FROM THE EDITOR
WELCOME Emma Coates Editor
This bumper August/September issue of NHD includes our own carnival of dietetic and nutritional wonders. They flow between these pages like the parade at London’s Notting Hill. After each article you’ll be wondering what’s coming next! Leading us in this month is Rebecca Gasche as she takes us through an overview of Malabsorption after surgery, looking at the types of surgery that can cause malabsorption and the current thinking behind managing the complication. Following on closely behind is an article from Jacqui Lowdon updating us on events at the European Cystic Fibrosis Conference held in Belgrade in June. The latest CF research and hot topics discussed at the conference make interesting reading. Our paediatric articles come from Mary Feeney, who discusses the BSACI/ BDA FASG guidance for UK healthcare professionals on preventing food allergy in higher risk infants. Martha Hughes takes a look at preterm infant feeding highlighting the important role that specialist dietitians play in providing the nutritional support and intervention required for these infants. We welcome back Jenni Simmons too, Paediatric Speech and Language Therapist, with an article focusing on the management of paediatric dysphagia in the community.
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.
Emma has been a registered dietitian for 12 years, with experience of adult and paediatric dietetics.
It’s that time of year when the sun is shining, the sandals are on and there’s so much to do. It’s another summer of music festivals and seasonal events for making happy memories and for releasing some of those feel-good endorphins. Maeve Hanan asks the question, Sweeteners: friend or foe? looking at the current evidence and clearing up some of the confusion around these much used sugar replacers. Looking further into the psychology of eating, Nikki Brierley sheds some light on the potentially hidden epidemic of eating disorders in the elderly population. Another question from one of our contributors places the spotlight on Huel, a controversial meal replacement product with big ambitions. Alice Fletcher investigates whether Huel is the future of food for human health and sustainability of the planet. Our second winner of the NHD British Lion eggs writing competition is Freelance Dietitian Cordelia Woodward. In a thoroughly researched article, Cordelia reports on the safety and benefits of eating eggs during pregnancy. A worthy winner! And don’t forget, we have our regular feature Dietitian’s Life plus Ursula’s F2F this month with Prescribing Support Dietitian, Alison Smith. Do you think these stripy socks go with these gladiator sandals? Or should I be daring and give my toes a proper airing under my festival kaftan? Enjoy the read! Emma
www.NHDmag.com August/September 2018 - Issue 137
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NEWS
Emma Coates Editor Emma has been a registered dietitian for 12 years, with experience of adult and paediatric dietetics.
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ENERGY DRINKS AND KIDS: HOW HARMFUL ARE THEY? The first energy drink appeared on our shelves in 1994, with Red Bull being the forerunner for a new market of caffeinated soft drinks, designed to keep you going. The drinks have been a source of debate regarding how safe/ harmful they are and on the regulation around their sale and advertising, particularly to children and young people. An energy drink is defined as a soft drink containing more than 150mg of caffeine per litre, often containing other stimulants such as guanine, taurine or ginseng. The high glucose content of energy drinks is also a concern and may be contributing to the obesity crisis. Brands such as Monster, Rockstar and Red Bull contain around 300mg caffeine per litre, less than filter coffee at 400mg per litre, but UK kids love them. According to consumer usage data from Mintel, around 63% of boys and 58% of girls between 16-24 years of age regularly consume energy drinks. The European Food Safety Authority (EFSA) research suggests our younger kids are also regular consumers too, with two-thirds of 10- to16-year-olds, along with 18% of three- to 10-years-olds consuming these high caffeine beverages. There are concerns from EFSA that just one can of energy drink can exceed the recommended caffeine limit for children, which is ≤2.5mg/kg per day in children and adolescents. For healthy adults, the recommended limit is ≤400mg/ day, but ≤200mg/day in healthy pregnant women, as recommended by the NHS. Health risks for children include abdominal discomfort, headaches, irritability, insomnia or sleep disturbances and raised blood pressure. There are also concerns regarding adolescent bone health, where energy drinks are consumed in place of calcium containing drinks, thus reducing calcium intake during a period in the lifespan where bone deposition is at its peak. According to EU labelling guidelines (Regulation (EU) No 1169/2011), soft drinks with more than 150mg of caffeine per