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MODERN DIETARy TREATMENT

Additional articles for subscribers only NHDmag.com

ULCERATIVECOLITIS

PART 2

Editor's report

April 2016

A REVIEW OF THE OLDEST BOOK ON DIETETICSBY URSULA ARENS AND DR MARGARET ASHWELL

The first issue of Modern Dietary Treatment was published pre-war in 1937, and we are most fortunate to have the original Elsie-Widdowson annotated copy that would have been given to the publisher to form the basis of a later update. Edition Two appeared in 1940 and the final third edition was published in 1951. The introduction to the book cheers the rapid advance in the science of nutrition from about 1910. These include revolutionary developments in knowledge about vitamin and mineral metabolism and improvements in food analysis. The vitamin researchers in the first third of the last century were the intellectual heroes of the time: Frederick Gowland Hopkins could match Bill Gates-today for acclaim and the Cambridge nutrition department outputs were unrivalled for pioneering science concepts. Elsie, who was a biochemist at Kings College Hospital and Margery Abrahams, who was a dietitian at St Barts Hospital, authored the first edition of Modern Dietary Treatment. In the first correction in the book, there is the update that Elsie was now at the Department of Medicine in Cambridge. The first chapters cover basic dietary principles. Later chapters are more applied to discussion about diet modification in relation to disease states. High and low Calorie diets, invalid diets, diets for diabetes or diseases of kidney and alimentary systems, and diets for mineral metabolism disturbances all get

GoinG forward (by lookinG back to dietetics in the 1930s)Modern Dietary Treatment by Elsie Widdowson and Margery Abrahams is 79 years old, but still offers a lot to think about in one of the first books on dietetics.

NHD-Extra: book rEviEw

individual chapters. As does the topic of diets for Jewish patients. Large final sections of the book describe diet food lists, recipes and food composition data. There are revealing errors, which perfectly capture the developments of our understanding of nutrients. So, for example, it is asserted that the iron in meat is mainly in a form that is unavailable to the body; today we would consider the opposite to be the case. Another example of muddle is some of the statements about the B vitamins. While many vitamin B forms had been described, Elsie and Margery stated that only B1 and B2 (described as vitamin B and vitamin G in America) were needed in humans. The name for B2 is given as lactoferrin (now riboflavin), and the American vitamin ‘G for Goldberger’ was actually what is now described as the anti-pellagra vitamin niacin. The vitamin B complex is, complex, and these inaccuracies show the difficulties in trying to capture the state-of-knowledge at the time. The first edition has no mention of vitamin E, but the handwritten paper insert updates this section for the next edition. Deficient status results in fetal resorption in pregnant rats, but whether vitamin E deficiency had any connection

Dr Margaret ashwell, obE, PhD, FafN, rNutr (Public Health), research Fellow

Ursula arens writer; Nutrition & Dietetics

Ursula has spent most of her career in industry as a company nutrition-ist for a food retailer and a pharmaceuti-cal company. She was also a nutrition scientist at the British Nutrition Foundation for seven years. Ursula helps guide the NHD features agenda as well as contributing fea-tures and reviews

Dr Margaret Ashwell has been a Senior Research Scientist with the Medical Research Council, Science Director of the BNF and an Independent Consultant, working for government and industry. She is an author and editor of the biography of the nutrition pioneers, McCance and Widdowson. She was appointed an OBE in 1995 and was elected as a Fellow of the Ass-ociation for Nutrition (AfN) in 2012.

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with habitual abortion in humans had not been satisfactorily proved. Vitamin E is still the vitamin most looking for a function (in human nutrition). There are delightful statements in the book that would surprise dietitian readers of today. Such as the warnings about diets containing large amounts of vegetables - these are wasteful for normal people since they tend to displace more concentrated and nourishing foods. Such as comments on the challenges of giving advice to diabetic patients who are, ‘elderly or stupid.’ Such as snack suggestions for those with anaemia: toast with minced hog’s stomach - not doubt an effective measure, but a culinary challenge today. The chapter on diabetes diets is the most interesting one for history-of-nutrition enthusiasts. While 1921 is the search-google year for the discovery of insulin, there were fierce debates over carbohydrate control, and Elsie and Margery describe these. Pre-insulin days meant starvation and then feeding high fat diets, and then very incrementally increasing amounts of carbohydrate, until a tolerance level was achieved. However, it appeared that even in the mid-1930s ‘Newburgh and his followers in America and many continental doctors’ still advocated very low carbohydrate diets for blood glucose control. For dietitians and doctors who

