Dietetics

Our Medical Team

Gastroenterology

Working within Gastroenterology, we provide patient care across both the ward and clinic setting, working closely with specialist nurses and doctors to provide the best results. We offer dietary advice to patients with a wide range of conditions such as Crohn's disease, ulcerative colitis, irritable bowel syndrome (IBS), pancreatitis, bacterial overgrowth and liver disease. We offer advice and support on dietary restrictions to help with gut-related symptoms, including reducing or increasing fibre intakes, whilst also offering guidance on specialist diets such as the low FODMAP diet. From experience, we recognise that no two patients with bowel conditions are the same and are happy to use our knowledge and skills to provide a tailored service to meet individual needs.

Stroke

There is a 31-bed hyperacute and acute stroke unit that accepts patients from a wide geographical area. Close links with therapy colleagues provide enhanced multi-professional working.

Respiratory

There are three respiratory wards and one of these has Non-Invasive Ventilation (​NIV) beds. Royal Stoke​​ specialises in​​ PEG (Percutaneous Endoscopic Gastrostomy)​ insertion under NIV so is a specialist centre for people with Motor Neurone Disease. In addition the hospital and more specifically the respiratory, neurology and palliative care teams contribute to the MNDA (Motor Neurone Disease Asso​ciation) Care Network and are developing an improved care pathway for these patients.

Cystic Fibrosis

The North West Midlands Cystic Fibrosis (CF) Centre is a designated centre providing care for children and adults with CF across North and South Staffordshire, Burton, Shropshire and Wolverhampton.  The CF Specialist Dietitians are an integral part of the centre's paediatric and adult multi-disciplinary teams which contain motivated and highly skilled individuals.  The high quality care offered by both teams and the excellent facilities were highlighted in a recent CF Trust peer review.  Patients receive input from our teams during inpatient hospital stays, outpatient visits to clinic and care whilst at home. We cover a wide geographical area caring for nearly 140 patients and are part of monthly outreach clinics in Shrewsbury and Wolverhampton. As dietitians we also participate in providing training and education, regional and centre service meetings and weekly multi-disciplinary team meetings. We work closely with our diabetes team colleagues to ensure optimum care for our patients.

Diabetes

The diabetes team's work is a combination of out-patient clinic work, group work, training of other health professionals and in-patient work. We work with people with Type 1 diabetes, Type 2 diabetes and gestational diabetes. The team work with consultants and diabetes nurses to support people to understand diabetes and make lifestyle choices to help their condition.

Our Surgical Team

Trauma

The UHNM Major Trauma Centre is one of 22 adult centres in England providing care to those who have suffered a significant injury in the North West Midlands and North Wales. Our bespoke Acute Rehabilitation and Trauma Unit is one of the first hyper-acute specialised rehabilitation units to be developed within a Major Trauma Centre. Dietitians work as part of the multi-disciplinary team, providing individualised dietary advice to help patients achieve their maximum rehabilitation potential.

Oncology

The Oncology team provides nutritional advice to patients that are experiencing difficulties with eating, drinking or weight changes due to their cancer or treatment.

We can provide information on how the cancer and treatment may impact eating and drinking, along with tailored dietary advice to support patients to deal with some of the common side effects of cancer or treatment, such as taste changes, sore mouth, nausea, poor appetite, unintentional weight changes and adapting to a modified texture diet.

We see patients across a range of settings in the cancer centre, including on our inpatient wards, chemotherapy unit, radiotherapy centre and outpatient clinics both at Royal Stoke University Hospital and County Hospital. We work very closely with the wider multidisciplinary team and will regularly see patients alongside doctors, specialist nurses and speech and language therapists.

If you or someone you know are experiencing problems with eating or unintentional weight changes, speak with a doctor, nurse or healthcare professional at the hospital who can make a referral to our team.

For further information or helpful tips on eating, diet and cancer, click on the link below to view Macmillan's full range of diet resources:

 https://www.macmillan.org.uk/information-and-support/coping/side-effects-and-symptoms/eating-problems

Critical Care Unit

Critical care dietitians work with patients who have been admitted to the intensive care unit for the management of acute life-threatening conditions.  This can include patients with a wide range of medical conditions e.g. following major surgery, trauma, severe infections and respiratory disorders.  There is a 36-bed unit split over 4 pods.  Dietitians in the team work very closely with the multi-disciplinary team including doctors, pharmacists, surgeons and nurses.

