Maintaining your Diet and Exercise Routine during Holidays

 

It is not unusual to come to your holiday and believe you need a well-deserved break, not only from work or study but from your usual exercise and diet regime. This is understandable. That said, it is important that diet and exercise are not completely forgotten when you go on holidays. 

There is evidence to suggest that eating and exercising habits during the holiday period contribute substantially to the overweight and obesity epidemic in developed countries. The major reasons behind these weight changes are fairly self-explanatory. The holidays are unstructured compared to a working week, and more time is spent sleeping in, dining out, partying and drinking, which leaves little time and energy for exercise. Combined with the excess calorie intake from food and alcohol, this inevitably leads to weight gain and the associated negative health outcomes.

Importantly, this trend also occurs in children, and may be contributing the rise of childhood obesity and health problems.

It is very important to be aware, for yourself and for your children, of the health risks associated with weight gain and how to avoid holiday weight gain. This is not to say you need to wake up at 6am to do weights at the gym or completely avoid your favourite foods. Exercise and dietary regimes can be altered for the short holiday periods, but it's best to work out a diet and exercise regime that doesn't lead to weight gain. If you do gain weight over the holidays, it's important to consciously try to lose the weight when you go back to work.

Throughout adulthood we tend to put on weight. While slight weight increases are natural, moderate weight gain can have serious health consequences and should be actively prevented. It has been found that the weight we put on during our holidays contributes heavily to the increase as we age. Adults put on as much to 500% more weight during their holidays compared to when working.

The weight gain may not seem significant after a one-week holiday, but after years these slight increases will "weigh-up". Studies have shown that people who put on 0.48 kg during their holiday are unlikely to actively lose the weight once they return to work. Most people do not think that half a kilo each holiday will add up to a steady increase in weight over adulthood.

Studies have identified that there are some people and times of the year during which holiday weight gain is more likely. People who are already overweight or have been overweight in the past are more vulnerable to weight gain over the holidays than those in the healthy weight range. Furthermore, when holidays are taken in colder environments or during the winter, there is an increased prevalence of weight gain.

People who are able to maintain their normal exercise regime and dietary regime during their holiday will have more success in managing their weight. This is especially important for people considered to be at higher risk of putting on weight, such as somebody who is already overweight and taking their holidays for a month during winter.

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If you believe you may be susceptible to weight gain over your holiday, you will benefit from planning an exercise routine for your holiday. Your doctor and local gym will be able to help you organise a program that you can maintain during your holiday.

Children and school holidays

It is not only adults who tend to put on weight during holidays. Studies have identified that this trend extends to children as young as 6 and 7 years old. One study monitored students' body mass index (BMI) over the year and found that there was a significant increase in BMI over the holiday period compared to during the school term. This finding was especially noted in children who were already overweight.

Similarly to in adults, this weight gain in children is suggested to be due to the breakdown of "routine" that occurs during the holidays. It is relatively easy to regulate children's behaviour while at school by restricting the times of the day when they eat and allocating regular time for sport. Once children leave school, they have more freedom to indulge in sedentary activities, such as watching TV or playing on the computer, and are not necessarily encouraged to participate in sporting activities. Excessive snacking is also likely to be increased indoors and at home compared to during the school day.

Normally, a child's weight will change over the year, with slight increases during winter which are then lost during summer. This means that children maintain relatively the same weight (not taking into account normal child growth) at a given time in the year. In obese children, this pattern is not observed.  Obese children put on weight during the summer school break, and do not lose it at other times of the year. Nutritionists have suggested that this abnormal pattern may disrupt weight rhythms, which further contributes to obesity in children.

Parent involvement in children's nutrition and physical activity is extremely important and will help improve habits for children at home. Parents should encourage their children to get involved in after-school sporting activities or holiday sport programs, and to spend more time playing active games outside. TV and video games should be restricted to about an hour a day, perhaps in the middle of the day when it is too hot to play outside. Parents should also monitor very carefully what their children are eating and how often they are eating. Developing an eating routine for the holidays, similar to the school day routine, will help to keep them healthy. Of course, treats during the holiday are fine, as long as they are balanced with lots of healthy food, water and exercise!

Strict self-monitoring is one way that people can avoid weight gain during their holidays. Self-monitoring involves regularly and diligently monitoring how much you are eating, drinking and exercising. To avoid weight gain, make sure your energy intake is not more than your energy expenditure. Both intake and expenditure may change during holidays compared to work days, and on different days of a holiday.  

Reference
Panel on Macronutrients & Standing Committee for the Scientific Evaluation of Dietary Reference Intakes. Energy. Chapter 5. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (Macronutrients), National Academy of Sciences. 2005. [cited 2009, June 6], Available from http://www.nap.edu/catalog/10490.html

This information will be collected for educational purposes, however it will remain anonymous.

A study found that people who consistently monitored how much they ate and exercised during their holidays were able to maintain their weight or even lose weight.

Another study found that self-monitoring was even more effective when individuals monitoring their weight were given encouragement and support from a health professional during their holiday. A group of obese people received phone calls and daily mailings from healthcare professionals while they were on holidays, encouraging them to exercise and reminding them to monitor their daily energy intake. Compared to a group of obese people who monitored themselves without such support, the obese people who had regular reminders from health professionals gained less weight.  

While it may not always be feasible to receive this kind of aid from healthcare programs, you can set up a system of your own. Ask your friends and family to help you monitor yourself during the holidays. Perhaps you can pair up with a friend and provide each other encouragement and support through phone calls and meetings.

Holidays that involve hiking, skiing, climbing and other strenuous activities are popular choices for Australians. Recreational holidays have been associated with positive effects on fitness, recreational ability, mood, social esteem and confidence. People who engage in recreational activities during their holidays feel healthier, and this actually contributes to staying healthy once back at work.

Bear in mind that there may be health risks involved with recreational holidays if you're not fit and your body is not used to exercising. If this is you, be sure to see a doctor before planning a recreational holiday. Activities such as hiking and skiing, even at low intensity, will increase the heart and metabolic rate. This is good for your health if you are fit, but if you're unfit, sudden increases in heart rate can be dangerous. This is especially true if you are holidaying at a high altitude.

If you have been inactive for over 6 months, it is wise to seek advice form a medical professional, especially if you have or have had any cardiovascular (heart), muscular or weight problems. A doctor, physiotherapist or sports trainer will be able to assess your current fitness level and help you plan a fitness program that will allow you to physically prepare for your trip.

In order to stay motivated to exercise in the holidays,  it may be useful to mix up your usual exercise regime and change your exercise goals. For example, if your usual goal is to build muscle and lose weight, perhaps during holidays a more appropriate goal would be to simply keep active.

Holidays are a time for family and friends, so try to plan fun exercise sessions the whole family can enjoy. You may like to check out community exercise facilities or find a spot to go for walks after lunch.

Generally, it is wise to do some exercise in your holidays. However, for serious athletes and sport enthusiasts, the opposite may be true. Athletes can do too much exercise (overtraining), especially coming to the end of the season. For people who usually train professionally every day, a six-week break at the end of a season is necessary for the body to recuperate and prepare for the next season.

For example, professional dancers who take a break over summer show increased flexibility, leg strength and fitness when they get back to training, compared to those who do not take the break. Taking a break also reduces the risk of injuries, poor performance and illness the next season.

In a society where overweight and obesity has become an epidemic, we need to think very carefully about the foods we eat and how much of them we are eating. While "kilojoule-counting" can take the pleasure out of eating, you need to know how much energy is contained in the food you eat, in order to ensure you don't eat too many calories. This is particularly important if you are already overweight or find it difficult to maintain a healthy weight.

This is not to say that all "bad" foods should be totally avoided, but they should be well thought out. Make decisions about which are your favourite treats and "budget" them into your daily energy limits. You can ask your doctor, a dietitian or nutritionist to help you work out how much you should be eating and what foods will give you enough energy without filling you with sugar and fats. And remember, how much you eat needs to be balanced against how much you exercise. If you overindulge one day, try also doing a bit of extra exercise to account for the weight gain.

The following are tips for avoiding overindulging (not only during your holidays, but all year round):

Eat slowly: Take your time to recheck your appetite during a meal. It takes a few minutes for your brain to register the "full" signal from your stomach. In this time, second helpings may already be piled on a plate. You can better monitor your appetite by eating slowly and drinking water between mouthfuls.Avoid the food table: If you are prone to recreational eating, the temptation of snacking at parties is heightened by standing next to the food table. You should stand away from where snacks are served, and perhaps chew gum in order to fight the temptation.Eat before partying: Going to a party absolutely starving is a recipe for overindulging. The best pre-party food involves snacks that are high in protein and complex carbohydrates (low GI foods). This will help maintain a full feeling. It's also wise to fill up on something healthy before you do your grocery shopping.Eat before drinking: Alcohol should be avoided on an empty stomach. Not only will you feel hungrier when you have alcohol, but you may also lose your ability to control your energy intake, a combination for overindulgence. Alcohol is also very high in calories, so drinking alcoholic beverages can contribute a considerable amount to your daily calorie intake.Serve vegies first: Making sure your plate is filled up with vegetables will not only ensure that the meal stays relatively healthy, but it is also a great way of filling up. Go for variety and fun: Mix up your usual exercise regime with fun holiday exercise, for example enjoying the great outdoors, hitting the dance floor at a party, or spending active time with the kids;Change your goals: Make sure your exercise goals are realistic for the holiday period. For example, if your usual goal is to build muscle and lose weight, perhaps during holidays a more appropriate goal would be to simply keep active and avoid gaining weight; Keep active: Not only will this help you keep motivated during the holidays, it will make restarting work and your usual exercise regime less daunting;Be prepared: Make a physical activity plan for your holiday; Avoid winter blues: Be especially careful of weight gain during cold holidays, as holidays taken in colder environments or during the winter are associated with an increased risk of weight gain;Don't have too much variety: Try to maintain your normal exercise routine as much as possible. People who are able to maintain their normal exercise regime and dietary regime during their holiday will have more success in managing their weight; Child's play: Be aware that children also have a tendency to gain weight during holidays from school, so be involved in your child's exercise and eating over the holidays. Parent involvement is thought to help kids make healthy choices;Turn off the TV: Give children plenty of ideas for active recreational pursuits so that they don't spend too much sedentary time watching TV or playing on the computer; Go outside: Keeping kids outdoors will not only help them burn energy, it may also reduce the amount of energy they consume because they are less likely to snack; Watch yourself: Monitor how much you eat and exercise during the holidays. People who consistently monitor these behaviours in the holidays are more likely to maintain or even lose weight;Be adventurous: Plan a recreational holidays such as hiking or skiing, as these types of holidays tend to have a positive effect on fitness;Check-up: Prepare your body for a recreational holiday by starting to exercise well before the holiday and seeing your doctor for a fitness check; Every bit counts: Don't ignore weight gain when you get back to work, even if you've only gained a small amount of weight (e.g. half a kilo). If you do not lose that weight, you'll be starting your next holiday half a kilo heavier. Over time, if you gain half a kilo every holiday and fail to lose it once you get back to work, you could gain a significant amount of weight. 

