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News Round-up

 

PENG Survey on Use of Water in Enteral Nutrition

The Parenteral and Enteral Nutrition Group (PENG) of the British Dietetic Association (BDA) are inviting professionals working with people receiving enteral nutrition to complete an online survey about the use of water in enteral nutrition.

PENG initially surveyed dietitians about water practices in 1999, and are aiming to establish how practice has changed since that time.

PENG are looking for responses from individuals rather than from groups. The survey should take no more than 20 minutes to complete. The deadline for responses is 31st December 2019.

To complete the survey, please visit: https://qmu.onlinesurveys.ac.uk/water-usage-in-enteral-nutrition-2

 

Malnutrition Pathway Expands its Resource Library

Further to the recent update of the ‘Managing Adult Malnutrition in the Community’ guideline document and patient leaflets a number of new materials have been developed to assist healthcare professionals in identifying and treating malnutrition.

“The new materials have been developed in collaboration with experts working with malnourished patients across the UK in response to requests from professionals for resources in these areas,” says Anne Holdoway, Consultant Dietitian and Chair of the Consensus Panel which developed the guide. “There is some great work going on up and down the country to ensure patients are identified and treated for malnutrition and I would like to thank those who have been involved in the development of these resources for sharing their knowledge with other professionals in order to help raise awareness of malnutrition and encourage best practice across the UK.”

The new resources include a range of fact sheets, PowerPoint presentations for use in educating other professionals and a series of top ten tips for implementing the malnutrition pathway designed for specific professional groups.

Fact sheets

  • Dysphagia – an A4, 8-page, fact sheet compiled by Anita Smith, Consultant/Professional Lead Speech and Language Therapist and Anne Holdoway, Consultant Dietitian. This fact sheet includes information on the clinical consequences, causes and prevalence of dysphagia. It also includes as tips on managing patients with dysphagia and identifying those who are at risk of malnutrition as well as information on the International Dysphagia Diet Standardisation Initiative (IDDSI) framework for texture modification.
  • Falls – Every year more than 1 in 3 people over 65 suffer from a fall.1 With nutritional status being an independent predictor of falls in older people in the community2 and improvement in nutritional status having been found to reduce falls risk,3 this fact sheet outlines key actions for implementing nutrition screening and assessment into falls pathways. Compiled by Louise Nash, Frailty Dietitian and Anne Holdoway, Consultant Dietitian.
  • Care Homes – Aimed at the 11,300 care homes looking after around 410,000 residents in the UK4 this fact sheet outlines why older people and the elderly are particularly vulnerable to malnutrition, why is it important for homes to acknowledge the problem of malnutrition and outlines considerations for good nutritional care. This fact sheet has been compiled by Dr Anita Nathan, GP and Member of the GPs Interested in Nutrition Group in conjunction with Anne Holdoway, Consultant Dietitian.

PowerPoint presentations

There are two PowerPoint presentations on the website which have been designed to assist professionals in educating other healthcare professionals on malnutrition and to assist in presenting the financial case for treating malnutrition to reduce healthcare costs:

  • 'A Guide to Managing Adult Malnutrition in the Community’ - this presentation gives an overview of the Managing Adult Malnutrition in the Community guidelines. It includes referenced background information on the clinical and financial consequences of malnutrition as well as information on key national guidelines which focus on the identification and treatment of malnutrition.
  • ‘Counting the Cost of Malnutrition and its Management’ – focusing on the huge financial burden (>£23 billion per year) that malnutrition places on health and social care in the UK (with a breakdown for England, Ireland, Scotland and Wales). This presentation discusses how we might reduce these costs and support NICE guidance through identification and timely management.

Top Ten Tips series

The Top Ten Tips series has been developed so that guidance on using the malnutrition pathway in practice can be focused according to specific professional groups. The tip series includes guidance for:

  • Dietitians – including actions they might consider in order to implement the use of the malnutrition pathway in their area and engage stakeholders and community healthcare professionals in the identification and treatment of malnutrition.
  • GPs – advising on how GPs might incorporate malnutrition screening and treatment into their everyday activities particularly in high risk groups.
  • Pharmacists – focusing on time and resource efficient actions that Pharmacists might consider in order to ensure patients with malnutrition are identified and treated. Tips separated into those specific to Community Pharmacists and those for Pharmacists in GP Surgeries.
  • Nurses – looking at integrating nutritional screening and care into current practice and how nurses might engage with other key stakeholders to implement the malnutrition pathway.
  • Care Homes – aimed at all professionals working in care homes this tip sheet give advice on identifying and managing malnutrition, including the implementation of care plans and engagement with other care home personnel to create an environment that prevents malnutrition.

