1
|
- Dr Alan Stewart
- www.stewartnutrition.co.uk
|
2
|
- Introduction 3-5
- Methodology, Analysis, Population Characteristics 6-12
- Malnutrition: undernutrition 13-20
- Malnutrition: overnutrition 21-24
- Malnutrition Risk Factors: socio-economic and personal 25-55
- Lessons from History
|
3
|
- Though the industrial and agricultural revolutions did much to reduce
widespread food shortages malnutrition still occurs
- Landmark discoveries in nutrition made in the 20th century
began to document the specific
impact of poor nutrient intake on health
- These discoveries and the need for even food distribution during the two
World Wars resulted in the formulation of advice and food policies to
prevent undernutrition in the general population
- Financial hardship and deprivation are not the only determinants of
inadequate food intake and malnutrition in the UK population
- Poor nutrient status affects all age groups - growth, development,
physical and mental health, earning capability and longevity
- Correcting undernutrition benefits both the individual and society
- To correct problems of malnutrition requires an understanding of the
findings of nutritional surveys as well as lessons from history
|
4
|
- The term malnutrition covers both undernutrition and overnutrition
- In the UK obvious severe undernutrition is not common outside of serious
illness or dietary problems but overnutrition – obesity, is
- Numerous nutritional surveys of the UK population reveal that mild deficiencies
of micronutrients are not uncommon, may co-exist with overnutrition and
can adversely influence physical or mental health
- Deficiencies of three micronutrients (iron, vitamin A and iodine) in all
countries are monitored by the WHO and are only marginally more common
in the low income groups in the UK. www.int/vmnis/en
- However, deficiencies of folate, vitamins D and C are more common and
potentially affect health in all age groups
- The causes of the these and other deficiencies include poor food
choices, illness, smoking, alcohol excess and lack of sun exposure
|
5
|
- Undernutrition
- Poor Growth - Protein-energy, vitamin A and iodine
- Underweight – Protein-energy
- Anaemia – Iron, folate, vitamins B12 and C
- Rickets and Osteoporosis - Calcium and vitamin D
- Poor Pregnancy Outcome – Folate, severe anaemia, vitamins C and D
- Major Deficiency Syndromes – Vitamin C (scurvy), vitamin B1(beri-beri)
etc.
- Overnutrition
- Obesity – Energy from food or alcohol
- Hypertension – Obesity, excess of
sodium and alcohol
- Poor Pregnancy Outcome – Obesity, excess of vitamin A
- Liver disease – Obesity, alcohol, excess of iron or vitamin A
- Unwise Food Choices
- Increased Mortality – vascular disease and cancer mainly
- Increased Morbidity – many: dental caries, digestive problems, food
allergy
|
6
|
- Being in receipt of benefits has often been associated with a less
healthy diet and poorer nutritional state and health
- The LIDNS was commissioned by the Food Standards Agency to assess the
nutritional status of this group
- A representative sample aged 2 to over 80 years was drawn from those in
the most deprived 15% of society, living in a household where at least
one adult was in receipt of benefits
- Data was collected on food intake over 4 days, measures of height,
weight and blood pressure and, on those aged 8 years and over, blood
samples to assess specific nutrients
- Information about alcohol consumption, smoking, medication, supplement
use, physical activity and oral health was collected
- See www.food.gov.uk/science/dietsurveys/lidnsbranch/
|
7
|
- 3,728 people took part in the survey and completed the diet record and
1,435 (age >8yrs) provided a blood sample
- As in the previous four National Diet and Nutrition Surveys (NDNS) those
in institutions, of no fixed abode or who were pregnant or very ill were
not included
- The data have been analysed by sex, age,
geographic location, whether urban or non-urban dwelling and by
ethnicity
- In the report data on micronutrient intake is presented from Food
Sources only and not All Sources (food and supplements)
- This means that the prevalence of inadequate intake (below the LRNI) may
have been slightly overestimated
- Supplements usually provided <10% of total intake
- Direct comparison with the corresponding NDNS, which looked at intakes
from All Sources, is thus not straightforward
|
8
|
- Sex
Male 40% Female 60%
- Ages
2-10 yrs 19% 11-18 yrs 14%
19-34 yrs 17% 35-49 yrs 17%
50-64 yrs 12% 65+ yrs 21%
- Marital Status
Married 28% Separated 6%
Divorced 19% Widowed 18%
Never married, single 29%
- Dwelling Location
Urban 19% Sub-urban 78% Rural 3%
- Education
Those aged >16 yrs with no qualification
Men 51% Women 58%
|
9
|
- England n = 2433. Scotland n = 392, Wales n = 437, N. Ireland n = 466
- Total n = 3728
|
10
|
- The small number of people in the different ethnic minorities makes
detailed interpretation of nutritional differences unreliable
|
11
|
|
12
|
- Many had income from more than one type of source/benefit
|
13
|
|
14
|
|
15
|
- Protein intakes <10% of energy intake are likely to be inadequate for
some people unless total energy intakes are very high
- Intake of protein/kg body weight and related measures were not presented
- Low protein diets are often low in iron, vitamin B12 and other nutrients
|
16
|
- NDNS Adult (19-64 yrs) intakes of those in receipt of benefits are 70%
of those who are not
- Low intakes of fruit and vegetables will often result in poorer status
of vitamin C and folate and reduced iron absorption
|
17
|
- Haemoglobin Normal Ranges World Health Organisation;
1.5-6.0 yrs >11.0g/dl, adult women >12.0g/dl, adult men >13.0g/dl.