Introduction to Nutrition

Nutrition is defined as the processes by which an animal or plant takes in and utilises food substances. Essential nutrients include protein, carbohydrate, fat, vitamins, minerals and electrolytes. Normally, 85% of daily energy use is from fat and carbohydrates and 15% from protein. In humans, nutrition is mainly achieved through the process of putting foods into our mouths, chewing and swallowing it. The required amounts of the essential nutrients differ by age and the state of the body, for example: physical activity, diseases present (e.g. prostate cancer, breast cancer or weakened bones – known as osteoporosis), medications, pregnancy and lactation.

Nutrition is essential for growth and development, health and wellbeing. Eating a healthy diet contributes to preventing future illness and improving quality and length of life. Your nutritional status is the state of your health as determined by what you eat. There are several ways of assessing nutritional status, including anthropometric (i.e. physical body measurement), food intake and biochemical measurement. 

Your body mass index (BMI) is a good indicator of your nutritional status. It takes into account your weight and height, and correlates well with total body fat expressed as a percentage of body weight. The correlation depends on age, with the highest correlation seen in ages 26–55 years and the lowest in the young and the elderly. If you take your weight in kilograms and divide it by your height in metres squared, the figure you obtain is your BMI.

High values indicate excessive fat stores and low values indicate insufficient fat stores. Your BMI can therefore be used as a diagnostic tool for both over-nutrition and under-nutrition. If your BMI is between 25.0 and 29.9 you are classisfied as overweight. If it is above 30.0, you are classified as obese. The healthy BMI range is 18.5–24.9. However, the BMI is best used together with waist circumference.

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BMI calculations will overestimate the amount of body fat for:

Body builders; Some high performance athletes; Pregnant women.

BMI calculations will underestimate the amount of body fat for:

The elderly; People with a physical disability who are unable to walk and may have muscle wasting.

BMI is not the best measure of weight and health risk. A person's waist circumference is a better predictor of health risk than BMI.

BMI and children

The healthy weight range for adults of a BMI of 20 to 25 is not a suitable measure for children.

For adults who have stopped growing, an increase in BMI is usually caused by an increase in body fat. But as children grow, their amount of body fat changes and so will their BMI. For example, BMI usually decreases during the preschool years and then increases into adulthood.

For this reason, a BMI calculation for a child or an adolescent must be compared against age and gender percentile charts. These charts should be used only by health professionals such as your general practitioner, child health nurse, or dietitian.

Body fat distribution and health risk

A person's waist circumference is a better predictor of health risk than BMI. Having fat around the abdomen or a 'pot belly', regardless of your body size, means you are more likely to develop certain obesity-related health conditions. Fat predominantly deposited around the hips and buttocks doesn't appear to have the same risk. Men, in particular, often deposit weight in the waist region.

Studies have shown that the distribution of body fat is associated with an increased prevalence of diabetes, hypertension, high cholesterol and cardiovascular disease.

Generally, the association between health risks and body fat distribution is as follows:

Least risk – slim (no pot belly); Moderate risk – overweight with no pot belly; Moderate to high risk – slim with pot belly; High risk – overweight with pot belly.

Waist circumference and health risks

Waist circumference can be used to indicate health risk.

For men:

94 cm or more – increased risk; 102 cm or more – substantially increased risk.

For women:

80 cm or more – increased risk; 88 cm or more – substantially increased risk.

Being physically active, avoiding smoking and eating unsaturated fat instead of saturated fat have been shown to decrease the risk of developing abdominal obesity. 

When there is an imbalance between your nutrient requirements and your intake, malnutrition sets in. There are two forms of malnutrition – under-nutrition and over-nutrition. Over-nutrition is common in many developed countries, including Australia.

Dietary factors are associated with some leading causes of death, such as:

Nutrients can be described as the chemical components of food and can be classified into six broad groups: carbohydrates, proteins, fats, vitamins, minerals and water. Water is not technically a nutrient, but it is essential for the utilisation of nutrients. Nutrients perform various functions in our bodies, including energy provision and maintaining vital processes such as digestion, breathing, growth and development.

Energy balance

Your energy requirement depends on your age, size and activity level. If your energy intake equals the amount of energy you expend, then you are in energy balance. If your intake exceeds your expenditure, the excess energy is converted to body fat and you gain weight. On the other hand, if your intake is less than your expenditure, your body uses up fat stores and you lose weight. Therefore, for weight to remain stable, the total amount of calories that are consumed must not exceed the total that is used up through metabolic processes (e.g. exercising, sweating, breathing). Energy intake must match energy output. The average energy intake is about 2800 kcal/day for men and 1800 kcal/day for women, although this varies with body size and activity level.

Carbohydrates

Carbohydrates can be classified as monosaccharide (e.g. glucose, fructose, galactose), disaccharide (e.g. sucrose, lactose, maltose) and polysaccharide (e.g. starch, fibre). Carbohydrates must be reduced to the simplest form of glucose (through digestion) before your body can make use of them. Carbohydrates should make up at least 55% of your total energy intake. The brain is a special part of the body that depends primarily on glucose for its energy and requires about 100 g/day of glucose for fuel. In some situations, the body can compensate for decreased levels of carbohydrates by using alternative energy pathways such as burning fatty acids.

Protein

Protein is important for the production, maintenance and repair of tissues in the body. When energy intake is insufficient, protein intake must be raised. This is because ingested proteins are preferentially directed towards glucose (sugar) synthesis and oxidation. The tissues and organs in the body are made up of protein and protein compounds. Enzymes (biological catalysts), antibodies and hormones also consist of protein. The building blocks of protein are called amino acids. The body can make all of the 20 amino acids except eight, which are termed essential amino acids. These are isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. Histidine is essential only for infants. The number and nature of amino acids present in a particular protein determines that protein's characteristics.

For adults, the recommended dietary allowance of protein is about 0.75 g/kg body weight per day. Animal products tend to have the highest amount of proteins, followed by legumes (beans), cereals (rice, wheat, corn) and roots. Animal protein (from meat, eggs, fish, milk) contains all the essential amino acids and is normally referred to as 'complete' or 'high biological value' protein. Protein derived from plants lack one or two essential amino acids. However, a good combination of plant-based protein can be of equal value to animal protein. For example, legumes lack methionine but have adequate amounts of lysine. Cereals, on the other hand, lack lysine but have a lot of methionine. Therefore, a mixture of rice and beans will supply all the essential amino acids.

Excess protein cannot be stored in the body, so we need to consume protein daily. Consuming too much protein is not recommended because it promotes increased calcium excretion through urine, which increases the risk of developing osteoporosis. Additionally, too much protein intake may lead to a greater concentration of the amino acid homocysteine in the blood, and the subsequent conversion to thiolactone. Thiolactone is associated with increased levels of atherosclerosis and endothelial damage.

Fats and oils

Most of the fats we consume occur in foods as triglycerides. A triglyceride is comprised of three fatty acid molecules attached to a glycerol molecule. Fatty acids are made up of carbon and hydrogen atoms and can be either saturated or unsaturated. Saturated fatty acids (SFA) have the maximum number of hydrogen atoms attached to the carbon chain, while unsaturated fatty acids have less than the required hydrogen atoms. For example, monounsaturated fatty acids (e.g. oleic acid) have two hydrogen atoms missing. Monounsaturated fats are found mainly in nuts, avocados, olive oil, canola oil, grapeseed oil, peanut oil, flaxseed oil, sesame oil, corn oil, safflower oil, sunflower oil, etc.

Polyunsaturated fatty acids (PUFA) have more than two hydrogen atoms missing (e.g. linoleic acid and linolenic acid). Linoleic and linolenic acids are regarded as essential fatty acids (EFAs) because the body cannot make them. There are two categories of EFAs: omega-3 and omega-6. The number that comes after "omega-" represents the position of the first double bond, counting from the terminal methyl group on the molecule. Omega-3 fatty acids are derived from linolenic acid and omega-6 from linoleic acid. Alpha linolenic acid (ALA) is converted into eicosapentaenoic acid (EPA), and later into docosahexaenoic acid (DHA) in the body. Sources  of omega-3 fats include salmon, mackerel, sardines, anchovies, tuna, flaxseed oil, walnuts, etc. Sources of omega-6 fats include palm oil, soybean oil, canola oil, sunflower oil, nuts, etc. Evidence from research indicates that omega-3 fatty acids reduce inflammation and help prevent certain chronic diseases such as heart disease and arthritis. Omega-3 fatty acids are highly concentrated in the brain and appear to be crucial to brain function as well as normal growth and development. Infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are at risk of mental impairment. 

Generally, saturated fatty acids raise blood cholesterol levels, whereas unsaturated fatty acids lower them. Saturated fats are found in foods such as butter, meat and dairy fats. Trans fats are artificially created during food processing. In the body, trans fats act in a similar way to saturated fats and may raise cholesterol levels. These fats are considered to be harmful to your health. Trans fats are found mainly in deep-fried fast foods and processed foods made with margarine.

Fats are a concentrated and rich source of energy. It is recommended that your total fat intake is no more than 30% of your energy (calorie/kilojoule) intake. Polyunsaturated fat should be less than 10% of energy, and saturated fat and trans fat together should be less than 10%. The rest of your fat intake should consist of monounsaturated fat.

Vitamins

Vitamins constitute a group of nutrients that are needed in small quantities. Like amino and fatty acids, most vitamins cannot be made in the body and must be obtained from dietary sources. Only vitamin D can be manufactured by the body. Essential vitamins are grouped into two families: water soluble and fat soluble. Water soluble vitamins can dissolve in water (thiamine, riboflavin, niacin, vitamin C, folic acid). These cannot be stored by the body and need to be consumed every day. Fat soluble vitamins can dissolve in a fat medium (vitamins A, D, E, K). These are taken into our bodies when we consume fat-containing foods. Vitamins are needed for various reasons, including the formation of hormones and blood cells. They generally act as coenzymes. An inadequate supply of vitamins in our diet leads to the development of diseases.

