UP FRONT Welcome to this final issue of 2019 and the first of 2020! We’ve made it through another 12 months, and we welcome in not on only a new year but a new decade – the NEW roaring 20s! It’s amazing to think that 100 years ago we were on the verge of a decade that saw a collection of truly life-changing discoveries, inventions and creations. During the 1920s, the first commercial radio station was launched, soon to be followed by the advanced development of television towards the end of the decade by John Logie Baird. Music and television were only just starting to reach the masses, a huge step up at the time from reading the latest news in the broadsheets and still a world away from the 24/7 online access we have to information resources. In health and nutrition, insulin was first used in the treatment of diabetes in 1922, discovered by Banting, Best and Macleod at the University of Toronto and we also saw new vitamins being identified and researched. In 1928, Adolph Windaus received the Nobel Prize in Chemistry, received for his studies on vitamin D and its connection with sunlight. Sir Frederick Hopkins and Christiaan Eijkman also received a Nobel Prize in 1929 for their work around ‘growth stimulating vitamins’, which we now know as some of the B vitamins. We saw all women over the age of 21 being granted the vote in 1928. Women felt more confident and empowered, with new independence, which was reflected in the fashion and styles of the day. Hair and dresses were shorter; women started to smoke, drink and drive motorcars. The ‘flapper’, who was generally considered attractive, reckless
and independent, appeared on the scene; with her wild behaviour, she was often shocking to society. 1920s-style girl power was definitely a thing! And it was not just the female Bright Young Things who were making changes in the 1920s. In early 1924, Margaret Bondfield, was appointed as Parliamentary Secretary to the Minister for Labour – the first woman ever to become a government minister. The 1920s saw an almighty boom in many things creative, nutritional, industrial and societal; setting the wheels in motion for life as we know it today. However, poverty within the working classes was stark in contrast to the middle and upper classes. The end of the decade saw mass unemployment, poverty and economic decline, leading to the depression of the 1930s. We start the ‘new’ 20s in a challenging position, not fully sure of the political events that will unfold over the coming months, with concerns for our NHS and social care on the agenda. You could say that little that has changed in our society since those discoveries and innovations of the 1920s. However, there is always scope for new ideas and new ways of working. The 2020s are sure to be a rollercoaster ride, but we’ll no doubt create our own version of the ‘roaring 20s’ with added modern twists! Emma
Emma Coates Editor Emma has been a Registered Dietitian for 12 years, with experience of adult and paediatric dietetics.
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PaediaSure is the most popular ONS* brand for children in the UK,1 and has a great taste that kids love.2-5 From standard to energy dense, with or without fibre, juice style or peptide-based, there’s a PaediaSure to suit every little monkey (elephant, or zebra).
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HELPING KIDS BE KIDS AGAIN References: 1. Data on file. Abbott Laboratories Ltd., 2019 (IMS data, June 2018 - May 2019). 2. Data on File. Abbott Laboratories Ltd., 2007 (PaediaSure Plus & PaediaSure Plus Fibre taste testing). 3. Data on File. Abbott Laboratories Ltd., 2013 (PaediaSure Fibre taste testing). 4. Data on File. Abbott Laboratories Ltd., 2013 (PaediaSure & PaediaSure Peptide vs. Peptamen Junior Powder). 5. Data on file. Abbott Laboratories Ltd., 2017 (Sensory research and evaluation: PaediaSure Plus vs. PaediaSure Compact). Date of preparation: August 2019 ANUKANI190244