We also have a 16-bed cardiothoracic critical care unit which is also supported by the dietetic team.

Bariatric

The bariatric dietetic team delivers pre-operative dietary support and education in the outpatient environment to patients who are due to undergo bariatric surgery. We also see our patients when they are admitted for their operations and then follow them up for two years following surgery. Our input ranges from general healthy eating and weight reduction advice to dealing with deficiencies of specific macro and micro nutrients post-operatively. There are three dietitians and a dietetic tech in our team and we work closely as a multi-disciplinary team with bariatric clinical nurse specialists, surgeons, endocrinologists and anaesthetists.​

Our Renal Team

We are a team of seven specialist dietitians. We help patients with kidney disease, working alongside the wider team and serving the Staffordshire and Cheshire areas.

We provide care to patients with all levels of kidney disease requiring dietary advice. This includes the following:

• Dialysis – We provide haemodialysis at Royal Stoke (this is our base unit) and we have two satellite units, County Hospital and South Cheshire. We also provide home haemodialysis and peritoneal dialysis
• On the ward
• Critical Care
• Patients with a kidney transplant

Dietary advice is individualised to each patient depending on their blood results, treatment plans and any additional medical conditions. ​

Our Paediatric Team

Our highly skilled team of paediatric dietitians work closely with clinicians and multidisciplinary teams in many specialties within the children's unit, advising on therapeutic diets or nutritional support for in-patients. They also attend multidisciplinary clinics with specialist teams and run busy dietetic-led outpatient clinics for a range of conditions, accepting referrals from local GPs and consultants at UHNM, for children and young people at the Royal Stoke and County Hospitals. Our aim is to provide patient-centred holistic care.

Our team is made up of a dedicated dietetic assistant and 11 paediatric dietitians, some of whom are nationally renowned for the work they do within their specialist areas, contributing to nutrition publications and national guidelines.

Specialist areas include Neonatology, Gastroenterology, Parenteral Nutrition, Home Enteral Feeding, Children's Intensive Care Unit (CICU), Eating Disorders, Diabetes, Prader Willi, and Cancer and Cystic Fibrosis. UHNM is a regional centre for Cystic Fibrosis.

Our County Hospital Team

At County Hospital we have a team of two dietitians and a dietetic assistant who provide a wide-ranging inpatient and outpatient service to patients who live in the Stafford area.

Inpatient services include dietetic support for acute medical conditions, endocrine conditions, care of the elderly and respiratory wards as well as the small critical care and busy chemotherapy unit. We pride ourselves on working closely with the active multi-disciplinary teams and close liaison with our catering team who produce patient food onsite.

We hold six outpatient clinics on a weekly basis. These cover general referrals and more specialist patient groups such as IBS/FODMAP and head and neck o​ncology patients.​

Our Community Team

The community team consists of three dietitians. We hold clinics in a range of community locations and provided individualised dietary advice upon receipt of a referral from the GP. The GP can also request home visits for patients who are housebound and also for those who are in care homes. We work as part of the multidisciplinary community teams, liaising with district nurses, GPs, diabetes specialist nurses and speech and language therapists. ​

Please click on the link below if you have been invited to attend your appointment via Attend Anywhere video calling.

The virtual waiting room opening hours are 08:45 AM to 04:15 PM.

https://nhs.vc/uhnm/dietetics

(Please note, if you have not been invited to attend your appointment via Attend Anywhere, do not click on this link, as you will not be seen once you are admitted to the virtual ‘waiting room’).

I’ve been diagnosed with IBS, will changing my diet help? from UHNM NHS Trust on Vimeo.

Carbohydrate Counting

Rice

Fish fingers

Pizza

Crackers

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From BDA, The association of UK Dietitians

Irritable Bowel Syndrome (IBS) is a medical term used to describe a collection of gut symptoms.