Vitamin A: Derived from carotene, vitamin A affects vision, reproduction, and the formation and maintenance of skin, mucous membranes, bones and teeth. Deficiency results in night blindness (difficulty in adapting to darkness). The body obtains vitamin A from either carotene (vitamin A precursor) or by absorbing ready-made vitamin A from plant-eating organisms. Carotene is found in dark green leafy vegetables and yellow-orange fruit/vegetables. Pre formed vitamin A is found in milk, butter, cheese, egg yolk, liver, and fish-liver oil.Vitamin B complex: The vitamin B complex is a mixture of eight essential vitamins necessary to enhance immune and nervous system function, and promote cell growth and division. Pregnant or lactating women, alcoholics and the elderly are more likely to suffer from vitamin B deficiency.Vitamin B1 (thiamine): Thiamine, or vitamin B1, acts as a catalyst in carbohydrate metabolism. Thiamine deficiency causes beriberi, a vitamin deficiency disorder characterised by muscular weakness, swelling of the heart and leg cramps. In severe cases, beriberi may lead to heart failure and death. The richest dietary sources of thiamine are pork, organ meats (liver, heart, and kidney), brewer's yeast, lean meats, eggs, leafy green vegetables, whole or enriched cereals, wheat germ, berries, nuts, and legumes.Vitamin B2 (riboflavin): Riboflavin, or vitamin B2, acts as a coenzyme in the metabolism of carbohydrates, fats, and respiratory proteins. The best sources of riboflavin are liver, milk, meat, dark green vegetables, whole grain and enriched cereals, pasta, bread and mushrooms.Vitamin B6 (pyroxidine): Pyridoxine, or vitamin B6, is necessary for the absorption and metabolism of amino acids. It also plays a role in the body's use of fats and in the formation of red blood cells. The best sources of pyridoxine are whole grains, cereals, bread, liver, avocados, spinach, green beans and bananas.Folic acid (vitamin B9 or folacin): Folic acid is a coenzyme needed for forming body protein and haemoglobin. Folic acid deficiency is associated with neural tube defects. Dietary sources are organ meats, leafy green vegetables, legumes, nuts, whole grains and brewer's yeast. Folic acid is lost in foods stored at room temperature and during cooking.

Minerals

Minerals are essential, acting as cofactors of enzymes (i.e. enzymes would not exist or function without minerals). Some of the minerals necessary for health are:

Calcium: Calcium is a very important mineral in the diet, especially for women at menopause. The major function of calcium is to build and help maintain strong bones. It can stop the onset of osteoporosis and reduce bone loss and fragility. It is involved in blood clotting. Calcium deficiency can develop when there is a lack of vitamin D.Iron: Iron in food exists as haem and non-haem iron. Haem iron, found in red meat, is relatively well (20–30%) absorbed. Non-haem iron, found mostly in cereals, pulses, certain vegetables (e.g. spinach) and eggs, is generally less well absorbed. Non-haem iron absorption depends on other factors in the diet. For example, vitamin C and animal protein enhance non-haem iron absorption, while tea, coffee and phytates inhibit it.Zinc: Zinc represents only 0.003% of the human body, but is essential for synthesising protein, DNA and RNA. It is required for growth in all stages of life. Sources include meats, oysters and other seafood, milk, and egg yolk.How much calcium do you consume?

Calcium is found in many foods, in particular dairy products and to a lesser degree bony fish, nuts and legumes, fruit and vegetables. It plays an important role in building and maintaining healthy bones and teeth.

Individuals need to consume sufficient amounts of calcium throughout their lifespan.  Calcium requirements increase throughout childhood, peak during puberty, then stabilise until an individual is approximately 50 years old, when bone mass deteriorates and more calcium is required.

Click here to calculate your required calcium intake

Water

For adults, 1–1.5 mL water per kcal of energy expenditure is usually sufficient to allow for normal changes in physical activity, sweating, and dietary solute load. Water losses consist of 50–100 mL/day through faeces (stools), 500–1000 mL/day by evaporation, and approximately 1000 mL/day through urine. If external losses increase, we must increase the amount of water we ingest. In special circumstances such as diarrhoea and vomiting, water requirements further increase.

It is critical that nutrients in our body are available in sufficient amounts and in the right proportions. This can be achieved by eating a balanced diet. We must eat a variety of foods, since different foods contain different nutrients in varying amounts. In stressing the importance of variety in our diet, Nutrition Australia encourages all Australians to ensure that their daily diet includes 30 individual foods. This may appear impossible at first thought, but in reality can easily be attained by eating typical diets based on carefully selected foods. Food selection based on the 'Healthy Eating Pyramid' can assist you in planning your meals for a balanced and healthy diet.

A healthy diet consists mainly of plant foods (e.g. fruits and vegetables, potatoes, cereals, etc.) and moderate amounts of animal products (e.g. milk, fish, lean red meat and poultry). Fats and oils should normally provide less than 30% of our energy, and less than 10% of this should be saturated fat. Lean red meat, poultry and fish, eggs and dairy foods are rich sources of animal protein. Dairy foods, apart from supplying quality protein, are good sources of calcium. Good vegetable sources of protein include legumes (e.g. peanuts, lentils, kidney beans), soya products (e.g. tofu), grains, nuts and seeds.

The food pyramid is a simple practical guide to selecting varied foods for meals. The Australian Nutrition Foundation Inc. (Nutrition Australia) has developed its own food pyramid. The rationale behind the food pyramid emphasises the need to include generous amounts of plant-based foods (cereals, legumes, fruits and vegetables) and moderate amounts of animal products (meat, fish, milk, eggs) in our diets. Furthermore, our diet should contain only small amounts of energy-dense foods (e.g. sugar, fats and oils). The base of the pyramid (plant-based foods) is broad, and the top (animal products) is narrow. Eating according to the structure of the food pyramid ensures we consume a healthy diet. With care the food pyramid can also assist vegetarians and vegans to consume a nutritionally balanced diet, although some people will require dietary supplements (e.g. vegans will require vitamin B12).

Carbohydrates should make up at least 55% of our total daily energy intake. The quality and quantity of these carbohydrates are important in blood sugar and appetite control. After you consume carbohydrate-containing foods, your pancreas secretes insulin to break the carbohydrates down into their building blocks. Insulin acts to lower blood glucose levels. When your blood glucose levels decrease to a particular level, your brain is sent a signal and you become hungry again.

Even though different foods may contain the same amounts of carbohydrate, their effects on blood glucose control may be very different. This has lead to the development of measures such as the glycaemic index (GI) and glycaemic load (GL) of a food product. The concept of GI was formulated by Jenkins and colleagues in 1984. They found that blood glucose response to carbohydrate foods is independent of the amount of carbohydrates they contain. The limitation of the GI lies in the difficulty of translating the concept into practice, since the glycaemic effect of foods is not constant and can vary depending on the way the food is cooked.

Low GI and GL foods have been shown to be associated with health advantages such as decreased blood sugar levels. Foods with a low GI (less than 55) cause a slower and lower rise in blood glucose levels. These include breads such as mixed-grain and oat breads, barley, pasta, noodles, beans, sweet potatoes, green peas and milk. Foods with a high GI (greater than 70) cause a faster and higher rise in blood glucose levels. High GI foods include white bread, steamed white rice and chips.

By incorporating low GI foods into your diet, you will bring down the average GI of your meal, have a lower, slower blood sugar response to the meal and feel 'full' for longer.  By consuming low GI foods, you are more likely to be satisfied and feel full for longer periods of time. This helps you to maintain a healthy weight and avoid diseases such as heart disease, diabetes and some cancers. 

Some tips for maintaining a healthy diet and incorporating the GI index into your daily routine include:

Follow the Dietary Guidelines for Australians and try to incorporate a variety of foods into your eating plan. Try to use low GI foods instead of high GI foods when possible. Try to have one low GI food at each meal.

Liver Cleansing Diet

The Liver Cleansing Diet: Love your liver and live longer is a book by Sandra Cabot that has sparked much recent interest in liver cleansing diets. Liver cleansing diets claim to remove toxins that are clogging the liver. This cleansing of the liver is proposed to help it to work more efficiently, leading to weight loss. A range of nutritional supplements and liver tonics are often recommended to accompany liver cleansing diets. Despite the popularity of these diets (Cabot’s book has sold over 1.4 million copies) there is little scientific evidence to support the claims made by their proponents.

The liver is an important organ in the human digestive system and is situated in the upper, right-hand part of the abdomen. It is the largest gland in the human body and weighs about 2kg in an adult human. The liver is served by two main blood vessels: the hepatic artery which carries oxygenated blood from the heart to the liver, and the hepatic portal vein which carries nutrient-filled blood from the stomach and the intestines, to the liver. The liver holds approximately 13% of the body’s total blood supply. It has several key functions that include:

Removal of damaged red blood cells and toxins (such as alcohol and nicotine) from the blood.Conversion of glucose (sugars from food) to glycogen for storage.Conversion of glycogen back to glucose to provide energy for the body.Conversion of excess proteins and amino acids into urea for excretion by the kidneys.Production and storage of vitamins and minerals (such as copper and iron). Production of bile (chemicals which help to break down fats in the intestine).Production blood clotting factors.

Liver cleansing diets can be classified under the umbrella of ‘detox’ or detoxification diets. They claim that the body (in particular the liver) needs cleansing in order to help it function better. Liver cleansing diets often focus on eliminating toxins that enter our bodies through the food that we eat. They also claim to aid in weight loss.

The diet

The dietary recommendations of liver cleansing diets are generally in line with a healthy eating plan. The diets usually suggest avoiding sugar, caffeine, alcohol, and fatty foods, while increasing intake of grains, water, fresh fruits and vegetables. In particular they focus on eating unprocessed foods. Processed foods (foods that are no longer in their natural state) can include more additives (such as salt and sugar) and preservatives (natural or synthetic chemicals added to foods to prevent spoiling). Liver cleansing diets tend to be time-limited, and therefore offer an attractive short-term option for people attempting weight loss.

