Diet and nutrition

Good nutrition has a key role to play both in the prevention and management of diet-related diseases such as cardiovascular disease (CVD), cancer, diabetes and obesity (World Health Organisation, 2003). Healthy eating during childhood and adolescence is vital as a means to ensure healthy growth and development and to set up a pattern of positive eating habits into adult life. The promotion of evidence-based healthy eating messages is fundamental. Alongside this, it is necessary to ensure that guidelines concerning a nutritionally adequate diet are implemented to help prevent diet-related deficiencies and malnutrition in vulnerable infants, children and adults.

 

In the UK, the poorer people are, the worse their diet, and the more diet-related diseases they suffer from. This is known as food poverty. Poor diet is a risk factor for the UKs major causes of death: cancer, coronary heart disease (CHD) and diabetes. It is only recently that the immense contribution it makes to poor health has been quantified: poor diet is related to 30% of life years lost in premature death and disability (De Rose, Messer & Millman, 1998).

 

Tackling food poverty is recognised as key to achieving Government targets on reducing inequalities, reducing illness from cancer and CHD and improving the health of children and older people. However, action needs to be more than health professionals giving advice to individuals. It must change the ‘food environment’ – that is, accessibility, affordability, culture – in which people live (O’Neil, 2005).

 

Poor diet is a major health risk. It contributes to:

 

- Almost 50% of CHD deaths

- 33% of all cancer deaths

- Increased falls and fractures among older people

- Low birth weight and increased childhood illness and mortality

- Increased dental disease, especially in children

 

This topic is most closely linked to:

 

- Obesity

- Physical activity

- Cancer

- Circulatory diseases

- Diabetes mellitus

- Oral health

Last updated: 2015-12-02 10:36:15
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1. What are the key issues?

Breastfeeding rates are amongst the lowest in England and the gap between Redcar & Cleveland and England is widening.

At all ages, the proportion of people who are overweight and obese is higher than England.  Only one in five adults eats a healthy diet.

There is low uptake of vitamin supplements through the Healthy Start scheme.

People in vulnerable groups and those with low incomes are at increased risk of having malnutrition from diet-related illness.

There is inconsistent advice on optimal nutrition from professionals.

There are high rates of dental decay in children, which will be significantly influenced by diet.  There is a four-fold difference in decay rates between the best and worst wards.

 

Last updated: 02/12/15

2. What commissioning priorities are recommended?

2012/01
Commission evidence-based best practice to maximise breastfeeding initiation and continuation.  Ensure appropriate support services are in place and that health professionals are appropriately trained to provide support and consistent advice throughout antenatal and postnatal periods. Amended from 2012, remains a priority.

 

2012/03
Continue to commission services to increase and maintain the uptake of the national Healthy Start initiative, in particular vitamin supplements, to both professionals and the target audience. Amended from 2012, remains a priority.

 

The following commissioning priorities are new for 2015:

 

2015/01

Commission services to improve children’s diet during early years of life alongside commissioned work to promote healthy weight.

 

Other key priorities that are not necessarily related to commissioning include:

 

2012/02
Promote healthy eating, making use of national campaigns and brands, and develop joint working with key sectors, such as planning and transport departments, to ensure the potential for physical activity and healthy eating is maximised, including the use of health impact assessments to address the causes of poor diet. Amended from 2012, remains a priority.

 

2012/05
Develop consistent and integrated strategies among all health and social care providers to detect, prevent and treat malnutrition.  Make appropriate training available to staff in all settings so that they have a common basic knowledge of nutrition and the skills to promote a nutritionally adequate diet. Remains a priority.

 

2012/06
Ensure that good quality and healthy food is provided by working with local public sector service providers, such as schools, hospitals, and prisons. Remains a priority.

 

2015/02

Support the delivery of cookery training, especially for priority groups in line with the emerging evidence base.

