NHD Magazine - May 2016

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Network Health Digest The Magazine for Dietitians, Nutritionists and Healthcare professionals


  • May 2016: Issue 114



    Faltering growthgalactosaemiahome enteral FeeDingteenage eating DisorDers

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    The Magazine for Dietitians, Nutritionists and Healthcare Professionals NHDmag.com

    Coeliac AwarenessWeek 2016

    9th-15th May

  • wiltshirefarmfoods.com0800 066 3169To order a FREE brochureor to arrange a tasting call

    The new Free From range does away with major food allergens, not flavour. Carefully prepared for patients with single to multiple allergies, these tasty meals are free from 12 of the key allergens as listed in the Food Information for Consumers Regulations. Providing more choice and less worry in one simple solution.

    Arrange a free tasting today and discover how our Free From range can help your patients.

    Free from gluten, milk, egg, nuts, peanuts, fish, crustaceans, lupin, molluscs, sesame, sulphites and celery.

    Not free from flavour.

    Free Fromby

    346 - Sweet & Sour Chicken



  • www.NHDmag.com May 2016 - Issue 114 3

    Checking my Twitter feed during these announcements made for some exciting and informative reading. Dr Emma Derbyshire RD discusses the Eatwell Guide in her Food For Thought column this month. Dr Mabel Blades RD addresses the additive combination of salt and sugar found in modern diets, and their contribution to our affinity with salty, sweet, fatty foods. Further to reporting on hot topics in this NHD digital issue, we are covering the lifespan this month - and a few bits in between. Jacqui Lowdon RD, Specialist Paediatric Dietitian, sets the ball rolling with a valuable overview of faltering growth assessment and management. Freelance Dietitian and Eating Disorders Specialist, Priya Tew RD, then takes up the baton with her insightful teenage eating disorders feature. Priya shares her experiences and skills in working with this challenging patient group and condition. Moving on to older patient groups, in our Cover Story, Maeve Hanan RD, Sunderland based Dietitian, looks at the sunshine vitamin D and its role in the health of people over the age of 65, while Anne Wright RD takes a closer look at hydration in residential aged care facilities. She defines the consequences of dehydration in the

    elderly and discusses strategies to tackle the problem. We are delighted to publish an article on Galactosaemia from metabolic dietitians, Suzanne Ford RD, Pat Portnoi RD and Professor Anita MacDonald. The article discusses suitable cheeses for people on a low lactose diet and presents the evidence for their safe use. We have two excellent nutrition support articles too in this issue, the first being from Royal Brompton Hospital Dietitians, Marcela Fiuza Brito RD and Ione de Brito-Ashurst RD. Marcela and Ione take us through the use of parenteral nutrition (PN) in a surgical cardiothoracic patient, highlighting the current recommendations for PN use. In the second of the nutritional support articles, Siobhan Oldham RD discusses the demands on home enteral feeding services and her experiences in developing a future proof service at her trust in Gloucestershire. Finally, 9th to 15th May is Coeliac Awareness Week and we have included an article from Anne Roland Lee RD, Dr Schar USA, which evaluates the current nutritional status of the gluten-free diet and looks at the future developments for this essential diet. Happy reading! Emma


    Theres never a dull moment in Dietetics and the last few weeks have proven no exception. Weve had the updated Eatwell Guide and that long awaited announcement of the sugar tax. Both of which have sparked much debate and thought, which we Dietitians just love.

    From the eDitor

    emma coateseditor

    emma has been a registered dietitian for nine years, with experience of adult and paediatric dietetics. She specialised in clinical paediatrics for six years, working in the NHS. She has recently moved into industry and currently works as metabolic Dietitian for Dr Schar UK.

    wiltshirefarmfoods.com0800 066 3169To order a FREE brochureor to arrange a tasting call

    The new Free From range does away with major food allergens, not flavour. Carefully prepared for patients with single to multiple allergies, these tasty meals are free from 12 of the key allergens as listed in the Food Information for Consumers Regulations. Providing more choice and less worry in one simple solution.

