Nutrition Flashcards
Summarise healthy eating in the UK
In the UK healthy eating recommendations for the general population are set by Public Health England.
At a population level these are based on Dietary Reference Values (DRV’s). DRV’s are a series of estimates for different population subgroups for the essential macro- and micro-nutrients to prevent nutritional deficiencies. They are not recommendations or goals for individuals.
To translate the DRV’s into ‘food terms’ the Eatwell guide has been created. This is a pictorial guide to healthy eating showing the proportions in which different types of foods are needed to have a well-balanced and healthy diet. The proportions shown are representative of your food consumption over the period of a day or even a week, not necessarily each meal time.
What constitutes a healthy diet
at at least 5 portions of a variety of fruit and vegetables every day
Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates; choosing wholegrain versions where possible
Have some dairy or dairy alternatives (such as soya drinks); choosing lower fat and lower sugar options
Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish every week, one of which should be oily)
Choose unsaturated oils and spreads and eat in small amounts
Drink 6-8 cups/glasses of fluid a day
What are dietary reference values
series of estimates for population for the recommended daily intake of essential macro and micronutrients
Describe the different categories for processed food
Minimally processed: rice, nuts, fresh fruit/veg; little processing to keep it fresh
Processed culinary ingredients: oil, butter, sugar and salt
Processed foods: pasta, bottled veg, canned fish, fresh bread, cheeses
Highly processed foods: crisps, biscuits, crackers, sausages, salami, ready meals
Describe low carb diets and the data associated with them
Low carb diets: <130g carbs per day (<26% total energy) may decrease triglycerides and increase HDLs while improving weight loss and reducing diabetes risk
PURE Study: prospective observational study that showed eating carbs the most increased all cause mortality but not CVD mortality (eating more fats decreased risk of death)
ARIC and PURE: indicate lowest mortality at 50-55% of energy from carbohydrates but low carb (<40%) and high carb (>70%) increased mortality- low carb more so
Describe the types of intermittent fasting diets
16/8 diet: fasting for 14-16 hours and then restrict eating to 8-10 hours
5:2 diet: eat normally 5 days a week and restrict intake to 500kcal on 2 days
Eat-stop-eat diet: 24 hour fast 1/2 times a week
Alternate day diet: fast every other day
Spontaneous meal skipping: where convenient
Describe intermittent fasting diets
Obesity - linked with lack of healthy lifestyle, not necessarily with fractionation or shorter or longer feeding intervals
Replacement of in natura or minimally processed food by ready-to-eat industrialized products = preponderant factor for weight gain and not its fractionation
Weight Loss in overweight and obese = equivalent weight and lean mass loss x continuous energy restriction
Dietary Restriction = Favour binge eating behaviour
Describe the data associated with intermittent fasting diets
There are insufficient scientific subsidies to not follow a daily food standard with meals fractioned in 5 or 6 portions throughout the day
Conducts related to this practice = based in animal studies and observational data from religious fasting (short term)
There are some randomized trials for periods of > 6 months = similar weight reduction, lipemia, CV and cancer parameters
Published studies are not sufficient to confirm the hypothesis of reversion or attenuation of: diabetes, cancer, CVD and others
Describe plant-based diets
Plant-based diets contain a host of food and nutrients known to have independent health benefits
Evidence linking red meat intake, particularly processed meat, and increased risk of CHD, cancer and type 2 diabetes provides indirect support for consumption of a plant-based diet
Describe the impact of vegetarian diets
Vegetarian diets have not shown any adverse effects on health
However, restrictive and monotonous vegetarian diets = nutrient deficiencies with deleterious effects on health
What is the advice for vegetarian diets
Appropriate advice = ensure a vegetarian diet is nutritionally adequate
Bioavailability of proteins is different- need to consume more
What is malnutrition
“Malnutrition is a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue / body form (body shape, size and composition) and function and clinical outcome” (BAPEN , 2018)
The term malnutrition does include obesity, however this session will relate to “undernutrition” only.
Describe the epidemiology of malnutrition
Epidemiology: approx. £20bn/year due to under nutrition; estimated 3m people in UK are under nourished, with 1/4 admitted to hospital at risk
25-34% of patients admitted to hospital at risk
30-42% of patients admitted to care homes at risk
18-20% of patients admitted to mental health units at risk of undernutrition
70% of patients weigh less on hospital discharge
Describe the determinants of malnutrition
inadequate food interacts with disease, but increased by household food insecurity, alongside poor and unhealthy social environment
Inadequate food intake: poverty, cooking skills, isolation, bereavement, limited access
Disease related: N&V, diarrhoea, early satiety, depression, immobility, increased nutritional requirement (burns/cancer/Crohn’s)
What are the consequences of malnutrition
Consequences: reduced immunity, muscle weakness, kidney failure, depression, apathy and neglect, reduced fertility, risk of hypothermia, growth failure, stunting, deficiencies
Mortality: exponentially increases with greater body mass loss
Practical impact: increased risk of falls/#s, muscle wasting, low mood, increased admissions, reduced independence, increased infections and increased confusions
How do we diagnose malnutrition
Diagnosis: nutrition screening > nutrition assessment > diagnosis
Screening: quick and simple, during initial assessment of patient and then at regular intervals by non-nutrition professionals
Assessment: detailed and in-depth, and can involve anthropometrics - performed by dietitian or specialist nurse; first: anthropometrics - assessing weight, BMI, % weight loss; second: food record chart or food diary; thirds: bloods for albumin, CRP, creatinine and cholesterol
Describe nutritional screening
QUICK and simple, practical
During initial assessment of patient; regular intervals
By non-nutrition professional
Describe nutrition assessment
More detailed, in-depth
Could use anthropometrics
By a dietitian or specialist nutrition nurse
Why do we use nutrition screening
To assess a patient’s nutritional status and categorise into a risk
Completed by a nurse within 24 hours of hospital admission
Describe Malnutrition Universal Screening Tool (MUST)
BMI score
Weight loss score
Acute disease effect score
How do we assess malnutrition
Weight
Weight loss
BMI
Other anthropometric measures (skinfold thickness, muscle circumference, hand grip measure)
What should we do with patients
Screen all for RISK of malnutrition
Multi-system approach to assessments of malnutrition
