Unbalanced diet

What is an unbalanced diet?

A diet supplies both macro-nutrients (proteins, fats and carbohydrates) and micro-nutrients (vitamins, minerals and trace elements). An unbalanced diet does not supply enough nutrients.

 

What are the complaints associated with an unbalanced diet?

An unhealthy diet is a major risk factor for a number of chronic diseases. Health deteriorates most when people eat too little fish and fruit. Eating too much fat is a risk factor for cardiovascular disease. An iron deficiency leads to complaints such as anaemia. Shortages of micro-nutrients cause diseases in certain risk groups, examples being a vitamin K deficiency in newborns (up to 3 months), a vitamin B12 deficiency in vegans and alcoholics, or a folic acid deficiency in women around conception. A vitamin D deficiency can be found in young children, people with dark skins, people who do not go outside enough, women who are pregnant or breastfeeding, women who wear a veil, women aged over 50 and men aged over 70. A vitamin D deficiency can result in osteoporosis, an increased risk of bone fractures, muscle weakness and immune disorders.

 

How common is an unbalanced diet in the general population?

Only a small proportion of people comply with the WHO recommendation to eat fish twice a week, virtually no one complies with the recommendation of 200 grams of vegetables a day and only 7% eat two pieces of fruit. 144

 

How common is an unbalanced diet in people with intellectual disabilities?

A Dutch survey of 470 people in the Netherlands with intellectual disabilities aged 50 years and over showed that 98.9% failed to comply with the WHO recommendation relating to the consumption of fish, vegetables and fruit. 115


A large Australian survey of 2540 people with intellectual disabilities (in which questionnaires were answered by carers and parents) found that 18% of the study sample had an unbalanced diet. 116


People with intellectual disabilities are more likely to have a vitamin D deficiency, iron deficiency and vitamin B12 deficiency. 117


A Finnish study of 138 males with intellectual disabilities found that 78% had low (less than 50 nmol/L 25-OH vitamin D) blood levels for vitamin D. 118


The Dutch GOUD study looked at nutrition using the MNA list (Mini Nutritional Assessment). This list has proven a reliable and effective way of establishing a picture of diet in older people with intellectual disabilities if it is completed by attendants or carers, but not by the people with intellectual disabilities themselves. 477


Research with this list has shown that 69% do not get consume enough calories, that 98% do not comply with the recommendations for fibre consumption, that 90% eat too much saturated fat and that 30% consume too few proteins, with the risk of a faster loss of muscle mass and muscle strength, and therefore an increased risk of a loss of independence. 478


Dutch research looking at children with severe multiple disabilities shows that malnutrition is not necessarily related to levels of calorie intake but more to personality characteristics. Dietary status is poorer in girls, older children, mobile children and, to a lesser extent, children who do not receive tube feeding owing to, among other things, the energy used by these children. 479

100% General population
99% People with intellectual disabilities

144

Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Diasbil Rehabil. 2006 Feb;28(4):181-91

115

De Winter CF, Magilsen KW, van Alfen JC, Penning C, Evenhuis HM. Prevalence of cardiovascular risk factors in older people with intellectual disability Am J Intellect Dev Disabil. 2009 Nov;114(6):427-36

116

Koritsas S, Iacono T. Secondary conditions in people with developmental disability. Am J
Intellect Dev Disabil. 2011 Jan;116(1):36-47

117

Lennox N. Nutritional Disorders. In: Management Guidelines Developmental Disability. Version 2 2005. ISBN 0-9757393-1-X. P 163-173

118

Kilpinen-Loisa P, Arvio M, Ilvesmäki V, Mäkitie O. Vitamin D status and optimal supplementation in institutionalized adults with intellectual disability. JIDR Volume 53, Issue 12, Date: December 2009, Pages: 1014-1023

477

Bastiaanse LP, Vlasveld G, Penning C, Evenhuis HM. Feasibility and reliability of the Mini Nutritional Assessment (MNA) in older adults with intellectual disabilities.J Nutr Health Aging. 2012;16(9):759-62

478

Evenhuis, HM (red). Gezond ouder met een verstandelijke beperking. Resultaten van de GOUD-studie 2008-2013. Wetenschappelijk rapport. 2014, Erasmus MC

479

Calis EA, Veugelers R, Rieken R, Tibboel D, Evenhuis HM, Penning C. Energy intake does not correlate with nutritional state in children with severe generalized cerebral palsy and intellectual disability.Clin Nutr. 2010 Oct;29(5):617-21

Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Diasbil Rehabil. 2006 Feb;28(4):181-91

De Winter CF, Magilsen KW, van Alfen JC, Penning C, Evenhuis HM. Prevalence of cardiovascular risk factors in older people with intellectual disability Am J Intellect Dev Disabil. 2009 Nov;114(6):427-36

Koritsas S, Iacono T. Secondary conditions in people with developmental disability. Am J
Intellect Dev Disabil. 2011 Jan;116(1):36-47

Lennox N. Nutritional Disorders. In: Management Guidelines Developmental Disability. Version 2 2005. ISBN 0-9757393-1-X. P 163-173

Kilpinen-Loisa P, Arvio M, Ilvesmäki V, Mäkitie O. Vitamin D status and optimal supplementation in institutionalized adults with intellectual disability. JIDR Volume 53, Issue 12, Date: December 2009, Pages: 1014-1023

Bastiaanse LP, Vlasveld G, Penning C, Evenhuis HM. Feasibility and reliability of the Mini Nutritional Assessment (MNA) in older adults with intellectual disabilities.J Nutr Health Aging. 2012;16(9):759-62

Evenhuis, HM (red). Gezond ouder met een verstandelijke beperking. Resultaten van de GOUD-studie 2008-2013. Wetenschappelijk rapport. 2014, Erasmus MC

Calis EA, Veugelers R, Rieken R, Tibboel D, Evenhuis HM, Penning C. Energy intake does not correlate with nutritional state in children with severe generalized cerebral palsy and intellectual disability.Clin Nutr. 2010 Oct;29(5):617-21