- Adult ranges have been adopted from ages 15yrs and upward
- British laboratories often use a normal range of >11.5g/dl for adult
women
- Levels of 11.5-11.9g/dl in women can result in symptomatic iron
deficiency
|
18
|
|
19
|
- Test red cell folate; normal range is >350 nmol/l
- Group Boys age 8-10 yrs only 7 subjects - too few to analyse
- Symptomatic deficiency often develops before macrocytic anaemia develops
|
20
|
- Test plasma folate; normal range is >7 nmol/l
- Group Boys age 8-10 yrs only 7 subjects - too few to analyse
- Plasma folate is easily raised by supplements and may not reflect tissue
status
- Multivitamin supplements were taken by men 6%, women 10%, children 4%
|
21
|
- Test serum vitamin B12; normal range is > 118 pmol/l
- Serum level may be reduced by o.c. pill without deficiency developing
- Symptomatic deficiency often develops before macrocytic anaemia
|
22
|
- Test plasma vitamin C; normal range is >11 umol/l
- Milder depletion was present in ~7% of 8-18yr olds and ~20% of adults
|
23
|
- Test serum 25-hydroxy vitamin D; normal range >25 nmol/l
- Group Boys age 8-10 yrs only 7 subjects - too few to analyse
- No measure of correlation between intake and serum status was made
|
24
|
- No attempt was made as part of LIDNS to determine the degree of
correlation between intake of a nutrient and its level on testing
- This was assessed in other nutritional surveys (see opposite)
- Data presented for males (above) and females (below)
- All data from NDNS except adults 19-64 yrs – vit. B12, from DNSBA
- All correlations were significant (p<0.05) except for vit. D (4-18
yrs) and vit. B12 men 65+ yrs
- The higher the correlation coefficient the more likely that a deficiency
could be caused or treated by dietary factors alone
|
25
|
|
26
|
|
27
|
|
28
|
|
29
|
- Population advised mean intakes for adults is 11% of food energy
- Highest Mean Intakes were observed in:
White men and boys and Black women and girls
Women and girls in Scotland and boys in Northern Ireland
|
30
|
|
31
|
- Sugary drinks = carbonated + not carbonated (approximately 75% are
carbonated)
- No other food groups show anything like the same degree of age-related
variation in carbohydrate provision as fruit and nuts, and sugary drinks
- Soft, sugary drinks occupy the “space” left by the lack of dietary fruit
|
32
|
- Sugary drinks = carbonated + not carbonated (approximately 75% are
carbonated)
- No other food groups show anything like the same degree of age-related
variation in carbohydrate provision as fruit and nuts, and sugary drinks
- Age ranges for young people are slightly different to those of LIDNS
|
33
|
- Drink figures for 1.5 to 4.5 years are estimates
- Approximately 15% of participants in NDNS were in receipt of benefits
- Age-related change in carbohydrate source is similar to but less marked
than LIDNS
|
34
|
|
35
|
- Levels >2.8 umol/l indicate excess and an increased risk of
osteoporosis
- They can be due to excessive intake (diet or supplements), obesity, type
2 diabetes, alcohol excess or renal failure [LIDNS causes are unclear]
- Retinol supplements were taken by <13% of men and <22% of women
- The highest regional upper 2.5 percentile levels were: Northern Irish
men 4.0 umol/l and Scottish women 3.78 umol/l
|
36
|
- Plasma ferritin levels are lower in women due to menstrual losses of
iron
- Levels >300 ug/l can be due to chronic inflammation, infection,
injury, liver disease, iron excess (diet or supplements) or
haemochromatosis
- Iron supplements were taken by <6% of men and <9% of women
- In Wales the upper 2.5 percentiles were: men 3,338 ug/l, women 620 ug/l
|
37
|
- The Scientific Advisory Committee on Nutrition
- reviewed the LIDNS and concluded…
“ Identification of the pathways of causality linking
deprivation, diet and health are critical to understanding of the
clustering of diet-related disease and the development of targeted
interventions designed to lessen inequalities in diet-related ill health
in the UK.”