FooD aND NUtritioN

supported greater intakes of carbohydrate, there was much confusion on diets. Thankfully, Dr RD Lawrence published the Line Ration diet scheme in 1936, which gave lists of interchangeable foods containing 10g units of carbohydrates. This dramatically simplified communication about the diabetic diet, with black line foods for carbs and red line foods for proteins and fats. Page 185 of the book is the only one printed in colour, and ‘going red’ must have been a debated and costly publishing decision. Many therapies described in Modern Dietary Treatment are lost and long forgotten: Sherman, Lenhartz and Epstein diets ring no bells in nutrition discussions of today. It is also amazing that there is no single reference in the book to the terms allergy, gluten, or saturated fats. Today’s demon, sugars, is only described as an attractive and useful way to add energy to the diet of a child or invalid. There have been explosive expansions in nutrition science data available for dietetic professions to consider in optimising health in the pre- and post-diagnosed. But all of these must still be funnelled into on-the-plate choices, which for most people, of course, are mainly driven by many other factors. But Elsie and Margery’s book considers just these issues, and they will be the same issues needing expert guidance in the future.

The chapter on diabetes diets is the

most interesting one for history-of-nutrition

enthusiasts.

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Part 1 of this article can be found in NHD Magazine, april issue 113

case study: ulceratiVe colitis (ibd)The impact of IBD on the nutritional status and life of an 18 year old

Part 2: Post-surgical experiences, diet with an ileostomy and the ileoanal pouch

NHD-Extra: CoNDitioNS & DiSorDErS

Emma CoatesNHD Editor

Case Study Part 2

It was dark, she had no idea what time it was. For a minute, she wasn’t sure where she was, but it all came flooding back. Lying in a bed, propped up a little and surrounded by beeping machines. Wires and tubes to the left and right of her. The cannula in her left hand pulled a little as she tried to scratch her nose. Looking around the room, she felt a similar pull in her neck. Another cannula in the left of her neck. It made her shiver a little. Remembering why she was there, she patted her abdomen, expecting it to be tender. No pain, nor discomfort, just the rustle of the new ileostomy bag and the large white dressing on her surgical wound. The nurse came in, ‘Well hello, you’ve been sleeping. Don’t you worry; we’ll get you back on your feet in no time’. Maria smiled and nodded off again . . .

emma has been a registered dietitian for nine years, with experience of adult and paediatric dietetics. she specialised in clinical paediatrics for six years, working in the nhs. she has recently moved into industry and currently works as Metabolic dietitian for dr schar uk.

Maria stayed on the High Dependency Unit for three days after her surgery (a restorative proctocolectomy with ileoanal pouch construction and temporary ileostomy; see Part 1 of this case study in NHD April 2016, for more information about this procedure). In the weeks preceding the surgery she was introduced to a specialist stoma care nurse who explained the surgical procedure to Maria and her family. She was able to answer the many questions Maria had about life with an ileostomy. What will it look like? Will she feel it? How big are the bags? Will it smell? The list went on. Following her surgery, the stoma care nurse reviewed Maria on the ward and after a few days, as Maria was able to get up and walk around, she went through changing the bag and how to care for the skin around the stoma. In the few days following the surgery, Maria hadn’t been eating well, therefore her stoma output had been limited. However, as she gained her appetite back, she found many foods resulted in higher outputs than others; for example, high fibre cereal and fruit. In addition, the effects of some foods were particularly malodourous and this was not pleasant. For the first five days post-surgery the output was quite liquid. However, the consistency improved and could be described as toothpaste or porridge consistency (type 6 stools7). Initially, the bag required emptying every two to three hours, but as things settled over the week following the surgery, this reduced to approximately three to four times per day. Please see Table 1 for an overview of some of the dietary considerations with an ileostomy. As Maria’s weight had dipped to 45kg (BMI 16.3kg/m2) prior to surgery, she was referred to the dietitian by the ward nursing staff. She was prescribed 3 x 220ml milkshake style, 1.5kcal/ml oral sip feeds per day. Maria initially struggled to consume all three of the sip feeds each day, but once she was discharged home, this became easier and she continued to take them for approximately three months. She made the decision herself to discontinue them as she was

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NHD-Extra: CoNDitioNS & DiSorDErS

In the main, most people with an ileostomy can manage a normal diet.1

In the first few weeks after surgery, most patients require a low-fibre diet. A high-fibre diet can increase the size of stools, which can cause the bowel to become temporarily blocked. After around eight weeks, a normal diet can be introduced.2

reintroducing foods a healthy, balanced diet, including plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains, should be encouraged. Patients may reintroduce new foods slowly after surgery. there may be long-term anxiety around eating some foods, especially after many years of avoiding them due to Gi symptoms. introducing at the rate of one new food at each meal may be agreeable. this will allow patients to judge the effects of the food. keeping a ‘food/symptom diary’ may be useful.

wind/flatulence/bloating Some foods may cause wind, e.g. beans and pulses, brassica vegetables, onions, nuts and eggs. Fizzy drinks and beer also cause wind. these may be best avoided or kept to a minimum. Fennel and peppermint tea may help to reduce wind. Skipping meals may make the problem worse.2

Malodourous/smelly stools Some food may create malodourous stools, e.g. fish, eggs, spiced foods, cabbage. Many people worry that their bag will smell. However, all modern appliances have air filters that have charcoal in them, which neutralises the smell. Special liquids and tablets that are placed in the bag are available to reduce any odour.

