Bradford Nutrition the local hot potatoes and how we can ...€¦ · Bradford Nutrition – the...
Transcript of Bradford Nutrition the local hot potatoes and how we can ...€¦ · Bradford Nutrition – the...
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Bradford Nutrition – the local hot potatoes and how
we can manage them. Clare Gelder
Principal Dietitian
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Aim
• To provide an overview of local nutritional issues affecting women of child bearing age and young children in Bradford
• Consider the and the management strategies as well as the difficulties faced when dealing with these issues
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Learning Outcomes
At the end of the session, delegates will have an understanding of ;
– The common nutritional problems observed in these population groups
– How these issues are managed
– Strategies and practical interventions
– Signposting to further resources and support
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Drivers for Change • National Institute for Health & Care Excellence
– Antenatal care CG62
– Antenatal & Postnatal Mental Health CG45
– Diabetes CG63,
– Maternal and Child nutrition PH11
– Quitting smoking in pregnancy PH26
– Weight Management before, during and after pregnancy PH27
– Pregnancy & complex social factors CG110
• Every Baby Matters Strategy
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Nutritional issues in women and pregnancy
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Bradford
• The average number of babies per mother in Bradford is 2.24 (2013: 8,039 babies born)
• National Total Fertility Rate is 1.82
(Office National Statistics, 2014)
• In the UK: 1 in 5 women diagnosed
‘clinically obese’ in pregnancy
• In Bradford its 1 in 4 women
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Bradford Infant Mortality
• 8,322 live births district wide (B&A)
• Infant Mortality Rate (IMR) is the number of deaths under 1 years old per 1000 live births.
• National = 4.0. Bradford = 5.8 (2016 health profile)
• Was 7.0 (2010-2012)
• Bradford was 8.3 (2005-7), 7.9 (2008-10) 5.1 (2014-15)
• 69 infant deaths in 2010, 59 recorded 2010-12
• 58% births in poorest 40% of Bradford
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Importance of good nutrition in pregnancy
• ↓ risk of foetal and maternal deficiencies
• ↑ chance of healthy pregnancy (mother and baby)
• Preparation for breastfeeding
• Improved development and long term health (mother and child)
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Preparing for pregnancy Women with BMI 30 or more
• Encourage weight loss before pregnancy
• Discuss health risk
• Highlight benefits of weight loss
• Support from weight loss programmes
• Aim for 5-10% weight loss initially
• Encourage a BMI in healthy range
• Advise folic acid supplements
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Pregnancy Women with BMI 30 or more
• Biggest risk is from being obese rather than weight gained during pregnancy
• Dieting is NOT recommended
• Appropriate weight gain:
Body Mass Index Weight Gain (single pregnancy)
<18.5 12.5-18 kg
18.5-24.9 11.5-16kg
25-29.9 7-11.5kg
>30 5-9kg
US National Academy of Science 2009
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Pregnancy: Women with BMI 30 or more
• Discuss health risks
• Benefits of healthy diet and physical activity for mum and baby
• Address concerns – diet and activity
• Advice from a reputable source
• Offer referral to a dietitian
• Dispel myths – eating for two
• Healthy Start Scheme
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After childbirth: Women with BMI 30 or more
• 6-8 week postnatal check - opportunity to discuss weight
• If not ready, offer further appointment in 6 months
• Realistic expectations for weight loss
• Take account of demands of caring and health issues
• Family support
• Encourage breastfeeding
• Physical activity – check with GP/midwife first
• Support from structured weight management groups
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Effective weight loss programmes – before and after pregnancy
• Based on balanced, healthy diet
• Encourage regular physical activity
• Incorporate behaviour change advice
• Identify and address people’s barriers
• Practical and tailored to individuals
• Sensitive to the person’s concerns
• Realistic weight loss of 0.5 – 1 kg per week
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Vitamin D deficiency
Year Total Incidence per 1,000
2012/13 2,073 19.2
2013/14 3,039 28.4
2014/15 3,002 28.2
Prevalence of vitamin D deficiency in 15-44 year old
females in the Bradford district
(source: SystemOne)
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Who is at risk of vitamin D deficiency?