- www.sacn.gov.uk
|
38
|
- Socio-economic
- Low income/food expenditure*
- Food insecurity*
- Lack of domestic facilities* (cooker, fridge, microwave etc)
- Poor mobility/access to shops*
- Poor educational attainment*
- Poor ability or cooking skills*
- Household type and number of dependents
- Lone dweller or lone parent family*
- Ethnic origin
- Personal
- Poor dental health*
- Alcohol excess
- Obesity*
- Smoking*
- Life stage – infant, menstruating woman, pregnant/lactating, elderly
- Physical illness*
- Lack of exercise*
- Country or location of dwelling
|
39
|
- All differences shown are significant p<0.05.
- Males and females in the lower income group tended to consume less food
- Few differences between the groups were significant (only limited data
presented)
- Differences: men - energy (-8%), sodium (-5.5%) and iron (-6.0%); women
- none
|
40
|
- Other options – support from others, information on food and health,
more time, better cooking skills, facilities or local shops were each
rated, on average, at <6%
|
41
|
- Other options – support from others, information on food and health,
more time, better cooking skills, facilities or local shops were each
rated, on average, at <7%
|
42
|
- There would appear to be a saving of ~10% if not dwelling alone
- Older people did not spend less than younger people but drank less
alcohol
|
43
|
- * Differences significant p<0.05, for men and women
** Differences significant p<0.05, for women only
|
44
|
- All differences are significant p<0.05
|
45
|
- Defined as:
- Security
“Access by all people at all times to enough food for an active
and healthy life”
- Insecurity
“Limited or uncertain availability of nutritionally adequate and
safe foods or limited or uncertain ability to acquire acceptable foods
in socially acceptable ways”
- Assessed by:
- A series of questions to determine current and past availability of
food, whether the person is regularly able to obtain the food that they
need
|
46
|
- Only limited data on men presented
- All differences in women were significant p <0.031
- Food insecurity in women approximately doubled the risk of inadequate
intake (<LRNI) for iron, zinc,
magnesium and potassium
|
47
|
|
48
|
- In males energy difference significant p <0.031; all other nutrients
p <0.004
- In females all nutrients difference significant p <0.009
|
49
|
- Other options – support from others, information on food and health,
more time, better cooking skills, facilities or local shops were each
rated, on average, at <6%
|
50
|
- Other options – support from others, information on food and health,
more time, better cooking skills, facilities or local shops were each
rated, on average, at <7%
|
51
|
- Less Skilled = would need help cooking a main dish from basic
ingredients
- Differences were statistically significant p<0.05 and adjusted for
sex of Main Food Provider and age of the respondent
|
52
|
- Being an adult in a house with children does not appear to increase the
risk of poor protein intake for adults
|
53
|
- Being an adult in a house with children does not appear to increase the
risk of poor n-3 Essential Fatty Acid intake for adults
|
54
|
|
55
|
- For men intakes <45g/day are unlikely to be adequate
- For women intakes <35 g/day are unlikely to be adequate
- Such diets are also likely be low in iron, zinc, copper and some B
vitamins
|
56
|
- Other similar National Surveys have been conducted over the last 25
years in Britain and include (date of publication)
- DNSBA (1990)
The Diet and Nutritional Survey of British Adults ages 16 to 64
yrs looked at the influence of social class on nutrient intake
- NDNS (1995 - 2004)
Four National Diet and Nutrition Surveys looked at nutrient
intake and, sometimes, status of those in receipt of benefits compared
with those who were not
|
57
|
- Data presented on adults aged 16=64 yrs n=1070, who participated in the
Dietary and Nutritional Survey of British Adults
- Intakes were from dietary sources only and adjusted for energy intake
|
58
|
- Data presented on adults aged 16=64 yrs n=1096, who participated in the
Dietary and Nutritional Survey of British Adults
- Intakes were from dietary sources only and adjusted for energy intake
|
59
|
|
60
|
- Data from National Diet and Nutrition Survey British Adults. TSO 2003/4
- Intakes <LRNI are likely to be adequate for <2.5% of the
population
|
61
|
- Data from National Diet and