The tonics and supplements

Liver cleansing diets often recommend supplements to aid in the cleansing process. There is a range of different supplements available. Most contain a mix of herbal or plant-based ingredients.

How does the diet help with weight loss?

According to proponents of liver cleansing diets, a change in diet can lead to a more efficient functioning liver. It is the improved liver functioning that is proposed to lead to weight loss. Current medical and scientific opinion about how the liver operates does not suggest that the liver has a primary role in weight control. However, nutritionists have noted that the diet itself, regardless of its purported effects on the liver, should lead to weight loss in the short-term. Liver cleansing diets tend to recommend low calorie foods. Consuming less energy than the body requires is a scientifically well-evidenced and accepted method for weight loss.

What is the evidence that liver cleansing diets work?

Most ‘evidence’ in support of liver cleansing diets is anecdotal. That is, proponents of the diets will outline success stories from individual patients or clients. As outlined above, the liver cleansing diet may lead to weight loss due to the consumption of a healthy and balanced diet. However, there is little evidence to suggest that the liver can be cleansed by eating certain foods, or by taking supplements or tonics.

Scientists rely on stringent criteria to judge whether a particular supplement or diet leads to its claimed benefits. One way to show that a supplement works, in the way it is supposed to, would be to conduct a clinical trial. Clinical trials could allow scientists to carefully observe what happens to the livers of patient when they consume these supplements. However, to date, there have been no clinical trials or any other peer-reviewed studies that show how the diet or supplements affect liver functioning. The recommended supplements are expensive, and, at best, unnecessary (especially if you are eating a balanced diet). Supplements are often untested and can be harmful if patients are allergic to the ingredients, or if the supplements interact with prescription medications.

There is no scientific evidence to suggest that it is necessary, or even possible to ‘cleanse’ the liver. The body naturally removes toxins through the liver, kidneys, and intestines. People who lead healthy, active lifestyles do not need to take extra steps to remove the toxins from their livers or bodies. However, if an individual’s diet or lifestyle includes high fat foods, high sugar foods, caffeine, alcohol, cigarettes, drugs, or limited exercise, then a change in diet or lifestyle to prevent toxins entering the body is the healthiest and most effective approach to detoxification.

Liver cleansing diets recommend foods and lifestyle choices that will tend to result in less toxins entering the body.These diets may lead to weight loss and other health benefits (such as improved skin quality and reduced fatigue) due to better lifestyle choices, for example eating healthy foods, and eating less fatty and sugary foods (rather than because of any effects on the liver).The diet recommendations are sensible and nutritious if adopted over the long-term. The theory behind liver cleansing diets is not supported by scientific research.There is little scientific evidence to support the use of the supplements and tonics recommended to accompany these diets.Some supplements can interact with prescription drugs and should not be taken without appropriate medical advice.Liver cleansing diets tend to focus exclusively on liver functioning as the solution to weight loss, to the neglect of other weight loss methods (i.e. physical activity). A regular diet that contains whole grains and unprocessed foods is good for your body.Don't take any supplements without discussing them with your doctor.Sustained exercise, a balanced diet and a healthy lifestyle are the best ways to remove toxins from the body.

 

Exercises To Do and Avoid During Pregnancy

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AppId is over the quota

Exercise during pregnancy is well recognised as being both a safe and beneficial practice for mother and foetus. So while all women should be encouraged to engage in physical activity no studies have yet identified “how much is too much” which makes it necessary to be cautious and speak with your doctor about your specific circumstances.

There are some general guidelines which outline which exercises are recommended for pregnant women but the appropriateness of these activities will be largely determined by pre-pregnancy fitness level and previous exercise experience as this will dictate what intensity, frequency and type of activity can be safely maintained by each individual during pregnancy.

The body changes that occur in a woman while she is pregnant may interfere with the ability to engage in some types of exercise.

There is a significant increase in body weight during pregnancy that can make jogging and running uncomfortable. The change in body weight and weight distribution can alter balance and coordination making sports that require these skills challenging and even dangerous.

The ligaments and joints around the pelvic region will begin to loosen up as the pregnancy progresses in order to prepare the body for labour. For this reason activities which may impose a risk of injury in this area should be avoided. This is anything that requires quick changes of direction, jumping and jerky movements.

Physiologically, the increase in resting heart rate associated with pregnancy necessitates that women do not over exert themselves.

The decrease in blood pressure which occurs in pregnancy may also make some women light-headed and dizzy meaning that activities involving balance may be difficult.

It is recommended that pregnant women, with what is considered as a low risk pregnancy, engage in moderate intensity exercise for 30 minutes a day, 4 times a week. Low risk pregnancies are those which are not otherwise constrained by medical or obstetric complications.

Depending on the woman’s individual medical history and exercise experience, the exercise program will need to be initiated differently. Your doctor can help you with this.

More information on Beginning an Exercise Program During Pregnancy.

What is classed as “moderate” intensity exercise is subjective and will be quite different depending on individual fitness levels. A good way to determine a comfortable intensity while exercising is through the talk test. If you cannot maintain a conversation during exercise then this is not considered to be moderate intensity and you should reduce the intensity of your physical activity until you can.

Appropriate physical activities to engage in during pregnancy are quite common sense. Any activities that have a low risk of falling, injury and joint and ligament damage should be chosen. This includes low impact activities that do not require too many quick changes to the centre of gravity or depend predominantly on balance.

Warm up

All exercise should begin with a warm up and cool down period. The hormones produced during pregnancy make women especially flexible in preparation for childbirth but this can lead to excessive stretching and pulling which can cause injury. Stretching should be done very gently, especially after the first trimester.

For more information on Warming Up Before Exercise.

Walking 

Walking is the most common exercise amongst pregnant women. Walking is safe for everyone, including pregnant women who are only just beginning to exercise. Walking has a low risk of falls and it is easy to control exertion levels. Brisk walking is low impact for joints and muscles yet still gives a total body workout and improves cardiovascular fitness.

Water sports

Some water sports such as swimming, water aerobics and water walking are safe and fun sports.

Swimming works almost all muscles in the body without the risk of overheating. Water aerobics is great for cardiovascular fitness. These water sports are safe as there is no risk of falling or losing balance and the water supports body weight so the risk of muscle strain is low.

Water activities are especially effective for women who experience back pain and leg swelling during pregnancy as it has been found to alleviate these symptoms.

Stationary cycling

Cycling is another good cardiovascular workout that will help improve leg muscle strength. During pregnancy stationary cycling is a better alternative because as your belly grows, especially in the third trimester, balance on a bike will be difficult.

Weight training

Studies to date on light to moderate resistance training using free weights and weight machines during pregnancy have found no adverse findings in patients that regularly engaged in the activity before pregnancy. Women who have never engaged in weight training prior to their pregnancy should not begin once they have conceived.

Studies have shown that there are benefits from engaging in weight training while pregnant. Improvements in strength and flexibility have been noted. This is turn will help the body adapt to the physiological changes that occur during pregnancy. Women may find they can tolerate their heavier body weight and altered centre of gravity better with muscle strengthening that is gained from training, especially focussing on lower back strength.

Running

Running is safe in moderation for women that were running frequently before they became pregnant. It is not advised that women that have never run before take up running during their pregnancy. Depending on the individual, the running regime may need to lessen in intensity and frequency.

While frequent moderate intensity exercise is safe and recommended for pregnant women there are some sports that will increase the risks of injury, stress and other complications. Some activities will simply be too uncomfortable or tiring. It is important that women who are planning to exercise while they are pregnant are aware of what exercises they should avoid including:

Heavy weight training lifts that involve maximal isometric muscle contractions are thought to put too much stress on the cardiovascular and musculoskeletal system;Holding your breath during difficult positions during yoga or while weight training. If you are ever not breathing during any exercise this is a clear indication you are over-exerting yourself and you need to stop immediately;Exercises lying on your back after the first trimester of pregnancy should be avoided to reduce the risk of affecting blood flow to the foetus and hypotension from vena cava compression by the uterus;Exercises which involve lying on the stomach;Some abdominal strengthening exercises will be very uncomfortable due to muscle weakness and the development of abdominal seperation, a condition where called diastasis recti. This occurs as a result of the growing uterus;Standing still for long periods of time is not recommended;Contact sports and high-impact sports such as ice hockey, soccer and basketball can risk abdominal trauma, excessive joint stress and falls;Scuba diving should be avoided as the pressure can result in birth defects and foetal decompression sickness;Any activities that increase the risk of falls should be avoided in order to reduce the risk of injury to you and your foetus. This includes sports such as gymnastics, horseback riding and water skiing;Any activities which require changes to the centre of gravity should be avoided as this can cause balance problems. This includes vigorous racquet sports such as squash and tennis;Any sports at altitude may induce altitude sickness which in turn can reduce the oxygen supply to the foetus. This does not appear to be the case for moderate intensity exercise at altitudes anywhere up to 2,500m but if you want to exercise at altitudes above this upper limit you should be guided through appropriate acclimatisation and make modifications to you activities as guided by your doctor. If you experience symptoms of altitude sickness including excessive shortness of breath, chest pain and light-headedness and weakness, you must stop exercising immediately and seek medical aid.

 For more information about pregnancy and exercise, including pre-pregnancy exercise, suitable types of exercise, risks and benefits of exercise and exercise myths, see Pregnancy and Exercise.

 For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see Pregnancy.

For more information on fitness and exercise, including stretches, types of exercise, exercise recovery and exercise with health conditions, as well as some useful videos, see Fitness.National Collaborating Centre for Women's and Children's Health. Antenatal care: routine care for the healthy pregnant woman. Clinical Guideline March 2008 2nd ed. RCOG Press; London: 2008. [Full Text]Sydney South West Academy of Sport Policy Statement: Exercise During Pregnancy [online]. SWSAS [cited June 2010]. Available from: URL: http://www.swsas.org.au/documents/pregnancy and sport policy.pdfDavies GAL, Wolfe LA, Mottola MF, MacKinnon C. Exercise in pregnancy and the postpartum period. Joint SOGC/CSEP Clinical Practice Guideline. 2003; 129: 1 - 7. [Full Text]The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Endorsed statements [online]. Pregnancy in Sport - Guidelines for the Australian Sporting Committee, 2002 [cited Apr 2010]. Available from: URL: http://www.ranzcog.edu.au/womenshealth/endorsedstatements.shtml  Mottola M. Exercise Prescription for Overweight and Obese Women: Pregnancy and Postpartum. Obstet Gynecol Clin N Am. 2009; 36: 301–16. [Full text]Gavard JA, Artal R. Effect of exercise on pregnancy outcome. Clin Obs Gynecol. 2008; 51(2): 467–80. [Abstract]Nutrition Australia: Physical Activity During Pregnancy [online]. Sports Nutition 2010 [cited June 2010]. Available from: URL: http://www.nutritionaustralia.org/national/resourcesAmerican Congress of Obstetricians and Gynecologists: Exercise during pregnancy [online]. ACOG 2003 [cited June 2010]. Available: URL: http://www.acog.org/publications/patient_education/bp119.cfmSleeping positions during pregnancy [online]. American pregnancy association, 2010 [cited July 2010]. Available from URL: http://www.americanpregnancy.org/pregnancyhealth/sleepingpositions.html

Mediterranean Diet

The Mediterranean diet is a diet based on plant foods. It is high in N-3 fatty acids, antioxidants and phytochemicals.