Symptoms vary from one individual to another and can be worse for some than others. It is a very common condition affecting around one in five adults. An assessment for IBS should be considered if you have had any of the following symptoms for at least six months: abdominal pain or discomfort, bloating, or change in bowel habit.

A diagnosis of IBS should be considered only if there is abdominal pain or discomfort that is either relieved by defaecation or associated with a change in bowel habit.

This should be accompanied by at least two of the following four symptoms:

• altered stool passage (straining, urgency, incomplete evacuation
• abdominal bloating (more common in women than men), distension, tension or hardness
• symptoms made worse by eating
• passage of mucus.

Other features such as lethargy, nausea, backache and bladder symptoms are common in people with IBS, and may be used to support the diagnosis. It is important to have a diagnosis of IBS confirmed and other conditions such as coeliac disease and inflammatory bowel disease ruled out. Four reasons to consult your doctor for referral to see a specialist are where you have possible IBS symptoms and any of the following:

• unintentional and unexplained weight loss rectal bleeding
• a family history of bowel or ovarian cancer
• a change in bowel habit to looser and/or more frequent stools persisting for more than six weeks in a person aged over 60 years.

What steps can I take if I have IBS?

Try to:

• eat three regular meals a day
• try not to skip any meals or eat late at night (smaller meal sizes may ease symptoms
• limit alcohol intake to no more than two units per day and have at least two alcohol free days a week
• reduce intake of caffeine-containing drinks e.g. no more than two mugs (three cups) a da
• reduce intake of fizzy drink
• drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks, for example herbal tea
• cut down on rich or fatty foods including chips, fast foods, pies, batter, cheese, pizza, creamy sauces, snacks such as crisps, chocolate, cake and biscuits, spreads and cooking oils, and fatty meats such as burgers and sausages
• reduce your intake of manufactured foods and cook from fresh ingredients where possible
• limit fresh fruit to three portions per day (one portion is 80g).

Seek advice from a healthcare professional about the amount of dietary fibre that is right for you.

Helpful Hints:

• take time to relax – relaxation tapes, yoga, aromatherapy or massage may help
• take regular exercise such as walking, cycling, swimming
• take time to eat meals – chew your food well
• keep a food and symptom diary whilst you are making changes so you can see what has helped
• Make one change at a time so that you can see what has helped.
• Make changes according to your symptoms.

Dietary changes can often help IBS symptoms and sometimes simple changes are all that are needed

If symptoms include bloating and wind:

• Limit intake of gas producing foods e.g. beans and pulses, Brussels sprouts, cauliflower, and also sugar-free mints/chewing gum.
• You may find it helpful to eat oats (such as oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day).

If symptoms include constipation:

• Try to gradually increase your fibre intake – any sudden increase may make symptoms worse. Rich sources include wholegrains, oats, vegetables, fruit and linseeds. They help to soften stools and make it easier to pass.
• Try adding one tablespoon per day of brown or golden linseeds (whole or ground) to breakfast cereal, yoghurt, soup or on salad. Have around a small glass/teacup (150ml) of fluid with each tablespoon of linseeds taken.
• Avoid eating extra wheat bran

If symptoms include diarrhoea:

• Replace lost fluids by drinking plenty.
• Limit caffeine intake from tea, coffee and soft drinks to three drinks per day.
• Try reducing intake of high-fibre food (such as whole-wheat breakfast cereals and breads)
• Avoid sugar-free sweets, mints, gum and drinks containing sorbitol, mannitol and xylitol.

Probiotics

You may wish to try ‘probiotic’ supplements, yoghurts or fermented milk drinks. Take them daily for at least four weeks to see if they improve symptoms. If they do not appear to help then you could try an alternative brand.

Further advice

Give your bowels time to adjust to any changes. If your symptoms persist after following general lifestyle and dietary advice, try to re-introduce the foods you have cut out and ask your doctor to refer you to a healthcare professional with expertise in dietary management, who can ensure your diet is nutritionally adequate whilst following dietary intervention e.g. a dietitian.