The website, also now includes specific sections for dietitians, GPs, nurses, pharmacists, speech and language therapists, patients and carers, and aims to enable professionals, patients and carers to easily access materials that are most relevant to them (www.malnutritionpathway.co.uk/healthcare-index). A section has also been launched aimed at those working in care homes which includes top ten tips for care homes, the care homes fact sheet and example care plans for those at high, medium and low risk of malnutrition (www.malnutritionpathway.co.uk/carehomes).

Professionals can sign up to the Pathway newsletter which comes out three times a year and includes updates on relevant guidelines, reports, clinical papers and activities relating to disease related malnutrition. Previous copies of the Pathway can be downloaded here and professionals can sign up to get updates by clicking here.

The ‘Managing Adult Malnutrition in the Community’ guide and pathway is being used across the UK and since its launch in June 2012 www.malnutritionpathway.co.uk has been visited by over 85,000 professionals, patients and carers.

All of the resources can be downloaded for free from the website.

References: 1. Age UK. Stop Falling: Start Saving Lives and Money. 2010.; 2. Chien MH and Guo HR. Nutritional status and falls in community-dwelling older people: a longitudinal study of a population-based random sample. PLoS One. 2014. www.ncbi.nlm.nih. gov/pubmed/24614184.; 3. Neyens et al. Malnutrition is associated with an increased risk of falls and impaired activity in elderly patients in Dutch residential long-term care: A cross-sectional study. Archives of Gerontology and Geriatrics. 2013; 56(1): 265-269.; 4. Care homes market study: summary of final report. 2017. https://www.gov.uk/government/publications/care-homes-market-study-summary-of-final-report/carehomes-market-study-summary-of-final-report.

 

Vitamin D Deficiency is Associated with Poor Muscle Function in Adults aged 60+

New research from Trinity College Dublin shows that vitamin D deficiency is an important determinant of poor skeletal muscle function in adults aged 60 years and over. Maintaining skeletal muscle function throughout life is a crucial component of successful ageing, in promoting independence, mobility, quality of life and reducing falls and frailty. While resistance exercise is known to preserve muscle function, there is growing evidence that adequate vitamin D status may also be protective. The paper was recently published in the international journal Clinical Interventions in Ageing.

Key findings

  • The prevalence of muscle weakness was twice as high among older adults with vitamin D deficiency (40.4%) compared with vitamin D adequacy (21.6%).
  • Similarly, impaired 'muscle performance' was 3 times higher in older adults with vitamin D deficiency (25.2%) compared with vitamin D adequacy (7.9%).
  • Based on more complex statistical analysis, the study showed that vitamin D deficiency significantly increased the likelihood of impaired muscle strength and performance.
  • The study confirmed the associated benefits of physical activity. Older adults partaking in regular moderate physical activity had significantly lower likelihood of poor muscle strength and physical performance.
  • In summary, vitamin D deficiency was associated with impaired muscle strength and performance in a large study of community-dwelling older people.
  • It is generally accepted that vitamin D deficiency (at the 25(OH)D <30 nmol/L cut-off) should be reversed to prevent bone disease, this strategy may also protect skeletal muscle function in ageing.

The findings are based on the analysis of data from 4157 community-dwelling adults aged 60 years and over, from the English Longitudinal Study of Aging (ELSA). Two validated measures of muscle function were assessed, namely hand grip strength and the Short Physical Performance Battery (SPPB). Serum vitamin D was measured [25-hydroxyvitamin D] with a concentration <30 nmol/L classed as vitamin D deficient, the cut-off known to be associated with bone disease.

Maria O'Sullivan, Associate Professor in Nutrition at Trinity College Dublin said: "Our results show that vitamin D deficiency increased the likelihood of poor muscle function in older adults and confirms the protective effect of physical activity. Maintaining muscle function is incredibly important, and often overlooked, in promoting healthy ageing. Addressing this through multimodal approaches that incorporate physical activity, reversing vitamin D deficiency and other modifiable diet and lifestyle components require further investigation."

Dr Niamh Aspell, first author of the study said: "Overall our findings add weight to the evidence in favour of public health strategies to eliminate vitamin D deficiency in older populations. Future research, however, should identify and focus on older adults with vitamin D deficiency and aim to better understand if reversing this deficiency improves skeletal muscle function."

Dr Eamon Laird, Co-Author and Trinity Research Fellow added that: "Vitamin D deficiency and physical activity are modifiable factors. Some countries, for example Finland, have successful implemented a vitamin D food fortification policy which has all but eliminated deficiency in the population. Such a policy could similarly be implemented in the UK and Ireland for older populations."

Niamh Aspell N, et al. (2019). Vitamin D Deficiency Is Associated With Impaired Muscle Strength And Physical Performance In Community-Dwelling Older Adults: Findings From The English Longitudinal Study Of Ageing. Clinical Interventions in Aging; 14: 1751 DOI: 10.2147/CIA.S222143.

