slowed growth, nausea, vomiting, loss of appetite & excessive calcium in blood

Vitamin E: Interference with blood thinning medication, as it can antagonise vitamin K-dependant clotting factors

Question 17

What are the effects of carbohydrate deficiency?

Answer 17

• Fatigue
• Headache
• Nausea
• Muscle aches & Cramps
• Seizures & Paralysis (severe)

Question 18

What are the effects of protein deficiency?

Answer 18

• Oedema
• Muscle wastage
• Brittle nails
• Thinning hair

Question 19

What are the effects of lipid deficiency?

Answer 19

• Eating disorders
• Inflammatory bowel disease
• Dermatitis
• Poor growth & reproduction

Question 20

What are the effects of vitamin deficiency?

Answer 20

Vitamin A: Eye problems, dry & itchy skin, infertility & reduced growth

Vitamin B: Anaemia

Vitamin C: Scurvy - 10mg a day - signs of scurvy include tooth loss, fatigue, muscle weakness, increased susceptibility to infection & bleeding from skin & mouth - this occurs as vitamin C is involved in the synthesis of collagen

Vitamin D: Impairment of bone mineralisation. Often asymptomatic

Vitamin E: Impaired reflexes, weak muscles, difficulty walking & premature infants.

Question 21

What is gov doing to tackle obesity?

Answer 21

• Online & TV adverts about healthy eating.
• Restricting BOGO for unhealthy food
• Restaurants have calorie labels
• Alcohol colorie labelling
• Expansion of NHS weight loss services.

Question 22

What is the MUST tool?

Answer 22

Malnutrition Universal Screening Tool

• 5 step screening tool for adults who are malnourished, or at risk of malnourishment.
• If a person scores 2 or more, they are identified as being high risk

Question 23

Whole diet approaches to disease prevention & treatment.

Answer 23

1. DASH diet - good at preventing hypertension - a fruit & veg diet with low fat diary e.g. milk & low fat yoghurt.
2. Mediterranean Diet - fruit, veg, extra virgin olive oil, seeds, herbs, spices, fish & sea food - less salt, meat & confectionary. 30% reduced risk of cardiovascular disease after 5 years. Also helps w/ cognitive function & memory.
3. Eat-well guide- plate illustration- introduced in early age to children