A food diary
|Muesli with almond milk and an apple
|2 soft boiled eggs, pitta bread with olive oil spread, 4 slices cucumber, tomato and an apple
|Cod cooked in butter with oven cooked chips , carrot and peas
4 pints of water
|Porridge with almond milk
|2 slices best of both bread with olive oil spread, 2 poached eggs with black pepper, packet of cheddar biscuits, banana
|Rice with peppers, mushroom, baby corn, chopped chicken breast in stock
|Chamomile tea *2
4 pints of water
A BMI calculation: weight; 57kg, height 1.64m: 57/(1.64*1.64) = a BMI of 21. This is classified as healthy with an average risk of diseases associated with excess weight.
Objective analysis of the diet sample (from the food diary table above)
The Eatwell Plate recommends that about 33% of your daily food is starchy carbohydrates. The food diary above demonstrates a diet that reflects this recommendation across the 3 meals. Breakfast is muesli and porridge, Lunch has pitta bread and ‘best of both’ bread while dinner has chips and rice. If this is a typical example of diet a variety in breakfast to include wholegrain cereals for a wider variety of nutrients to be provided. For lunch healthier choices may include wholemeal, rye or seeded breads and for dinner alternatives to chips would be oven baked wedges with skins on or jacket potatoes, alternatives to rice would include pasta or cous cous.
A further 33% of the daily food intake should be fruit and vegetables. The example days from the food diary fall slightly below this recommendation. Adding dried fruit to muesli, fresh or dried fruit to porridge, snacking on sticks of vegetables would all help to increase the amount of fruit and vegetables in this diet.
Protein on the Eatwell Plate is about 12% of the recommended daily amount. The diet represented in the table above does reach this goal with eggs for lunch and either fish or chicken for dinner. Although the quantity of each type of protein has not been mentioned, a suggestion would be to include a wide variety of proteins which include pulses and beans as well as 2 portions of oily fish per week.
15% of the daily plate for a balanced diet needs to be dairy and dairy alternatives. The food journal doesn’t represent a balance in this area. To boost the nutrients from this part of the plate a consideration would be to add plain natural yogurt to muesli, add some low fat cream cheese to the chicken and rice dish or add fruit and yogurt as a dessert or snack.
The final part of the Eatwell plate represents oils and spreads, olive oil spread used in the food journal is an unsaturated fat. This is a healthier option than butter as long as it is used sparingly. The butter used to cook the cod could be replaced with an unsaturated alternative such as the spread used at lunch time or it could be grilled rather than fried to avoid extra fat being absorbed into the food.
The cheddar biscuits come under the part of the Eatwell Guide that is suggested to be eaten in small amounts and infrequently and would fall into part of the balanced diet if not eaten more than a few times each week.
Although the Eatwell Plate demonstrates a balanced plate for daily intake, it does not specify quantities of each part. If two people were to set all of their daily food out, one person may cover an entire dining table while the other may fit all of their food onto one dinner plate. Each of these people may have a correctly proportioned plate in regards to 33% carbohydrate, 33% fruit and vegetables, 12% protein, 15% dairy and 8% oils and spread. However the quantity (in grams for example of protein) of each individual item may tell a different story of one person overeating and another undereating leading to health concerns of either obesity or malnourishment.
To see if the food journal is not just balanced but is also meeting nutritional requirements we would need to look into the food content in more detail and compare the provision with the tables set out by the Department of Health for Daily Recommended Values and Reference Nutrient Intakes. The values used are calculated for the person that has provided the food journal, a 38 year old female.
Daily protein intake should be 42.75g for this person. An average chicken breast is about 150g and contains about 46g of protein, eggs containing about 6g of protein each and an average piece of cod contains about 41g per 230g of weight. The protein requirements have been met on the days recorded in the journal.
Using an analysis tool on Google to calculate vitamin content of particular foods it is clear that the vitamin A recommendation of 600µ has been met. However if there is a day when either eggs or carrots are not eaten, which are high in vitamin A, then the total consumed falls below the RNI. This is one reason that it is important to eat the five recommended portions of fruit and vegetables so that a person is not reliant upon one food to provide all of their nutritional needs.
