'Improving dietary intake through knowledge and behaviour change' Aliya Porter BSc Hons RNutr Registered Nutritionist

Transcription

1 'Improving dietary intake through knowledge and behaviour change' Aliya Porter BSc Hons RNutr Registered Nutritionist

2 Where are we? 27% of women in England were obese, and a further 30% of women were overweight. 4% of women were morbidly obese. Health Survey for England 2016 (2017) 58% of women aged 16 and over met the aerobic guidelines of at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week or an equivalent combination of both, in bouts of 10 minutes or more. Health Survey for England 2016 (2017)

3 Where are we? Mean intake of free sugars as a percentage of total energy intake is 11.2% for women aged 19 to 64 years (SACN recommend <5%) - mainly from confectionary, preserves, cereals and non alcoholic beverages 13% of adults aged 19 to 64 years met the recommendation of no more than 5% of daily total energy intake from free sugars. NDNS, 2018 Image: attn.com

4 Where are we? Fruit and vegetables Mean intake is 4.2 portions a day Only 31% of adults meet the 5 A Day recommendation Fibre 9% of adults aged 19 to 64 years met the recommendation for fibre. Cereals and cereal products were the main source of fibre ranging from 38% to 44% of intake across the age groups, followed by vegetables and potatoes (21% to 32%) and fruit (6% to 16%). Mean fibre intake was 19.0g (SACN recommend 30g/day) NDNS March 2018 Image:

5 Where are we? Folate 16% of women of childbearing age (16 to 49 years) had a RBC folate concentration below the clinical threshold indicating risk of anaemia (305nmol/L). 91% of women of childbearing age had a RBC folate concentration below the threshold indicating elevated risk of NTDs (748nmol/L) 57% of women of childbearing age had a serum folate concentration below the clinical threshold indicating possible folate deficiency (13nmol/L). This includes 15% who had a serum folate concentration below the WHO clinical threshold for folate deficiency (7nmol/L). NDNS, 2018

6 Where are we? Iodine The median urinary iodine for women of childbearing age (16 to 49 years) in Year 7 and 8 (combined) was 102µg/L with 17% of the population below 50µg/L. While these values met the WHO criterion for adequate intake for the general population, they do not meet the criterion for iodine sufficiency in pregnant and lactating women (ie median urinary iodine concentration within µg/L). NDNS, 2018

7 7/78/Salt_shaker_on_white_background.jpg Where are we? Salt Average salt consumption for adults in 2014 was 8.0 grams per day. NDNS, 2016 This is coming down but is a long way off the maximum 6g a day recommendation

8 Where are we? Food trends also changing too: In May 2016, the Vegan Society commissioned Ipsos Mori to poll 10,000 people on their dietary habits and found that Britain s vegan population had increased from 150,000 to 542,000 in the space of a decade (alongside a vegetarian population of 1.14 million). Of those, 63% were female and, significantly for veganism s future growth, almost half were in the age category. The Guardian 1/4/18

9 Complications due to poor diet Deficiency in vital nutrients can contribute to: Neural tube defects (folate and B12), Low birth weight (iron) Increased risk of preeclampsia (calcium) Cretinism (iodine) Birth defects and poor fetal development (zinc) Preterm birth (iron) (Hurst and Abayomi, 2017) Maternal diet linked to increased risk of adult onset metabolic diseases such as Type 2 Diabetes, CVD and cancer in their offspring (Poston, 2011, Blumfield et al, 2012, Rao et al 2012, Wood-Bradley et al 2013)

10 Complications due to poor diet Obesity - increased risk of gestational diabetes, hypertension, caesarean delivery, stillbirth and foetal macrosomia Heslehurst et al 2014, Scott-Pillai et al 2013, I Guelinckx et al (2008) Weight gain in pregnancy is a significant predictor of long term obesity among all women regardless of their initial BMI (Amorim et al 2007, Mamun et al 2010) Charnley and Abayomi (2016) and Hurst and Abayomi (2017)

11 Image: Open to change Women are more aware of health and seek clear, credible, evidencebased information (Ferrari et al, 2013, Olander et al 2012) Referred to as a powerful teaching moment for behaviour change (Olander et al 2016, Phelan 2010)

12 The difference between healthy weight and healthy eating advice One focuses on calories and weight loss, the other focuses on health more holistically. One might feel like there is less stigma attached. We all need support with healthy eating.

