Stockton JSNA


Diet and nutrition

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, there are still several areas of concern.

Age
Infants, children and young people
Young mothers are one-third less likely to breastfeed; however rates have increased for all age groups nationally (NHS Information Centre, 2010).  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
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 (BAPEN, 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.

 

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 (NHS 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.

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. 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.

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).

Many areas of dietary concern for people in lower socioeconomic groups were similar to that of the general population; 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 indicated as a causal factor in a number of mental illnesses.

Depression increases the risk of mortality by 50% and doubles the risk of coronary heart disease in adults (DH, 2011). 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.

 

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