 

Last updated: 02/12/15

3. Who is at risk and why?

Nationally, there have been positive changes in the diet of British people over 15 years (Scientific Advisory Committee on Nutrition, SACN, 2008).  However, the latest data from the National Diet and Nutrition Survey shows that overall, the UK population is still consuming too much saturated fat, added sugars and salt, and not enough fruit, vegetables, oily fish and fibre (Public Health England 2014).  Additionally, there are still several areas of concern.

 

Age
Infants, children and young people

Rates of breastfeeding have increased for all age groups nationally (Health & Social Care Information Centre, 2010).  However, young mothers have 50% lower breastfeeding initiation rates and are then less likely to continue breastfeeding compared to older mothers.

It is estimated that 30% of hospital admissions would be avoided for each additional month of full breastfeeding and that 100% of full breastfeeding among 4-month-old babies would avoid 56% of hospital admissions in babies who are younger than 1 year (UNICEF, 2012).

The diets of under-fives in the UK are too low in vitamins A and C, iron and zinc and, for some groups of children, vitamin D.  Children’s diets also contain too few fruits and vegetables, too much of the type of sugars that most contribute to tooth damage, and too much salt (Caroline Walker Trust, 2006).

Children are eating too many unhealthy snacks.  Nearly three in ten secondary school pupils are snacking on crisps, sweets or fizzy drinks three or more times a day (British Heart Foundation, 2011)

Children aged 11-18 have low iron intake, predominantly among girls where 46% have a mean daily intake below the recommended amount. This has implications for growth and development, and an increased risk of iron deficiency anaemia (Whitton et al. 2011).

Dietary habits seem to be set at an early age and seldom improve spontaneously (Frémeaux et al, 2011).


Young adults aged 19-24 years

The Scientific Advisory Committee on Nutrition (2008) found that:

 

 

  • Almost all (98%) young adults in this age group consumed less than the minimum recommended intake of fruit and vegetables. Mean consumption was 1.6 portions per day.
  • This group exceeded the maximum recommendation of added sugar (11% of food energy) with mean intakes sugar at 16% food energy. The main source was soft drinks with the average intake being 8-9 cans each week.
  • Almost one-third of women in this age group have a low vitamin D status.
  • Over 40% of young women had an iron intake below the recommended level.
  • One-fifth of young men had a salt intake above 15g per day; the recommended maximum is 6g.

Adults aged 65 years and over living in institutions
There is evidence of low intake and status for a number of vitamins and minerals for older people living in institutions. In October 2006, the Food Standards Agency issued nutrient and food-based guidance for UK institutions. Malnutrition was found to affect more than 1 in 3 adults on admission to hospitals, more than 1 in 3 adults admitted to care homes in the previous 6 months, and 1 in 5 in adults on admission to mental health units in the UK (British Association for Parental and Enteral Nutrition, 2010). Most of those affected were in the high risk category. Malnutrition is common in all types of care homes and hospitals, all types of wards and diagnostic categories, and all ages.  According to the report, much of the malnutrition present in institutions originates in the community.

Gender
Almost one-third of women aged 19-24 have a low vitamin D status.

Over 40% of young women had an iron intake below the recommended level.

One-fifth of young men had a salt intake above 15g per day; the recommended maximum is 6g.

Some men, following divorce, consume a poor diet (e.g. living on “Pot Noodles” and takeaway food) due to their lack of cooking skills (Eng et al. 2005).

Socioeconomic status
Women from disadvantaged groups have a poorer diet and are more likely either to be obese or to show low weight gain during pregnancy and their babies are more likely to have a low birth weight. Mothers from these groups are also less likely to take folic acid or other supplements before, during or after pregnancy (Food Standards Agency, 2009).

Mothers in low socioeconomic position continue to have a strong impact on patterns of infant feeding (Health and Social Care Information Centre, 2010). Incidence of breastfeeding remains higher amongst mothers in managerial and professional occupations. However across the UK as a whole, breastfeeding rates increased in all socioeconomic groups (Health and Social Care Information Centre).