Fat intake under the Mediterranean diet is moderate (up to 35% of total calories). It consists predominately of monounsaturated fats (e.g. olive oil) as opposed to polyunsaturated (e.g. canola oil) and saturated (e.g. animal) fats.

The diet is also low in cholesterol, salt and sugar. It has received a lot of attention in recent years because scientists have shown that following a Mediterranean diet is associated with a number of health benefits.

The Mediterranean diet comes from the Mediterranean region, which includes countries such as Greece, Turkey, Malta and Italy. Many of the foods eaten in the Mediterranean region are also common in other parts of the world (e.g. fish), and, as a result of globalisation, immigration and the world food market, foods once considered to be specialties of the Mediterranean region (e.g. olive oil, feta cheese) are now mass produced and available on the shelves of supermarkets throughout the world. As such, people in many parts of the world eat traditional Mediterranean foods.

The important combination of foods traditionally eaten in the Mediterranean is not necessarily adhered to by people who eat Mediterranean foods. However, it is the combination of foods on which the diet is based, rather than the individuals foods it includes, which is important in relation to the health benefits associated with the diet. For example, eating lots of olives and feta cheese without the whole grains and legumes, or in combination with saturated fats or sugary drinks, is unlikely to be beneficial to one's health, and is not a Mediterranean diet.

The Mediterranean diet combines a high intake of fresh vegetables, fruits, legumes (e.g. chick peas) and cereals (e.g. oats) with a relatively high fish intake and minimal saturated fats intake. Red meat is eaten on rare occasions, as are sweets and butter. Cheese, yoghurt, eggs and red wine are consumed most days, in moderation. Olive oil, which is a monounsaturated fat, is used in place of butter and oil containing saturated fats.

Two people following the Mediterranean diet can consume a different amount of energy (i.e. calories) and still be following the diet. The total number of calories eaten will depend on whether one is trying to lose or gain weight, or simply maintain a healthy lifestyle.

For weight loss, a diet restricted to 1500 calories per day for women, and 1800 per day for men, is recommended. Many individuals will eat more than that; in general, it is recommended that one does not eat more than 2400 calories per day.

It should be noted that even people who eat in excess and become overweight or obese still receive benefits from following a Mediterranean diet. Compared to obese people who follow other diets, they are less likely to suffer from metabolic syndrome, which often leads to diabetes and cardiovascular disease.

The Mediterranean diet offers health benefits because of the combination of foods consumed and the relative quantities in which they are consumed. A typical Mediterranean diet should include the following.

Less saturated fat and more monounsaturated fat

Fat should contribute 25–35% of total calories (roughly the same as a healthy, balanced diet). Less than 10% of total calorie intake should be from saturated fats.

Instead of saturated fats, olive oil is used for cooking and salad dressings. Low fat nuts (e.g. almonds) are consumed in moderate quantities. On a typical day, someone adhering to a traditional Mediterranean diet might derive fat from 30–45 grams of olive oil (1–2 tablespoons) and a handful of walnuts or almonds.

Small quantities of saturated fats are eaten every day in the form of yoghurt and cheese (low fat, natural varieties are best, particularly if weight loss is the goal. If fruit yoghurt is consumed, it should be low fat without added sugar).

Less meat, eggs and poultry

Poultry, and even more so red meat, are consumed only occasionally (e.g. either poultry or meat might be eaten once a week). Up to four eggs can be consumed per week.

More seafood

Seafood (e.g. fish, shellfish, fish eggs) is the predominate form of meat eaten be followers of the Mediterranean diet. It is eaten 2–3 times per week, in servings of 100 grams.

Dairy products

Different dairy products are consumed daily, but in moderation and usually in the form of cheese or yoghurt and not butter or milk. It is typical to eat the equivalent of a small tub of yoghurt and a small piece of cheese every day.

More nuts and legumes

Legumes or nuts are usually eaten every day in moderate quantities (e.g. a small handful of nuts as a snack, or a serving of beans). Nuts are usually low fat varieties like almonds and walnuts, eaten as a snack or added to cooking. Legumes include chickpeas (the legume used to make hummus), peas and beans.

Cereals

Cereals have traditionally been mostly whole grains. They include home-made bread, pasta and polenta. They are eaten daily, at all meals, in moderate portions.

Fruits

Grapes, figs, tomatoes, cucumbers and melons are common and consumed several times every day. Tomatoes and cucumbers are eaten with most meals (e.g. on toast for breakfast, in salads), while melons and figs are common deserts.

Vegetables

Lots of leafy green vegetables, including lettuce and wild herbs, carrots, beetroot and onions, are eaten in large quantities every day.

Red wine

Red wine is the predominant form of alcohol. A glass of red wine can be consumed daily, although it should be consumed with meals.

The health benefits of a Mediterranean diet were first highlighted in the 1950s, when scientists noticed that the rates of coronary heart disease and other chronic conditions were low in Italy. Since then, the lower rates of chronic diseases have been linked to the dietary patterns of people living in the Mediterranean region (i.e. adhering to a Mediterranean diet). Studies have shown that following a Mediterranean diet can:

Increase longevity: A European study showed that elderly people (older than 60 years) who followed a Mediterranean diet were less likely to die (i.e. they lived longer) than elderly people who did not follow a Mediterranean diet.Reduced risk of cardiovascular problems: Following a Mediterranean diet after having a heart attack can reduce the risk of both having and dying from a heart attack in the future.Reduced risk of metabolic syndrome: Individuals who follow a Mediterranean diet are less likely to develop metabolic syndrome. Many individuals who already have the syndrome can reverse the metabolic alterations associated with it by following a Mediterranean diet.Reduced risk of type 2 diabetes mellitus: Following a Mediterranean diet reduces the risk of developing diabetes for healthy people and for people who are obese (and therefore have a high risk of developing diabetes).Reduced risk of cancer: A European study showed that following a Mediterranean diet reduced the risk of developing cancer.Increased weight loss: Obese individuals who follow a Mediterranean diet lose more weight than those following similar diets matched for total calorie and fat intake.

The nutritional balance of a diet (i.e. the combination of fats, cereals, sugars, vitamins and other nutrients), and particularly the types of fats consumed, have different effects on the body. For example, monounsaturated fats are associated with less abdominal obesity (instead, fat is stored around the hips and buttocks) than saturated fats. In terms of diabetes and cardiovascular disease, evidence suggests that abdominal fat poses greater health risks than fat which is stored around the buttocks. Saturated fats are also associated with endothelial dysfunction, which increases the risk of metabolic syndrome and diabetes.

Fish is a good source of long chain omega 3 fatty acids, which play an important role in fighting the metabolic imbalances that cause diabetes. Refined grains (which are largely excluded from traditional Mediterranean diets in favour of whole grains) are associated with increased glucose and triglyceride levels after eating, which increases the risk of cardiovascular problems and diabetes. Butter and full fat milk have a greater impact on cholesterol levels than other dairy foods like cheese and yoghurt, which are most common in Mediterranean diets.

The health benefits of the Mediterranean diet come from the combination of foods consumed. Combining components of the Mediterranean diet (e.g. fish and potatoes) with saturated fats (e.g. fried fish and chips), alcohol or excessive food consumption is not a healthy alternative.

When all components of the Mediterranean diet are consumed in the correct proportions, (and particularly when they are consumed in overall moderation), the diet is beneficial for one's health.

It is also important to remember that regular, moderate intensity exercise is necessary for good health. The Mediterranean diet is not a substitute for daily physical activity.

There are many ways that a diet can be modified to more closely resemble the important combination of nutrients found in a typical Mediterranean diet. To begin, try:

Replacing animal fats and butter with olive oilReplacing red meat with fish and lean poultryGrilling meat, fish and poultry rather than frying itDrinking red wine with meals instead of without food and instead of beer or mixersEating low fat nuts like almonds and walnuts instead of potato chips, pretzels, peanuts, cashews and other snacks which are high in fatWhen cooking, using yoghurt or olive oil instead of cream or butterLooking for tasty new recipes .

Nutrition in Children

The nutritional needs of children and adolescents are different from those of adults because children are growing and developing. Children need a wide range of nutritious foods, with high intake of important minerals and vitamins such as protein and calcium. If your child's intake of good food is poor, they can fail to gain or lose weight. This may be followed by failure to grow taller.  

Infants and children are more likely to suffer from poor nutrition than compared to adults. There are a number of reasons for this.

Low Nutritional Stores: Newborn infants have low stores of fat and protein. The smaller your child, the less reserves of energy they have. This means that they can only cope with starvation for shortened periods of time. High Nutritional Demands For Growth: The amount of nutrition children require is greatest during infancy. This is because of their rapid growth during this period. When your child is 4 months old, 30% of their nutritional intake is used for growth. By the age of 1 year, this falls to 5%. Rapid Development in the Nervous System: Your child's brain grows rapidly during the last four months of pregnancy and also during the first two years of life. The connections between the nerve cells in the brain are being formed during this time. Good nutrition is important to ensure that this occurs properly. Illness: Your child's nutrition may be compromised following an episode of illness or surgery. The body's energy requirements are increased, thus intake of food and nutrients should be increased.

