NUTRITION - LIFE STAGES

Children (five to 12 years)

As children get older, they have an increasing amount of freedom over food choice and often eat outside the home. Peer pressure and advertising also start to play their part in your children’s food preferences.

Nutrition and children

Although their growth is slower than in infancy, school-aged children still have high nutritional needs but fairly small appetites. So it's crucial all meals and snacks continue to be rich in nutrients and energy. The food choices children make during the crucial years of development can influence their future health risk and can also influence food habits in later life.

A structured eating plan with regular meals and snacks is important to establish good eating habits. Ensure there's also plenty of variety - burgers and chips are fine occasionally, but not for every meal.

A limited number of foods makes it difficult to obtain the full range of nutrients. Make sure your child has a range of foods based on each of the main food groups.

Energy

School children still have a high energy requirement for growth and activity, but increasing numbers are becoming overweight. This is because they’re eating too many calories and not being active enough to use up the extra energy they’ve eaten.

If you think your child is putting on too much weight, don't make a big issue of it. Instead, encourage physical activity in whatever form (football, netball, walking the dog, cycling, swimming and so on).

Base meals and snacks on the five main food groups, but limit fatty and sugary snacks.

An overweight child still needs a nutrient-packed diet that provides all the essential building blocks for growth and development. Encouraging healthy eating should ensure children maintain a healthy weight. Make sure the whole family is eating healthily to provide good role models.

Calcium

This mineral is important for healthy bone development. Good sources include dairy products such as milk, cheese, yoghurt and fromage frais, as well as fortified orange juice, green leafy vegetables, cereals, sesame seeds and tofu.

Your child should ideally aim for three servings of calcium-rich food a day - for example, a 150ml glass of milk, a small pot of yoghurt and a small matchbox-sized piece of cheese.

Folate

This vitamin is important for growth, but intake is low in some children, especially those who skip breakfast because fortified cereals are a good source of folate. Other sources include bread, green leafy vegetables and pulses.

Iron

This mineral helps to keep red blood cells healthy. Insufficient iron intake can lead to iron-deficiency anaemia, but this is much less common in primary school–aged children than their younger and older siblings.

Good sources of iron include red meat, liver, fortified breakfast cereals, beans and pulses.

To help absorb the iron more effectively from non-meat sources, combine it with vitamin C-rich foods such as citrus fruits and fruit juice.

Fatty and sugary foods

This group includes spreading fats (such as butter), cooking oils, sugar, biscuits, cakes, crisps, sweets, cream and ice cream, chocolate and sugary drinks. These foods shouldn't be eaten too often and, when they are, should only be consumed in small amounts.

They're loaded with calories, fat and sugar, and don't necessarily contain many vitamins and minerals. Also, sugary foods and drinks (including fruit juice) can increase the risk of dental decay.

Limit the amount of sugar and sweets eaten, and offer them at the end of meals, rather than in-between.

Some sugar-free or diet drinks can also cause decay because of their acidity. Milk or water is the best drink between meals.

School meals

School dinners in England are subject to strict nutritional guidelines, and other rules cover school tuck shops and vending machines. Primary schools now have to stipulate the vitamin content of school meals, and secondary schools need to do so from 2009.

The Scottish and Welsh governments are also developing legislation to tighten up on school dinner food choices.

Encourage your child to:

• always choose foods rich in protein, such as meat, poultry, fish, eggs, cheese or beans, but encourage them not to eat pies, pasties, sausages or burgers every day as these are very high in fat
• choose at least one starchy food - bread, jacket potatoes, boiled potatoes, rice or pasta
• eat at least one portion of vegetables – raw, cooked alone, or as part of a salad
• eat a piece of fruit - fresh, dried or juiced

Ideas for packed lunches

It's easy to slip into offering your child the same food every day in a packed lunch. There are many types of bread that can add variety to sandwiches. Try pitta bread, chapattis, crusty rolls, muffins or bagels with one of these healthy fillings:

• Chicken with a low-fat dressing and salad
• Grated cheese and pickle
• Bacon, lettuce and tomato
• Tuna and tomato
• Salmon and cucumber
• Hummus and red pepper

Other suitable items include:

• Fruit, both fresh or dried
• Cheese cubes
• Pot of yoghurt or a yoghurt drink
• Cherry tomatoes or sticks of vegetables
• Small pot of potato, pasta or rice salad
• Hard-boiled egg
• Fruit juice or soup in a flask

Snack ideas

Some children need a snack between meals, often around the time they arrive home from school. Encourage healthier options rather than filling up on crisps, savoury items or sweets. Try offering the following:

