Factors that influence a healthy individual’s nutritional needs

• Age: Children have higher metabolic rates than adults, and so require more energy and also need to eat the correct amount and type of food to support growth. In adulthood, as age increases, energy requirements decrease due to the lower metabolic rate of older people compared with younger adults.

• Sex: Men require more energy, hence calories, because they have a higher metabolic rate than women due to their relatively greater muscle mass.

• Amount of physical activity: As energy is used as fuel, the higher the level of activity the more energy is used up and more calories are required.

• Height and build: The bigger the size of the body, the larger the amount of nutrients required to maintain cells.

• Pregnancy: The rapid growth of the foetus, during the second and third trimesters of pregnancy, changes nutritional needs although the exact changes vary from woman to woman. In particular, the demand for energy, protein and vitamins A, B, C and D are higher. However, ‘eating for two’ is not necessary as decreased maternal energy towards the end of pregnancy often compensates for the increased energy requirements of the foetus. In addition, the average British diet usually contains sufficient protein to meet the increased demands.

• Lactation: Women who are breast-feeding require more energy and therefore increased calorific intake (up to 500 calories a day) as well as increased vitamin A, C and D and calcium intake. Table 5.5 gives the estimated energy requirements for adults.

Estimated average energy requirements for energy – men		Estimated average energy requirements for energy – women
Age	kcal		Age	kcal
18–34 • Sedentary 2500 • Moderately active 2800 • Very active	2500 2800 3350		18–54 • Most occupations • Very active	2100 2500
35–64 • Sedentary • Moderately active • Very active	2400 2750 3300		55–74 (assuming sedentary) 75+ (assuming sedentary) Pregnancy Lactation	1900 1680 2400 2750
65–74 (assuming sedentary)	2400
75+ (assuming sedentary)	2150

These healthy eating recommendations need to be considered, along with client choice, when assisting an individual to choose a healthy meal. It is good practice to spend time with the client to establish their likes and dislikes. If you are with the client you can direct their choice towards the correct food to choose. For example, if a client is underweight or has a wound or pressure sore, you can encourage them to choose highprotein/ high-calorie options to help facilitate weight gain and provide them with sufficient amounts of protein, which is required for effective wound healing.

If a person’s appetite is very poor or due to illness they have increased nutritional demands as a result of higher metabolic rate, food intake may be insufficient to meet nutritional needs. In these instances a wide range of supplements can be used. Supplements are used to increase the nutritional value of oral intake, with some providing only calories whilst others, in addition to calories, containing proteins, vitamins and minerals. Some can be added to the client’s normal diet (for example powdered glucose polymers such as Polycal and Maxijul) and others are drinks that the client has between meals (for example Fresubin, Fortisip and Enlive). A

dietician will prescribe the most appropriate supplements for the client following a nutritional assessment. The client’s cultural and religious beliefs also need to be considered when assisting the client to choose their meals. All hospitals are now required to provide special diets such as halal meals for Muslim clients as

well as cater for vegetarians and vegans (see Table 5.2). However, it must be recognized that the choice available for these clients can be restricted.