NHD Editor, Emma Coates, in her new Up Front column, reflects on the latest government review on hospital food and asks, “Why Prue?. . .
October sees the return of shorter days and chillier nights, but we are nearing the culinary treat that is the final of The Great British Bake Off (GBBO), which hopefully won’t result in any exploding ovens, or showstopper disasters! “Millions wasted on ‘unpalatable’ hospital food”, is not something you’ll hear on The GBBO, but this was a recent comment made by celebrity chef and Bake Off judge, Prue Leith, as the government announced the launch of its latest hospital food review. The standard of food in our hospitals is a hot potato, which has been reviewed, discussed and often criticised for many years. Yet, little seems to have improved. With any large-scale production of food, it’s a challenge to meet the diverse needs of many recipients and within budget. However, when it comes to hospital food, there really isn’t much room to manoeuvre, as the diversity of needs must be met and it’s unacceptable to provide poor quality food to some of the most vulnerable in our society. Prue has been taken on as advisor to the government regarding this review. She is not the first celebrity chef to get on board with such schemes. Albert Roux, Lloyd Grossman and James Martin are all previous famous chefs who’ve taken a run at this mammoth task, and don’t forget Jamie Oliver’s intervention. So, why will this review be any different? Well, the government has pledged to look into the positive impact of good quality food on aiding faster recovery, which will be supported by referring to case studies from across the
UP FRONT Emma Coates Editor
country. It will also consider the potential use of new systems to monitor food safety and quality, which includes more transparent methods for regular review and looking at how NHS boards are held to account. Additional aspects of the review also include how to increase the number of hospitals with their own chefs and kitchens. The government is seeking support from national bodies and they will work together to potentially reduce reliance on repacked or frozen options, with the aim to source food and services locally. Eventually, the aim is to ensure that the 140 million meals served to patients across the country every year, are healthier, tastier and patient choice is greater, along with new national quality standards for the food served to staff, patients and visitors. But why choose Prue? Whilst she is a well-established celebrity chef and television judge, is she really the right choice for this job? Former Chair of the School Food Trust and restaurateur with a CBE, Prue has previously spoken out on the need for hospitals to provide healthy, nourishing and filling options to aid recovery and for meals to be tailored to the individual needs of the patient. But, only time will tell. Whether this latest review of hospital food will result in positive changes remains to be seen, but we can wait with optimism that this time it might be different. Enjoy all the nourishment this issue of NHD has to offer. Emma
Emma has been a Registered Dietitian for 12 years, with experience of adult and paediatric dietetics.
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11 COVER STORY Weight management services and obesity 6
News
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Public health messages
Latest industry and product updates
43 PKU New research into weaning
For a healthy diet
16 EOSINOPHILIC OESOPHAGITIS 19 Dysphagia Causes and
management
23 Undernutrition Prevalence in the UK 31 Bacteria The good, the bad and the ugly
44 IMD watch The role of Sapropterin
47 DIET TRENDS: ACTIVATED CHARCOAL 50 F2F Interview with Dr Laura Thomas 52 A day in the life of . . . A food and health development worker
35 BREASTFEEDING: DUTY OF HCPS
54 Events, courses & dieteticJOBS Dates for your diary
39 CMPA The challenges of weaning
and job listings
55 Dietitian's life Eating out with restrictions
Copyright 2019. All rights reserved. NH Publishing Ltd. 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.
Editor Emma Coates RD
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Emma Coates Editor Emma has been a Registered Dietitian for 12 years, with experience of adult and paediatric dietetics.
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SACN REPORT ON SATURATED FATS AND HEALTH The Scientific Advisory Committee on Nutrition (SACN) has published the final version of its report, Saturated fats and health. In 2014, it was agreed that a review of the evidence on saturated fats and health was required, due to the ongoing scientific and media debate focusing on the relationship between saturated fats and cardiovascular disease (CVD). The report, published in August 2019, confirms a saturated fat link to blood cholesterol and heart disease and concludes that there is no need to change current advice. Based on 47 systematic reviews and meta-analyses, SACN concludes that: • higher saturated fat consumption is linked to raised blood cholesterol; • higher intakes of saturated fat are associated with an increased risk of heart disease; • saturated fats should be swapped with unsaturated fats; • there is no need to change current advice that saturated fat should not exceed around 10% of food energy.
Professor Paul Haggarty, Chair of the Saturated Fats and Health Working Group of SACN, said, “Looking at the evidence, our report confirms that reducing saturated fat lowers total blood cholesterol and cuts the risk of heart disease. Our advice remains that saturated fats should be reduced to no more than about 10% of dietary energy.” Read the full SACN report here: www.gov.uk/government/publications/saturated-fats-and-health-sacn-report
HIGHLIGHTING THE ROLE OF REGISTERED NUTRITIONISTS. We have recently received feedback from a reader who was keen to highlight that in addition to Registered Dietitians, Registered Nutritionists (RNutr) and Registered Associate Nutritionists (ANutr) are suitably qualified to give dietary advice to patients. The feedback precipitated from our article Eating disorders: the potential impact of dietary advice, published in our August/September issue, where it was stated that only dietitians are qualified to give dietary advice and only dietitians are regulated. Whilst the publishers of NHD recognise that there are areas of dietary advice only dietitians can manage and the AfN code of practice is very clear on this, we also acknowledge the value and qualifications of Registered Nutritionists and Registered Associate Nutritionists. We apologise for the misinformation within the article in question. For further information about Registered Nutritionists (RNutr) and Registered Associate Nutritionists (ANutr) and the UK Voluntary Register of Nutritionists (UKVRN) visit: www.associationfornutrition.org/default.aspx?tabid=76
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. 6
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NEWS NICE GUIDELINES HYPERTENSION IN ADULTS: DIAGNOSIS AND MANAGEMENT (NG136). Published in August, this guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with Type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively. This guideline includes new and updated recommendations on: • diagnosing hypertension; • starting antihypertensive drug treatment; • monitoring treatment and blood pressure targets; • choosing antihypertensive drug treatment; • who to refer for same-day specialist review.
This guideline updates and replaces NICE guideline CG127. It also updates and replaces the section on blood pressure management in the NICE guideline on Type 2 diabetes in adults (NG28). NICE has also produced a guideline on hypertension in pregnancy. Read more at: www.nice.org.uk/guidance/ng136.
Results from a prospective EPIC-Oxford study show that UK adults who are fish eaters or vegetarians have lower risks of ischaemic heart disease than meat eaters, but that vegetarians have a higher risk of total stroke. Vegetarian and vegan diets have become increasingly popular in recent years, but the potential benefits and hazards of these diets are not fully understood. Previous studies of two diet groups have reported that vegetarians have lower risks of ischaemic heart disease than nonvegetarians. However, no evidence has been reported on a difference in the risk of mortality from stroke, possibly because of limited available data and lack of available evidence on stroke subtypes. The Oxford study showed that fish eaters and vegetarians (including vegans) have lower risks of ischaemic heart disease than meat eaters. However, vegetarians (including vegans) have higher risks of haemorrhagic and total stroke than meat eaters. Future work should include further measurements of circulating levels of cholesterol subfractions, vitamin B12, amino acids and fatty acids in the cohort, to identify which factors might mediate the observed associations. Additional studies in other large-scale cohorts with a high proportion of non-meat eaters are needed to confirm the generalisability of these results and assess their relevance for clinical practice and public health. RISKS OF TOTAL STROKE IN VEGETARIANS STUDY
Read more at: www.bmj.com/content/366/bmj.l4897
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