• Crunchy muesli and yoghurt
• Toasted crumpet or teacake
• Fresh fruit
• Low-fat yoghurt or fromage frais
• Nuts, seeds or dried fruit
• Small carton of milk
• Fruit smoothies
• Cheese and crackers or oatcakes
• Slice of fruit loaf or malt loaf

Key points

• Base food for children around three regular meals with any additional snacks mid-morning and mid-afternoon or before bed. Discourage continuous grazing throughout the day.
• Encourage a variety of foods from the main food groups.
• Encourage your child to have healthy nutritious snacks rather than lots of fatty and sugary foods and drinks.
• School meals and packed lunches are an important contribution to the day's nutritional intake. Encourage your child to make the right choices at school, or provide a healthy packed lunch as an alternative.
• Encourage your child to be active. Coupled with a healthy diet, this will provide the foundations to good health and weight control in the short term and in the future.

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Adolescence

Teenagers go through many changes, and it's vital their diets keep pace with this development.

Teenagers and diet

Teenagers' diets should sustain growth and promote good health. During this time, a number of physiological changes occur that affect nutritional needs, including rapid growth and considerable gains in bone and muscle (especially in boys). This is also a time when teenagers begin to develop real independence from their parents, including making decisions about the food they eat. Teenagers often choose food in response to peer pressure or as an act of defiance against parents. It's not all bad news, as there are many opportunities to encourage healthy dietary habits in teenagers, particularly when relating good food choices to sporting or physical prowess. Ensure there are plenty of healthy options available at home for healthy meals and snacks.

Nutrition

The National Diet and Nutrition Survey of Young People Aged 4-18 Years provides detailed information on the nutritional intake and physical activity levels of young people in the UK. .

The findings reveal average consumption of saturated fat, sugar and salt is too high, while that of starchy carbohydrates and fibre is low. During the seven-day recording period, more than half the young people surveyed hadn't eaten any citrus fruits, green leafy vegetables (such as cabbage or broccoli), eggs or raw tomatoes. The survey also showed that one in ten teenagers have very low intakes of vitamin A, magnesium, zinc and potassium. Intake of iron and calcium was also below ideal levels among many of the teenagers. Meanwhile the rising levels of obesity suggest many young people are eating too many calories.

Iron deficiency

Iron deficiency is one of the most common nutritional deficiencies in the UK. In the National Diet and Nutrition Survey, up to 13 per cent of teenage boys and 27 per cent of girls were found to have low iron stores. Rapid growth, coupled with a fast lifestyle and poor dietary choices, can result in iron-deficiency anaemia. Teenage girls need to take particular care because their iron stores are depleted each month following menstruation.

The main dietary source of iron is red meat, but there are lots of non-meat sources, too, including fortified breakfast cereals, dried fruit, bread and green leafy vegetables. The body doesn't absorb iron quite as easily from non-meat sources, but you can enhance absorption by combining them with a food rich in vitamin C (found in citrus fruits, blackcurrants and green leafy vegetables). In contrast, tannins found in tea reduce the absorption of iron, so it's better to have a glass of orange juice with your breakfast cereal than a cup of tea.

Calcium deficiency

The survey also highlighted that 25 per cent of teens had a calcium intake below the recommended level, which has serious implications for their future bone health.

Osteoporosis is a disease that causes bones to become brittle and break very easily. Bones continue to grow and strengthen until the age of 30, and the teenage years are very important to this development. Vitamin D, calcium and phosphorous are vital for this process, with calcium requirements for the teenage years ranging from 800mg to 1,000mg per day.

Calcium-rich foods should be consumed every day. The richest source of calcium in most people's diet is milk and dairy products. Encourage your teenager to eat two to three portions of dairy food each day – for example, a glass of milk, a 150g pot of yoghurt and a small matchbox-sized piece of cheese. If your teenager doesn’t eat dairy products, try fortified soya milk. Dairy foods are often avoided by teenage girls because of concerns about fat content. Low-fat dairy foods are equally rich in calcium, so providing these versions to aid consumption can be helpful.