Nationally, breastfeeding rates amongst mothers in routine and manual occupations increased from 65% in 2005 to 74% in 2010, therefore narrowing the gap between the highest and lowest socioeconomic groups.

Mothers in lower socioeconomic groups are more likely to introduce solid foods earlier than recommended and their children are at a greater risk of both ‘growth faltering’ (that is, they gain weight too slowly) in infancy and obesity in later childhood (Armstrong et al, 2013). In addition, average daily intakes of iron and calcium are significantly lower, and rates of dental caries are significantly higher among children from manual groups compared with those from non-manual groups (Gregory et al. 1995; Health and Social Care Information Centre, 2015).

About 39% of people from low income groups report that they worry about having enough food to eat before they receive money to buy more. Similarly, about one-third (36%) report that they cannot afford to eat balanced meals. Overall, one-fifth of adults in low income groups report reducing the size of, or skipping, meals. Five per cent report that, on occasion, they have not eaten for a whole day because they did not have enough money to buy food (Food Standards Agency, 2008).

 

People have adopted a wide range of strategies to try and manage shortfalls in household income, and using food banks is often the last resort (Lambie-Mumford et al. 2014; Perry et al. 2014). However, more people are using them to make ends meet and the evidence suggests that need is driving demand, not supply (Cooper, Purcell & Jackson, 2014). Research in West Cheshire suggests that 47% of referrals to food banks were the result of problems with social security benefits with a further 20% the result of low, insecure incomes and 11% due to debt (Spencer, Ogden & Battarbee, 2015).

Many areas of dietary concern for people in lower socioeconomic groups were similar to that of the general population (Scientific Advisory Committee on Nutrition, 2008); but the following were more marked:

 

 

  • Average consumption of fruit and vegetables was lower with the average daily intake being 2.5 for women, 2.4 for men, 2 for girls and 1.6 for boys.
  • Intakes of added sugar, especially amongst children and saturated fats were above current recommendations.
  • Intakes of dietary fibre fell below current recommendations.
  • Evidence of inadequate nutritional status for iron, folate and vitamin D.
  • A substantial proportion of men and women were overweight or obese.

Ethnicity
People from South Asian and African-Caribbean communities tend to have a greater prevalence of vitamin D deficiency, which is thought in part to be due to darker skin tone (SACN, 2008).

Compared with white Europeans, South Asian children reported a higher mean intake of total energy, total fat, polyunsaturated fat and protein whilst carbohydrate (particularly sugars), vitamins C and D, calcium and iron were lower. These differences were larger for Bangladeshi children (Donin et al. 2010).

Compared with white Europeans, Black African and Black Caribbean children had lower intakes of total and saturated fat, fibre, vitamin D and calcium. (Donin et al. 2010)

Vulnerable groups
Learning disabilities
People with a learning disability have a greater prevalence of health problems. It is well established that they are nutritionally vulnerable. Historically, many people with a learning disability lived in long-stay hospitals where many nutritional problems occur. These problems can include the following; underweight (this leads to less resistance to infections and less resistance to pressure sores); overweight; constipation; dehydration and specific nutrient deficiencies. The main other issue cited is the higher prevalence of obesity and underweight in this population (The Caroline Walker Trust, 2007).

People suffering mental ill health
Self-neglect and disorganised lifestyles may be a symptom of mental health needs and may result in malnutrition. The 2007 National Nutrition Screening Week found 19% of adults admitted to mental health units were ‘malnourished’. Poor nutrition has been associated with a number of mental illnesses such as depression (Dipnall et al, 2015).

Depression increases the risk of mortality by 50% and doubles the risk of coronary heart disease in adults. People with schizophrenia or bipolar disorder have higher rates of obesity, abnormal lipid levels and diabetes. They are also less likely to benefit from public health programmes and mainstream screening (Department of Health, 2011).