Nutrition Survey British Adults. TSO 2003/4
- Intakes <LRNI are likely to be adequate for <2.5% of the
population
|
62
|
- Data presented on free-living elderly n=491
- All nutrients were deficient in >10% of subjects
- Dietary vitamin D provides ~10% of requirement only
|
63
|
- Data presented on free-living elderly n=491
- All nutrients were deficient in >10% of subjects
- Dietary vitamin D provides ~10% of requirement only
|
64
|
- Other options – taste, special dietary requirements or slimming, habit
and convenience were each rated,
on average, at <12%
|
65
|
- Other options – taste, special dietary requirements or slimming,
convenience and habit were each rated, on average, at <7%
|
66
|
|
67
|
- Socio-economic
- Low income/food expenditure*
- Food insecurity*
- Lack of domestic facilities* (cooker, fridge, microwave etc)
- Poor mobility/access to shops*
- Poor educational attainment*
- Poor ability or cooking skills*
- Household type and number of dependents
- Lone dweller or lone parent family*
- Ethnic origin
- Personal
- Poor dental health*
- Alcohol excess
- Obesity*
- Smoking*
- Life stage – infant, menstruating woman, pregnant/lactating, elderly
- Physical illness*
- Lack of exercise*
- Country or location of dwelling
|
68
|
- NSP Non-starch polysaccharides; NMES Non-milk extrinsic sugars
- No data on differences in intake of potassium, magnesium or folate were
presented but are likely to be similar to but less than those for
vitamin C
- Data on younger age groups were not presented
|
69
|
- Men % consuming alcohol: working 83%, unemployed 65%, economically
inactive 64%
- Women % consuming alcohol: working 72%, unemployed 58%, economically
inactive 54%
|
70
|
- NDNS Men: % consuming alcohol; no benefits 84%, benefits 59%
- NDNS Women: % consuming alcohol; no benefits 71%, benefits 55%
- LIDNS % consuming alcohol; Men 49%, Women 39%
- Methodology: LIDNS – 4 day (vs NDNS 7 day) diary may skew data
|
71
|
|
72
|
|
73
|
- Other National Surveys have been conducted over the last 25 years in
- Britain and include (date of publication)
- DNSBA (1990)
The Diet and Nutritional Survey of British Adults looked at the
influence of social class on nutrient intake
- NDNS (1995 - 2004)
Four National Diet and Nutrition Surveys looked at nutrient
intake and, sometimes, status of those in receipt of benefits compared
with those who were not
|
74
|
- Intake determined from 7 day diary of adults aged 16 to 64 years
- Caution, no adjustment for age, health, diet or supplements was made
- Vitamins C and D not measured.
Heavy drinking women n = 14.
|
75
|
- Intake determined from 4 day diary
- Caution, no adjustment for age, health, diet or supplements was made
- Non-drinkers were more likely to be older and have abnormal liver test
|
76
|
- Smoking prevalence in the general adult population (2008) males 24%,
females 20%
|
77
|
- Smoking status determined by interview of adults aged 16 to 64 years
- Caution, no adjustment for age, health, diet or supplements was made
- Vitamins C and D not measured.
|
78
|
- Smoking status determined by interview of adults aged > 65 years
- Caution, no adjustment for age, health, diet or supplements was made
- Heavy smoking men n = 28; women n = 13
|
79
|
- Intakes from food sources only were compared with Lower Reference
Nutrient Intakes for the relevant age group and sex
- “Lower Reference Nutrient Intake – an amount of the nutrient that is
enough for only the few people in a group who have low needs”. ~2.5% of the population
- Prevalence of low intake may be slightly overestimated by the methods
used
|
80
|
- Serum ferritin low:
children < 15ug/l, men <20ug/l, women <15 ug/l
- Ferritin levels may be increased by chronic inflammation and heavy
smoking both common in the LIDNS population
|
81
|
|
82
|
|
83
|
- Regional data on young people not presented
- An elevated C-Reactive protein is a marker of current inflammation and
thus “illness” as well as signifying an increased cardiovascular risk.
|
84
|
|
85
|
- The causal relationship between these variables is not clear
- Employment and income appear to be the best determinants of physical
activity
|
86
|
- Regional data on young people <19 yrs not presented
- Anaemia defined as Hb <13.0g/dl (men) and <12.0 g/dl (women)
|
87
|
- Data presented relates to adults only
|
88
|
- 5-a-day was achieved in England – 10%, Scotland – 4%, Wales – 6%, N.