Foods to choose

Adolescence is a time of rapid growth, and the primary dietary need is for energy - often reflected in a voracious appetite. Ideally, foods in the diet should be rich in energy and nutrients. Providing calories in the form of sugary or fatty snacks can mean nutrient intake is compromised, so teenagers should be encouraged to choose a variety of foods from the other basic food groups:

• Plenty of starchy carbohydrates - bread, rice, pasta, breakfast cereals, chapattis, couscous and potatoes
• Plenty of fruit and vegetables - at least five portions every day
• Two to three portions of dairy products, such as milk, yoghurt, fromage frais and pasteurised cheeses
• Two servings of protein, such as meat, fish, eggs, beans and pulses
• Not too many fatty foods
• Limit sugar-rich food and drinks

Other important dietary habits to follow during adolescence include:

• Drink at least eight glasses of fluid a day.
• Eat regular meals, including breakfast, as it can provide essential nutrients and improve concentration in the mornings. Choose a fortified breakfast cereal with semi-skimmed milk and a glass of fruit juice.
• Take regular exercise, which is important for overall fitness and cardiovascular health, as well as bone development.

Slimming

Many studies have reported that teenagers, especially girls, are dissatisfied with their weight, and have low self-esteem and a distorted view of their body image.

The most popular methods of losing weight are skipping meals, avoiding red meat, snacks and sugary foods, and even fasting, but these aren't always healthy options. This is a crucial age when a nutritious diet is important - and the so-called growth spurt increases the demands for these nutrients.

If teenagers want to slim, ensure that it's appropriate - are they really overweight or just dissatisfied with their natural body shape? If they do diet, help them to do so sensibly. Strict or faddy diets tend to be low in essential nutrients and frequent unsuccessful dieting can lower self-esteem even further. Sensible eating and regular exercise are the key to slimming success. Cut down on sugary and fatty foods to reduce excess calories while maintaining nutrients.

The teenage years are a time when eating disorders can develop. If you think your teenager may have one, speak to your doctor or practice nurse, or get in touch with the Eating Disorders Association for confidential information and advice.

Vegetarianism

Being a teenage vegetarian needn't be a problem, providing the diet is well balanced and provides suitable alternatives to meat, such as pulses and soya products like tofu.

Meat provides protein, iron, essential B vitamins and zinc - all necessary for the growing teenager. Alternative sources include:

• Iron - fortified breakfast cereals, breads, dried fruits, beans, peas and lentils. Try to have two portions of iron-rich foods every day. To help with absorption, eat them with foods rich in vitamin C (for example, oranges, fruit juice, tomatoes and vegetables).
• B vitamins - if you're still consuming dairy products daily then intakes of these vitamins shouldn't be a problem. For vegans, vitamin B12 can be found in some yeast extracts, soya milks, breakfast cereals and TVP (texturised vegetable protein) products.
• Zinc - can be found in wholemeal breads, cereals, beans and pulses.

Acne

Contrary to popular belief, there's little scientific evidence that acne is caused or exacerbated by fatty and sugary foods. Hormonal factors are the most likely cause.

Key points

• Eat regular meals from the main food groups, and minimise intake of high-fat and sugar-rich foods
• Pay particular attention to getting enough iron and calcium in the diet, and eat lean red meat or non-meat iron sources and dairy products every day
• Maintain a healthy weight
• Be physically active

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Adults

Eating well and drinking sensibly are good investments for your immediate health.

Why good nutrition matters

By eating a nutritious diet and being physically active, you can maintain a healthy body weight and reduce your risk of developing diet-related illnesses, such as type 2 diabetes, heart disease and some types of cancer.

Some of the most important risk factors for premature death in adults are:

• Smoking
• Obesity
• Physical inactivity
• Raised blood cholesterol
• Raised blood pressure
• Excessive alcohol intake

With the exception of smoking, applying the principles of healthy eating and being more physically active can make a significant impact on all of these risk factors.

What is a healthy diet?

To understand how you can eat healthily, it's important to know which types of food to consume and why. Your body requires a well-balanced diet, with a good supply of carbohydrates, especially high-fibre foods, plenty of fruit and vegetables, some protein, low-fat dairy products and plenty of fluid. The best way to get the right balance is to follow the principles of healthy eating shown on the Food Standards Agency's 'eatwell plate' at www.eatwell.gov.uk.

Why don't we eat healthily?

A consumer survey carried out by the Food Standards Agency revealed that knowledge of what constitutes a healthy diet is actually quite high. Most of the adults surveyed knew which kinds of food they should be eating more of, such as fruit and vegetables, or less of, such as fat and salt.

But data from the National Diet and Nutrition Survey, published in 2003, shows that UK adults eat too much saturated fat, sugar and salt, not enough dietary fibre and, on average, their fruit and vegetable intake is fewer than three portions a day.

The rising number of people becoming overweight also tells us that, for a variety of reasons, this knowledge about diet is not being translated into positive action to achieve a healthier diet.