 

Other Areas

There is increasing concern about the consumption of energy drinks in adolescents and young adults (particularly males), especially in terms of sugar content, impact on behaviour including increased risk taking and substance misuse and adverse effects affecting the cardiovascular and neurological systems (Ali et al. 2015; Sanchis-Gomar et al. 2015). A survey by the European Food Safety Authority (2013) found that 21% of UK adults were high chronic consumers of energy drinks (European average 12%), with an equivalent figure of 19% in adolescents (European average 12%).  The average consumption for adolescents in the UK was 3.1 litres per month, the highest in Europe (average 2.1 litres). Concerns over behaviour have led some schools to ban them whilst others have gone further by encouraging local shops not to sell them to students. However, robust evidence in relation to behaviour is sparse or non-existent.

Last updated: 04/12/15

4. What is the level of need in the population?

Healthy Eating Behaviour

The national Public Health Outcomes Framework provides local authority level data on healthy eating for adults. The 2014 data for Redcar & Cleveland shows 50.6% of adults eating at least 5 portions of fruit and vegetables per day, similar to the England average (53.5%).

 

 

Social sub-groups of the population that consume less than 2 portions of fruit per day are listed in the following table. Mosaic groups I, K and O make up 36% of Redcar & Cleveland’s population. Nationally, these groups tend to consume less fruit than average. Data from the Active People Survey suggests that 54.5% of the Redcar and Cleveland adult population eat five portions of fruit and vegetables a day, compared to a North East average of 54.4% and England 56.3%.

 

Population consuming <2 portions of fruit per day by Mosaic Group, Redcar & Cleveland

 


Deprivation          
Redcar and Cleveland is ranked the 49th most deprived local authority nationally. As a consequence, those living in the most deprived areas may face additional barriers to accessing and consuming a healthy diet. Evidence would suggest that locally this is the case due to the high rates of obesity and physical inactivity in these areas.

 

Breastfeeding
Breastfeeding initiation in Redcar & Cleveland is significantly lower than England.  Rates have remained similar in Redcar & Cleveland since 2005/06, whereas increases are seen in comparable areas and the gap is widening.  In 2014/15, Redcar & Cleveland had the sixth lowest breastfeeding initiation rate of all area in England.

 

 

By the time babies are six to eight weeks old, between one in four and one in five are being breastfed, about half the proportion seen in England.  In 2014/15, Redcar & Cleveland had the third lowest breastfeeding rate at 6-8 weeks (22.5%) of all areas in England.

 

 

Since 2013, there have been issues with the infant feeding data quality across the whole NHS – some of the rates have been questioned (i.e. are potentially incorrect) whilst data has simply not been available for some areas. Additionally, the data has been more frequently reported at CCG level rather than Local Authority.

 

Breastfeeding rates vary considerably within Redcar & Cleveland.  In Grangetown ward, fewer than one-third of mothers initiated breastfeeding, compared with more than 60% in Hutton and Saltburn wards.

 

 

 

Healthy Start

Nationally collated data indicates that uptake of the Healthy Start scheme overall is progressing well in Redcar & Cleveland, with 89% of those eligible taking part. However, the uptake of vitamin supplements remains low in comparison to those that are eligible to benefit with only:

 

  • 1.2% of those eligible accessing women’s vitamins tablets;
  • 0.3% of those eligible accessing children’s vitamin drops.

The low uptake is of a concern as the Healthy Start vitamins can reduce the risk of health problems associated with vitamin deficiencies such as rickets and spina bifida. Clearly, the vitamin supplement element of the Healthy Start scheme in Redcar and Cleveland is being underutilised and presents an opportunity for further improvement.

 

Oral health

Poor oral health is a good indicator of poor nutrition. Families living in deprived areas tend to have diets containing high levels of sugar which can have an adverse effect on oral health and weight.  The decay rate in Redcar & Cleveland children is approximately one-and-a-half times the national average and there are significant dental health inequalities between wards with those in the most deprived wards having the worst oral health. Further information can be found in the oral health section.


