14 minute read
The final helping
Neil Donnelly Neil is a Fellow of the BDA and retired Dietetic Services Manager. His main areas of interest are weight management and eating disorders.
Over the summer we saw the best athletes in the world competing at the Olympic Games in Brazil. Sport has been watched by millions of people globally and countries have embraced the success of individual athletes.
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Will this encourage more of us to get out of our chairs and find out how we can take part in a huge variety of activities available on our doorstep?
The National Lottery has provided much needed financial support for many of our Olympic and Paralympic athletes to enable them to have the best training facilities and professional advice available. What an opportunity for young people! For me, this is where such a difference could be made to the childhood obesity crisis. The benefits of increased activity are well known and parents and professionals have their part to play.
Some years ago, I was given the best visual aid I have ever received. It was a five pound block of bright yellow fat. In fact, it wasn’t a block, it was a lump which replicated the colour and feel of that found under the skin of an obese individual. Many of you will have seen this. I also have a one pound lump. The impact of this was enough to make people think just what they were carrying around with them and the problems they were storing up for the future.
To this, I would now like to add a most informative and ground-breaking TV documentary on obesity which was shown recently on BBC Three. Entitled OBESITY: The Post-Mortem, the centrepiece of the programme is a woman, aged 60, who died of heart failure. The 12-hour dissection, condensed to an hour, was undertaken at the Royal College of Surgeons in London and explores how obesity damages the organs, the diseases it causes and why obesity is placing so much stress on our healthcare system. I would recommend that every hospital Trust has it running on a loop at every outpatient obesity clinic. I would also recommend that every secondary school shows it as part of its health promotion programme. It is a challenging documentary to watch, but then obesity is challenging!
Dietitians are recognised first and foremost by the public as experts in weight management. The BDA are currently running an online conversation about the future of our profession. If we are to show that we really can be effective, we need to make a more productive, more innovative input to the problem that is reducing our NHS to mainly tackling obesity-related issues.
It is never too late for people to take charge of their health and lessen the impact on their bodies. The next generation expects. Watch The Post-Mortem and see how you feel!
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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. www.nutritionalinsight.co.uk hello@nutritionalinsight.co.uk
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@network healthgroup.co.uk We would love to hear from you.
LATEST ON DIETARY FIBRE
There is an abundance of evidence published about links between dietary fibre and health. Whilst fibre was first identified and some mechanisms proposed by the eminent scientists Burkitt and Trowell, a new review takes most recent evidence on board.
The review published in the British Journal of Nutrition explains that dietary fibre not only speeds up transit time, but also has other important roles such as increasing the viscosity of the digesta and altering flow and mixing behaviours. It also goes on to explain that a better understanding is needed on how the ‘different’ fibre forms affect rates and extents of starch and lipid digestion.
Given that the Scientific Advisory Committee on Nutrition last year concluded that we should officially use the AOAC definition of fibre. More research is needed analysing fibre intakes and underpinning mechanisms aligned with this definition. This includes the UK National Diet and Nutrition Survey which has previously focused on non-starch polysaccharides.
For more information, see: Grundy MM et al (2016). British Journal of Nutrition [Epub ahead of print].
BENEFITS IN PACING PROTEIN INTAKE
Previous research has suggested that even protein intakes across meals can help to improve muscle synthesis in young adults compared with ad hoc intakes. Now new work has looked at whether this can lead to long-term muscle preservation in older adults.
Data was analysed from the NuAge study (Quebec Longitudinal Study on Nutrition as a Determinant of Successful Aging). This included baseline and two-year follow-up 24-hour food recall and DEXA data from 351 men and 361 women aged 67 to 84 years.
Findings showed that men and women with evenly distributed protein intakes and men with higher protein intakes had significantly higher lean muscle mass at follow-up, even when confounders were considered.
These findings imply that higher protein intakes and an even distribution across meals helps to preserve lean mass is ageing adults. Continued research with longer periods of follow-up are now needed.
For more information, see: Farsijani S et al (2016). American Journal of Clinical Nutrition [Epub ahead of print].
DON’T ‘PET’ CHILDREN TO AVOID OBESITY
An excellent new review has now likened obesity in children to obesity in pets. The paper - very much on topic - discusses the concept of ‘pet-parenting’. This is when obesity (in children and pets) is due to excessive treats and meal amounts - a form of doting love and affection. Those giving the treats/food then often get caught up in a cycle of giving these treats/foods in order to avoid the ire of the child or pet. Sound familiar? Begging, pestering, whimpering, whining - hate to say it, but it does to me!
