Nutrition

Healthy Eating

Having a healthy diet is about having a balance of all the 6 main food groups, eating regularly, maintaining a healthy body weight and enjoying your food. It is important to eat enough to maintain your weight. This is a balance of calorie intake versus calorie expenditure.

The Food Groups

A healthy diet should include a variety of all the different food groups' throughout the day to ensure an adequate intake of nutrients including vitamins and minerals.

Starchy Carbohydrates - e.g. Bread, rice, potatoes, pasta, cereals, oats, scones, and teacakes. These provide us with our energy to help our body function efficiently. We should aim to eat some of these at each meal time.

Fruit and vegetables - e.g. all fruit and vegetables, fresh, frozen, tinned, dried. These provide us with lots of vitamins and minerals as well as fibre. Aim to eat 5 a day.

Milk and dairy Foods - e.g. milk, cheese, yogurt, cream. Choosing full fat variety is a good way to increase calorie intake and low fat options to help with weight reduction. These are a good source of calcium. Aim to eat 2-3 portions per day.

Meat, fish and alternatives - Red meat, liver, poultry, fish, eggs, beans, pulses, nuts, soya and quorn. These provide us with protein and iron. Aim for 2-3 portions a day.

Fatty and Sugary foods - Cakes, sweets, fizzy drinks, chocolate, biscuits. These are high in calories and a good way to boost appetite and intake for those who are underweight. These foods should be eaten in moderation and limit intake as part of weight control.

Fluids - at least 6-8cups of fluid per day to keep us hydrated. Try water, teas, coffee, fruit juice, squash, , soups and milky drinks.

The Eat Well Plate (www.food.gov.uk)

This shows a balance of all the food groups that we should aim to have throughout the day. Follow the guide above and the Eat well plate to have a healthy balanced diet.

A high fibre, low fat diet is not appropriate for some older people i.e. those that have a lot of infections or repeat illness or those with a poor appetite to start with. These people require a diet that is nutrient dense.

Healthy Snacks

For those with a normal appetite and a normal weight and no reported swallowing difficulties.

Fruit slices- apple/pear/melon/banana
Grapes/cherries/berries (small handful)
Carrot/cucumber/celery sticks
Dried fruit –apricots/prunes
Glass of fruit juice/milk
Plain/fruit scone, malt loaf or teacake with jam and margarine
Yoghurt, jelly or mousse
Mini fruit pies/muffins
Bread roll/small sandwich
Milky drink (Ovaltine/hot chocolate/Horlicks)
Crackers with cheese or cheese spread

Common Nutritional Problems:-

Poor appetite and weight loss
Obesity
Diabetes
High cholesterol/ heart related problems
Alzheimer’s/dementia
Constipation
Dehydration
Swallowing difficulties
Osteoporosis

Reasons For A Poor Appetite And Weight Loss:-

Underlying disease or illness
Depression or loneliness
Availability of food (ability to prepare/shop and eat food)
Inappropriate textures (unable to chew or swallow certain foods or consistencies of fluids)
Requires assistance with feeding and drinking
Lack of snacks or nourishing drinks

Encourage with high energy/high protein foods as small regular meals/snacks to help boost appetite. Adequate calories can be obtained by choosing the right kinds of foods (see below).

Nutrition Support (high energy/high protein)

Encourage with little and often.

Try and choose high fat, high calorie foods i.e. full cream milk, butter, jam/sugar. Add plenty of butter, cheese, cream and full cream milk to foods and drinks to fortify them and increase calorie intake.

Aim for 3 small meals and 3 nourishing drinks or snacks in between meals.

Dried milk powder is an additional way to enrich your food and drinks with calories and protein. Per pint of full cream milk, add 4tablespoons of milk powder, mix thoroughly and use throughout the day. It can also be added to custards, puddings, sauces and soups.

High Energy High Protein Snacks

Glass of full fat milk (fortified with milk powder)
Hot chocolate/ovaltine/horlicks made with full fat milk
Crumpets/muffins/bagels spread thickly with butter/margarine/cream cheese
Trifles/rice pudding/chocolate mouse/fruit corners/full fat yoghurts (thick and creamy)
Sponge pudding/individual pies or tarts/fresh fruit served with cream/ice cream/custard
Instant desserts/whips/blancmange
Buttered malt loaf/scone/teacakes
Crackers and cheese
Bread/toast with butter and chocolate spread/honey/jam/peanut butter
Chocolate biscuits/bars/crisps/savoury snack

High Energy Light Meal Ideas

Soup and bread (creamy more wholesome soups and buttered bread)
Sandwiches – fillings e.g. egg/cold meat/fish, peanut butter, jam, cheese
Toast – cheese/beans/scrambled/poached eggs/sardines/mackerel
Jacket potatoes – cheese/beans/coleslaw/butter

When someone's appetite is poor, try not to worry about fruit and vegetables and cooked meals. Focus on foods and drinks that the person likes and having a nourishing drink, snack or pudding every few hours throughout the day.