School meals

School meals in Redcar & Cleveland meet the Food Based and Nutrient Based Standards for school lunches set by the Government.  In 2010/11, school meal up take in primary and special schools in Redcar & Cleveland (54.6%) was higher than England (44.1%) but lower than the North East (60.3%).  Up take in secondary schools (64.0%) is higher than both the regional and national averages (45.0% and 37.6% respectively).


Free school meal eligibility in Redcar & Cleveland is above England and North East averages. Free school meal uptake in all schools in Redcar & Cleveland is similar to the national and regional averages but 11.6% of children in primaries and 26.3% in secondary schools do not take up their eligibility.

 

 

Last updated: 02/12/15

5. What services are currently provided?

 

Primary care

One-to-one consultations on nutrition and dietary advice are available within primary care. General practices also carry out brief interventions, particularly as part of the Tees Healthy Heart Check programme to improve lifestyle behaviour including dietary habits.


Antenatal care

Community midwifery services provide antenatal advice on dietary intake and supplements including folic acid and vitamin D.


Secondary care

South Tees Hospitals NHS Foundation Trust Nutrition and Dietetic Department provides clinical dietetic services for a wide variety of diet-related medical conditions.  These include diabetes, coeliac disease, food allergies and intolerance, faltered growth, cardiac rehabilitation sessions, irritable bowel syndrome and nutritional support amongst a number of other services.


Mental health and learning disabilities

Tees, Esk and Wear Valleys NHS Foundation Trust cover a wide range of mental health, learning disability and substance misuse services. The dietetic team are implementing two pathways of care for malnutrition and weight management. 


In-patient food provision is monitored to ensure that menus provided for in-patient settings meet the nutritional guidelines and needs of the client group.  Healthy options are promoted using a traffic light food labelling system together with the provision of health promotion education groups and sessions for people with learning disabilities.


Care settings

To address issues of malnutrition in care settings, the Malnutrition Universal Screening Tool (MUST) training is provided for primary care hospitals and community nursing staff in Middlesbrough and Redcar & Cleveland.

Breastfeeding support

Antenatal support sessions are provided by maternity services.  Following discharge from the midwifery service, locality health visiting teams support mothers further with breastfeeding and infant feeding.

 

The Redcar & Cleveland Breastfeeding Service has an Infant Feeding Coordinator who leads on:

 

  • implementation of UNICEF best practice standards;
  • training for health visiting, children’s centre staff and primary care;
  • audit of compliance with UNICEF best practice standards;
  • supporting staff with clients with complex breastfeeding problems;


There are nine Breastfeeding Support groups in Redcar & Cleveland.  These groups are run by Early Years practitioners based in the Sure Start Children’s Centres.


Healthy Start

Healthy Start is a statutory scheme which aims to improve the health of pregnant women and families on benefit or low incomes.  Vouchers are provided to exchange for fresh fruit and vegetables as well as milk and infant formula milk.  Vitamin supplements are also provided.  Healthy Start targets pregnant women and families with children under four years old. Those on low incomes and all pregnant women under the age of 18 are eligible for free vitamins.


There are currently three distribution points in Redcar & Cleveland: Guisborough Primary Care Hospital; Redcar Primary Care Hospital and Fabian Road Clinic, Eston

 

Weaning
Nutrition workers support the Health Visiting service and Sure Start Children’s Centres by providing advice on introducing solid foods. This can be during specified health drop-ins or in group situations, which supports parents by providing safe and practical advice.


Community cooking sessions

A number of providers in Redcar & Cleveland offer cookery classes ranging from basic classes to more professionally orientated courses.


Workplace initiatives

The regional Better Health at Work Awards encourage employers in the North East to consider how they can improve the health of their workforce. Implementing and promoting healthy eating is an integral part of the scheme including the development of a healthy eating policy.


