NHD Magazine - February 2016

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The Dietitians' Magazine Issue 111

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<ul><li><p>Issue 111 February 2016NHDmag.com</p><p>Public EnEmy no 1</p><p>Anne HoldowayRegistered Dietitian &amp; Chair of PENG</p><p>PENG: bEcausE suPPort aNd iNfluENcE mattEr. . . p44</p><p>ISSN 1756-9567 (Online)</p><p>dieteticJOBS wEb wAtCH NEw REsEARCH</p><p>Carrie Ruxton p12</p><p>PREGNANCY ANd NUTRITIONINfANT mIlk INTOlERANCE</p><p>fOlIC ACIdCRITICAl CARE ANd ObEsITY</p><p>www.dieteticJobs.co.uk</p><p>since 2009</p></li><li><p>IMPORTANT NOTICE: Breastfeeding is best for babies, and is recommended for as long as possible during infancy. Similac Alimentum is a Food for Special Medical Purposes and should be used under the supervision of a healthcare professional. </p><p>REFERENCES: 1. Sampson HA et al. J Pediatr 1991;118(4):520-525. 2. Data on le. Abbott Laboratories Ltd., 2013 (Similac Alimentum case studies). 3. Borschel MW and Baggs GE. T O Nutr J 2015;9:1-4. 4. Koo WWK et al. J Am Coll Nutr 2006;25(2):117-122.</p><p>Date of preparation: July 2015RXANI150117</p><p>NHD_SimilacAlimentum_DPS.indd 1 24/10/2015 15:44</p></li><li><p>,)0(3"3*)&amp;&amp;,!(#("-(-")1(.),0-3'*.)'-1,2</p><p>,)0(.)1&amp;&amp;.)&amp;,.) #( (.-.)&amp;,.#'#&amp;'(./'3</p><p>&amp;')#&amp;(*&amp;')()#&amp; ,-/**),.-/'-),*.#)(()('#(,-.#)(4</p><p>SIMILAC ALIMENTUM. FOR BIG LITTLE MOMENTS.</p><p> .,')(."-) )*#(!1#."."-&amp;*&amp;--</p><p>1),,3(",.,%#(!,#-) ",)1-</p><p>'#&amp;%&amp;&amp;,!3-/(&amp;3..&amp;')'(.%</p><p>."#-)-(.-'-)..&amp; .,&amp;&amp;</p><p>THIS IS HUGE</p><p>NHD_SimilacAlimentum_DPS.indd 2 24/10/2015 15:43</p></li><li><p>NHDmag.com February 2016 - Issue 1114</p><p>Chris Rudd, Dietetic Advisor</p><p>Neil donnelly, Fellow of the bDA</p><p>Ursula Arens, writer, Nutrition &amp; Dietetics</p><p>dr Carrie Ruxton, Freelance Dietitian</p><p>dr Emma derbyshire, Nutritionist, Health writer</p><p>Emma Coates, senior Paediatric Dietitian</p><p>kaylee Allan, specialist Dietitian, North bristol NHs trust</p><p>kirstine farrer, Consultant Dietitian, salford Royal NHs</p><p>dr Isabel skypala, Consultant Allergy Dietitian</p><p>kit kaalund Hansen, Adult Ketogenic Diet therapy Dietitian</p><p>Anne Holdoway, Registered Dietitian, Chair of PENG</p><p>belinda mortell, Registered Dietitian, Glan Clwyd Hospital</p><p>6 News latest industry and product updates10 Introducing Emma Coates Welcome to NHDs new Editor16 Pregnancy &amp; nutrition The role of dHA during pregnancy23 Infant milk intolerance An overview of paediatric milk allergy28 Folic acid fortification Reviewing the evidence30 Critical Care Obesity and nutrition on the ICU35 Malnutrition &amp; the elderly The pioneering PaperWeight Armband</p><p>39 Adult food allergies Causes and symptoms42 IMD watch Epilepsy and ketogenic diet Therapy44 On behalf of PENG In support of the dietetic profession48 dieteticJOBS latest career opportunities</p><p> Events &amp; courses Upcoming dates for your diary</p><p>49 A day in the life of . . . A new bdA Council member</p><p>51 The final helping The last word from Neil donnelly</p><p>12coVER SToRyis sugar public enemy no 1?</p><p>Editorial Panel</p><p>Contents</p><p>Editor Chris Rudd RDPublishing Director Julieanne Murray Publishing Editor Lisa JacksonPublishing Assistant Katie Dawson Design Heather DewhurstAdvertisement Sales Richard Mair Tel 01342 824073 richard@networkhealthgroup.co.uk</p><p>Address suite 1 Freshfield Hall, the square, Lewes Road, Forest Row,East sussex RH18 5EsPhone 0845 450 2125 (local call rate) Fax 0844 774 7514Email info@networkhealthgroup.co.uk www.nHDmag.com www.dieteticJobS.co.uk</p><p>All rights reserved. Errors and omissions are not the responsibility of the publishers or the editorial staff. Opinions expressed are not necessarily those of the publisher or the editorial staff. Unless specifically stated, goods and/or services are not formally endorsed by NH Publishing Ltd which does not guarantee or endorse or accept any liability for any goods, services and/or job roles featured in this publication. Contributions and letters are welcome. Please email only to info@networkhealthgroup.co.uk and include daytime contact phone number for verification purposes. Unless previously agreed all unsolicited contributions will not receive payment if published. All paid and unpaid submissions may be edited for space, taste and style reasons.</p><p>@nHDmagazine</p></li><li><p>NHDmag.com February 2016 - Issue 111 5</p><p>fROm THE EdITOR</p><p>Chris Rudd NHd Editor</p><p>The NHD Team would like to thank Chris Rudd for all her work, help and advice over the years. Her role as Editor, and Clinical Editor before that, has enabled NHD to forge forward, providing our readers with informative articles from experts in their field and giving the magazine a true dietetic focus. We wish Chris all the best in her retirement.</p><p>Welcome to issue 111 and i do hope that the new year has been a happy and healthy one so far.</p><p>Many of you may be busy planning for the Nutrition and Hydration week from 14-20 March and I do hope that some of you will be entering into the record breaking world cream tea party on Wednesday 16 March. 