News Round-up
Coeliac UK Welcomes Government Continued Support of Key Gluten-free Staples on Prescription
Coeliac UK, the charity for people with coeliac disease, said the decision by the Department of Health and Social Care to retain access to gluten-free breads and flour mixes on prescription in England is a positive outcome for people with coeliac disease, and recognises the need for this important ongoing support in managing a lifelong autoimmune disease.
Chief executive of Coeliac UK, Sarah Sleet, said: “We are pleased the Department of Health and Social Care listened carefully to the consultation responses including the charity’s evidence built up over many years around the issues of cost, availability and nutritional contribution of gluten free staples in managing a lifelong gluten-free diet. The vast majority of consultation responses from patients and clinicians agreed that access to gluten-free staples is key to helping patients, particularly the most vulnerable, keep to a gluten-free diet and avoid expensive health complications as a result.
It is clear the Department of Health and Social Care has carefully reviewed the strong evidence base that we put to them with the help of our coeliac disease community, and made the right decision regarding the treatment and care of people with coeliac disease.”
The charity said the Department of Health and Social Care’s decision to restrict gluten-free items on prescription to just bread and flour mixes, for patients medically diagnosed with coeliac disease of all ages, was reasonable given the financial challenges faced by the NHS.
“We still have work to do to ensure the final regulations outcomes are adequate in enabling patients with coeliac disease, especially the most vulnerable, adhere to the diet and manage their condition,” Ms Sleet said.
A strict gluten-free diet is the only treatment for coeliac disease, a lifelong autoimmune condition where the body attacks itself when gluten is consumed.
While the charity is pleased that the needs of coeliac disease patients are being recognised at a national level, there is still concern at the actions already taken by individual Clinical Commissioning Groups (CCGs) to withdraw gluten-free food on prescription in some regions.
“As CCGs are autonomous and do not have to follow national guidance we will identify where access to prescriptions has effectively been removed and challenge those CCGs to review and reverse their actions which are certainly harder to justify in light of this decision announced by the government,” continued Ms Sleet.
“Irrespective of the Department of Health and Social Care’s decision, we continue to provide support and information on more affordable ways for people to manage their gluten-free diet. With the cost of gluten-free food so high, anyone needing to adhere to a gluten-free diet for medical reasons can benefit from this kind of support,” Ms Sleet said.
Upper Limit for Intake of Folate is Invalid – Government urged to fortify flour with folic acid
There is no need for an upper limit of folate intake, according to a study by Queen Mary University of London and the School of Advanced Study, University of London.
The study shows that the maximum suggested intake of folate (1 mg/day) is based on a 'flawed' analysis. The findings support recent calls1 for the Department of Health and Social Care to approve the fortification of flour with folic acid, in order to protect babies from having neural tube defects.
Anencephaly and spina bifida (collectively referred to as neural tube defects) are serious and relatively common birth defects, affecting one in every 500-1,000 pregnancies. In 1991, a Medical Research Council randomised trial showed that increasing folic acid intake immediately before and early in pregnancy prevented most cases of neural tube defects.
As a result, 81 countries, including the USA since 1998, have introduced mandatory folic acid fortification of cereals, which has been found to reduce the prevalence of neural tube defects, without any evidence of harm. In countries that have introduced fortification, the number of neural tube defects has decreased by up to a half.
Despite successive recommendations, the UK has not introduced mandatory fortification. One reason given is that this might lead to more people having a folate intake above an 'upper limit' suggested by the US Institute of Medicine2 (IOM). However, the new research, published in Public Health Reviews, says that the IOM analysis was 'flawed' and there is no need for an upper limit.
The IOM analysed the results of studies, mainly conducted half a century ago, on individuals with B12 deficiency who had been wrongly treated with folic acid, and claimed that neurological damage tended to occur more frequently in patients treated with higher doses of folic acid. The IOM concluded that treating individuals with vitamin B12 deficiency with higher doses of folic acid might lead to an increased risk of neurological damage.
The new re-analysis of the data finds no relationship between dose of folic acid and the development of neurological damage. The neurological damage was not caused by folic acid – it arose by not treating B12 deficiency with vitamin B12. As a result, there is no need for a folate upper limit (just as there is no upper limit for other B vitamins such as B1, B2, B5 or B12).
Lead author Professor Sir Nicholas Wald from the Wolfson Institute of Preventive Medicine at Queen Mary, who also led the original 1991 randomised trial, said: "With the upper limit removed there is no scientific or medical reason for delaying the introduction of mandatory folic acid fortification in the UK and other countries that have not yet adopted this proven public health intervention.
Failing to fortify flour with folic acid to prevent neural tube defects is like having a polio vaccine and not using it. Every day in the UK, on average two women have a termination of pregnancy because of a neural tube defect and every week two women give birth to an affected child."
Women who could become pregnant are advised to start taking a daily folic acid supplement, but most do not do so, emphasising the need for fortification. Even with fortification, women should still be advised to take folic acid supplements to achieve a greater level of protection than that afforded by fortification alone. The importance of fortification is that it provides a protective population safety net.
In the UK, white flour is already fortified with iron, calcium and other B vitamins (niacin and thiamine).
Co-author, Professor Joan Morris from the Wolfson Institute of Preventive Medicine at Queen Mary, said: "From 1998, when the United States introduced mandatory folic acid fortification, to 2017, an estimated 3,000 neural tube defects could have been prevented if the UK had adopted the same level of fortification as in the US. It's a completely avoidable tragedy."
Co-author, Colin Blakemore, former head of the Medical Research Council, said: "Spina bifida is one of the most common disabling birth defects, but British research has shown that this tragic condition is a vitamin deficiency that can easily be prevented. Eighty-one other countries have benefited from this research, which was funded by the British taxpayer. It's time for the British public to reap the full benefits of that research."