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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LIMITED DIETARY KNOWLEDGE RISKS POOR HEALTH IN VEGETARIANS A new survey recently commissioned by the Health and Food Supplements Information Service (HSIS),1 has highlighted worrying gaps in knowledge, leading to an enhanced risk of nutritional deficiencies. The OnePoll survey interviewed 1000 vegetarian and vegan adults across the UK and found that 28% of vegans and 13% of vegetarians have been diagnosed with a nutrient deficiency following a blood test. The key nutrients which could be an issue on vegetarian or vegan diets were iron, vitamin D, vitamin B12, calcium and zinc. These are all found in animal-sourced foods, but tend to be less bioavailable, or present in smaller amounts, in plant foods. Yet, despite this, more than 6 in 10 people claimed that their plant-based diet provided all the nutrients they need. The examples of deficiency were accompanied by poor general knowledge about how to obtain adequate nutrient intakes when following a vegan or vegetarian diet. Whilst 1 in 10 respondents had turned to a meat-free diet in the past year, and half had been vegan or vegetarian for longer, 60% overall admitted that they had done no research before cutting out animal products and most did not take a targeted dietary supplement, as recommended by the NHS and the Vegan Society. The HSIS survey found that advice on diet and nutrition came mostly from family and friends (32%), wellness blogs and celebrities (25%), or newspaper and magazine articles (14%). Only a quarter were aware of iron and zinc issues and 6% were aware of iodine deficiency. Significant groups believed – wrongly – that apricots, spinach, mushrooms and apples are high in protein, or that broccoli (33%) and pulses (20%) were good sources of vitamin B12. One in four had no idea where to get omega-3s in the diet and 1 in 10 worried unnecessarily about lack of vitamin C, which is a negligible risk in a plant-based diet. Turn to page 19 for more on plant-based diets. 1 www.hsis.org/vegetarian-and-vegan-trends-pushing-more-people-into-deficiency-risk
SUGAR REDUCTION: REPORT ON PROGRESS 2015-2018 Public Health England (PHE)’s second-year report on progress made by the food industry to voluntarily reduce sugar in everyday foods, shows an overall 2.9% reduction since 2015. Retailer own-brand and manufacturer branded yoghurts and fromage frais, and breakfast cereals have reduced sugar by 10.3% and 8.5% respectively. Progress has been made under the Soft Drinks Industry Levy (SDIL), including a 28.8% sugar reduction per 100ml in retailer own brand and manufacturer branded products and a 27.2% reduction per 100ml for drinks consumed out of home. There has been a consumer shift towards zero or lower sugar products, with sugar purchased from soft drinks decreasing in all socio-economic groups. The amount of sugar removed – 30,133 tonnes – has been done so without reducing soft drink sales, resulting in around 37.5 billion fewer kilocalories sold in sugary drinks each year. For the full report: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/839756/ Sugar_reduction_yr2_progress_report.pdf
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www.NHDmag.com December 2019 / January 2020 - Issue 150
THIS INFORMATION IS INTENDED FOR HEALTHCARE PROFESSIONALS USE ONLY
BREAST MILK IS BEST FOR PRETERM INFANTS When breast milk isn’t available, nutriprem is nutritionally closer than any other preterm formula* Preterm infants have very high nutrient requirements and face a significant risk of growth failure, developmental delay, necrotising enterocolitis (NEC) and late-onset sepsis.1 Breast milk is best for preterm infants and offers an array of benefits including decreased rates of these conditions and improved neurodevelopmental outcomes.1 However, when breast milk is not available or in limited supply, a preterm formula that is nutritionally closer to breast milk offers the best alternative.2
Whey and casein proteins are important for supporting optimum development in preterm infants Breast milk contains a mixture of whey and casein proteins in varying proportions, from around 20% casein at birth, rapidly increasing to over 40%.3 Whey and casein proteins have individual specific functions, including digestion, immune function and mineral absorption.3 While the unique benefits of breast milk proteins can not be replicated in a formula, only nutriprem provides a protein composition which mirrors that of breast milk by including both whey and casein proteins in appropriate ratios.
Intact proteins in breast milk support gastrointestinal development Over 99% of proteins in breast milk are intact.4 Experts believe that intact protein may have a role in gut maturation, as the intact proteins in breast milk are digested into bioactive peptides which support the development of the gut.5,6 Hydrolysed
and partially hydrolysed formulas are available and have a role in supporting some preterm infants who fail to tolerate an intact protein formula. However, these formulas may prevent the formation of bioactive peptides that occurs during the digestion of intact proteins.6,7