They may suggest you trial a diet restricted in shortchain fermentable carbohydrates (also known as a low FODMAP diet). Most people will be able to see an NHS dietitian after being referred by a doctor, health visitor or other medical staff. You may be able to self refer. Alternatively, if you wish to see a private dietitian, you can search online at freelancedietitians.org, which is run by the BDA’s Freelance Dietitian Group.

NOTE: IBS is not caused by food allergy. If you feel that you may be suffering with a food allergy, please refer to Allergy UK or Anaphylaxis Campaign for further information.

Summary

Dietary changes can often help IBS symptoms and sometimes simple changes are all that are needed. Remember to monitor your progress by keeping a food and symptom diary. If you need further help, ask your doctor to refer you to a healthcare professional with expertise in dietary management.

From BDA, The association of UK Dietitians

What are probiotics?

Although people tend to think that bacteria are harmful germs that spoil food or make you ill, there are many bacteria that are good for our health. The gut is the organ of the body where food is digested and absorbed and it naturally contains trillions of bacteria that are important for helping us stay healthy. Probiotics are ‘good’ bacteria found in food products or supplements that can beneficially affect our health by improving the balance and function of the gut bacteria. They are found in many different forms such as yoghurts, tablets, capsules and sachets.

Probiotics are generally considered safe for healthy people of all ages. However, people whose immune system does not function properly may be at risk when taking a probiotic and should seek specific advice from a doctor or dietitian.

How do probiotics work?

Many probiotics have been shown to restore the balance of the gut bacteria which can help our body work at its best. When we eat or drink probiotics they compete for space and for food with potentially harmful bacteria – evicting them from our gut. Probiotics also stimulate our own immune system to help it to fight infections better. For example, some studies have shown that they can make colds last for shorter lengths of time and improve your response to vaccines!

Probiotics can also help us to digest fibre from our diet. When they do this, probiotics produce acid compounds that keep the lining of our gut healthy.

Did you know?

The number of bacteria in your gut is almost ten times more than the number of your own body cells. If you gathered all of your gut bacteria together, they would weigh approximately 1kg (over 2lb). The bacteria in the gut can be knocked out of balance for many different reasons, including: getting older, taking antibiotics, illnesses such as irritable bowel syndrome or inflammatory bowel disease or following an episode of food poisoning (gastroenteritis) or gut surgery.

What can probiotics be used for?

A lot of research has been done to find out if taking probiotics is good for healthy people and people with specific disorders. The scientific evidence for their use keeps growing, but here are a few areas where probiotics may be beneficial:

Taking a course of antibiotics

Antibiotics are really useful at fighting off bacterial infections, however, they also cause major changes to the balance of our gut bacteria, which sometimes results in us getting diarrhoea. Lots of research shows that many probiotics will help protect people from getting diarrhoea when they take antibiotics. Probiotics must be taken as soon as you start the antibiotics and continue for at least one week after the end of the course.

Preventing the Clostridium difficile superbug

Some people, particularly those taking antibiotics, are at risk of catching the gut superbug Clostridium difficile (sometimes called “C-diff”). This bug causes very bad diarrhoea, and although it can be treated with antibiotics, up to four in ten people will get C-diff again. Dietitians and other clinical researchers have found that a probiotic milk drink containing Lactobacillus casei and Lactobacillus bulgaricus may prevent older people who are taking antibiotics in hospital from getting C-diff in the first place.

Travelling overseas

Travellers’ diarrhoea can occur due to a bacterial or viral infection during or following a trip to specific countries. The symptoms are passing watery stools three or more times a day, either during or shortly after travelling. It usually lasts for around three to five days and is a common but usually mild illness that is spread through poor hygiene. A review of 12 different studies has shown that overall probiotics can reduce the chance of you getting travellers’ diarrhoea. If you are going to a part of the world where
travellers’ diarrhoea is common then you might consider taking the probiotic Saccharomyces boulardii or a mixture of probiotics called Lactobacillus acidophilus and Bifidobacterium bifidum for the entire holiday.

Constipation

Constipation is common in the UK and its symptoms include infrequent bowel movements, hard stools, a bloated stomach and straining. Recent studies have shown that probiotics may help to ease the symptoms of constipation. If you suffer from constipation, try products that contain Bifidobacterium lactis for a trial period of four weeks. If they don’t work, try another brand or stop taking them.