There is an important growth period during adolescence, in which your child will experience a marked increase in the rate of weight gain and height. The growth spurt in children begins on average at 10 to 11 years in girls and at 12 to 13 years in boys, although there is wide variation. During the adolescent growth spurt boys gain about 20 centimetres in height and 20 kilograms in weight. Girls gain around 16 centimetres and 16 kilograms. The maximum weight gain tends to occur about three months after that for height. Adolescence is a very important period for gaining calcium and for building up strong bones, especially in girls. The majority of bone formation occurs during adolescence, thus it is important to ensure adequate calcium intake. Data from studies suggest that for most healthy adolescents the maximal calcium balance is achieved with intakes of between 1200 - 1500 milligrams a day.

Height

Growth and nutrition are closely related to each other. The average height of a population reflects its nutritional status. In the developed world, the population has gotten taller in height. In undeveloped countries, there are shorter children, due to lack of nutrition and energy intake for adequate growth.

Disease in adult life

There is evidence suggesting that undernutrition whilst the mother is carrying her baby can result in growth restriction. This is associated with an increased incidence of diseases such as high blood pressure, heart disease, stroke, type 2 diabetes mellitus, and lung disease in later life.

Obesity

Australia is involved in a worldwide obesity epidemic, affecting children of all ages. Overweight children are likely to become obese adults, and an overweight child with an obese parent has more than a 70 per cent chance of being obese in young adulthood. Obesity occurs when the total amount of calories that are consumed exceed the total that children use up through metabolic processes (such as playing, sweating and breathing). A gross measure of the degree of obesity can be determined by the Body Mass Index (BMI). This is determined by:

BMI = body weight (in kg) / stature (height, in meters) squared

While in adults, the BMI cut-offs internationally accepted as definitions of overweight and obesity (25 kg/m2 and 30 kg/m2) are based on increased risks of morbidity and mortality, no such outcome based definition exists for children. Definitions for children and adolescents have generally been based on data sets collected from other groups of children of corresponding ages.

The use of BMI is less appropriate for infants, children and adolescents because of different rates of gain in weight and height during development. It is common for children to gain weight quickly and their BMI may increase rapidly during puberty. For this reason, it is important to compare BMI calculations against age and gender percentile charts. For example, if a child has a BMI in the 65th percentile, 65% of kids of the same gender and age have a lower BMI. A child above the 95th percentile is considered overweight because 95% of the population has a BMI less than he or she does. A child whose BMI is at the 50th percentile is close to the average of the population. A child below the 5th percentile is considered underweight because 95% of the population has a higher BMI. Children can also have a high BMI because he or she has a large frame or increased muscle mass, not excess fat.

This information will be collected for educational purposes, however it will remain anonymous.

It is also important to look at the BMI values over a period of time, as a trend instead of focusing on individual measurements. Single values, taken out of context, might give you the wrong impression of your child's growth. Prevention is better than treatment.

Once your child is overweight or obese, it is more difficult to loose weight. There are undesirable effects on your child's body both physically and mentally. Obese children are more likely to develop high sugar levels and high cholesterol levels. This can lead to diseases such as diabetes and blood vessel and heart problems. There may also be effects on your child's self esteem and body image - obese children may be stereotyped and called names or bullied at school.

Energy

Marked variability exists in the energy requirements of children because of different growth rates and physical activity levels. Total energy requirement recommendations are based upon how much energy your child uses, plus 3 to 4 percent to cover the energy needed for growth. The recommended composition of dietary energy intake consists of reduced consumption of cholesterol, total fats, (especially, saturated fat) and an appropriate weight and height for your child's age.

Protein

Protein is important in children for growth, tissue repair and to make essential hormones and enzymes in the body. When energy intake is insufficient, protein intake must be raised. This is because ingested proteins can be directed towards pathways of energy synthesis. For children, the recommended dietary allowance for protein is about 1g/kg body weight per day. Foods such as milk and cheese are excellent sources of calcium and protein for children.

Fats

Fats are a concentrated and rich source of energy. In children, it is recommended that fat intake total no more than 30% of calories. Saturated fat and trans-fat should be limited to less than 10% of calories, and polyunsaturated fats to less than 10% of calories. The rest of the fat intake should consist of monounsaturated fats.

Trans fats: These fats are artificially created. This solidifies the oil and limits the body's ability to regulate it's cholesterol. These fats are considered to be harmful to your child's health. Trans fats are found mainly in deep-fried fast foods and processed foods made with margarine. Saturated fats: This type of fat is found in foods such as butter and beef fat. Polyunsaturated fats: This group includes omega 3 and 6 essential fatty acids (EFA's).There are high levels found in fish oil, vegetable and nut oils. Monounsaturated fatty acids: This is found mainly in chicken fat and vegetable oils such as olive, canola and peanut oil.

Carbohydrates

Carbohydrate recommendations for young children are similar to those recommended for adults (around 55% of total energy intake). To meet their carbohydrate needs, active children should enjoy a diet high in carbohydrate rich foods as well as nutritious high carbohydrate snacks between meals.

Water

Maintaining adequate hydration is essential for the prevention of conditions such as dehydration and heat stress (when heat is absorbed from the environment faster than the body can get rid of it.). Your child's body has less developed mechanisms to regulate body temperature. They produce more body heat per kilogram of body weight than adults, but their ability to transfer heat through their blood, to the skin is diminished. When exposed to high temperatures, children may absorb more heat than adults, because they have a high ratio of skin exposed to the sun. This shows the importance of regular fluid intake in your child.

It is recommended that active children drink 150 - 200 mLs of fluid 45 minutes prior to exercise, plus an additional 75-100 mL every 20 minutes during exercise. Water is recommended as the best choice of fluid.

As discussed above, carbohydrates should make up at least 55% of total daily calories. In more recent times, the quality and also quantity of these carbohydrates has been shown to be important in blood sugar control. Even though different foods may contain the same amounts of carbohydrates, the effects on blood sugar control may be totally different. This has lead to the development of measures such as the glycemic index (GI) and glycemic load (GL) of a food product.

As parents, we want to provide our children with the best possible foods for maintaining a healthy diet and for control of rises in their blood sugar levels. Low GI and GL foods have been shown to be associated with health advantages such as a decrease in blood sugar levels. This is particularly important if your child suffers from diabetes, to prevent hyperglycemic (elevated blood sugar levels which can cause symptoms such as dry mouth, an increase in going to the toilet to pass urine and nausea) episodes. In the longer term, control of blood sugar levels is also important to prevent diseases such as heart disease, major vessel disease and obesity. The Glycemic Index (GI) is obtained by measuring the effect that a carbohydrate containing food has on blood sugar levels, compared to the effect of the same amount of pure sugar, on blood sugar levels.

The following ranges are usually applied to determine the GI of a particular food:

Low GI - 55 or less. Medium GI - 56 to 69. High GI - 70 or more.

Foods with a low GI (less than 55) means that they cause a slower and lower rise in blood sugar levels. These include: breads such as mixed-grain and oat breads, barley, pasta, noodles, beans, sweet potatoes, green peas and milk.

Foods with a high GI (greater than 70) means that they cause a faster and higher rise in blood sugar levels. High GI foods include: white bread, steamed white rice, chips and coffee.

By aiming to provide your children with low GI foods, this will help bring down the average GI of their meal and prevent sudden increases in blood sugar levels. Foods with a low GI are also often more healthy and nutritious. These foods allow blood sugar levels to be sustained at a lower level over a longer period of time. After we consume carbohydrate containing foods, the body signals the pancreas to secrete a hormone called insulin to break it down. Insulin acts to lower the body's sugar levels. When the blood sugar levels decrease to a particular level, the brain is sent a signal and we become hungry again.

By providing children with low GI foods, they are more likely to be satisfied and feel full for longer periods of time. This helps in maintenance of a healthy weight and avoiding the development of diseases such as high cholesterol, increased blood pressure levels and heart disease. The glycemic load (GL) of a food ranks the effect of a specific serving size of that food on the blood sugar levels.

GL Ranges

The following ranges are usually applied to determine the GL of a particular food:

Low GL - 10 or less. Medium GL - 11 to 19. High GL - 20 or more.

The following values are applied to define the GL per day:

Low GL - less than 80. High GL - more than 120.

Foods with a low GL means that they cause a more steady and lower rise in blood sugar levels. These include: many fruits and vegetables. Foods with a high GL means that they cause a faster and higher rise in blood sugar levels.

High GL foods include those such as white rice and refined snack foods such as chips and sweetened drinks. Generally, foods with a low fibre content and high carbohydrate levels have high GI and GL values, whereas those with high fibre contents have lower GLs.

Clinical studies have also shown that the dietary GL is linked to risk factors for heart and major vessel disease, diabetes and obesity. For more information on the glycemic index and glycemic load, and tips on how to provide your children with low GI foods, visit these pages on Glycemic Index (GI) and Glycemic Load (GL).

Infants

In infants up to the age of 6 months, breast milk universally provides the ideal food, containing all nutrients your baby will need to grow and develop. The breast fed infant typically nurses every two to three hours while awake, or eight to twelve times a day. It is recommended that solids should not be started before the age of four months, but not be delayed much beyond the age of six months.

Modern infant formulas provide a suitable form of nutrition when an infant does not have access to breast milk. Traditionally formulas are based on cow's milk, with varying proportions of casein and whey proteins. There are also formulas based on soy or goat's milk and lactose-free formulas for infants who cannot tolerate cow's milk or lactose.

The frequency of feeding is highly variable in a formula fed infant because of differences in the time the stomach takes to empty. Feeds should be guided by the infant's demand: most infants will demand six to nine feeds a day. They will slowly increase their intake from 30 to 90 ml every three to four hours by the end of the first week of life. Overall, the formula fed infant consumes an average of 100-110kcal/kg per day during the first year of life.

The introduction of solid foods should ideally start with iron-enriched infant cereals at about six months. Gradual introduction of various vegetables, fruits, meats, poultry and fish can then occur. Ensuring that the foods introduced are high in nutrients and providing a good variety of texture is also important.

By twelve months of age, an infant should preferably be consuming a wide variety of family foods and progressed from pureed foods to foods that are chopped into small pieces. Vitamin and mineral supplements are not usually needed for healthy, full-term infants or children. However in lower socioeconomic areas, there may be deficiencies such as water without fluoride and poor intake of foods rich in vitamins and minerals, which means that further supplementation will be required. 

Children

From the age of twelve months onwards, children grow at a much slower rate than compared to their infancy phase. While growth slows somewhat, nutrition remains a top priority. Young children are also discovering their independence and may test their choice in food selection, leading to reduced interest in eating. This can give the impression that they are poor or fussy eaters. Generally, this does not compromise normal growth, but if additional constraints are placed on the diet, such as restricting certain types of foods (including cholesterol rich foods), nutritional deficiencies can occur.