Lactose is a key energy source for breastfed infants Lactose, the main carbohydrate and key energy source for breastfed preterm infants, enhances calcium absorption and may provide a prebiotic effect.8-10 Lactose therefore is the predominant carbohydrate in nutriprem. Maltodextrin is an alternative polysaccharide carbohydrate source often used in preterm formula, but has been linked to reduced stool frequency and increased stool hardness and therefore may not be appropriate for use as the main carbohydrate source for preterm infants.11
Phospholipid-bound LCPs help create a fat profile closer to breast milk Fatty acids are typically bound to triglycerides, but in breast milk up to 20% of the long-chain polyunsaturated fatty acids (LCPs) are instead bound to phospholipids, which improves their absorption in preterm infants.12–14 Only nutriprem preterm formulas contain 15% of the LCPs in phospholipid bound form. Together with betapalmitate sourced from natural milk fat and 10%* of fat from medium chain triglycerides (MCT), the fat composition of nutriprem preterm formulas are closer to breast milk than any other preterm formula in the UK.15–20
Prebiotic oligosaccharides (OS) significantly impact gut microbiota and GI health Breast milk is incredibly rich in prebiotic OS with approximately 200 prebiotic OS identified to date,21 which encourage the growth of beneficial bacteria (such as bifidobacteria) and inhibits growth of potentially harmful bacteria in the gut.21 Nutriprem preterm formulas* contain a blend of 9:1 short-chain GOS:long chain FOS, which mimics the prebiotic effect of the oligosaccharides found in breast milk. Nutricia’s GOS/FOS blend has been proven to help promote a microbiota composition, stool frequency and stool consistency closer to breastfed infants.11,22,23
The only nutritionally complete post discharge formula with a composition closest to breast milk Experts recommend that infants at risk of long-term growth failure require a specialist post discharge formula with increased protein, minerals and trace elements.24 Only nutriprem post discharge formula offers a nutritionally closer to breast milk composition, prebiotic oligosaccharides and sufficient iron to meet their daily requirements up to 6 months corrected age.2,25**
NUTRIPREM IS NUTRITIONALLY CLOSER TO BREAST MILK THAN ANY OTHER PRETERM FORMULA IN THE UK.*
Composition
Preterm breast milk
nutriprem 1
Gold Prem 128
nutriprem 2
Protein ratio
60:40 whey:casein3
60:40 whey:casein
100% whey
60:40 whey:casein
100% whey
Protein type
Over 99.9% intact protein4
100% intact protein
100% partially hydrolysed protein
100% intact protein
100% partially hydrolysed protein
Lactose
Lactose
Maltodextrin
Lactose
Lactose
7.3g/100ml26
5g/100ml
3.7g/100ml
5.9g/100ml
5.3g/100ml
Main Carbohydrate Lactose level Medium chain triglycerides (MCT) Phospholipid bound LCPs Betapalmitate source Prebiotic Oligosaccharides Iron
7-17%
15–18
10%
39.5%
Gold Prem 228
10%
~6%
Up to 20% of LCPs12,14
15% of LCPs
0% of LCPs
15% of LCPs
0% of LCPs
Naturally occurring
Natural milk fat
Structured vegetable fat
Natural milk fat
Structured vegetable fat
0.5-1.1g per 100ml27
0.8g per 100ml
No prebiotic OS
0.8g per 100ml
No prebiotic OS
1.2mg/100ml
0.8mg/100ml (will not meet 2-3mg/kg in typically consumed volumes)
Guidelines recommend 2-3mg/kg up to six months corrected age2,25
Correct as of May 2019. *nutriprem 1 and nutriprem 2 only **SMA Gold Prem 2 contains 0.8mg/100ml iron which will not meet the recommended daily iron requirements of preterm and low birth weight infants up to 6 months corrected age
NOT nutritionally complete**
IMPORTANT NOTICE: Breast milk 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. Underwood MA. Pediatr Clin North Am. 2013;60(1):189–207. 2. Agostoni C et al. J Pediatr Gastroenterol Nutr. 2010;50(1):85–91. 3. Lönnerdal B. Am J Clin Nutr. 2003;77(6):1537S–1543S. 4. Lönnerdal B. Protein in Neonatal and Infant Nutrition: Recent Updates. 2016;86:97–107. 5. Senterre T., Rigo J. Nestle Nutri Inst Workshop Serv. 2016;86:39–49. 6. Vandenplas Y et al. J Pediatr Gastroenterol Nutr. 2016;62(1):22–35. 7. Wada Y and Lönnerdal B. Peptides. 2015;73:101–105. 8. Abrams SA, Griffin IJ, Devila PM. Am J Clin Nutr. 2002;76:442–6. 9. Schaafsma G. Inter Dairy J. 2008;18(5):458–465. 10. Ziegler E et al. J Pediatr Gastroenterol Nutri. 1983;2(2):288–94. 11. Mihatsch W et al. Acta Paediatr. 2006;95(7):843–8. 12. Bitman J et al. Am J Clin Nutr. 1984;40(5):1103–19. 13. Carnielli V et al. Am J Clin Nutr. 1998;67(1):97–103. 14. Harzer G et al. AM J Clin Nutr. 1983;37(4):612–21. 