Irritable bowel syndrome (IBS)

Approximately one in ten adults in the UK have IBS and symptoms include severe diarrhoea or constipation, together with abdominal pain. Some patients with IBS have been shown to have changes in the balance and function of their gut bacteria. Although many of the studies so far have been small and inconclusive, in general researchers have shown that certain probiotics may help to reduce symptoms of IBS, particularly bloating. Dietitians recommend that patients with IBS take probiotics for a trial period of four weeks and if they don’t work to try another brand or stop them – they won’t work for everybody.

Inflammatory bowel disease

Ulcerative colitis and Crohn’s disease are both inflammatory bowel diseases that result in severe diarrhoea and major changes to the balance of the gut bacteria. Some probiotics have been shown to be very useful for patients with ulcerative colitis, particularly for helping them to stay well for longer. However, their use for patients with Crohn’s disease is not as conclusive.

Prebiotics

Some probiotics find it difficult to reach the gut because they are killed by acid in the stomach. One way of boosting your own natural good gut bacteria is through eating prebiotics. Prebiotics are types of carbohydrate that only our gut bacteria can feed upon. Eating prebiotics therefore causes more good gut bacteria to grow in your gut.

You can get prebiotics by eating onions, garlic, asparagus, artichoke, chicory and banana. However, in the UK we don’t eat large quantities of these foods and so some people choose to take a prebiotic supplement such as fructo-oligosaccharide. Although some research studies have been done on the use of prebiotics in the areas covered above, in general, more studies have been done on probiotics. More research is required in these areas for the use of prebiotics.

Did you know?

Not all probiotics work the same way! Research has shown that different probiotic bacteria have different effects in health and disease, which means not all probiotics will help with all symptoms or conditions. Ask your doctor or dietitian for information on the best probiotic to use for your symptoms.

Summary

There are lots of natural bacteria in our gut which help us stay healthy but these can sometimes be knocked out of balance. Probiotics are good bacteria which can improve the balance of our gut bacteria and can be found in food products such as fermented milk drinks, some yoghurts and supplements.

Probiotics are generally safe for healthy people to take. However people whose immune systems do not work properly may be at risk so they should seek professional advice beforehand.

From BDA, The association of UK Dietitians

Fibre is an essential nutrient for the normal functioning of the gut. It is related to a reduced risk of chronic diseases such as diabetes, cardiovascular disease, type 2 diabetes and bowel cancer.
Most of us need to eat more fibre and having a very good intake from a wide variety of foods is linked to a better overall nutritional intake.

What is fibre?

Dietary fibre is the edible parts of plants resistant to digestion and absorption in the small intestine. It is completely or partially broken down by bacteria in the large intestine. Fibre includes carbohydrates called polysaccharides and oligosaccharides, plus lignin. The many health benefits of fibre are shown in Table 1.

Table 1:

Health benefits of fibre

Some of the best food choices for fibre are:

• starchy foods: porridge, oat bran, high fibre breakfast cereals, sweet potato, potato with skin, wholemeal or wholegrain bread and pasta 
• beans and pulses such as baked beans, hummus and dahl
• vegetables: peas, parsnip, mixed veg (from frozen), green beans, carrot, canned sweetcorn and broccoli
• fruits: pear, apple, raspberries and blackberries, plums and prunes, banana and orang
• seeds such as linseeds and chia seed
• nuts such as almonds, hazelnuts and peanut butter.

When you read food labels check for the grams of fibre per serving or 100 g. A food product is: ‘high fibre’ if it contains at least 6g of fibre per 100g a ‘source of fibre’ if it contains at least 3g of fibre per 100g.

How much fibre do you eat?

In the UK, the average fibre intake for adults is 60% (18g) of what it should be (30g). Overall for children, those at primary school age should try to eat 5g more a day, whilst those secondary school aged should try to eat 9g more. For adults, dietary fibre intake should increase to 30g a day, as part of a healthy balanced diet.

Table 2:

How much fibre should I have?