Depending on their age, size, and activity level, young children need about 1,000-1,400 calories a day. According to the healthy food pyramid, this can be achieved by:

six servings of from the breads/cereals/rice/pasta group (1 serving = 1 slice of bread, 1 cup of cereal, 1/2 cup of cooked cereal, rice, or pasta). five servings from the fruit and vegetables group (1 serving = 1 cup of raw leafy vegetables, 1/2 cup of other vegetables cooked or raw, 3/4 cup of vegetable/fruit juice, 1 medium apple, banana, orange, pear). two servings from the milk/yoghurt/cheeses group (1 serving =1 cup of milk or yogurt, or 2 slices (40g) of cheese). two servings from the meat and beans group. (1 serving = 55-85g of cooked lean meat, poultry, or fish, 1/2 cup of cooked dry beans).

Milk

Milk is an important part of a child's diet as it is a good source of calcium and vitamin D, which helps build strong bones. Young children should be getting at least 500 milligrams of calcium a day. This is easily provided by two servings of dairy foods every day.

Iron

After 12 months of age, children are at increased risk for iron deficiency because their intake of iron-fortified formula or breast milk is greatly reduced. Young children should be getting about seven milligrams of iron each day.

It is important to ensure that your child is receiving enough iron, as low iron levels can affect a child's growth and may lead to learning or behavioural difficulties. Iron deficiency anaemia - a condition where there is a decreased number of red blood cells in the body can also develop. Red blood cells help carry oxygen throughout the body and depend on iron to be produced. If there are not enough red blood cells, tissues and organs in the body do not receive enough oxygen and fail to function as well as they should.

It is very important to realise that cow's milk is low in iron. Drinking a lot of cow's milk (more than three cups of milk) also put your child at risk of developing iron deficiency. Children can also be filled with milk and less likely to eat iron rich foods. In some cases, milk can decrease the absorption of iron and irritate the lining of the gut (intestine). This may result in small amounts of bleeding and loss of iron through the stools.

To help avoid iron deficiency occurring, you should try and limit your child's milk intake to less than three cups a day and increase iron rich foods such as green leafy vegetables and lean meats.

Adolescents

Nutritional needs during adolescence are influenced primarily by the commencement of puberty with the onset of growth spurts and changes in body composition and organ systems. There is an increase for energy and almost every nutrient. Growth during adolescence is accompanied by an increased proportion of body fat for girls and an increased proportion of lean body mass and blood volume in boys.

The most common nutrient and vitamin deficiencies involve iron and calcium. Iron deficiency is the most prevalent dietary deficiency in:

Older adolescent girls Pregnant teenagers Vegetarian teenagers Lower socioeconomic groups Athletes who have increased iron losses.

Rapid growth in adolescence leads to increased vulnerability to iron deficiency. Increases in lean body mass, blood volume, and red cell mass raise iron needs for the body. It is also more common in teenage girls due to iron loss from menstruation and decreased dietary intake. We should therefore encourage adolescents to eat iron fortified breads and cereals and other iron rich foods such as lean meat, dried fruits, nuts and green leafy vegetables. It is recommended that pregnant teenagers take iron supplements.

Calcium intake is particularly important for women. Intake tends to be low in adolescent diets due to factors such as drinking less milk in favour of carbonated drinks and avoiding dairy products due to concerns about weight gain. Bone mass achieved during adolescence is important to decrease the chance of osteoporosis in later life. We should encourage at least two to three serves of milks, yoghurts and cheeses each day.

Adolescence is a time of independence and new body images, and can be a transitional stage when food habits change and adolescents are seeking more control over their food intake. Common eating behaviours during this time include eating away from home, increased intake of fast foods, snacking and skipping meals. Adolescents have increased energy requirements, which require high calorie snacks. However, commonly chosen snack foods are typically high in fats, sugars and salts. We should aim to increase nutritious snacking through promoting healthy snacks such as increased fruit and vegetables.

The National Health and Medical Research Council (NHMRC) have released a set of recommended dietary guidelines for Australian children. These guidelines apply to the general population of healthy children from birth to eighteen years.

1. Encourage and support breastfeeding:

There is no doubt that breast milk is the best diet for babies. In developing countries where there is a high incidence of infection and contamination within the environment, breast feeding improves survival. Breast feeding also helps promote an intimate relationship between the mother and baby. It may also provide an advantage in long term development of the brain and it's related structures, especially in pre-term infants. The most likely nutrients in breast milk that are responsible for this are long chain polyunsaturated fatty acids.

2. Children and adolescents need sufficient nutritious foods to grow and develop normally:

Growth (weights and heights) should be checked on a regular basis for young children. Physical activity is important for all children and adolescents.

3. Enjoy a wide variety of nutritious foods:

Children and adolescents should be encouraged to:

Eat plenty of vegetables, legumes and fruits Eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain Include lean meat, fish, poultry and/or alternatives Include milks, yoghurts, cheese and/or alternatives

Reduced-fat milks are not suitable for young children under 2 years, because of their high energy needs, but reduced-fat varieties should be encouraged for older children and adolescents.

Choose water as a drink Alcohol is not recommended for children

Care should be taken to:

Limit saturated fat and moderate total fat intake Low-fat diets are not suitable for infants Choose foods low in salt Consume only moderate amounts of sugars and foods containing added sugars

4. Care for your child's food: prepare and store it safely:

This is important to ensure decreased spread of infections within children.

Physical activity is an important part of everyday life for children and adolescents. It plays an important part in physical growth and the development of a range of skills. It also provides a mechanism for balancing energy intake and energy output and decreases the incidence of obesity. In girls, physical activity is related to bone density in adulthood. The physical activity guidelines for Australians make the following recommendations:

Children should be active every day in as many ways as possible. Children should achieve at least 30 minutes of moderate-intensity activity on most, preferably all, days. If possible, children should enjoy some regular, vigorous exercise for extra health and fitness.

Snacks and lunchbox ideas:

As part of a healthy diet children should eat 3 main meals and 2-3 snacks a day. In children, snacks are an important part of daily food intake. They should be tasty, easy to prepare and full of nutrition. Ideal snacks include:

Slices of fruit bread / buns. Slices of fruits / vegetables. Small handfuls of plain / wholemeal crackers with cheese, fruits or vegetables. Small cup of popcorn / dried fruits. Tub of low fat yoghurt. Homemade / low fat muffins

Drinks in school

For the lunchbox

Fill with a variety of healthy foods. Include plenty of fresh fruit, vegetables and bread or crackers. Incorporate low fat protein food such as meats, fish, dairy products or eggs. Different breads and rolls such as wholemeal, multigrain, white hi-fibre, bagels, pocket, focaccia, turkish and flat breads can be used for variety. Margarine spreads should be used sparingly. Sandwiches can be cut into different sizes and shapes for novelty. There are many fillings, which can be tried, depending on the child's taste - lean beef, chicken or pork with lettuce, tomatoes, avocadoes, etc.

It is important to involve the child in choosing their own lunch from a range of healthy options. Children who are involved in their own food choices may be more likely to adhere to good eating habits.

Nutrition in the Mature Woman

Nutritional status in old age is as important as in any other stage of the life cycle. Some physiological changes that occur as part of the ageing process tend to have significant impact on the health and nutritional wellbeing of mature women. Changes in body composition (e.g. reduction in lean muscle mass) and reduced physical activity levels have direct links to energy requirements. The digestive and immune systems become less efficient, and the ability to taste and smell is diminished or lost. This decreases the enjoyment of eating. Digestive problems may be experienced because it is harder to absorb nutrients or chew and swallow food. Stomach acids (e.g. gastric acid) production is decreased. The acids enhance the effective absorption and utilization of nutrients (e.g. vitamin B12, folic acid, and iron). The lower acid production can render mature women vulnerable to nutritional deficiencies.

Improving your nutritional status by consuming a varied diet and maintaining a healthy lifestyle throughout old age has immense benefits. For example, a 30% reduction in atherosclerotic disease was observed among older women who consumed 5-10 servings of fruits and vegetables per day, compared to those who consumed 2-5 servings per day. Adequate nutrition helps to give your immune system a boost in its fighting power by providing you with the necessary amounts of vitamins and minerals, including vitamin C, E, A, B6, selenium and zinc.

Generally, energy needs decrease and protein requirements increase as you age. The important nutrients most likely to be deficient in the diet of mature women include vitamin B-12, vitamin A, vitamin C, vitamin D, calcium, iron, and zinc. The nutritional requirements of mature women can be met if they have a good appetite and eat a variety of foods.

Energy

Energy requirements tend to decrease due to reduced physical activity and changes in metabolic functions. As muscle mass decreases in the mature, the requirement for energy becomes less than that of the younger adult. The basal metabolic rate also goes down, and so the energy needs of the mature are reduced. However, the same cannot be said of protein, vitamin and mineral requirements.

Protein

It is important that your protein intake increases to provide the necessary materials needed for healing wounds, fighting infection, repairing fractures, or maintaining nitrogen equilibrium. These conditions tend to be more prevalent as you age.

Vitamin D

Vitamin D helps your body to use calcium and helps your immune system to function properly (that is, vitamin D helps your body prevent and fight infections). The two main sources of vitamin D are sunlight and your diet. Rich dietary sources of vitamin D are fatty fishes and fortified dairy products. Some mature women may avoid consuming dairy products because lactose intolerance is more common in older adults. Skin manufactures vitamin D only in the presence of sunlight. The vitamin D precursor in the skin that allows this decreases with age, putting mature women at greater risk of vitamin D deficiency.

Calcium

The recommended daily intake of calcium increases from 800 mg in premenopausal women to 1000 mg in postmenopausal women. The increased demand for calcium is necessary to cater for hormonal changes that take place at menopause. In order to meet the calcium needs of postmenopausal or over 65-year-old women, a daily intake of 1500 mg is recommended. Dairy foods (eg. milk, cheese, yogurt, custard and ice cream) are the major sources of calcium in the Australian diet. Other food sources include calcium-fortified products and fish with chewable bones (eg. salmon). Adequate calcium intake can help protect you from chronic conditions such as osteoporosis, colon cancer, and hypertension.