litre must carry a warning about the high caffeine content and state that they are not recommended for children. However, this isn’t a particularly effective deterrent, with the UK having the highest energy drink consumption by children across Europe. Earlier this year, UK supermarkets banned the sale of energy drinks to children under the age of 16, however, smaller shops, convenience stores and vending machines haven’t necessarily followed suit. The marketing of energy drinks to children and young people has also been scrutinised, but regulating it has been a challenge. Energy drinks manufacturers use many platforms for sharing messages about their products. Social media, sporting events and online gaming are key routes of advertising, which are accessible to children and young people with or without parental controls. While energy drinks are perceived to be trendy and their accessibility and marketing continue to be relatively unregulated, kids will continue to consume them. Legislation to regulate energy drinks and their consumption by children is required to make significant changes to the current situation. For information on further reading please visit the Subscriber zone at NHDmag.com
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NEWS TYPE 2 DIABETES AND FOOD CRAVINGS A recent study from Australia1 has investigated the effects of higher protein intakes compared with higher carbohydrate intake on food cravings in people with Type 2 diabetes. This study aimed to compare whether a high protein (HP) diet would provide greater reductions in cravings than an isocaloric higher-carbohydrate diet (HC). In the randomised controlled trial, a total of 61 adults with Type 2 diabetes consumed either a HP diet (consisting of approximately 29% protein, 34% carbohydrate, 31% fat) or an HC diet of 21%:48%:24% respectively. The study took place over 24 weeks, with participants engaging in 12 weeks of weight loss (WL) and weight maintenance (WM). The average age of the participants was 55 years +/8 years with a BMI of 34.3 +/1 5.1kg/m2. A Food Craving Inventory (FCI), which measured the types of food craved as well as questionnaires to measure the food craving states and traits were used at 0, 12 and 24 weeks of the study. Weight changes were similar between both the HP and HC groups. During the weight loss phase average loss was equal to -7.8 ± 0.6kg and during the weight management phase, the average weight fluctuation was -0.6 ± 0.4kg. All food cravings (except carbohydrates) decreased over the 24 weeks study and sweets and fast food craving, loss of control and emotional cravings reduced, particularly if the subject lost weight
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Visit our new area specifically designed for healthcare professionals who manage patients with neurological disorders. FREE access to: • CPD E-learning modules • Downloadable resources • Case studies and clinical summaries • Multidisciplinary tools to aid patient management Visit www.nestlehealthscience.co.uk/hcpeducation-hub to find out more today! during the study. Obsessive preoccupation with food decreased in both the weight loss and weight maintenance phases. The study’s investigators have concluded that both the HP and HC diets provided significant reductions in food cravings after similar weight losses which were maintained when weight was stabilised.
Reference 1 Nerylee A et al (2018). Reductions in food cravings are similar with low-fat weight loss diets differing in protein and carbohydrate in overweight and obese adults with Type 2 diabetes: A randomised clinical trial. Nutrition Research. Volume 57, September 2018, Pages 56-66. www.sciencedirect. com/science/article/pii/S0271531717310837
dieteticJOBS.co.uk SPECIALISED DIETITIAN – STATES OF GUERNSEY Guernsey is a picturesque island situated in the English Channel with a population of just over 60,000. Famed internationally for its great beaches, views and food, it offers a fantastic work-life balance as well as a range of other perks. We are looking to appoint a Specialised Dietitian to offer support and training to community colleagues at all levels (GP, Community Nurses, Community care staff, Care homes and nursing homes,
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GP support staff) in nutrition screening, nutrition support within our “food first” approach and enteral feeding and will encourage appropriate nutrition prescribing. We offer a full relocation package which includes interview and relocation travel, this is in addition to our competitive pay and annual bonus. Furthermore we offer subsidised accommodation for those travelling to the Island alone, and an 8-year employment permit for those wishing to bring a partner or family. Terms and conditions apply to all bonuses, relocation package, accommodation, travel and employment permits. Contact: Myfanwy Datta, Clinical Lead Dietitian on tel. 01481 707342 or email: myfanwy.datta@gov.gg. Closing Date: 14th August 2018. For more information visit: www.gov.gg/dietitianjob