Some media coverage of healthy eating habits can make it seem as though a healthy diet will be incredibly difficult to achieve - either very expensive or not very tasty. But it's possible, with a few simple changes, to make your diet significantly healthier and reduce your risk of illness without it being an onerous task (see the Balance of good health article for details). There are lots of different things you can do, so approach the changes one at a time.

Everyone should be eating a variety of food to achieve a healthy diet, but some nutrition issues are more specific to men or women.

Nutrition issues for men

While both sexes need to maintain a healthy body weight, men in particular should be wary of excess weight. In men, extra pounds tend to be stored around the tummy. Sometimes referred to as abdominal fat, this increases the risk of developing heart disease and diabetes to a greater extent than fat stored on the hips and thighs, which is more typical for women.

This risk of abdominal obesity is even greater for men of Afro-Caribbean and Asian origin.

Prostate Cancer

A recent review of risk factors for cancer found that foods containing lycopene might help to reduce the risk of prostate cancer in men. Tomatoes are a rich source of lycopene, but it's not currently clear whether there are other compounds present in tomatoes - and other foods - that might be acting in conjunction with lycopene to achieve this protective effect.

So, rather than focusing your attention on eating nothing but tomatoes, try increasing your overall intake of all fruit and vegetables.

Nutrition issues for women

The physical demands of pregnancy and breastfeeding place extra nutritional demands on women.

Women are also at higher risk of developing iron deficiency anaemia than men.

How diet can alleviate the symptoms of premenstrual tension (PMT) and the menopause is also the focus of much interest among scientists. Supplements of linolenic acid, vitamin D or calcium have been reported to help with PMT symptoms, and soya-rich diets may also be beneficial.

Many of the studies in this area are not conclusive, so women should follow the principles of healthy eating and be wary of taking large doses of single supplements.

A review of risk factors for cancer found strong evidence of a link between alcohol intake and breast cancer. This gives women another reason to stay within safe alcohol limits.

Nutritional supplements

Healthy adults choosing a variety of foods from each of the food groups shouldn't need a vitamin and mineral supplement (see the Balance of good health article). Studies haven't shown any specific benefits of taking vitamin and mineral supplements, and in some cases they can increase health risks.

But research shows people who eat at least five portions of fruit and vegetables a day have much lower rates of coronary heart disease and cancer.

It's not only the antioxidant vitamins that protect our health - fruit and vegetables also contain a whole variety of other natural and bio-active substances known as phytochemicals. Simply taking a vitamin or mineral supplement can't replace the disease-combating effects of real food.

Certain population groups, such as pregnant women, the elderly and children, may benefit from taking a nutritional supplement.

People who have a poor appetite or erratic eating habits may wish to take a broad-spectrum multivitamin and mineral supplement, but don't take specific supplements unless you've had specific medical advice.

Key points

• Good nutrition is essential for good short-term and long-term health to protect against chronic disease.
• To get your nutrient balance right, eat from the main food groups every day.
• Stay within safe alcohol limits: women should not exceed two to three units a day, and men no more than three to four, and everyone should have some alcohol-free days each week.
• Be active and maintain a healthy weight.

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Older adults - staying fit and healthy

Eating well and being active will help you stay fit and healthy so you can live life to the full and reduce the risks of ill health.

Older adults in the UK

The number of older adults in the world is growing both in absolute and relative terms. In 1994, 16 per cent of the UK population was aged over 65. By 2031, this will increase to 23 per cent, and 10 per cent of this figure will be made up of people over 75 years old. The greatest challenge over the coming years will be maintaining the health of this increasing number of older adults.

Deciding what we mean by 'older people' is a little arbitrary. The World Health Organization classifies people aged between 45 and 59 as 'middle age', 60 to 74 as 'elderly' and over 75 as 'old'.

But the nutritional needs of older adults are difficult to neatly categorise into absolute age groups. Dietary needs depend on current health, and while many older people are fit and active, some others who are younger may be frail and require additional care.

Nutrition for generally fit and healthy older adults

Activity

Research shows that remaining active can help to maintain both mental and physical health. Keeping up the activities you enjoy doing will help to maintain physical fitness and preserve muscle tissue. Preserving your strength will help to maintain your independence. Remember, activity doesn't necessarily mean joining an exercise class. Gardening, walking to the shops and housework can all count as types of activity too.

Energy

Energy requirements can decline with age, particularly if physical activity is limited, but the need for protein, vitamins and minerals remains the same. It's vital that food choices are nutritionally dense, which means you still need to eat a variety of foods to get all the vitamins and minerals you need, but with fewer calories. If you're overweight or obese, it's even more important to be calorie conscious.