Iron

Iron requirements for women decrease after menopause, since iron is no longer lost through menstruation. Therefore, iron requirements in postmenopausal women are similar to that of adult men (that is, 8.7 mg/day). Despite this, it is still important that iron-rich foods are eaten daily. There are two different types of iron found in foods, haem and non-haem. The iron from lean red meat, poultry and fish is known as haem (organic) and is well absorbed. Iron found in legumes (eg. chickpeas and baked beans), nuts, dark green vegetables, whole grain breads and dried fruit is non-haem (inorganic). Non-haem iron is not readily absorbed compared to haem iron. For example, one cup of fortified oatmeal will provide about 10 mg of non-haem iron, while 100 g of lean steak will provide 3 g of haem iron. Include vitamin C-rich foods (eg. fresh orange juice, salad or green vegetables) with meals to increase iron absorption from plant foods.

If you do not consume enough dietary iron, iron deficiency anaemia may occur. Postmenopausal women should be cautious in taking iron supplements because of the risk of iron overload, which will lead to an excess of iron being found in the blood and stored in organs such as the liver and heart.

Zinc

Aside from low dietary intake, some factors affect zinc status by inhibiting absorption. They include high supplemental iron intake and phytates obtainable from grains, cereals, rice and legumes. Zinc from vegetable foods may be less bioavailable than zinc from animal sources. Other situations that may cause secondary zinc deficiency include physiologic stress, trauma, and infections. Ageing women may be vulnerable to zinc deficiency because of their vulnerability to these very situations. Some of the adverse effects of poor zinc status may include reduced immune function, dermatitis, loss of taste, and impaired wound healing.

Zinc helps your body produce white blood cells to fight infection; helps your white blood cells release more antibodies; increases the number of killer cells that fight against cancer; and slows the growth of cancer. Zinc-deficient mature women will have less ability to resist infections compared to women who get enough zinc.

Zinc supplementation may be necessary for individuals with inadequate zinc status.

Vitamin B12

People eat less food rich in vitamin B12 (e.g. meat) as they age, perhaps due to difficulty chewing meat and to financial constraints against buying the meat. Furthermore, reduced production of stomach acids may hinder the bioavailability of vitamin B12, as gastric acid is necessary for the digestion of food rich in vitamin B12. Bacterial overgrowth in the gut of the mature may make vitamin B12 less available for absorption and utilization. It may be necessary to supplement the diet of the mature with vitamin B12 in order to ensure an adequate supply. Evidence from recent research shows that the amino acid homocysteine, like blood cholesterol, is a risk factor for coronary disease. To a large extent, the blood level of homocysteine is controlled by vitamin B12, vitamin B6, and folic acid. It is therefore possible that adequate micronutrient status of these vitamins may reduce the risk of cardiovascular disease and stroke, especially in old age.

Vitamin C

Vitamin C is important for ageing women because it is needed for your immune system to function efficiently. Vitamin C supports this by:

Increasing the production of infection-fighting white blood cells and antibodiesIncreasing the levels of interferon (this is the antibody that coats cell surfaces, thus restricting viruses from entering cells)

Vitamin C also reduces the risk of cardiovascular disease by:

Raising levels of HDL cholesterol while lowering blood pressureInterfering with the process by which fat is converted to plaque in the arteries. Vitamin C intake lowers the rates of various cancers, Including colon, prostate, and breast cancer.

Vitamin E

Vitamin E is an important antioxidant and immune booster because it:

Stimulates the production of natural killer and B cells, (those that seek out and destroy bacteria and cancer cells) May also reverse some of the decline in immune response commonly seen in ageing

Vitamin A and beta-carotene

Vitamin A is a fat-soluble vitamin. Eggs, palm oil, carrots, green leafy vegetables and animal products such as liver are good sources of vitamin A. It is easily bioavailable from food sources containing fat. The safe upper limit for pregnancy and lactating women is 3000 micrograms for those aged over 19 years. It is recommended that women be encouraged to obtain vitamin A from the diet rather than supplementation. Vitamin A and beta-carotene, in addition to maintaining good eye sight, boost the immune system in a number of ways. They:

Increase the number of infection-fighting cells, natural killer cells and helper T-cellsAre powerful antioxidants that mop up excess free radicals responsible for accelerating ageingHelp the thymus gland to grow, protecting it from the harmful effects of stressProtect the respiratory system from infectionsReduce the risk of cardiovascular disease by interfering with the oxidation (and hence formation of arterial plaques) of fats and cholesterol in the bloodstream

The table shows the recommended daily intake of some vitamins and other nutrients for women as they age.

Table: Recommended daily intake for women

 Nutrient  31–50 years old   51–70 years old   > 70 years old 

Malnutrition in mature women may be attributed to one or more of the following factors: 

Inadequate food intake Food choices that lead to dietary deficiencies Illness that causes increased nutrient requirements, increased nutrient loss, poor nutrient absorption, or a combination of these

The impairment of physiological functions and other vital processes make mature women very prone to cardiovascular diseases.

Osteoporosis

Osteoporosis is common in mature women. It weakens bones, causing them to be easily fractured after falls. Though osteoporosis may be treated with a range of different medications, it is better to prevent it.

To help prevent osteoporosis, 1200 mg of calcium daily (through calcium-rich foods and/or a calcium supplement) and sufficient vitamin D (400IU or 10mcg) should be taken. Excessive smoking and alcohol abuse must be avoided. Engaging in weight-bearing exercise such as walking, running, tennis, and dancing is also encouraged.

The risk of developing osteoporosis increases once a woman has reached menopause due to reduced levels of the hormone oestrogen. Reduced oestrogen levels are associated with increased calcium loss in bones. Most of the calcium in your body is stored in your teeth and bones. The concentration of calcium in body fluids needs to be constant. If over a long period not enough dietary calcium is taken, the bone loses its calcium to the body fluids in order to maintain the necessary concentration.

The problem of osteoporosis relates to failure in meeting the requirements for calcium and vitamin D. Vitamin D, synthesised by our bodies in sunlight, controls calcium absorption from our diets. As we advance in age, the efficiency of vitamin D synthesis diminishes. mature women, especially those living in areas without enough sunshine, may have to depend on their diets for enough vitamin D to maintain calcium absorption. Research evidence indicates that by increasing the dietary intake of vitamin D, osteoporosis and its associated problems can be prevented.

Evidence from research conducted amongst postmenopausal women has shown that calcium supplements taken, especially in conjunction with moderate exercise, are effective in preventing osteoporosis. Calcium tablets and milk powder were equally effective in slowing the rate of bone loss at the hip.

The causes of osteoporosis include:

A low calcium diet, especially before 20 years of age A low vitamin D diet and little or no sun exposureExtended bed rest or lack of weight-bearing exercise Medications (eg. corticosteroids, anticonvulsants)Cigarette smoking Excessive alcohol intake Underweight or eating disorders (e.g. anorexia nervosa) MenopauseGender - Women have a greater risk of developing osteoporosis, especially if they have had an early menopause or hysterectomy (before the age of 45) Ethnicity - Caucasian and Asian women are at highest risk, followed by African-Caribbean and Latino womenFamily history - There is a higher risk if one or both parents had osteoporosisAge - The greater the age the higher the risk Body size - Small thin-boned women are at higher risk People with medical conditions which affect the absorption of foods (e.g. Crohn's disease, coeliac condition or ulcerative colitis)

Cancer

The immune system plays an important role in preventing infection, cancer, and other conditions. The immune system is the body's defense against harmful substances (eg. bacteria, viruses, fungi and parasites). The immune system produces antibodies which kill the invading organism or neutralize the toxin. Unfortunately, the mass and function of your immune system declines as you get older.

Research suggests that some of the decline in immune function can be reversed by increasing the intake of nutrients such as vitamin B6, zinc, and vitamin E. It is also suggested that some nutrients such as selenium, vitamin B6, vitamin B12 and folic acid can help protect against some kinds of cancer. An adequate diet may help to prevent certain forms of cancer during old age. For example, studies by the World Cancer Research Fund and the American Institute for Cancer Research found compelling evidence that a high fruit and vegetable diet reduces the risk of cancers of the mouth and pharynx, oesophagus, lung, stomach, colon and rectum. Evidence of probable risk reduction was found for cancers of the larynx, pancreas, breast, and bladder.

Diabetes

Type 2 diabetes is an age-related disease. Its onset is linked to diet, lifestyle and physical activity. As we age, fat accumulates in the abdomen. The size and strength of our skeletal muscle declines, leading to muscle weakness and a reduction in physical activity. Abdominal fat accumulation and reduced energy expenditure leads to insulin resistance. Insulin is a hormone secreted by the pancreas. Its main function is to facilitate glucose uptake by the muscle. The body uses insulin as a "key" to unlock a door, allowing the glucose molecules to pass from the blood into the body cells. In some instances, the body cells are unable to respond to the insulin. This is called insulin resistance.

Insulin resistance occurs when the normal amount of insulin secreted by the pancreas is not able to unlock the cell doors. When the body cells do not respond to even high levels of insulin, glucose builds up in the blood, resulting in type 2 diabetes.

Type 2 diabetics produce sufficient quantities of insulin, but their bodies do not respond adequately. In contrast, for people with type 1 diabetes, insulin is present in very small quantities (or may even be absent) and insulin injections are warranted. Obesity is a risk factor for insulin resistance, and because older people are generally more inactive, they are more predisposed to becoming obese. Poor glucose utilisation in the mature is caused by reduced lean muscle mass and insulin resistance. This may explain why type 2 diabetes is prevalent among aged people.

As you age, you may have difficulty getting and absorbing certain nutrients valuable for your well being. The following may help:

If you are unable to chew hard foods, go for softer foods such as juices, cooked fruits and vegetables, ground meats and dairy foods (unless you are lactose intolerant).Some medicines may affect your sense of taste, making you lose your appetite. If you have problems with particular medicines it may be wise to consult your doctor about alternatives. You may also like to use tasty spices on your food. Taste and smell are closely related, so foods with strong scents also have strong flavours.Identify foods that may cause stomach upsets and make substitutions or avoid them altogether. For example, if milk disagrees with you, try cream soups, yoghurt and cheese to get your calcium. If cabbage and broccoli are a problem try alternatives such as potatoes, green beans and carrots. You may consider taking fruit juices instead of fresh fruit.Dietary supplements may be beneficial (eg. Vitamin B12 and calcium).Make sure you drink enough fluids every day (eg. water, beverages) since you may have a decreased sensitivity to thirst.