2016 for NHD also offers you exciting developments. In a new column from the Parenteral and Enteral Nutrition Group (PENG) of the British Dietetic Association (BDA), Chair, Anne Holdoway shares PENG: because support and influence matter, providing us with an overview of the plethora of projects that are being undertaken by the PENG Committee, Clinical Leads and members. One of PENGs resources is the Managing Adult Malnutrition in the Community guide and pathway and that links nicely with another article by Kirstine Farrer that informing us of a pioneering non-medical, non-intrusive tool that is helping health and social care professionals to identify people at risk of malnutrition and signpost them to information and advice. Find out all about it in Malnutrition in the elderly: identifying and signposting with the PaperWeight Armband. Issue 111 takes us through all the major life stages from pregnancy, infant feeding, adult allergies and into elderly nutrition. We cover obesity too, with Kaylee Allans article on Feeding critically ill obese patients which gives us a review of the available evidence and </p><p>summarises key points to consider when assessing the nutritional requirements in the critical ill obese. If you are interested in adult food allergy, Dr Isabel Skypala tells us more in Food Allergy in Adults, while keeping with the allergy theme, in our paediatric section we also revisit Infant milk intolerance and allergy: are you sure? by Emma Coates. Another new section starting in this issue is IMD Watch - in association with the NSPKU. We welcome Kit Kaalund Hansen, the first NHS funded Ketogenic Dietitian for adults with epilepsy in the UK and her article Epilepsy and Ketogenic Diet Therapy: Managing expectations in patients will tell you more. Finally, as I reflect back over the years, I joined NHD at Issue 41 and have seen the magazine grow and develop over those years. Now is the time for me to say Goodbye as I sign off from NHD. I would like to say an enormous thank you to all of you who have accepted my invitation to write for us - there have been seven years of excellent articles. My thanks also go to the NHD Team for their support. Emma Coates will take over from me from the next issue, so please look out for her invitations to you to write for NHD. I wish you all well and please enjoy our magazine and all the resources on offer for years to come. I feel that I know many of you, so do keep in touch and let me know of all the great work that you are doing.</p><p>Chris Rudds career in continuous dietetic service has spanned 35 years. She is now working part time with the Sheffield PCT Medicines Management Team, as a Dietetic Advisor.</p></li><li><p>dr Emma derbyshire Phd RNutr (Public Health)Nutritional Insight ltd</p><p>www.nutritional-insight.co.ukhello@nutritional-insight.co.uk</p><p>Dr Emma Derbyshire is a freelance nutritionist and former senior academic. Her interests include pregnancy and public health.</p><p>NHDmag.com February 2016 - Issue 1116</p><p>NEWs</p><p>In the US, new dietary guidelines are required under the 1990 National Nutrition Monitoring and Related Research Act, which specifies that every five years, the US Departments of Health and Human Services (HHS) and of Agriculture (USDA) must publish a joint report containing nutritional and dietary information and guidelines for the lay public. This report itself must be based on current scientific and medical evidence. Based on these requirements, the new 2015-2020 Dietary Guidelines for Americans were released this January. These have been developed for policymakers and health professionals and relate to how the general public, aged two years and older, can improve their overall eating patterns. The guidelines provide five main overarching points developed with the intention of helping to encourage individuals make shifts in their food and beverage patterns. These are to: 1) Follow a healthy eating pattern across the lifespan; 2) Focus on variety, nutrient density, and amount; 3) Limit calories from added sugars and saturated fats and reduce sodium intake; 4) Shift to healthier food and beverage choices, and 5) Support healthy eating patterns for all. Within these, it is also specified that a healthy eating pattern both includes and limits the inclusion of certain foods. These recommendations are shown below.</p><p>A HEAlTHy EATinG PATTERnincluDES limiTS</p><p>A variety of vegetables from all of the subgroups: dark green, red and orange, legumes (beans and peas), starchy, and other.fruits, especially whole fruits.Grains, at least half of which are wholegrains.fat-free or low-fat dairy, including milk, yoghurt, cheese, and/or fortified soy beverages.A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds and soy products.Oils.</p><p>saturated fats and trans fats, added sugars, and sodium.key recommendations that are quantitative are provided for several components of the diet that should be limited. These are to: consume less than 10% of calories per day from added sugars; consume less than 10% of calories per day from saturated fats; consume less than 2,300 milligrams (mg) per day of sodium; if alcohol is consumed, consume in moderation - up to one drink per day for women and up to two drinks per day for men and only by adults of legal drinking age.