Fat

Advice to restrict fat intake, particularly cutting saturated fat to improve heart health, remains true for older people who are fit and well. A dietary survey of older people showed most eat too much saturated fat. Above the age of 75, fat restriction is less likely to be beneficial, and isn't appropriate if the person is frail, has suffered weight loss or has a very small appetite. In fact, in these situations additional fat may be used to increase the calories in meals and snacks to aid weight gain. Read our tips for tackling nutritional problems for older people.

Fibre

Older people can suffer from constipation and bowel problems mainly due to a reduced gut motility and inactivity. To relieve this, try eating high-fibre cereal foods, fruit and vegetables. Raw bran and excessive amounts of very high-fibre foods are not the answer, though; they're too bulky and may interfere with the absorption of certain nutrients. To help the gut work properly, it's also important to drink plenty of fluid, approximately eight medium glasses a day.

Fluid

Dehydration can make people feel drowsy or confused, it's important to drink, even if this means extra trips to the toilet. The risk of dehydration can be higher in older people because their kidneys don't function as efficiently as those of younger people. Older people are also not as sensitive to the feeling of thirst. Fluid intake doesn't just mean water - it can also include such drinks as tea, coffee, fruit juice and squash.

Sugar

Generally fit and healthy older people should limit foods and drinks that are rich in sugar, as it can impair dental health and contribute to weight gain when energy intake is too high. But for people who have a poor appetite, or who have lost weight, sugar-rich foods can be a useful source of calories.

Iron

Anaemia is common in older adults. Poor absorption of iron, due to changes in the gastrointestinal tract, blood loss and the use of certain drugs - together with a poor dietary intake - may be causal factors. Make sure your iron intake is sufficient by eating red meat and foods from non-meat sources (such as fortified cereals, dried fruit, pulses and green leafy vegetables) every day. Absorption of iron from a meal containing non-meat sources is maximised by consuming foods rich in vitamin C at the same time (such as a glass of fruit juice, fresh fruit or vegetables).

Zinc

Zinc is needed for a healthy immune system and to support the healing of wounds including pressure ulcers. Rich sources include meat, pulses, wholemeal bread and shellfish.

Calcium and vitamin D

Adequate intake of calcium and vitamin D may help to slow the rate of calcium loss from bones, which starts at the age of 30 and accelerates considerably in later years. Calcium-rich foods (milk and dairy foods) should be eaten every day.

Vitamin D comes mostly from exposing skin to sunlight, although some foods such as oily fish and fortified spreads and breakfast cereals contain vitamin D. As you get older it's advisable to take a vitamin D supplement, as your body isn't able to get enough from the diet and British weather alone.

Vitamin C

Older people may have low vitamin C intakes if not consuming enough fruit and vegetables. This may be because crisp fruit and vegetables are often avoided if their teeth are in poor condition or if they have badly fitting dentures.

Regular check-ups with the dentist can help to ensure that teeth remain healthy, enabling older people to continue to enjoy a variety of foods that will help maintain overall health.

Foods to choose

To meet your nutritional needs, aim to eat a varied diet including regular meals and snacks, and drink enough fluid.

Sometimes older people can no longer eat as much food at a single sitting, so include more nutritious snacks in between meals to boost nutrient intake.

Ideas for quick and nourishing snacks:

• Sandwiches filled with cooked meat, bacon, tinned fish, cheese or peanut butter. Use different breads for variety and add pickles, relish and sauces.
• Toast with pilchards, sardines, beans, cheese, ravioli, tinned spaghetti or well-cooked eggs.
• Crackers or digestive biscuits topped with cheese, toasted crumpets, teacakes, yoghurt, fruit, malt loaf, fruit cake, breakfast cereals or soup.

If it's difficult to get to the shops, keep some basic foods in your store cupboard:

• Milk: long-life, evaporated or dried milk, and canned milky puddings
• Meat and fish: cans of corned beef, stewed meat, ham, sardines, salmon and tuna
• Fruit and vegetables: a variety of canned or frozen fruits and vegetables, beans, pulses, long-life fruit juice, instant mashed potato
• Drinks: cocoa, malted milk and meal-replacement drinks
• Cereals: breakfast cereals, crackers, crispbread, oatcakes, rice, pasta and biscuits
• Other: soups, stock cubes, gravy, honey, jam, pickles and sauces
• Freezer ideas: frozen meals, bread or rolls, ice cream, fish and meat dishes

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