Healthy Schools

The Redcar & Cleveland Health Improvement team is supporting all schools to maintain Healthy School standards as well as supporting them to achieve the new enhanced Healthy Schools status.

 

Last updated: 02/12/15

6. What is the projected level of need?

Breastfeeding at 6-8 weeks is forecast to decrease, based on historical data, thus widening the gap between Redcar & Cleveland and England.


 

Other emerging nutritional deficiencies may also increase locally, and with the elderly population predicted to increase, the prevalence of malnutrition may also increase subsequently impacting on local NHS services and health costs.

Last updated: 02/12/15

7. What needs might be unmet?

Breastfeeding
Despite achieving UNICEF stage three for both acute and community services, rates of breastfeeding in Redcar & Cleveland remain stubbornly stagnant.


Interventions for families such as antenatal classes, breastfeeding support groups and weaning groups are underutilised by those least likely to follow national advice.


Vulnerable adults and children

Increased support and education for adults who move from a care setting to independent living and those already in supported living is needed as often they lack the resources and knowledge to purchase and eat a balanced diet, particularly for those adults with learning disabilities and mental ill health.


Black and minority ethnic groups

There is a need for targeted healthy eating and weight management services for the BME population.


Training and capacity building

There is a need for capacity and capability building in Redcar & Cleveland for frontline staff to ensure every contact maximises the health improvement opportunity, and to ensure consistent nutrition advice and support, particularly for those who care for vulnerable children and adults.


There is no consistent approach to educational needs and standards of practice for nutritional care and support in care settings, particularly linked to malnutrition.


Demand for cooking skills development and practical advice on healthy eating is high, but meeting this demand is subject to available staffing resources, funding and facilities.


Food poverty

It is likely that people living in deprived areas may face additional barriers to a healthy diet putting them at greater risk of diet-related disease such as obesity, type two diabetes, CVD and poor oral health.

Last updated: 02/12/15

8. What evidence is there for effective intervention?

NICE Guidance

 

National Institute of Health and Clinical Excellence (2006). Behaviour Change at Population, Community and Individual Levels (PH6). London: Author

 

National Institute of Health and Clinical Excellence (2006). Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition (CG32) . London: Author

 

National Institute of Health and Clinical Excellence (2008). Maternal and Child Nutrition (PH11). London: Author

 

National Institute of Health and Clinical Excellence (2010). Prevention of Cardiovascular Disease at Population Level (PH25). London: Author

 

National Institute of Health and Care Excellence (2010). Weight Management Before, During and After Pregnancy (PH27). London: Author

 

National Institute of Health and Care Excellence (2011). Food Allergy in Children and Young People: Diagnosis and Assessment of Food Allergy in Children and Young People in Primary Care and Community Settings (CG116). London: Author

 

National Institute of Health and Care Excellence (2011). Preventing Type 2 Diabetes: Population and Community-Level Interventions (PH35). London: Author

 

National Institute of Health and Care Excellence (2013). Managing Overweight and Obesity among Children and Young People: Lifestyle Weight Management Services (PH47). London: Author

 

National Institute of Health and Care Excellence (2014). Behaviour Change: Individual Approaches (PH49). London: Author

 

National Institute of Health and Clinical Excellence (2014). Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease (CG181). London: Author

 

National Institute of Health and Care Excellence (2014). Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults (CG189). London: Author

 

National Institute of Health and Care Excellence (2014). Overweight and Obese Adults - Lifestyle Weight Management (PH53). London: Author

 

National Institute of Health and Clinical Excellence (2014). Quality Standard for Nutrition Support in Adults (QS24). London: Author

 

National Strategies

 

Department of Health (2011). Healthy Lives, Healthy People: A Call to Action on Obesity in England. London: Author

 

Other documents

 

Jolly K, Ingram L, Khan KS. et al. (2012). Systematic review of peer support for breastfeeding continuation: meta-regression analysis of the effect of setting, intensity, and timing. British Medical Journal, 344, d8287