Wald NJ, Morris JK, Blakemore C (2018). Public health failure in the prevention of neural tube defects: time to abandon the Tolerable Upper Intake Level of folate. Public Health Reviews; https://doi.org/10.1186/s40985-018-0079-6 References: 1. The Times, 9 December 2017, LETTERS TO THE EDITOR - 'FOLIC ACID FOR BREAD' by Professor Lesley Regan, president, Royal College of Obstetricians and Gynaecologists; Professor Neena Modi, president, Royal College of Paediatrics and Child Health; Gill Walton, CEO, Royal College of Midwives; Jason Waugh, president, British Maternal and Fetal Medicine Society; Dr Asha Kasliwal, president, Faculty of Sexual and Reproductive Healthcare. URL: https://www.thetimes.co.uk/article/theresa-may-and-the-demands-of-leadership-p2htrs6rj; 2. The name of the Institute of Medicine was changed in 2015 to the National Academy of Medicine.
Women Taking Probiotics During Pregnancy Might Have Lower Pre-eclampsia and Premature Birth Risk
Probiotics taken during pregnancy might help lower the risks of pre-eclampsia and premature birth, suggests observational research in the online journal BMJ Open. But timing may be crucial, the findings indicate.
Pre-eclampsia, a condition in which the mother’s body mounts an exaggerated inflammatory response, affects up to 8% of all pregnancies, and can lead to severe complications for both mother and baby.
Premature birth (before 37 weeks) is a leading cause of illness and disability among the children born, affecting nearly one in 10 births in the US.
A growing body of evidence suggests that the mother’s diet influences the outcome of pregnancy. And previous research has suggested that probiotics might reduce certain complications of pregnancy.
To find out whether the timing of intake might be influential, the researchers used data on more than 70,000 pregnancies from the Norwegian Mother and Child Cohort Study (MoBa).
As part of the MoBa study, mums-to-be provided information on their diet, lifestyle, medical history, and other relevant background factors at 15, 22, and 30 weeks of pregnancy.
At 15 and 30 weeks, the questions included additional information on intake of different milk products containing probiotic bacteria before and during their pregnancy.
Nearly one in four (just over 23%; 6502) women said they had consumed probiotic milk products before their pregnancy; more than a third (over 37%; 11,221) had done so during early pregnancy; and a similar proportion (just over 32%; 12,784) had done so late on.
Intake of probiotic milk products was more common among older, more affluent and better educated women, who were pregnant for the first time.
Among the 37,050 women included in the pre-eclampsia analysis, the condition was diagnosed in one in 20 (5%; 1851). In 550 of these cases, it was severe. Probiotic intake was associated with a 20% lower risk of the condition, but only during late pregnancy.
And when differences between the severity of pre-eclampsia were looked at separately this association was significant only for those whose condition was severe.
Among the 34,458 women included in the premature birth analysis, 2858 babies were born early, some 1795 of which were spontaneous premature births, and 1065 of which were iatrogenic – in other words, caused by the consequences of medical treatment.
A significant association emerged between probiotic intake during early pregnancy and an 11% lower risk of premature birth, rising to 27% for preterm birth late in the pregnancy.
The amount of probiotic consumed didn’t seem to make any difference, the findings showed.
This is an observational study, so no firm conclusions can be drawn about cause and effect, nor were the researchers able to account for strain viability or shelf life, both of which may have influenced the findings. Further research is required, they emphasise.
Nevertheless, they conclude: “If future randomised controlled studies support a protective effect of probiotic consumption on reduced risk of pre-eclampsia and preterm delivery, recommending [it] would be a promising public health measure to prevent these adverse pregnancy outcomes.”
Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway. BMJ Open; http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-018021
The Sixth Nutrition and Hydration Week – 12th – 18th March 2018
Planning is taking place around the country in NHS Trusts and care homes with a view to holding events to promote their good practices and key messages on food and drink for those they care for.
There are many others around the world also making plans, especially on Wednesday 14th March when Afternoon Tea is the focus. The Weeks founders have also suggested other themes for people to use during the week: Monday – Breakfast; Tuesday – Snacks; Thirsty Thursday; Fruity Friday, Smoothie Saturday and Sundae Sunday.
Nutrition and Hydration Week will also continue its focus on:
- Promoting the 10 Key Characteristics for Good Nutritional Care
- Promoting Mealtimes Matter and Protected mealtimes
- Encouraging the introduction of Nutrition Advocates/Champions to each health and social care setting
- The introduction of minimum standards for good nutrition in all settings
- Sharing good nutrition and hydration practice
- Promoting continued education and professional development, especially in the health and social care sector for catering staff
- Improving staff awareness of their own hydration and nutritional requirements.
A detailed Charter of the week’s objectives is on the website.
Caroline Lecko commented: “We are amazed and inspired by the lengths people go to support those they care for by utilising the Week. Every year they just go the extra mile to grasp the opportunity to highlight and share their great work.”
Andy Jones added: “It’s brilliant to see how the Week has grown into a global event, and the willingness of people to collaborate across continents has been fantastic. It is through these people we have been able to make the Week the focal point of the year for many.”
Derek Johnson stated: “The Week has been fantastic for sharing ideas, highlighting great work and providing a platform for people to promote their own services. The collaboration between professionals and across heath and care has been tremendous and long may this continue.”
For further details of the legacy that Nutrition and Hydration Week is building across health and social care click here.
Advisory Committee on Borderline Substances (ACBS) Vacancies
Calling all BAPEN members... there are currently vacancies on the ACBS.
For full details, visit: www.gov.uk/government/organisations/department-of-health-and-social-care/about/recruitment