    Arrange a free tasting today and discover how our Free From range can help your patients.

    Free from gluten, milk, egg, nuts, peanuts, fish, crustaceans, lupin, molluscs, sesame, sulphites and celery.

    Not free from flavour.

    Free Fromby

    346 - Sweet & Sour Chicken



    NH-eNEWS plus NHD eArticle with CPD - click here . . .. . . the UKs only weekly enewsletter for

    dietitians and nutritionists.

  • www.NHDmag.com May 2016 - Issue 11444

    13 COVER STORYThe role of vitamin D in older adults



    Advertising Richard Mair Tel 01342 824073


    Phone 0845 450 2125 (local call rate) Fax 0844 774 7514email info@networkhealthgroup.co.uk www.nhDmag.com www.dieteticJoBs.co.ukaddress Suite 1 Freshfield Hall, The Square, Lewes Road, Forest Row,East Sussex RH18 5ES

    editor Emma Coates RDPublishing Director Julieanne MurrayPublishing editor Lisa JacksonPublishing assistant Katie Dennisspecial Features Ursula Arensnews Dr Emma DerbyshireDesign Heather Dewhurst ISSN 1756-9567 (Print)

    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.

    6 News latest industry and product updates

    9 Sugar and salt an addictive combination?

    20DYING FOR A DRINk Dehydration in care homes

    25 Home enteral feeding Developing a service in gloucestershire

    29 Parenteral nutrition its role in cardiothoracic surgery

    33 FALTERING GROWTH Diagnosis & management

    40 Eating disorders working with adolescents

    44 Coeliac disease the nutritional breakdown of a gFD

    52 Book review Death By Carbs by Paige nick

    54 A day in the life of . . . a coeliac UK helpline Dietitian

    56 Web watch online resources and updates

    57 Dates for your diary Upcoming events and courses

    58 The final helping the last word from neil Donnelly

    47GALACTOSAEMIA Suitable cheeses

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  • www.NHDmag.com May 2016 - Issue 1146

    Well, clearly, the name has changed from plate to guide. The image (Figure 1), no longer a plate with a knife and fork, reflects its new purpose as a guide to a whole dietary pattern rather than every mealtime. The segment sizes have also been adjusted using linear programming methods which account for current dietary habits in the UK population. Some foods have not made it into the main image and have

    been shifted to the outside. For example, high fat, salt and sugar foods are in the corner, reflecting advice that they are not an essential part of a healthy and balanced diet. Oils and spreads (the purple segment) are also out of the main image, indicating that they should be consumed in small amounts due to their high calorie and fat content. There is also a strong sustainability message, particularly for fish. This is a good step forward, although the message to eat less red and processed meat

    is a confused one given that certain UK populations are at risk of iron deficiency. Segment sizes for potatoes, bread, rice, pasta and other starchy carbohydrates are now considerably larger to align with higher fibre guidelines and new advice is to eat at least five portions of a variety of fruit and vegetables per day. Its also good news to see that some hydration guidance has been added. Water, lower fat milk and sugar-free drinks, including tea and coffee, have been recommended (six to eight glasses per day), but fruit juices and smoothies should be limited to no more than a combined total of 150ml per day. Sugary drinks should be swopped for diet, sugar-free or no added sugar varieties. An updated model was certainly needed and this is now clearer in some ways. My main concern, however, is that its a slight step back. Yes, its a generic model that can be used by all, but a level of specificity is also needed. For example, advising everyone to reduce their meat intake doesnt help those who may be anaemic. For more information, see: Public Health England (2016). The Eatwell Guide. Available at: www.gov.uk/government/publications/the-eatwell-guide (released 17th March 2016).

    FOOD FOR THOUGHTThe new Eatwell Guide has been a hot discussion topic recently and now we have it finalised to work with, but how different is it to the old Eatwell Plate?