13 So what advice should we be giving 1 You do not need to eat for 2 in terms of calories but you do need to eat for 2 in terms of micronutrients. Either baby won t get enough or they will but they will make you deficient. For example, if they take your calcium, your bones may suffer

14 So what advice should we be giving 2 It is recommended you take a vitamin D supplement (10 g) throughout pregnancy and whilst breastfeeding, and a folic acid supplement (400 g)when planning a pregnancy and up to 12 weeks gestation Image: news.camden.gov.uk You are talking to a pregnant woman but the folic acid message is useful for future pregnancies even if the message of preconception supplementation is too late. At this point it would be helpful to talk about Healthy Start

15 So what advice should we be giving 3 There are certain foods to avoid as they may harm baby including liver, swordfish/shark/marlin, more than 2 fillets or 4 tins of tuna a week, unpasteurised soft cheeses, non Lion eggs unless they are fully cooked, raw shellfish, pate (see full list on nhs.uk) But there is plenty you can eat. You need to have plenty of fruit and vegetables, lean protein foods, wholegrain starchy carbohydrates, and low fat unsweetened dairy products

16 4 Being pregnant doesn t mean resting all the time. Being active is good for you and good for baby Discuss what they already do and how they can do more

17 So what advice should we be giving 5 It is really important you keep well hydrated. 1900ml a day 9-10 glasses of 200ml for pregnant women Being well hydrated helps to reduce constipation, UTIs, hypertension, headaches, dizziness and poor concentration, nausea and helps to reduce food intake BDA factsheet

18 So what advice should we be giving 6 Encourage women to pay careful attention to get enough: Iron red meat, eggs, mackerel, almonds, Brazil nuts, hazelnuts, sunflower seeds and pulses (some in green leafy veg e.g. broccoli and spinach). Iodine found in milk, cod, haddock (recommend vegans have a supplement eg Veg1) Calcium dairy, fish with bones, bread, calcium set tofu, green vegetables Zinc lean meat, seafood, dairy, pulses and wholegrains Omega 3 oily fish, flax seeds, walnuts

19 So what advice should we be giving 7 Tailored advice and referral for support. Different needs, different approach Underweight, overweight women, adolescent girls, women from some ethnic minorities, vegetarians and vegans are more at risk of deficiencies Charnley and Abayomi, 2016 Also need different support for homeless women and refugees and asylum seekers Vegans recommend veg 1 supplement available from Vegan Society. This contains iodine which is suitable for pregnant women. Highlight that there are certain nutrients which the vegan diet might not get enough of during pregnancy. Signpost to Vegan Society website. Also helpful article here:

20 So what are the opportunities Booking in appointment Don t assume someone who is a healthy weight is eating properly and is physically active. Nutrition and physical activity are for everyone. Advice about foods to avoid during pregnancy and which supplements to take (vitamin D and folic acid) Advice about not eating for 2 when it comes to calories but the quality counts. Pregnancy is not the time to go on a diet but to give baby the best possible start, good nutrition is really important. Advice about good hydration Advice about physical activity Advice on key micronutrients and a general balanced diet Ask mum if she has any dietary restrictions to help identify if more information is needed.

21 So what are the opportunities Followup appointments Check mum is taking her vitamin D supplements After checking urine - advice about good hydration If mum mentions constipation, encourage good hydration, discuss fruit and veg intake, as well as intake of wholegrains and pulses Ask how they are getting on with eating regular meals and limiting high fat, high sugar drinks and snacks, and eating a balanced diet

22 So what are the opportunities Final appointments Discuss where they can get support with losing weight they have gained in pregnancy (NICE, 2010). Talk about the benefits Promote hydration, especially for breastfeeding mums Give examples of quick snacks breadsticks and homous, peanut butter or cream cheese on toast, oatcakes, vegetable sticks, fruit Encourage physical activity know what is available in your area for mums and babies Encourage mum to seek support from their health visitor when it comes to weaning their baby nutritioninthemind.com

23 Weight loss advice for all? Gunderson et al, International Journal of Obesity volume25, pages (2001) 1 in 4 women have substantial pp weight retention at 1 year 4-5kg 1 st pregnancy 18% OW, 7% OB 2 nd pregnancy 22% OW, 10% OB Bogaerts et al 2013

24 Resources firststepsnutrition.org society.com/resour ces/nutrition-andhealth/lifestages/pregnancyand-breastfeeding

25 Acknowledgements & questions? Thank you to Julie Abayomi Senior Lecturer and Dietitian Liverpool John Moores University for her support in putting this presentation together. Please contact me if you have questions: Aliya Porter - Registered Nutritionist