Ireland – 8%
- Low intakes of fruit and vegetables are likely to cause a poor status of
vitamin C, folate and reduced iron absorption
|
89
|
- Only 1% of boys and 4% of girls achieved 5-a-day
- A more appropriate target for most young people is 3 to 4 portions per
day
|
90
|
- Regional data on young people not presented
- Folate deficiency defined as Red Cell Folate <350 nmol/l
|
91
|
- Regional data on young people not presented
- Deficiency defined as Serum <118 pmol/l
|
92
|
- Regional data on young people not presented
- Deficiency defined as Plasma vitamin C <11umol/l
|
93
|
- Regional data on young people not presented
- National prevalence of deficiency: boys 6%, girls 20%
|
94
|
|
95
|
|
96
|
- Moderate undernutrition (vitamins C, D and folate ) is more common in
those who are in receipt of benefits in the UK
- Moderate overnutrition (obesity and possibly iron) is also more common
- The causes of poorer nutritional state are many and include poor dietary
intake, lack of education and cooking skills, smoking, alcohol, chronic
illness and poor dental health
- Lack of money and poor food access are rarely issues
- The impact of malnutrition on health and the social divide was not
assessed as part of LIDNS but the effects of malnutrition on children
and pregnant women are likely to be lasting
- Any solution will need to involve many professionals as well as
motivating the individuals/families concerned
|
97
|
- The commonest problems of overnutrition are obesity, dietary sodium
excess and biochemical excesses of retinol and iron. Solutions require:
- Personal Change and Responsibility
Dietary change to limit obesity especially in children, the
immobile or unwell
Personal measures to avoid an excess of alcohol and sugar
Increased daily exercise, sport and, for children, walking to
school
Avoidance of excessive or inappropriate use of nutritional
supplements
- Education Services
To improve general educational level
To teach the basis of a healthy diet, limiting intake of fats,
sugar and alcohol
To instruct on basic cooking skills and preparation of balanced
meals
To inform of the likely consequences of overnutrition across the
age-groups
- Health Services
Medical and dietetic help to identify and treat: obesity with
health problems, those with hypertension, liver or renal disease with
micronutrient excess
Medical help for those with mental or alcohol problems
Dental services to improve oral health and prevent loss of dental
function
|
98
|
- The problems of undernutrition, low protein-energy intake and
micronutrient deficiencies, will involve action by professionals to
reduce the risks
- Education Services
To improve general educational level
To teach the basics of a healthy, nutritious and economic
diet
To instruct on basic cooking skills, preservation of nutrients,
kitchen thrift
To inform of the likely consequences of a poor diet across the
age-groups
- Health Services
Dental services to improve oral health and prevent loss of dental
function
Medical services to identify and treat significant undernutrition
and those with illnesses likely to be caused or worsened by
undernutrition
Medical help for those who wish to quit smoking
Medical help for those with mental or alcohol problems
- Other Services
Social services to support those most at risk of poor nutrient
intake
Local services to ensure adequate supply of and access to
nutritious foods
Government policies to discourage alcohol, smoking and other
risk-taking behaviour and encourage and facilitate a healthy diet and
lifestyle
|
99
|
- The commonest problems of undernutrition, anaemia, vitamins C, D and
folate deficiencies would be often be lessened by diet and lifestyle
changes
- Personal Dietary Changes
Emphasising foods that are nutritious, inexpensive,
widely-available and easily prepared:
eggs
tinned oily fish (sardines and mackerel)
potatoes with their skins
dark green leafy vegetables – cabbage and spinach
apples, pears and oranges
- Personal Lifestyle Changes
Limiting alcohol and stopping smoking
Increased sun-exposure and more physical activity
Growing of own vegetables and fruit and their preservation
Appropriate use of nutritional supplements
- Other Changes
Measures that reduce social isolation and improve a sense of
community e.g. allotments, food cooperatives, family and community
