FROM THE EDITOR
WELCOME We live in a technology-laced environment and we (mostly) enjoy the benefits this brings; such as being able to talk to friends and family at anytime, anywhere, or being able to order supermarket shopping online and have it delivered quickly. There’s also the benefit of being able to work remotely, whilst still being linked closely to colleagues in the office. We can monitor various aspects of our health and wellbeing via our wrist device or mobile phone too. Nevertheless, there are times when technology simply frustrates us all to distraction. I hate my printer for example. I really do. It’s meant to print wirelessly from anywhere in the house, but more often than not, it decides to have a little game with me and not print anything out at all. I’m sure you’re all familiar with well-timed glitches that occur with technological devices at home and at work! Despite the pros and cons of using technology in our personal and professional lives, it seems that dietitians and nutritionists are getting on board with its uses in our profession. Ruth Barclay-Paterson, Diabetes Dietitian, reports on ‘telehealth’ in NHS Ayrshire and Arran, which provides successful dietetic management for patients with diabetes. Priya Tew discusses whether it’s time we should be embracing new software, apps and online consultations. She has compiled a range of software that she and other nutrition professionals have found useful in different situations. A wide range of topics feature in this double issue of NHD (which, as usual, will be on our website to view digitally – that’s technology for you!), including on potential preventive dietary approaches to dementia by Gill Hooper, who highlights that an estimated one million people in the UK
will have dementia by 2025 and this will Emma Coates Editor increase to two million by 2050. Moving from elderly care to paediatrics, Olivia Emma has been a dietitian Chaffey focuses on cow’s milk protein registered for 12 years, with allergy, talking us though this complex experience of adult dietary issue and how best to manage and paediatric dietetics. it. And gastroenterology? Well, Jess English has it covered, as she shares her insights into the current and potential treatment approaches of IBS, including genetic links in its aetiology. IBS sufferers may well be considering the flexitarian diet and in Tabatha Ward’s first article for us, she examines why it is becoming so popular. Evelyn Toner takes us through a review of ONS products, while appropriate prescribing of vital low-protein foods is looked at in IMD Watch by Catherine Kidd, Dietitian at GOSH in London. The IMD condition tyrosinaemia is tackled by Harriet Churchill, as she explains the dietary principles and management of this disorder, which is via a proteinrestricted diet. Our regular features include Face to Face and in this issue Ursula Arens interviews Jenny Rosborough, Public Health Nutrition Campaigner; and in Dietitian's Life we wish Pat Portnoi a happy retirement. If you have important news or Enjoy the read. research updates to share with NHD, or I’m off to roll my would like to send a letter to the Editor, eyes at my printer please email us at and count on my info@networkhealthgroup.co.uk smart phone how We would love to many steps it takes hear from you. me to get it working! Emma www.NHDmag.com June/July 2019 - Issue 145
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PREBIOTIC OLIGOSACCHARIDES: SUPPORTING GUT HEALTH IN PRETERM INFANTS FOR HEALTHCARE PROFESSIONAL USE ONLY
The importance of supporting the gut microbiota for positive health outcomes in preterm infants Infants who are born prematurely often face multiple health concerns, including day-to-day feed tolerance, poor gut barrier function and increased risk of infection.1–3 The gut microbiota in these infants is considered to be particularly important for protection against harmful microorganisms and for the maturation of the immune system.4 Increasing evidence suggests that promoting a healthy microbiota is key to ensuring the best possible outcomes in preterm infants.2
The benefits of breast milk on the microbiota Breast milk is universally recognised and associated with the best health outcomes in both preterm and term infants by providing a unique combination of nutrients and immune-protective factors.5 A key benefit of breast milk is the promotion of a healthy gut microbiota, which is in part attributed to the presence of prebiotic oligosaccharides (OS) supporting gut intestinal flora development (figure 1).4 Breast eastffed in infant
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Figure 1 – The microbiota of breastfed infants is dominated by beneficial bifidobacteria (up to 90%) and has lower levels of harmful bacteria (such as E. coli and Bacteroides) compared to infants fed a formula without prebiotics during the first 20 days of life.4
Prebiotic oligosaccharides positively influence the gut microbiota If breast milk is not available or not sufficiently available for a preterm infant, a specific preterm formula is recommended.6 Several clinical studies have proven that a formula containing prebiotic OS (compared to a formula without prebiotic OS) helps to support the preterm gut microbiota in a number of different ways: Increasing the number of bifidobacteria in the gut (Figure 2)7 Promoting stool frequency patterns and consistency similar to breast milk fed infants7,8 Reducing numbers of infection-causing bacteria in the gut9 Potentially improving enteral tolerance in very preterm infants8,10 Adapted from: Boehm, et al. 2002 13