 

FODMAPs Diet Relieves Symptoms of Inflammatory Bowel Disease

New research from King’s College London has found that a diet low in fermented carbohydrates has improved certain gut symptoms and improved health-related quality of life for sufferers of inflammatory bowel disease (IBD).

In a paper published in Gastroenterology a team of researchers carried out a trial of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) in patients with IBD, experiencing persistent gut symptoms despite gut inflammation being under control. They found that a four-week low FODMAP diet improved certain gut symptoms such as swelling of the stomach and flatulence compared to those on a placebo diet.

Working with leading gastroenterologists from Bart’s Health NHS Trust and Guy’s and St Thomas’ NHS Foundation Trust, the researchers studied 52 patients who suffer from IBD, and who had persistent gut symptoms despite no on-going gut inflammation, and allocated them to two groups; one to a low FODMAP diet, restricting intakes of foods such as wheat, dairy, onions and garlic, and the other a controlled ‘normal’ FODMAP diet. Of the group that received the low FODMAP diet, 52% reported adequate relief of gut symptoms, had a greater reduction in gut symptom severity and had a higher health-related quality of life score.

Lead researcher Dr Selina Cox from King’s College London, said: “While we know that the low FODMAP diet is effective in patients with irritable bowel syndrome (IBS), this is the first randomised, trial showing that it’s effective in reducing common gut symptoms. This improves health-related quality of life in patients with IBD when they are in remission.”

At present, there is no cure for IBD, but symptoms are managed with a combination of anti-inflammatory and immune-modulating medication, and surgery. However, symptoms can persist during periods of disease remission even when they are receiving medication to control gut inflammation, and patients report these symptoms to have a large impact on their life.

The authors also found the low FODMAP diet reduces certain gut bacteria, such as Bifidobacteria, that may be beneficial to health and may reduce inflammation. Despite the changes in beneficial bacteria, gut inflammation did not appear to increase after the low FODMAP diet in patients with IBD.

“We carried out this randomised controlled trial to establish whether these common gut symptoms in patients with IBD in remission could be managed by the low FODMAP diet. Indeed, this could represent a safe and cost-effective management option.” said Professor Kevin Whelan from King’s College London.

The team now plan to study the effects of a longer-term low FODMAP diet and establish the effect of FODMAP reintroduction on gut symptoms and gut bacteria.

Cox SR, et al. (2019). Effects of Low-FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients with Quiescent Inflammatory Bowel Disease in a Randomized Trial. Gastroenterology; DOI: https://doi.org/10.1053/j.gastro.2019.09.024.

 

Malnutrition Awareness and Prevention Network Calls for more action to be taken to prevent malnutrition in the UK

With 1.3 million older people in the UK malnourished or at risk of undernourishment, a new Malnutrition Awareness and Prevention Network (MAPN)* has been launched to call for increased funding for vital social care services for older people, such as meals on wheels and other community-based services (such as lunch clubs, support with food shopping and preparing meals).

The MAPN is calling for the recommendations in the 2018 All-Party Parliamentary Group on Hunger’s report Hidden Hunger and Malnutrition in the Elderly to be implemented as a social care priority. Key recommendations from the report include ensuring that care staff are trained to use the Malnutrition Universal Screening Tool to identify older people who are at risk of malnutrition. The report also recommends that providing older people who are at risk of malnutrition with at least one hot meal every day becomes a statutory duty for all local authorities. However, these recommendations have not yet been included in social care policy.

MAPN will campaign for greater awareness of malnutrition and dehydration amongst older people to help both families and members of the care community to spot the signs and take action to improve affected people’s diet and food security. The network has been running a Twitter campaign, Malnutrition Monday, throughout 2019 to help both families and members of the care community to spot the signs of malnutrition and take action to support those affected.

Professor Wendy Wills, Director of the Centre for Research in Public Health and Community Care (CRIPACC) at the University of Hertfordshire, commented: “The numbers of people living into and beyond their 80s and 90s will continue to increase in the UK and it is therefore vital that older people are supported to remain well-nourished so that they have a good quality of life. Family members, older people themselves and the health and social care professionals they come into contact with need to know about the signs of malnutrition so they can take steps to prevent this. MAPN will play an important role, to campaign for greater recognition and action to address malnutrition among the UK’s older population.”

* Members of the network include representatives from: the Malnutrition Task Force, University of Hertfordshire, Hertfordshire Independent Living Services, Eat Well Age Well, Food Train, Greater Manchester Nutrition and Hydration Programme, BDA Older People Specialist Group, Wessex Academic Health Science Network and Nutrition and Diet Resources UK.

 

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