Tips on how to increase your fibre

• Have a high-fibre cereal at breakfast.
• Add fruit to breakfast cereal.
• Have an oat-based cereal bar as a snack (*be aware of sugar content - check the label)
• Mix linseeds into yogurt.
• Have a wholemeal sandwich at lunch with carrot sticks and hummus
• Try a homemade vegetable soup with rye bread
• Have wholemeal pasta with vegetables at dinner time.
• Add pulses such as baked beans and lentils to dishes
• Add extra vegetables to sauces such as bolognaise, curry and chilli.
• Keep a supply of frozen vegetables so you are never without!
• Leave the skin on vegetables and fruit and aim to have 5 portions of fruit and vegetables a day. Have fresh fruit as a snack
• Blend together some fruit and milk/yogurt for a refreshing smoothie.
• Other snack ideas include an oat-based cereal bar, trail mix, popcorn or a slice of wholemeal toast

An example of foods to choose to provide you with the recommended ‘at least 30g of fibre’ in a day (for an adult)

If you need further help, ask your doctor to refer you to a dietitian.

Summary

Remember to increase your fibre intake gradually to avoid gastrointestinal symptoms such as bloating and gas and allow your gut to adjust to the higher intake. Remember to drink plenty of fluid, to allow the fibre to do its job properly, aiming for 8-10 cups of fluid per day at regular intervals.

From BDA, The association of UK Dietitians

Water is essential for life. As a major constituent of the body, it has many functions including transporting nutrients and compounds in blood, removing waste products that are passed in the urine and acting as a lubricant and shock absorber in joints.

Water regulates the body’s temperature; sweating is a very effective way of reducing the body’s temperature. The water content of the body varies with age and gender; males have more water than females because women have a higher proportion of body fat.

At birth the human body is approximately 70% water and this decreases with age; in the elderly it is about 55%. Drinking enough is vital to maintain good health in the short and long term e.g. for the prevention of constipation, kidney stones and urinary tract infections. Good hydration also can prevent other conditions e.g. chronic renal disease

Recommended adequate intakes of water from drinks

What happens if I don’t drink enough?

If you don’t consume enough water you will become dehydrated. The first thing you will notice is increased thirst and a dry sticky mouth. Other effects include tiredness, poor concentration, headache and dizziness or light headedness.

How much do I need to drink?

In the UK, drinks provide 70-80 % of our water needs; the remaining 20-30 % comes from food e.g. soup, stews, some fruits such as melon and vegetables such as celery. The table below shows the recommended amount of water that should be taken as drinks per day.

These are average values and an individual’s requirement will depend on many factors including temperature and humidity and exercise. Warm and
dry environments such as air conditioned offices or centrally heated homes increase the need for water as they speed up the evaporation of sweat on the skin.

How do I know I am drinking enough?

Thirst is only part of the way we regulate hydration in the body. When you drink you stop you feeling thirsty before your body is completely rehydrated. The colour of urine is the best indicator; if you are drinking enough your urine should be a straw or pale yellow colour.

What type of drinks should I have?

To an extent this is a matter of personal taste and preference. In the UK drinking plain tap water is a good way to get enough to drink. Chilling or filtering tap water are cheap ways of making it taste more pleasant. Bottled water has the same hydrating abilities as tap water. Tea and coffee provide water and can be a good way of keeping older adults well hydrated.

However if you drink a lot of tea and coffee you need to be aware of the amount of caffeine you are consuming. This is particularly important for pregnant women.

Regular fizzy and still drinks contain a lot of sugar and should only be drunk in small amounts. Fruit juices provide water and other nutrients but contain sugar so only have one small serving per day; this counts towards your 5-a-day.

Alcohol may make the body pass more urine than usual and make you dehydrated. It’s a good idea to also drink low-sugar soft drinks or water when drinking alcohol.

Common household measures include:

1 medium size glass ≈ 200 ml
1 can of fizzy drink ≈ 330 ml
1 mug ≈ 250 ml
1 cup ≈ 200 ml

≈ = approximate measurements

Children

While adults are very good at regulating water in the body these mechanisms are not yet fully developed in children. In addition younger children can’t ask for a drink or say they are thirsty so children are particularly vulnerable to dehydration.