• Those with someone else in the family with vitamin D deficiency • People from South Asian, African, African Caribbean and Middle Eastern
backgrounds • Those that have a low exposure to sunlight due to wearing concealing
clothing or spending time indoors • Teenagers (growth spurt) • Strict sunscreen users • People who are obese (BMI>30) • Pregnant or breastfeeding women • Breastfed and some formula fed babies • Children during periods of rapid growth such as in infancy • Children with chronic conditions (malabsorption, juvenile idiopathic
arthritis, rheumatic conditions, chronic steroid use, diabetes, disability and reduced mobility)
• People on medications interfering with Vit D metabolism: phenytoin, carbamazepine, steroids, rifampicin
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Discretionary Vitamin D Supplementation Policy
• All pregnant women booked with a midwife in B+A receive free vitamin D supplements
• All infants in B+A receive free vitamin D supplements from birth to 6 months
(some will continue to receive free up to 2 years)
Healthy Start vitamin tablets and
drops are the preparation of choice
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Gestational Diabetes
• TBC
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Nutritional issues in the under 5’s
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Reason for Referral to Dietetics
0 10 20 30 40 50 60 70 80 90 100
allergy & intolerance
dietary counselling and asessment
faltering growth
obesity
vitamin/mineral deficency
autism
constipation
other
Number
Based on referrals in to dietetics 15/16, BD3, 4, 5
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Childhood obesity
• 20% under 5’s (OW/O)
• Associated with fussy eating, early weaning and deprivation
• Genetics
• Lifestyle factors (activity, labour and time saving devices and choice of leisure activities)
Solution
• Healthy, balanced diet and adequate activity
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How common is vitamin D deficiency?
Year Total Incidence per 1,000
2012/13 64 1.3
2013/14 129 2.6
2014/15 255 5.2
Incidence of vitamin D deficiency in children age 0-5
years in the Bradford district
(source: SystemOne)
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Rickets • 67 cases of Rickets were diagnosed between 2007 and 2010
(NHS B&A, 2010).
• 20 cases were diagnosed between 2012 and 2015 (Source: SystmOne).
These figures are suggestive of a decrease in the incidence of Rickets
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Iron Deficiency Anaemia
• 40% of under 5’s in Bradford (diet)
• Immigrants and deprived areas (most effected)
• Infections, poor weight gain, development and cognitive delay and behavioural disorders
• Late weaning, inappropriate weaning, early weaning and excessive cows milk
Solution
• Improving maternal nutrition, appropriate weaning and a balanced diet
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Faddy Eating
• High prevalence (70% of 2yr olds)
• Deprived areas most effected
• Decreases with age (by 5yrs 1%)
• Associated with Vit D and Iron deficiency and late or inappropriate weaning
• Frequent drinks, snacking behaviour, lack of routine, unclear boundaries, neophobia, parental expectations and anxieties, parental depression,
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Faddy Eating
Solution
• Parental education – meal routine, portion sizes and menu planning
• Realistic expectations – children are not little adults
• Reassurance – most children grow out of faddy eating behaviours
• Consistency – parental confidence, establish new norms
• Peer support for children – positive role models
• Healthy Start vitamin supplements
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Faltering growth
• Commonly, infants may show some weight faltering in the first 2 years of life but it can also affect older children.
• Under-nutrition accounts for 95% of the faltering growth causes e.g. impaired absorption, increased requirements, insufficient energy given.
• 5% of the faltering growth comes from major organic disease.
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Faltering Growth Pathway
• It is estimated that of the children who have faltering growth, only 5% will have significant safeguarding concerns, e.g. abuse, neglect
• Children who are severely undernourished from whatever cause may suffer long term growth, developmental, behavioural and emotional problems.
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Faltering Growth Pathway
• Developed in Bradford as part of the EBM working group on nutrition
• To be rolled out to GP and HV asap
• Provides a clear schematic of what to do and when
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Complimentary Feeding
• Exclusive breastfeeding for six months confers several benefits on the infant and the mother,
• Complementary foods should be introduced at 6 months of age (26 weeks) while continuing to breastfeed.
• The DH Guidelines recommend the introduction of solid food ‘at around six months’
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Weaning - Born in Bradford • Older, better educated mums -> less chips and potatoes.
• Later weaning -> less processed meat.
• Breastfeeding, older mums, higher education -> more vegetables.
• Similar for fruit.
• Older mothers -> less sweet snacks.
• Later weaning, older mums, better education -> less savoury snacks.
• Earlier weaning, younger mums, less education -> more sugar-sweetened drinks.
• Overweight & older mothers -> low-sugar drinks.
* Adjusted for maternal age, parents’ education, ethnic group, energy intake, & infant age
Pink Sahota, BiB, 2013
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Complimentary feeding
Solution:
• Consistent messages from practitioners
• Promotion of best practice weaning
• Access to complimentary feeding workshops for all
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Poor Oral Health
• Bradford rates higher than national average
• Higher incidence in deprived areas
• Poor oral hygiene + sugary food/drinks
Solution
• Brushing teeth x2 daily, fluoride toothpaste and avoiding sugary food/drink between meals
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Conclusion
• There are many problems faced in the BSB relating to nutrition
• Many solutions require education of workers and volunteers to ensure consistent messages
• Need to tap in to the experts to ensure best practice is driven forward
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Thank You for listening
Any Questions?