Nutrition And The Health Professional
By James Collier BSc (Hons) - Consultant in Nutrition
The influence of nutrition in the Health Service is wide-ranging. Optimal health of patients relies on good nutrition from all ends of the spectrum. Nutrition plays a key role in the care of the critically ill, those with inadequate gut function, eating disorders patients, patients with food intolerances, the obese, and a vast range of other clinical problems.
Health professionals play a key role in for the care of their patients through nutrition and in this article I aim to demonstrate the extent of some major nutrition-related problems and discuss how health care professionals can help. The majority of illnesses are linked to nutrition either with nutrition as a potential causal factor or in helping the treatment; in many cases both. We often associate nutrition in hospitals with undernutrition and feeding people back to strength but in reality the role of nutrition is much wider than this.
Undernutrition is associated with a range of illnesses. Approximately 50% of surgical and 44% of medical patients have been found to be malnourished on admission to hospital (Lennard-Jones 1992), and 40% of patients have been found to be undernourished on admission to hospital (McWhirter & Pennington 1994). To identify undernourished patients nurses are now obliged to nutritionally screen all those admitted. This is a very topical area and discussed in detail in this supplement.
To combat this major problem, we must look at the provision of food in hospitals and on appropriate patients instigate nutritional support. The use of nutritional supplements has increased over the last few years; this is mainly due to a wider choice of types and more palatable flavours, coupled with increased awareness of their uses. A large systematic review of nutritional supplements was undertaken in 1998 and demonstrated positive outcomes of their use (Stratton & Elia 1999).
Enteral tube feeding is often required in patients where there is insufficient intake or a mechanical reason that they are unable to eat. If the gut is not functioning properly then parenteral nutrition may be initiated.
For more detailed information see our article on Enteral Tube Feeding
The prevalence of obesity in the UK in 1980 was 8%, and increased to 20% in 1998. Without intervention, this figure is expected to rise to 30% by 2010 (Broom 2001). The UK has the fastest rate of growth of obesity (NAO 2001). The cost of obesity to the NHS is huge, as much as £1/2 billion per year; Cirian-Marie Beddoes looks at strategies to combat this in her article.
Food intolerance ranges from immunoglobulin-related food allergies to gastro-intestinal adverse reactions to food. It is estimated that 1.4-1.8% of the UK population suffer from a true adverse reaction to food (DoH 2000), though anecdotally this figure is much higher. Although a majority of sufferers seek advice externally of the NHS, it is a growing area for concern.
Diabetes mellitus and diabetes-related complications constitute the forth-leading cause of death in many developed countries. There are over 1.4 million diagnosed diabetics in the UK, a majority of who are type 2 (McGough 2001). Obviously diet control plays a crucial part both in the control of a patient's diabetes and in reducing the risk of diabetes-related disorders.
The relation of diet to cardiovascular disease (CVD) is well researched (Yannois 1999). The aetiology of CVD is multi-factoral involving body weight, serum lipid levels, physical activity, genetics, and many more. It is no secret as the large role good nutrition plays directly and on individual risk factors for CVD, although it is not widely known that dietary advice may need to be on an individual patient and risk factor basis (Yannois 1999).
Nutrition has a varied role in the aetiology of different cancers. It has been shown to be significant in bowel and stomach cancers, but less so in, for example, lung and throat cancers. Certain antioxidant nutrients may be important in reducing risk. So generally a diet, along the lines of the Healthy eating Guidelines is advocated.
However, nutrition has a vital role in the treatment of most cancers, especially where the gastro-intestinal tract is involved or where there is a catabolic state. Appropriate nutritional support is crucial as soon as possible to minimise tissue wasting and improve quality of life.
Other nutritional problems
There are other ailments with nutrition links which health professionals come across in practice, eg drug-nutrient interaction, gout, inflammatory bowel disease, respiratory ailments and many, many more. For some of these there is good information available. In all cases if the nurse feels there may be a significant nutrition issue then a referral to a Dietitian should be done (in most cases this needs to be by a doctor).
The Health Professional's role
Whatever area of health care you work in, you come across nutrition everyday. To combat incidence of obesity, CVD, cancers and some other illnesses health promotion to the local population is important.
There are many local and national initiatives addressing issues individually, and nutrition is finally being seen as important by most doctors. The Government also sees optimal nutrition as a crucial factor in disease prevention and as a treatment.
As a health professional try to have links with your dietetic department and nutrition specialist nurse. Many hospitals are now appointing Nutrition Link Nurses on wards and recruiting Dietetic Assistants to help feed patients appropriately.
With the importance of Clinical Governance and Continued Professional Development, continued education on nutrition should be on every nurse's agenda (qualified and unqualified). It is only through us, as health professionals, that nutrition-related problems can be combated.
Broom I. Editorial. Obesity in Practice. Vol 2 No 3
Department of Health. 1991. Report on Health and Social Subjects 41 - Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report of the panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. HMSO
Department of Health. 1992. Report on Health and Social Subjects 31 - The Nutrition of Elderly People. Committee on Medical Aspects of Food Policy. HMSO
Department of Health. 2000. Adverse Reactions to Food and Food Ingredients - Report of the Committee on Toxicity of Chemicals in Food. HMSO
Holmes S. 2000. Nutritional screening and older adults. Nursing Standard 15(2): 42-44
Lennard-Jones JE (ed.). 1992. A Positive Approach to Nutrition as Treatment. London: Kings Fund Centre.
National Audit Office. 2001. Tackling Obesity in England. The Stationery Office.
McGough N. 2001. Prevention of type 2 diabetes. Nutrition in Practice 2(3): 1-4
McWhirter J, Pennington CR. 1994. Incidence and recognition of malnutrition in hospital. BMJ 308
Stratton RJ, Elia M. 1999. A critical, systematic analysis of the use of oral supplements in the community. Clinical Nutrition. 18(Suppl 2): 29-84
Wood S; Creamer M. 1996. Malnutrition in hospitals. The Nurses' role in prevention. Nursing Times: 92: 26, 67-68
Yannios T. 1999. The Heart Disease Breakthrough - The 10-Step Program that can save your Life. Wiley