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Figure 2 – Preterm infants receiving a formula with prebiotic OS for 28 days had significantly higher levels of bifidobacteria in the gut, compared to the group receiving a formula without prebiotic OS (p=0.0008).7
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Nutriprem 1 and nutriprem 2 are the only preterm that prebiotic OS, Nonformulas prebiotic containing formula contain (n=15) proven to increase the beneficial bacteria in the gut and to support gut health. Find out more: Healthcare Professional Helpline 0800 996 1234 eln.nutricia.co.uk @nutriciaELNUK Important notice: Breastmilk is best for babies. Nutriprem human milk fortifier, nutriprem protein supplement, hydrolysed nutriprem, nutriprem 1 and 2 are foods for special medical purposes for the dietary management of preterm and low birthweight infants. They should only be used under medical supervision, after full consideration of the feeding options available, including breastfeeding. Hydrolysed nutriprem, nutriprem 1 and 2 are suitable for use as the sole source of nutrition for preterm and low birthweight infants. References: 1. Calkins KL, et al. Clin Perinatol 2014;41(2):331–345. 2. Groer MW, et al. Microbiome 2014;2:(38):1-8. 3. Neu J. World Rev Nutr Diet 2014;110:253–263. 4. Harmsen HJM et al. J Pediatr Gastroenterol Nutr 2000;30(1):61–7. 5. Gartner LM, et al. Pediatrics 2005;115(2):496–506. 6. Agostoni C, et al. J Pediatr Gastroenterol Nutr 2010;50(1):85–91. 7. Boehm GM, et al. Arch Dis Child Fetal Neonatal Ed 2002;86(3):F178–F181. 8. Mihatsch WA, et al. Acta Paediatrica 2006;95(7):843–848. 9. Knol JP, et al. J Pedaitr Gastroentreol Nutr 2005;40(1):36–42. 10. Modi N, et al. Pediatr Res 2010;68(5):440-5.
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NEWS CLINICAL
Emma Coates Editor Emma has been a registered dietitian for 12 years, with experience of adult and paediatric dietetics.
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OBESITY: AN EVER-INCREASING FACTOR IN HOSPITAL ADMISSIONS Admissions to NHS hospitals, where obesity was recorded as either a primary or secondary diagnosis,1 increased by 15% (94,000) during 2016/17.2 The Statistics on Obesity, Physical Activity and Diet, England 2019, is an annual collection of new and previously published figures on obesity, including hospital admissions, prescription items, prevalence among adults and children, as well as physical activity and diet. New figures3 in the report show that around two thirds of the admissions where obesity was recorded as either a primary or secondary diagnosis4 in 2017/18 were for women (66%). Of the 6627 Finished Consultant Episodes (FCEs)5 for bariatric surgery in 2017/18,6 79% of the patients were female. The number of items prescribed by primary care for obesity treatment decreased by 8% from 401,000 items in 2017 to 371,000 items in 20187 and continues a downward trend since a peak of 1.45 million items in 2009. The Net Ingredient Cost (NIC)8 saw an increase for the first time in five years, rising from £6.9m in 2017 to £8.1m in 2018. Adult obesity prevalence9 stood at 29% in 2017, an increase from 26% in 2016, whilst prevalence of child obesity10 in both Reception and Year 6 was over twice as high in the most deprived areas11 than in the least deprived areas: 13% compared to 6% in reception year, and 27% compared to 12% in Year 6. Read the full report ‘Statistics on Obesity, Physical Activity and Diet, England, 2019’ online at https://digital. nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statisticson-obesity-physical-activity-and-diet-england-2019 <accessed 15/05/19> References can be found at the Subscriber zone: www.NHDmag.com
NEW TOOL TO BOOST REFERRALS TO VITAL DIABETES EDUCATION PROGRAMMES Diabetes UK and Kent and Medway STP have introduced a new tool designed to help healthcare professionals boost referrals to structured education courses for people with diabetes. The ‘Improving your diabetes knowledge’ Information Prescription has been developed as part of ongoing efforts to help support people living with diabetes gain better control of their condition and reduce their risk of developing life-threatening complications. Diabetes UK is encouraging HCPs to use the Information Prescription in order to have a useful conversation with their patients about structured education courses and boost referrals to local diabetes courses. The aim is to make the Information Prescription a key part of the patient’s care and treatment. The new Information Prescription is the latest template to be added to Diabetes UK’s Prescription range. Each of these is designed to simplify an area of diabetes management. The new template is available on EMIS and Vision and for download via the Diabetes UK website: www.diabetes.org.uk/IP-Prof. 6
www.NHDmag.com June/July 2019 - Issue 145
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REFERENCE: 1. Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. HMSO, London.