15. Genzel-Boroviczény O et al. Eur J Pediatr. 1997;156(2):142–7. 16. Boker S et al. Ann Nutr Metab. 2007;51(6):550–6. 17. Ehrenkranz R et al. J Pediatr Gastroenterol Nutr. 1984;3(5):755–8. 18. Bitman J et al. Am J Clin Nutri. 1983;38(2):300–12. 19. Innis S et al. Lipids. 1994;29(8):541–5. 20. Ballard O et al. Pediatr Clin North Am. 2013;60(1):49–74. 21. Marcobal A., Sonnenburg J. Clin Microbiol Infect. 2012;18, Suppl 4:12–5. 22. Boehm G et al. Arch Dis Child Fetal Neonatal Ed. 2002;86(3):F178–F181. 23. Knol J et al. Acta Paediatr. 2005;94(449):31–3. 24. Aggett P et al. J Pediatr Gastroenterol Nutr. 2006;42(5):596–603. 25. Domellöf M. World Rev Nutr Diet. 2014;110:121–39. 26. Koletzko B et al. Nutritional Care of Preterm Infants. Karger. 2014. 27. Kunz C et al. J Pediatr Gastroenterol Nutr. 2017;64(5):789–798. 28. SMA Gold Prem 1 and Gold Prem 2 datacards. Accessed May 2019. https://www.smahcp.co.uk/sites/site.prod1.smahcp.co.uk/files/2018-12/ZTC3149%20SMA%20Preterm%20Datacard%20FINAL_0.pdf
Healthcare professional helpline 0800 996 1234 eln.nutricia.co.uk
@NutriciaELNHCP
19-035. August 2019
NEWS THE ULTIMATE CHOLESTEROL LOWERING PLAN© UPDATED The facts and figures around heart health and cholesterol are stark. Coronary heart disease (CHD) remains one of the major killers in the UK: 2.3 million people are living with CHD and 64,000 die of CHD every year, with high cholesterol levels being one of the major risk factors to CHD. However, around 93% of these deaths have been attributed to risk factors that can be modified: dietary habits and lifestyle. Heart UK’s Ultimate Cholesterol Lowering Plan© (UCLP©), originally developed in 2011, addresses diet, with the aim of reducing cholesterol and managing heart health. The step-by-step plan is based on both heart health science and behavioural strategies, with users encouraged to build the plan that suits them best, so that change is realistic and easy to maintain. Download the updated UCLP© here: www.heartuk.org.uk/ultimate-cholesterol-lowering-plan/uclp-introduction. You can also access a free webinar to learn more about the latest evidence and updated plan here: www.nutrilicious.co.uk/the-uclp-webinar/
HELPING OLDER PEOPLE TO REMAIN HEALTHIER FOR LONGER A new report published by the British Geriatrics Society, Healthier for Longer: how healthcare professionals can support older people, examines how messages of prevention and healthy ageing apply to an older population group that may already be ill and frail, and to the HCPs who care for them. The prevention agenda, which has been highlighted as a priority for the Government and for health services, is shown in this report to be as relevant to the older population as it is to younger age groups. While the gains of prevention in relation to older people’s health may be modest in terms of years of life gained, the impact in terms of quality of life is likely to be significant. The report highlights steps that all HCPs can take to help promote healthy ageing and prevention in later life. These include: • ‘Care at every contact’ – every touchpoint of care is a potential opportunity to help people to engage in their own health and work with others to improve it. • ‘Cover the basics’ – older people need to be able to see, hear, eat, drink and sleep well even if other more complex health issues are being addressed. • ‘Consider the whole person’ – healthcare issues may not be the only or even the most pressing concern for a patient. Ask what matters to them and how they can be supported. Download the report here: www.bgs.org.uk/sites/default/files/content/resources/files/2019-11-04/BGS%20Healthier%20for%20Longer.pdf
NEW PORTION SIZE GUIDE LAUNCHED FOR INDUSTRY The Institute of Grocery Distribution (IGD), a research and training charity, has published a new guide for food businesses to help them review and set portion sizes, in a bid to help consumers reduce their calorie intake. The guide has been developed following extensive consultation with industry and is based on qualitative consumer research on eating out, on the go and in the home. More information on the guide is available to download at: www.igd.com/charitable-impact/healty-eating/reformulation/focus-areas/portion-size
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Click here to read the Dec/Jan issue Articles include: • Weaning preterm babies
• Nasogastric tube feeding • Fussy eating in toddlers • Constipation and treatment • Popular liquid diets
• Plant-based diets • Care caterers in social care • Follow-on formula new regulations