</p><p>FooD FoR THouGHT</p><p> Overall, most of these guidelines make good common sense. However, we can already see some discrepancies with new UK alcohol guidelines which further advise to spread alcohol intake over three days or more if as much as 14 units per week are being consumed. The new report also highlights the need for global consistency when it comes to referring to sugars. We see the term added sugars used here, whilst the latest UK Scientific Advisory Committee on Nutrition Carbohydrates and Health report replaces this with free sugars.</p><p>For more information US Department of Health and Human Services and US Department of Agriculture (2016). 2015-2020 Dietary </p><p>Guidelines for Americans. 8th Edition. Available at http://health.gov/dietaryguidelines/2015/guidelines/ Department of Health (2016). UK Chief Medical Officers Alcohol Guidelines Review Summary of the </p><p> SACN (2015). Carbohydrates and Health. TSO: London https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf </p><p>proposed new guidelines. Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf</p></li><li><p>NHDmag.com February 2016 - Issue 111 7</p><p>NEWs</p><p>FATTy AciD DiScREPAnciESA wealth of research has measured levels of fatty acids in relation to disease biomarkers. Now it has come to light that different approaches in doing this affects association patterns. Using data from two human cohorts, new work examined relationships between blood lipids (TAG, and LDL, HDL or total cholesterol) and circulating fatty acids expressed either as a percentage of total, or as concentration in serum. Overall, it was found that correlations between stearic acid, linoleic acid, dihomo--linolenic acid, arachidonic acid, docosahexaenoic acid and circulating TAG reversed when fatty acids were expressed as concentrations compared with a percentage of total. This reversal pattern was also seen in blood serum samples from both human cohorts. In summary, it seems that different methods of expressing fatty acids can lead to dissimilar correlations between blood lipids and certain fatty acids. Worryingly, this study raises important questions about how reversals in association patterns could affect the interpretation of findings from such studies. For more information, see: Sergeant S et al (2016). Br J Nutr Vol </p><p>115, No 2, pg 251-61.</p><p>There was much in the public domain last year about sugar, with interest about how to put sugar reduction guidelines into practice. Now, new work has looked into whether we can get used to having less sugar in our diets, in a similar way to how we become used to using less salt. A sample of healthy adults (n=29) aged 21-54 years were studied for one month and matched across groups for their baseline sugar intake and weight. They were then randomly allocated to: 1) eat a low sugar diet for three months (40% of calories from simple sugars were replaced with fat, protein or complex carbohydrate), or 2) no </p><p>change in sugar intake. For the last month of the study they ate as they wished. Overall, results showed that reducing dietary intakes of simple sugars altered perceived sweet taste intensity. Interestingly, even when sugar intakes were reduced, perceived pleasantness was unaffected. Sweetness variations in beverages, however, were not as well identified. These results indicate that sugar reduction does appear to influence perceived sweet taste intensity. More work is needed to determine how this may affect long-term consumption habits. For more information, see: Wise PM et al (2016). Am J Clin </p><p>Nutr Vol 103, No1, pg 50-60.</p><p>lATEST on PREGnAncy WEiGHT GAinExcess pregnancy weight gain is a growing problem. In turn, this has been linked to more challenging deliv-eries, with more C-sections being required due to the larger birth size of infants. Now, a new systematic review </p><p>has looked into the role that macronutrients play in this. After searching eight different scientific databases, 56 articles (46 observational studies and 10 trials) were found, although only 11 (20%) were regarded to be high quality. Twelve studies suggested that higher energy intakes could be associated with higher levels of pregnancy weight gain. Some trends were seen for fat, although more work is needed to look into the specific roles of individual types of fat and no trends were found for carbohydrate or protein. Overall, these findings indicate that energy intakes appear to be associated with levels of pregnancy weight gain, although better quality trials now need to feed into future pooled analyses. For more information, see: Tielemans MJ et al (2016). Am J Clin </p><p>Nutr Vol 103, No 1, pg 83-99.</p><p>SuGAR REDucTion - A PlEASAnT SuRPRiSE</p></li><li><p>NHDmag.com February 2016 - Issue 1118</p><p>NEWs PROdUCT / INdUsTRY NEWs</p><p>GSE FoR HiGH blooD PRESSuRE?Grape seed extract (GSE) is a rich source of proanthocyanidins (a class of polyphenols with antioxidant properties), but until recently, their potential health benefits has not necessarily be...</p></li></ul>