 

Kaunonen M, Hannula L. & Tarkka MT. (2012). A systematic review of peer support interventions for breastfeeding. Journal of Clinical Nursing, 21 (13-14), 1943 – 1954

 

Knai C, Pomerleau J, Lock K. & McKee M. (2006). Getting children to eat more fruit and vegetables: A systematic review. Preventive Medicine, 42 (2), 85 – 95

 

Government Office for Science (2007) Tackling Obesities: Future Choices. London: Author

 

Lara J, Hobbs N, Moynihan PJ. et al. (2014). Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials. BMC Medicine, 12, 60

 

McGill R, Anwar E, Orton L. et al. (2015). Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health, 15, 457

 

Moran VH, Morgan H, Rothnie K. et al. (2015). Incentives to promote breastfeeding: A systematic review. Pediatrics, 135 (3), e687 - e702

 

National Obesity Observatory – for a wide variety of publications and information related to obesity

 

Pomerleau J, Lock K, Knai C. & McKee M. (2005). Interventions designed to increase adult fruit and vegetable intake can be effective: A systematic review of the literature. Journal of Nutrition, 135, 2486 – 2495

 

Renfrew MJ, McCormick FM, Wade A. et al. (2012). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD001141

 

Story M, Kaphingst KM, Robinson-O’Brien R & Glanz K. (2008). Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health, 29, 253-272

 

Townsend N, Murphy S. & Moore L. (2011). The more schools do to promote healthy eating, the healthier the dietary choices by students. Journal of Epidemiology and Community Health, 65, 889 – 895

Last updated: 02/12/15

9. What do people say?

There is a lack of local consultation and data on what people say about diet and nutrition-related issues. However local stakeholders have been consulted on the topic, including voluntary sector, primary care, early year providers, Nutrition and Dietetics, lifestyle providers, people with learning disabilities and older people care providers and their comments have been included throughout.


Breastfeeding
The North East SHA commissioned research with mothers on reasons for their infant feeding choices. The most common reasons for planning to use infant formula were:

 

  • Participants did not like the idea of breastfeeding;
  • Other people can feed the baby;
  • Inconvenient due to mother’s lifestyle;
  • Previous children were fed with infant formula;
  • Participants had breastfed previous children and didn’t like it.


The most common reason for planning to breastfeed was that ‘breastfeeding is best for health of the baby’.

During audit preparation prior to the UNICEF Baby Friendly Initiative, both the women who were bottle feeding, but had initiated breastfeeding and women who were breastfeeding asked for local breastfeeding support groups as they had seen these on the television.


Women and families value the support that is provided by peer groups. This was identified in the final recommendations of the Public Health North East social marketing benchmarking research.


Women also highlight that embarrassment is a large part of choosing not to breastfeed and not knowing where would be “safe” to breastfeed when in public.

 

Last updated: 02/12/15

10. What additional needs assessment is required?

Audit of practice in care settings in relation to identifying malnutrition and processes used when malnutrition is identified.

Further insight into the poor uptake, awareness and promotion of Healthy Start vitamins, particularly in relation to vitamin D intake in the BME community.

Further insight into the availability of fast food take-away shops and shops selling affordable, healthy food in Redcar & Cleveland particularly in relation to schools and wards (food mapping).

An analysis of training needs for those working in care settings and for frontline staff.

Needs analysis to determine the level of breastfeeding services that might be required locally and to calculate the cost of commissioning breastfeeding services by:

 

  • identifying indicative local service requirements;
  • reviewing current commissioned activity;
  • identifying future change in capacity required; and
  • modelling future commissioning intentions and associated costs.

Develop a better understanding of local beliefs and attitudes to diet and nutrition and use this insight to commission culturally appropriate interventions aimed at improving diet and nutrition in target populations.