Access to water and avoiding lots of toilet breaks in schools can also be a problem. It is important that children drink frequently throughout the day. There is some evidence that children who drink extra water perform better in attention and memory tests.

Elderly people

Elderly people are vulnerable to dehydration and they may have difficulties accessing drinks. Fear of incontinence may also mean that some elderly people restrict their fluid intake.

Regular drinks should be encouraged; tea and coffee are a good way of getting elderly to drink. Elderly dehydrated people are at particular risk of urine infections and falls and should monitor how much they drink in hot weather.

Sport

It is important that water lost through sweat when exercising is replaced to maintain performance and health. Some athletes may find isotonic drinks useful.

Summary

Having regular drinks throughout the day will help you stay well hydrated especially when it is hot or you are exercising. Keep an eye on the colour of your urine; if it dark you need to drink more.

Children and the elderly are particularly vulnerable to dehydration and may need to be encouraged to drink more.

Further information

Food Fact Sheets on other topics including Sports, Pregnancy and Alcohol
are available at www.bda.uk.com/foodfacts

From BDA, The association of UK Dietitians

Malnutrition is a condition which happens when you don’t get the correct amount of nutrients from your diet

Malnutrition is a major public health issue costing the NHS over £19 billion per year in England alone. There are approximately 3 million people in the UK who are malnourished or at risk of malnutrition; 93% are living in their own home, 5% are living in care homes and just 2% are in hospital.

Consequences of malnutrition include:

• increased risk of illness and infection
• slower wound healing
• increased risk of falls
• low mood
• reduced energy levels
• reduced muscle strength
• reduced quality of life
• reduced independence and ability to carry out daily activities

This Food Fact Sheet will help you understand the signs of malnutrition and how to either stop it happening or to treat it.

Spotting malnutrition

Malnutrition can affect anyone, but it is more common for older people and those who are socially isolated.

This can be because they can’t get out much or because they have poor physical or mental health. It can happen over a long period of time which sometimes makes it difficult to spot.

Common signs of malnutrition are:

• unplanned weight loss – which can cause clothes, dentures, belts or jewellery to become loose
• tiredness and lethargy
• alterations in mood
• loss of appetite
• disinterest in food and/or fluids
• loss of muscle strength

Stopping and treating malnutrition

A balanced diet is essential for health and wellbeing. When someone has a poor appetite and is malnourished, nutrient dense foods as well as drinks containing nutrition can help to improve energy intake without making portions too big to manage. Protein, energy (calories) and vitamins and minerals are all important for people who are malnourished.

If you follow the points listed here, you can make sure you are eating well:

• Eat 2-3 portions of high protein foods every day such as meat, fish, eggs, nuts, beans, pulses, soya, tofu and other meat-free protein foods.
• Eat/drink 2-3 portions of dairy foods every day such as cheese, milk and yoghurt or non-dairy alternatives like soya, almond or coconut milk.
• Eat a serving of starchy food at each meal (e.g. bread, cereals, potatoes, pasta or rice).
• Eat some fruit and vegetables every day (fresh, frozen, tinned, dried or juiced).
• If you enjoy fish, go for oily fish such as mackerel, salmon, herring, trout, pilchards or sardines as these are rich in omega-3 fatty acids. Aim for 2 portions a week (can be tinned or frozen for convenience)
• Have at least 6-8 glasses/mugs of fluid every day, choosing drinks which contain some nutrition where possible such as milky drinks (malted drinks, hot chocolate, milky coffee, smoothies and milkshakes) which can provide energy, protein and vitamins and minerals or sugary drinks such as fruit juice, fizzy drinks or squash can provide extra energy.*

The following simple ideas will help you to increase the amount of energy and protein which you eat in a day:

• Eat ‘little and often’ – try a small snack between meals and a dessert after lunch and evening meal.
• Try not to have drinks just before meals to avoid feeling too full to eat.
• Avoid low fat/diet versions of foods and drinks for example skimmed or semi-skimmed milk, low fat yoghurt, sugar free drinks etc, or watery soups.
• Choose meals that you enjoy, are easy to prepare and eat, and are high in energy and protein. Items such as tinned fish or beans are easily stored and easy to prepare.
• If you are preparing food for others, remember that as we get older, our taste buds change. Older people may prefer much sweeter tastes than they used to.
• Add extra energy and protein to foods and fluid by adding high energy and protein ingredients – see above for ideas.