eating
|
100
|
- Eggs for breakfast, omlettes, spinach egg and cheese
- Jacket potatoes, wedgies, boiled potatoes, Bubble and Squeak
- Roast meat with cabbage, cabbage and potato soup, spinach added to meat
curry
- Sardine (not tuna) in pasta bake, fish curry, add to jacket potato
- Fruit as a desert, stewed cooking apples/apple pie or crumble
- Other Key Foods
- Traditional roast – left over for curry, cold cuts; liver once per month
- Abundant dairy foods – milk, cheese and custard; low-fat if obese
- Wholemeal bread, Hovis, quality breakfast cereals
- Vegetarian proteins, peanuts, chickpeas, beans – in casseroles
- Peas and beans – fresh and frozen
- Healthy fats – margarine, butter and rapeseed oil
- Variety of fruits and vegetables – seasonal, local or home-grown
|
101
|
|
102
|
|
103
|
|
104
|
|
105
|
- * Children in LIDNS are aged 2-18 yrs
- Figures in [ ] are estimates
|
106
|
|
107
|
|
108
|
|
109
|
- There would also be a small decline in sodium intake, men – 11%, women –
6%
- Oily fish intake (and long chain n-3 EFAs) would increase several
hundred percent
|
110
|
- There would also be a small decline in sodium intake, men – 5%, women –
3%
- Oily fish intake (and long chain n-3 EFAs) would increase several
hundred percent
|
111
|
- There would also be a small decline in sodium intake, boys – 4%, girls –
3.5%
- Oily fish intake (and long chain n-3 EFAs) would increase several
hundred percent
|
112
|
- Education “More” = GCSE grades A-C or above, “Less” = lower or no
qualifications
- P = significance level, linear regression analysis adjusted for age
|
113
|
- Risk Factors
- Rented 3 Bed-roomed terraced house, no garden
- 7 People in house
- Urban-dwelling South London
- Father working class (skilled)
- Father smoked and sometimes drank heavily
- Father sometimes away for prolonged periods
- No car
- Limited facilities – no fridge or
microwave
- Parents poor dental health – sugar in tea
|
114
|
- Risk Factors
- Rented 3 Bed-roomed terraced house, no garden
- 7 People in house
- Urban-dwelling South London
- Father working class (skilled)
- Father smoked and sometimes drank heavily
- Father sometimes away for prolonged periods
- No car
- Limited facilities – no fridge or
microwave
- Parents poor dental health – sugar in tea
- Outcome:
- 3 boys >6’, athletic, employed
daughter tall but overweight
- All children well-educated
(2/4 at grammar school)
- 2 Boys long lived 91 and 83 yrs
2 died – obesity & alcohol related
|
115
|
- Risk Factors
- Rented 3 Bed-roomed terraced house, no garden
- 7 People in house
- Urban-dwelling South London
- Father working class (skilled)
- Father smoked and sometimes drank heavily
- Father sometimes away for prolonged periods
- No car
- Limited facilities – no fridge or
microwave
- Parents poor dental health – sugar in tea
- Outcome:
- 3 boys >6’, athletic, employed
daughter tall but overweight
- All children well-educated
(2/4 at grammar school)
- 2 Boys long lived 91 and 83 yrs
2 died – obesity & alcohol related
- Protective Factors
- Father usually employed
- Mother (82) well-educated
- M-grandmother (90) lived in house
- Abundant food shops nearby
- Traditional meals: meat, fish, milk eggs, potatoes, fresh fruit &
veg++
- Public nutrition education
- Children received cod liver oil
|
116
|
- Doctors have a unique role in managing malnutrition
- Identify obesity: advise children, women before and during pregnancy,
those with weight-related disease
- Identify those with significant nutritional needs:
children-growing or
developing poorly
anaemic children, women
and the elderly
pregnant, deprived or
at-risk women
underweight adults – BMI
<18.5kg/m2 or unintentional weight loss
chronic illness – liver,
kidney disease, osteoporosis, depression
alcohol excess at any
age
anyone with symptoms or
signs of nutritional deficiency
- Assess risk factors for undernutrition – poor intake, alcohol, smoking,
illness, medical drugs, poor sun exposure
- Investigate – tests for anaemia, vitamin and mineral status, x-Rays
- Treat – diet, supplements, disease management, lifestyle change
- Measures to reduce smoking, alcohol excess and inactivity
- Measures to improve local and national food provision
|
117
|
|
118
|
- I would welcome you comments. Contact me at dr.stewart@stewartnutrition.co.uk
|