Last updated: 02/12/15

Key Contact

Name: Scott Lloyd

Job Title: Health Improvement Specialist

e-mail: scott.lloyd@redcar-cleveland.gov.uk

phone: 01642 771642

 

References

National strategies and documents

Department of Health (2004). National Service Framework for Children, Young People and Maternity Services: Maternity Services. London: Author

Department of Health (2004). Infant Feeding Recommendation. London: Author

Department of Health (2011). Healthy Lives, Healthy People: A Call to Action. London: Author

Scientific Advisory Committee on Nutrition (2015). Carbohydrates and Health. London: The Stationary Office

 

Local strategies and plans

Public Health North East (2012). North East Infant Feeding Weaning and Nutrition Guidelines. Newcastle: Author

 

Other references

Ali F, Rehman H, Babayan Z, Stapleton D. & Joshi DD. (2015). Energy drinks and their adverse health effects: a systematic review of the current evidence. Postgraduate Medicine, 127 (3), 308 – 322

Armstrong J, Dorosty AR, Reilly JJ et al. (2003) Coexistence of social inequalities in undernutrition and obesity in pre‑school children. Archives of Disease in Childhood, 88, 671 – 675

British Association for Parenteral and Enteral Nutrition (2011). Nutrition Screening Survey in the UK in 2010. Redditch: Author

British Heart Foundation (2011). The Real Five-a-Day? UK Kids Feast on Chocolate, Energy Drinks and Crisps. London: Author

Caroline Walker Trust (2006). Eating Well for Under 5’s in Childcare – Practical and Nutritional Guidelines. London: Author

Caroline Walker Trust (2007). Eating Well: Children and Adults with Learning Disabilities. London: Author

Cooper N, Purcell S & Jackson R. (2014). Below the Breadline: The Relentless Rise of Food Poverty in Britain. London: Oxfam

Department of Health (2011). No Health Without Mental Health: A Cross-Government Mental Health     Outcomes Strategy for People of All Ages. London: Author

DeRose L, Messer E. & Millman S. (1998). Who's Hungry? And how do we know? Food Shortage, Poverty, and Deprivation.  New York: United Nations University Press.

Dipnall JF, Pasco JA, Meyer D. et al. (2015). The association between dietary patterns, diabetes and depression. Journal of Affective Disorders, 174, 215 – 224

Donin AS, Nightingale CM, Owen CG. et al (2010). Nutritional composition of the diets of South Asian, black African-Caribbean and white European children in the United Kingdom: The Child Heart and Health Study in England (CHASE). British Journal of Nutrition, 104, 276-285

Eng PM, Kawachi I, Fitzmaurice G & Rimm EB. (2005). Effects of marital transitions on changes in dietary and other health behaviours in US male health professionals. Journal of Epidemiology and Community Health, 59, 56 – 62

European Food Safety Authority (2013). Gathering Consumption Data on Specific Consumer Groups of Energy Drinks. Parma: Author

Food Standards Agency (2008). Low Income Diet and Nutrition Survey. London: Author

Food Standard Agency, (2009). Annual Report of the Chief Scientist 2008/09. London: Author

Frémeaux AE, Hosking J, Metcalf BS. et al. (2011). Consistency of children's dietary choices: annual repeat measures from 5 to 13 years. British Journal of Nutrition, 106, 725 – 731

Gregory J, Collins D, Davies P et al. (1995). National Diet and Nutrition Survey: Children aged 1½ to 4½ Years. Volume 1: Report of the Diet and Nutrition Survey. London: The Stationery Office.

Health & Social Care Information Centre (2010). Infant Feeding Survey 2010. London: Author

Health & Social Care Information Centre (2015). Child Dental Health Survey 2013, England, Wales and Northern Ireland. London: Author

Herbert K, Plugge E, Foster C & Doll H. (2012). Prevalence of risk factors for non-communicable diseases in prison populations worldwide: A systematic review. The Lancet, 379 (9830), 1975 – 1982

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