Add extra energy by adding high calorie ingredients to food and drinks – suggestions listed below:

Other high energy and protein foods include:*

• cheese and crackers
• thick and creamy yoghurt
• Pot of custard or rice pudding
• nuts and seeds
• cereal bar or flapjack
• Bombay mix
• mini pork pie, sausage roll or scotch egg
• chocolate

* If there are any health concerns which have previously required you to limit fat and sugar in your diet, e.g. diabetes or high cholesterol, you should discuss whether you still need to limit these with a health professional.

Ready meals, meal delivery services and online shopping

You may find that your energy levels change throughout the week and that on some days you feel better than others. Here are some suggestions to make preparing meals easier:

• Make the most of the ‘good days’ by preparing extra meals which you can store in the fridge/freezer as individual portions for ‘bad days’.
• Buy a selection of fresh or frozen ready meals for times when you are not able to cook.
• Make use of meal home delivery services such as Wiltshire Farm Foods and Oakhouse Foods - supermarkets also offer online shopping and home delivery services which may make shopping easier for you.

Swallowing difficulties

If you notice any of the following when eating or drinking you should seek advice from a healthcare professional such as your GP or practice nurse, who can refer you on to specialist speech and language therapist or a dietitian:

• difficulty swallowing
• choking or coughing
• bringing food back up, sometimes through your nose
• a sensation that food is stuck in your throat or chest
• a change in the sound of your voice whilst/soon after eating i.e. your voice sounds ‘wet’

Other things to consider:

• Check dentures fit correctly - if not, visit your dentist.
• If you have difficulty using cutlery or with coordination, try ‘finger foods’ such as toast, sandwiches, biscuits, chunks of meat, cheese, vegetables or fruit cut into pieces etc.
• If you also suffer from constipation, try gradually increasing your fibre intake by consuming beans, lentils, fruit and vegetables and wholegrain foods whilst also increasing your fluid intake. You may need to fortify these foods as explained earlier.
• Regular exercise may help increase your appetite and build up your strength - start with something easy for you and increase the intensity gradually.
• If you have vision problems or for people with dementia, try using a coloured plate so that the food stands out from the plate.

Eating environment

Try to make sure that where you eat is as pleasant as possible and that meals and snacks look appealing. Eating with others often helps to encourage appetite.

Summary

Malnutrition is a common problem and if it is not spotted or treated it can make you very ill. The simple steps outlined above should help to identify and treat the condition. If these simple steps do not seem to help, seek advice from a healthcare professional.

https://www.bda.uk.com/resource/healthy-eating-for-children.html

https://www.bda.uk.com/resource/healthy-snacks.html

https://www.bda.uk.com/resource/iron-rich-foods-iron-deficiency.html

https://www.bda.uk.com/resource/calcium.html

https://www.bda.uk.com/resource/diet-behaviour-and-learning-children.html

https://www.cwt.org.uk/wp-content/uploads/2015/02/CHEW-5-11Years-PracticalGuide.pdf

https://www.bda.uk.com/resource/complementary-feeding-weaning.html

https://www.bliss.org.uk/parents/about-your-baby/feeding/weaning-your-premature-baby/about-our-weaning-guide

https://www.bliss.org.uk/parents/about-your-baby/feeding/weaning-your-premature-baby

https://www.bda.uk.com/resource/milk-allergy.html

https://www.bda.uk.com/resource/calcium.html

Cow’s Milk Protein Allergy Explained & Specialist Infant Formulas - Webinars on Food Allergy in Children - patientwebinars.co.uk

https://patientwebinars.co.uk/condition/fussy-eating-in-children/

Toddler and Infant Nutrition Advice - Infant & Toddler Forum (infantandtoddlerforum.org)