What to do? Well the scientists advise a series of withdrawal techniques where the problem foods (be it gravy bones or human biscuits) are gradually withdrawn, or portion sizes are reduced, eventually leading to their elimination. I tried to avoid introducing them in the first place; what they haven’t had they don’t know about. The main problem then comes when they are given treats by grandparents/wider family which leads to pestering down the line. So perhaps this theory needs to be extended to wider circles as well as to the parents!
Gemma Sampson Registered Dietitian, Senior R&D Dietitian, Vitaflo International
Gemma has experience as a registered dietitian in a variety of clinical and industry settings, with personal interests in sports nutrition, gluten-related disorders and plant-based lifestyles. She runs the nutrition blog Dietitian without Borders (www.dietitian withoutborders. com/)
For full article references please email info@ networkhealth group.co.uk
ORGANIC FOOD: IS IT REALLY BETTER FOR US?
‘Organic’ is no longer just associated with fresh fruits and vegetables; these days you can find organic pasta, organic sauces, organic biscuits, cakes and energy bars on our supermarket shelves. You name it, there’s an organic version somewhere trying to convince consumers that it’s healthier choice. a
For food producers, being able to market their produce as organic taps into a big market. In Europe alone, it is estimated that organic sales will continue to grow by 20% each year.2 While the definition of what is organic can vary, it generally encompasses chemical-free farming practices, but can also be extended to cover other positive food terms including ‘cage free’ or ‘natural’, which can add to the organic confusion.2 Marketing a product as organic attracts consumers and can even convince them to pay a premium price tag because higher prices tend to be associated with better quality. When a product is labelled organic, even if that food is heavily processed - as consumers associate ‘organic’ with a healthy diet of food containing superior nutritional qualities. But this may not always be backed up by science.1,3
WHY PEOPLE BUY ORGANIC FOOD The main priorities that have been identified as influencing people’s choice of organic, are health implications, improved product quality and concerns about the environment.3 Characteristics of people who regularly purchase organic products include values of altruism (relationship with others), sustainable environments, protection of the welfare of people and nature, spirituality and self-direction.1,2 As a result, organic food consumption is often linked to so-called alternative lifestyles including vegetarianism, active environmentalism and alternative medicine.2 However, organic fruit and vegetable purchases do not seem to be habitual for most consumers; one study discovered that 84% of organic sales came from 23% of customers.3 Beyond health implications, one of the most important criteria for consumers who purchase organic food, is because it reportedly tastes better.2 Although blind taste test trials have had mixed results comparing organic to non-organic fruits and vegetables.
A gap has been found between perceptions that organic produce is superior and actual purchases, which may be reflected by limited availability and the higher price tag associated with organic. People are more likely to purchase organic foods if they come from a higher socio-economic background and are more affluent.1
HEALTH IMPLICATIONS OF ORGANIC FOOD Improved health for individuals, as well as their families, as a direct result of eating organic food, is the main reason people choose to buy organic foods.1,2 Many consumers are convinced that organic food is always healthier and more nutritious, despite little conclusive scientific evidence to back up the claims. The Food Standards Agency in the UK concluded that there was ‘no evidence of a health benefit from consuming
organic compared to conventionally produced foodstuffs’.4
Organic foods are typically marketed as more nutritious, containing greater amounts of vitamins, minerals and antioxidants. This has been extensively studied in the literature, yet there is little evidence to justify these claims. Nutritional differences are typically subtle and may have negligible impact on actual dietary intake.
Earlier this year a study was released stating that organic milk and meat products contained 50% more omega-3 than conventional produce.5 However, this was primarily found within the fat content of the milk, which typically would not provide large amounts to the diet. Incorporating other dietary sources of omega-3 would provide a better impact on omega-3 status for an individual. Interestingly, organically produced milk was found to be lower in iodine than traditionally farmed milk - something worth considering in a society that has increasing levels of iodine deficiency.6 In the case of milk and meat products, the nutritional differences observed between organic and non-organic produce relates to the animal feed and not necessarily the farming practice.
In 2012 a systematic review evaluating the results of 17 human studies and 223 nutrient studies concluded that there “lacked strong evidence that organic foods are significantly more nutritious than conventional foods’.7
ENVIRONMENTAL CONSIDERATIONS OF ORGANIC FOOD Many consumers choose organic products as they believe they will be free from pesticides and chemicals. However, an organic label doesn’t guarantee that no pesticides were used during the farming process.
Baranski et al found that organic produce had a 30% lower risk of pesticide contamination compared to conventional fruits and vegetables, but were not necessarily 100% pesticide-free.8 So, while the research supports any claims that organic produce is lower in pesticides, organic fruits and vegetables aren’t necessarily pesticidefree. Some consumers choose organic because they associate it with better animal welfare.2
CONCLUSION While there are some subtle differences observed between organic and non-organic produce in terms of superior nutritional content and reduced pesticide levels, the evidence is not strong enough to make recommendations that all individuals start purchasing organic produce. Food marketing can often play upon the perceptions that organic is a healthier option. Although in the case of processed foods this may not be true. The hefty price tag that typically accompanies organic produce may be a barrier and it would be more practical to look at improving the overall fruit and vegetable intake of the population by any method before singling out organic over traditionally farmed produce.