Vitamin D is included in this diet through fortified foods such as almond milk as well as the yolks of eggs, this is not enough to meet RNI of 7µg. Most Vitamin D is absorbed through the skin from sunlight and as lifestyle is not included in the food jornal it cannot be concluded if the vitamin D intake is sufficient. Prolonged periods of under provision of vitamin D can lead to rickets in children and osreomalacia in adults where the bones are weak and the muscle and bones are painful.
Vitamin B1 (Thiamine) has an RNI of 0.8mg daily. On the first day the journal shows this target being reached but not on the second day. A wider variety of vegetables and fruit are eaten on the first day again this reflects the need for more portions of fruit and vegetables to be eaten daily. With long term deficiency the nervous system will be affected and can lead to beriberi disease.
Vitamin B2 (Riboflavin) is mostly provided from meat and dairy in the British diet with regular consumption of leafy green vegetables also contributing to the daily recommended amount. The RNI of 1.1mg is met as eggs and chicken have been listed as main foods on the food journal. Deficiencies in this vitamin are usually seen when other B vitamins are deficient and so there are no specific symptoms, however dryness of the mouth and skin, itchy eyes and anaemia are general vitamin deficient symptoms.
Over the 2 days represented in the food journal the RNI of 13mg for vitamin B3 (Niacin) is almost reached. If some seeds and nuts were added to the diet as a snack and some cheese added into dishes a deficiency could be avoided. Pellagra develops over time if vitamin b3 remains deficient with symptoms including diarrhea, dermatitis and dementia.
Looking at the food journal over both days the RNI for vitamin B6 (pyridoxine) of 1.2mg has been met. By including nuts and a wide range of fruits and vegetables along with some dairy and meat this target can be met consistently. Although deficiency does not seem to lead to particular symptoms there is evidence that supplementing and taking above the RNI can help women with pre-menstrual symptoms.
B9 and folic acid (Folates) have an RNI of 200µg with the inclusion of eggs and bread the minimum is easily met from this food journal. If these foods were not included it would be important to add more seeds, nuts and vegetables (particularly green) to the diet. Red cell formation is affected by a deficiency in this vitamin leading to a type of anaemia and in unborn babies can lead to neural tube defects and as such during pregnancy mothers are advised to supplement leading up to conception and in the first 12 weeks of pregnancy.
As Vitamin B12 is only found in animal products those on a plant based diet will be deficient unless taking supplements or seeking out vitamin enriched foods. This food journal shows that almond milk is consumed and a normal serving with cereal contains 0.38µg of B12. Eggs, chicken and cod all contribute to bringing the daily amount to the RNI value. Deficiency in this vitamin leads to failure of cell division and megaloblastic anaemia, if left untreated neurological health is affected with loss of sensory and motor function.
Fruit and vegetables are the largest source of Vitamin C, food groups which are under represented in this food journal. About 70% of the 40mg RNI is met here and could easily be exceeded by adding an extra 2 portions of fruit or vegetables. For example choosing boiled potatoes over chips. A deficiency in vitamin C leads to scurvy where the body becomes tired and weak with bone and muscular pain, decreased ability to heal wounds and roughness of the skin. As people age adequate vitamin C can prevent cognitive impairment which can lead to stroke and lower the risk of coronary heart disease, cancer and cataracts.
With only 34% of calcium needs being represented daily on the food journal (figure from British Nutrition Foundation September 2014) from the supplemented almond milk with breakfast and an additional 18-19% (dependent on type of bread) from the lunch menu this diet can lead to a risk of osteoporosis in later life. Calcium is needed for bone and tooth strength as well as muscle contraction and blood clotting. Using the Reference Nutrient Intake guide (from data from Department of Health), 700mg of calcium are needed daily. 200mg is obtained from the almond milk and about 340mg from the bread. If an extra portion such as a yogurt were added to the daily diet than the nutritional needs for calcium would be met.