Obesity

Being overweight can increase your risk of diabetes, breathing problems; joint disorders and can affect mobility. Even a 10% weight loss can improve quality of life and decrease overall health risks.

Strict dieting is not advised!

Try to have a balance of all the food groups (see 'Eat well' plate)
Decrease intake of high fat/calorie and high sugar foods
Eat 3 regular meals /day that consist of a balance of starchy foods, protein and plenty of fruit and vegetables.
Cook foods in a healthy way (avoid frying or greasy foods), grill meats and fish and steam/boil vegetables.
Increase the amount of regular, gentle exercise which will help achieve a slow, sensible weight loss.

Snacks (50kcals)

1 piece of fruit

1 scoop of ice cream

1 low calorie hot chocolate

1 fruit shortcake/ginger nut/jaffa cake/fig roll or rich tea

Snacks (100kcals)

2 fig rolls

2 Jaffa cakes

1 plain or chocolate digestive

1 harvest chewy bar

1 kit kat

1 treat size chocolate bar

1 packet of skips/quavers/wotsits

1 teacake

1 carton of fromage frais

1 scotch pancake or crumpet

1oz Brie, Camembert or Edam

Diabetes

The risk of developing type 2 diabetes increases with age and it is a common problem in people over the age of 65years.

Many will be started on medication as well as given dietary advice to help control their blood sugars. There are long-term complications that develop from diabetes especially if it is not well controlled:

Loss of sight
Kidney failure
Limb amputations
Increased risk of stroke and heart disease

Many people with diabetes are overweight and therefore will benefit from weight loss, i.e. regular meal pattern and having a well balance and varied diet based on the eat well place so that they still have a good intake of vitamins and minerals which are essential to maintain a healthy body.

Cutting down on high fat, high sugar, energy-dense foods such as fried food, pies, pastries, cakes, biscuits and puddings can help with weight loss and improve diabetic control.

Quality of Life must not be overlooked, so try to establish a balance between the control of the diabetes and enjoyment from the food.

For more information click here

Or contact your nearest General Practice Dietitian.

Eating For A Healthy Heart

Risk factors

High cholesterol
High blood pressure
Being overweight
Stress
Lack of exercise
Smoking
Drinking too much alcohol

Cholesterol

Cholesterol is a fatty substance made in the liver. It has 2 forms; a good (HDL) and bad cholesterol (LDL). It is produced from the fats we eat in our diet.

Good fats – monounsaturated (olive and rapeseed oils) and polyunsaturated fats (sunflower, corn or soya oils)

Bad fats – saturated fats (butter, cheese, pastries, pies, biscuits etc)

Tran's fatty acids - these act in the same way in the body as saturated fats and are found in a lot of cake and biscuit products

A high intake of fat particularly saturated fats or Tran's fats can raise cholesterol levels in the blood.

Total fat intake should be reduced as all fats are high in calories. This can also help with weight reduction that can improve heart health. It also reduces the development of other risk factors.

Tips for reducing fat:

Choose spreading fats that are 'higher in monounsaturated or polyunsaturated' and lower in saturated fat. Spread thinly or use a low fat spread.
Avoid frying foods - grill, bake, boil or microwave.
Remove visible fat and skin from meat, choose lean meats.
Eat more fish, especially oily fish that is high in Omega-3 fatty acids e.g. mackerel, sardines, pilchards, salmon, herring and kippers.
Choose lower fat dairy products e.g. skimmed or semi-skimmed milk, low fat yoghurts, and low or half-fat cheeses.
Reduce intake of fatty foods e.g. crisps, pies, pastry, cakes, samosas, pakoras, bhajis.

Dietary Cholesterol

It is not necessary to exclude foods that contain cholesterol.

Egg yolks– limit to a maximum of 1 per day.
Liver, kidney, prawns, squid and fish roe –a small portion per week.

Important factors for heart health

Dietary fibre - increase fibre intake especially soluble fibre such as pulses, oats, fruit and vegetables to help reduce cholesterol.

Fruits and vegetables - aim for 5 portions a day (80g). These contain easily digestible fibre and important anti-oxidant vitamins (A, C and E).

Salt - reducing salt intake can help to reduce or prevent high blood pressure. Cut down on salt added to food, adding in cooking, and reduce the amount of ready meals and pre-packed foods eaten.

Weight loss - cutting down on the fat intake in your diet can help with weight loss. Increasing activity helps to burn calories and reduces stress levels.

Alcohol - maximum sensible intakes are no more than 3-4units per day for men and 2-3units per day for women with 2-3 alcohol free days a week.

1 unit =1 pub measure spirits, ½ pint of beer or lager, 1 small glass of wine or sherry.

British heart Foundation website: www.bhf.org.uk

Dementias

Dementia is a progressive condition where the ability to remember, learn, understand and communicate is affected. Skills required for everyday activities gradually decline and changes in personality and behaviour can often be seen.