Comment from the editor
The organic label does have some credibility and shows that a food has been produced or farmed in a certain way. ‘Organic’ is regulated by the UK Government and the EU. Without official certification, farmers or producers can’t claim that a product is organic. The conversion of conventional farming to organic farming is supported in the UK and farmers and producers can apply for support grants and funding to achieve this. Once the conversion has been made official certification must be obtained for the term ‘organic’ to be used. Information about this can be found at www.gov.uk/guidance/organic-farming-how-to-get-certification-and-apply-for-funding Whilst organic food has an image of being healthier than non-organic food, or even possessing ‘super food’ properties, and because it is marketed as fully natural, pesticide free, ‘as nature intended’ etc, this is not necessarily the case. Organic farming or food production simply means this: • avoiding artificial fertilisers and pesticides; • using crop rotation and other forms of husbandry to maintain soil fertility; • controlling weeds, pesticides and diseases using husbandry techniques and where necessary approved materials to control pests and diseases; • using a limited number of approved products and substances where necessary in the processing of organic food. We plan to look into the nutritional implications of organic food in more detail in a future issue of NHD.
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NICE ADVICE [MIB74] STRETTA SYSTEM FOR GASTRO-OESOPHAGEAL REFLUX DISEASE
Published July 2016 Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet). It usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. It may just be an occasional nuisance for some people, but for others it can be a severe, lifelong problem. Read more on GORD here: www.nhs.uk/Conditions/ Gastroesophageal-reflux-disease/ Pages/Introduction.aspx; The Stretta System treats GORD symptoms which cannot be controlled using proton pump inhibitor (PPI) medication therapy, alongside surgery, or before surgery. The Stretta System is a radiofrequency (RF) energy device. During the procedure, known as Stretta Therapy, RF energy is delivered to treatment sites above and below the gastro-oesophageal junction. The manufacturer states that Stretta Therapy is non-ablative because it does not remove or destroy tissue, but regenerates the target tissue by creating hypertrophy that thickens the musculature to improve GORD symptoms. NICE has developed a medtech innovation briefing (MIB) on the Stretta System for gastrooesophageal reflux disease. Read more here: www.nice.org.uk/ advice/mib74standard 111).
NICE QUALITY STANDARD [QS128] EARLY YEARS: PROMOTING HEALTH AND WELLBEING IN UNDER 5s
Published August 2016 Covering services including: home visiting, childcare, early intervention services in children’s social care and early education. The standard includes vulnerable children who may need additional support. It does not cover clinical treatment, or the role of child protection services. www.nice.org. uk/guidance/qs128
NATIONAL DIET AND NUTRITION SURVEY REVEALS THAT CHILDREN ARE STILL CONSUMING TOO MUCH SUGAR
On 9th September 2016 the latest National Diet and Nutrition Survey (NDNS) was published by PHE. The results highlighted that poor eating habits are still a problem for children of all ages, with particularly worrying levels of sugar intake continuing to be the norm for teenagers. Despite much hard work from Government initiatives, such as Change for Life and, of course, from dietitians and nutritionists, the results were still poor. Teamed with the Government’s recent ‘weak’ ‘Childhood obesity – a plan for action’, the results from this survey seem to present a bleak picture for the health of our nation. However, PHE remain upbeat and positive in leading on the Government’s programme to reduce sugar available at retailers and to challenge food and drink manufacturers. PHE also call for increased awareness and implementation of the ‘Eatwell Guide’ in order to address excessive intake of calories and to increase fruit and vegetable consumption, as well as oily fish. www.gov.uk/government/ news/young-children-still-exceeding-sugar-recommendation
£816 MILLION INVESTMENT IN NHS RESEARCH
Twenty NHS and university partnerships across England have been funded to complete all kinds of health research via the National Institute for Health Research (NIHR). Research into cardiovascular disease, mental health, including dementia, diabetes, obesity and nutrition, are all being covered by part of the £816 million investment into NHS research. Previous rounds of funding have led to several medical breakthroughs, including clinical trials of new T-cell treatment for cancer, MRI brain scans to detect early Parkinson’s, detection of the early signs of Alzheimer’s disease and new immunotherapy trial to test cancer vaccine. Visit www.gov.uk/government/news/new816-million-investment-in-health-research for a full breakdown of where the funding is going and who is researching what!