Phosphorous is linked very closely to calcium in the diet. Both are found in animal and plant products for consumption and are then found in bone within the body. It is recommended to have a daily amount of 550mg. The food journal shows an adequate amount of phosphorus being eaten with the largest doses from meat and bread.
Magnesium has an RNI of 270mg with long term deficiencies leading to weak muscles and irregular heartbeat. This food journal shows that day 1 is slightly over RNI and day 2 is slightly under, so on balance the recommendation is being met.
Iron is an important part of the diet as it is needed to produce red blood cells to carry oxygen around the body. Haem iron is found in animal products particularly meat and liver while non-haem iron is found in plant products. The food journal has shown a mix of foods containing iron; cereals, fruit, vegetables and meat. This has enabled the diet to provide between 11.4-11.5mg of the recommended 14.8mg of iron which is on target for the national average of 97% of the RNI.
Zinc is closely linked to protein intake, which this food journal shows as adequately represented. However Zinc from the foods eaten on these days are not adequate for the body needs coming in at about 50% of the RNI of 7mg. Deficiency in this mineral can result in lower immunity, poor wound healing, poor growth and skeletal abnormalities.
The RNI for potassium is 3500mg, the food journal shows that less than 50% of this amount is being consumed. Some potassium rich foods include sweet potatoes, butternut squash, watermelon, plain yogurt and canned salmon. With high potassium levels blood pressure is controlled.
Sodium (along with chloride and potassium) maintain blood pressure and correct functioning of nerves and muscles. Sodium is mainly found in meat, fish, eggs, dairy and table salt. The food journal covers most of these food groups but again the RNI of 1600mg is not met. By making an addition of cheese as mentioned when looking at the Eatwell Plate and slightly increasing the quantity of protein from meat, fish and chicken then the daily amount would be increased to nearer the RNI. As only bread and cheese biscuits were consumed as processed foods the lower sodium amounts are healthier than being too high and affecting blood pressure. Muscle cramps, fatigue and nausea are signs to look out for if the levels of sodium become too low.
Dairy, sea-foods and some seaweeds are iodine rich foods. The food journal shows that cod has been eaten which has about 132µg of the 140 required. It is important then that a variety of fish be included in the diet to maintain levels of iodide (iodine is converted into this non toxic form soon after entering the body). When iodine levels decrease the thyroid hormone levels drop causing a change in the pituitary response which leads to a goitre, eyes may protrude and weight loss occurs.
In summary fruit and vegetables and dairy are under represented. The World Health Organisation report in 2003 notes that low intake of fruit and vegetables is in the top ten risk factors of global mortality. If adequate amounts of fruit and vegetables are consumed, recommended at 400g daily then the risk of diabetes, heart disease, colorectal and stomach cancers and obesity are decreased. While the food journal above is not showing that the lack in fruit and vegetables is being replaced by fats, carbohydrates or protein, and so increasing the risk of obesity, it may be in time as metabolism changes due to exercise pattern and age that the imbalance will start to show through ill health. A lack of fruit and vegetables in the diet means that that the correct balance of micronutrients and fibres are not being met.
Dairy and non-dairy alternatives are also underrepresented on this food journal. If calcium is deficient during childhood full height may not be achieved. If the deficiency continues into adulthood there is a risk of health concerns such as osteoporosis and osteopenia where the bone density is affected and bones become fragile. Calcium is linked to the reduction in colon cancer, lower blood pressure and a lower risk of coronary heart disease (page 199 Human Nutrition Mary E Barasi 2nd edition). As the food journal is provided by a woman calcium in the bones decreases rapidly during the first few years of menopause it would be recommended to increase calcium in the diet now to prevent the increased risks associated with this loss. Exercising, maintaining a healthy body weight, reducing smoking and alcohol intake, consuming the correct levels of vitamin D, K and C are all important factors in allowing the body to be able to absorb calcium keeping bones, nerves, heart and blood healthy.
It is clear from comparing the food journal and the recommended intake of vitamins and minerals that each supports the other and enhance how they work within the body. Getting a daily balance is important and the best way to do this is to eat a wide and varied diet whilst keeping to a portion size necessary for maintaining a healthy body weight.