1 in 5 people over 80years develop dementia and this can compromise their nutritional intake. They may experience difficulties in shopping, cooking and forgetting to eat, as well as changes in food preferences and unusual food choices. This can lead to a loss of weight in this group of people and inadequate nutrient intake.

Nutritional Advice for people with Dementia

Offer small meals and snacks at regular intervals
Encourage with foods that they like
Provide foods in a consistency that they can manage themselves Finger foods are a good idea if they have difficulties using utensils as it still allows them to maintain their independence. For example toast fingers, party sausages, mini rolls, teacakes, chopped fruit and vegetables.
Encourage them with nutritional drinks to increase their fluid and nutrient intake i.e. milk, hot chocolate, soups.

Website: www.alzheimers.org.uk

Constipation

This is mainly associated with an inadequate fluid and /or fibre intake and decreased activity. Increasing fluid and fibre intake gradually together can help improve constipation.

Fibre - wheat bran, edible skins and seeds of fruits and vegetables, whole-grains, fruits, oats, barley and beans.

Fluid - water, juice, cordial, tea, coffee, milk, milky drinks, and soups. Excessive intakes of tea and coffee can lead to dehydration and tea inhibits iron absorption.

Dehydration

Common causes

Older people do not feel as thirsty
Kidney function declines
An increased amount of water is lost via the skin
Immobility and or confusion
Medication
Urinary incontinence

The Effects

Increased risk of pressure sores developing
Drowsiness, confusion and or constipation
Water infections.
Increased risk of falls

It is important to encourage adequate fluid intake to prevent these problems.

Swallowing Difficulties

If you are concerned please contact the GP so that a swallow assessment can be done.

Many older adults develop swallowing problems and it is important that the food and fluid is of the correct consistency for them to swallow and therefore do not choke.

Choose softer foods that do not require a lot of chewing such as:

Mashed potato
Yoghurts
Milk based puddings
Soups
Sandwiches with soft fillings

Cook food thoroughly and add plenty of liquid/sauce to enable it to be swallowed easily.

Osteoporosis

This is a progressive disease that affects the bones and skeletal system. The deterioration of bone tissue and low bone mass leads to an increased risk of fractures as the bones are fragile. The majority of fractures are of the hip, wrist or spine.

Calcium and vitamin D are important nutrients for bone health.

Calcium

Calcium requirements for over 50's are 700mg/day. Milk, milk based foods and dairy products are the richest sources of calcium. They are well absorbed and easily available. Non-dairy sources include green leafy vegetables, dried fruit, bony fish, such as sardines (if the bones are eaten) and fortified cereal products.

Aim for 3 servings of milk and dairy products each day to ensure an adequate intake of calcium.

High intakes of calcium can affect the absorption and metabolism of minerals such as iron and zinc.

Vitamin D

Vitamin D helps the absorption of calcium and recommendations are 10micrograms/day. Our bodies can make vitamin D when our skin is exposed to sunlight. This is the best way to ensure an adequate intake. Dietary sources include oily fish, fish oils, red meat, liver and fortified margarines and breakfast cereals.

The combination of increasing calcium and vitamin D can maintain strong bones and decreases risk of fractures. A healthy body weight and weight bearing exercise also decreases the risk of osteoporosis.

Food Labelling

What to look for?

Fat - total fat and saturates

Sodium - try to choose lower sodium foods as this is converted into salt

Fibre - whole-grains, oats, pulses, wheat-bran, fruits and vegetables are high in fibre

Sugars and Starch - carbohydrates are made up of sugars and starch

Energy (calories) - foods that are high in fats and sugars tend to be high in calories. Choose lower calorie foods/drinks for weight control.

These should be listed as per 100g and often per portion. It is useful to compare similar products and to choose the one that best suits the individual.

What’s a lot and what’s a little?

For a meal serving or in 100g of food/snack use the following as a guide.

Key Store Cupboard Ingredients

For when it is difficult to get to the shops, or the whether is bad it can be useful to have some basic food items in the store cupboard.

These can include; -

Milk e.g. long life, evaporated and dried milk powder
Milky puddings e.g. rice pudding and custard
Canned meat and fish
Canned vegetables and fruit
Dried fruit
Breakfast cereals and porridge oats
Rice and Pasta
Crackers, crisp-breads and oatcakes
Biscuits
Canned soups
Drinks e.g. hot chocolate, juice, cordial
Stock cubes, gravy, sauces and pickles
Preserves e.g. jams, honey, peanut butter

This has been produced by Rachel Wood Community Dietitian at Rotherham Hospital

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A lot: these amounts or more	A little: these amounts or less
10g of Sugar	2g sugar
20g of Fat	3g of Fat
5g of Saturates	1g of Saturates
3g of Fibre	0.5g of Fibre
0.5g of Sodium	0.1g of Sodium