    Dr emma Derbyshire PhD rnutr (Public health)nutritional insight ltd

    emma is a freelance nutritionist and former senior academic. Her interests include pregnancy and public health.



    If you have important news or research updates to share with NHD, or would like to send a letter to the Editor, please email us at info@networkhealthgroup.co.uk We would love to hear from you.

    Figure 1: the new eatwell guide

  • www.NHDmag.com May 2016 - Issue 114 7


    WATER AND ENERGY INTAkEWater is calorie and sugar-free, but could drinking it help to regulate energy intake? New work, using data from the US National Health and Nutrition Examination Survey has now looked into this. Authors analysed data from 24-hour dietary recalls completed by 18,311 adults. Results showed that drinking more water, even just a one percentage point increase in the daily proportion of plain water consumed, had dietary benefits. Daily energy at this level of intake was found to reduce by 8.58kcal, total fat intake reduced by 0.21g, sugar intake by 0.74g, sodium intake by 9.80mg and cholesterol intake by 0.88g. Effects were also found to be greater amongst males and young/middle-aged adults. These are interesting findings, indicating that promoting the consumption of plain water could have a role to play in obesity prevention. Next, randomised controlled trials are needed to study this further. Formoreinformation,see:AnRandMcCaffreyJ(2016).


    ENERGY MISREPORTING IN EUROPEAN TEENSIn order to truly understand diet-disease associations, factors influencing misreporting of dietary energy need to be identified. While some work has looked into this in adults, less is known about teenagers. The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study has now looked into this. Data from two 24-hour dietary recalls was collected from 1,512 European teens aged 12-17 years. Reported energy intakes were compared with predicted total energy expenditure to identify under- or over-reporting. Results showed that overweight or obese teens were more likely to under-report, while underweight teens tended to over-report (as generally the case with adults). Being body content tended to reduce the likelihood of under-reporting while breakfast-skipping increased this. These are interesting findings that require consideration in future work looking into the dietary habits of teens and young people. For more information, see: Bel-Serrat S et al (2016). British JournalofNutrition[Epubaheadofprint].

    While the health bene-fits of breast-feeding for baby and mum are clear, the role of pumping milk seems

    to be over-looked. This is a viable option in giving human milk in a way that some mums may find easier. A new study has looked into how the decision to pump milk may affect the duration of human milk feeding. The study looked at 1,116 mothers who fed and pumped human milk for any time between 1.5 and 4.5 months after birth. Non-elective pumping was defined as mums who had difficulties feeding at the breast. Elective

    pumping was defined as when human milk was typically pumped to mix with solids. Overall, it was found that mums who had difficulties feeding their baby at the breast were more likely to discontinue non-elective pumping. Equally, mums who were pumping human milk most frequently also had a 2.6-fold risk of stopping.. These are important findings and certainly worthy of further study. From these initial findings it seems that more guidance and support is needed in this area. Most advice is given immediately after birth when support is also needed down the line. From personal experience, advice about pumping milk was at best scant and overshadowed by advice to breastfeed. Formoreinformation,see:FeliceJPetal(2016).TheAmerican



  • www.NHDmag.com May 2016 - Issue 1148



    There has been much interest in body weight recently, particularly in relation to cancer risk. Now, a new meta-analysis paper has looked into how pulses could play a role in the regulation of body weight and composition.

    Findings were pooled from 21 trials, a total of 940 participants. Analysis showed

    From 9th to 15th May, Coeliac UK will be highlighting the most commonly reported symptoms of coeliac disease with a range of initiatives. Whether you have five minutes to give or 50, theres a way for everyone to join in. You can support Awareness Week online with a number of initiatives including the social media takeover Thunderclap campaign! After you pledge your support on Coeliac UKs Thunderclap page on their website, a status featuring the key message, Is it coeliac disease? will be sent out from

    your Twitter, Facebook and Tumblr account etc, during Awareness Week, as well as that of all our other supporters. Alternatively, why not take a symptoms selfie to spread information about coeliac disease? Special selfie frames are available and the b...