Diarrhoea a high fibre intake, spicy or fried foods, alcoholic or caffeinated drinks may cause diarrhoea. Fruit juices, fresh or dried fruits, vegetables and salads are also possible causes. Some sweets and cakes are sweetened with sorbitol. this may have a laxative effect for some patients. Some patients may still require antidiarrhoeals to manage loose stools.

Dehydration as the re-absorb of water and minerals within the large intestine is now absent, there is a greater risk of dehydration. a good fluid intake is advised, particularly in hot weather or during activities or sports. rehydration powders my help to reduce dehydration.

Undigested food Soft, well-formed stools are usually formed in the large intestine. in its absence, patients may experience looser stools containing undigested foods, such as, sweetcorn, peas, mushrooms, apple, carrot etc. these are generally harmless, but patients should be advised to chew these foods well and even slitting the skins/kernels on peas and sweetcorn. rarely, these foods can cause a blockage of the stoma.

Foods to improve symptoms

to reduce output/improve stool consistency

Cheese and yogurtMash potatoes, boiled rice or pastaMarshmallows or Jelly babiesCreamy peanut butterready brek or porridgetoast half and half/ 50:50 bread may be better toleratedapple sauce/cooked appleripe banana

For nutrition support Full fat milk - aim for one pint per day in drinks or added to food.add extra olive oil or margarine to meals.Eat little and often - aim for six small, high calorie meals and snacks per day.Encourage milk puddings such as sago, semolina, yoghurt or rice pudding.Encourage milky drinks such as hot chocolate, ovaltine, build-Up or Complan, or prescribed sip feeds.

table 1: Dietary considerations with ileostomies

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eating well and felt that the sip feeds were dampening her appetite. For almost nine months, Maria had her ileostomy. She gained 5.0kg in weight and her BMI increased to 18.4kg/m2 (weight 50kg, height 1.65m). The ileostomy had given her a new lease of life. She was free from abdominal pain and her appetite had improved significantly. During the time with her ileostomy, Maria was able to introduce a fairly normal and healthy diet. She was managing five portions of fruit and vegetables per day and some higher fibre foods, such as Weetabix, wholemeal bread and baked beans. She avoided highly spiced foods, fizzy drinks, alcohol and some vegetables such as celery, sweetcorn and onions, as these caused her excessive wind and looser stools. She was more energetic and she was able to sleep well, which made a huge difference to Maria’s general wellbeing and allowed her to take on a few hours of volunteering work at a local charity shop. Although she remained self-conscious about her health issues and her ileostomy, she was able to engage in social events with her peers and family. Nine months on with her ileostomy, Maria was reviewed via a water-soluble enema and ultrasound scan (loopogram)3,4 to ensure her ileoanal pouch had healed and she was suitable for the reversal of the ileostomy. This procedure showed that the pouch had healed and Maria was booked in for her ileostomy reversal two weeks later. Following the reversal operation, Maria returned to the ward. She was anxious and elated at the same time. In many ways, she was pleased that the ileostomy was reversed, but she was concerned that she would be passing stools via her anus for the first time in nine months. Again, she had so many questions rush through her head. Will she have continence? Will she be in pain again? What if she can’t control her bowels? Her stoma care nurse was able to answer some of these questions.

toxic megacolon a rare but serious complication of severe ulcerative colitis.inflammation in the large intestine becomes swollen due to trapped gas caused by inflammation.it can cause a sudden drop in blood pressure, resulting in shock.the bowel can rupture and septicaemia can occur.Symptoms include abdominal pain, pyrexia and tachycardia.treated with intravenous fluids, antibiotics and steroids.the trapped gas can be drawn out via the insertion of a small tube in to the rectum and large intestine.in severe cases, surgery may be required, where the large intestine is removed (colectomy).

rectal or colon cancer Patients with long term (10 years or more) severe UC have an increased risk of colon or rectal cancer.Symptoms of this type of cancer can be masked by UC as they are similar - blood in the stool, diarrhoea and abdominal pain.regular gastroenterology reviews and monitoring of symptoms should be provided for long-term UC patients.6

osteoporosis and osteomalacia

osteoporosis and vitamin D deficiency are common in ibD.Major risk factors include older age, steroid use and disease activity.6

anaemias iron deficiency is common in ibD patients. regular haemoglobin, ferritin, transferrin saturation and CrP checked should take place.6

there is also an increased risk of folate or b12 malabsorption in after surgery where the ileum has been involved.

table 2: Complications in UC and ileoanal pouch patients

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NHD-Extra: CoNDitioNS & DiSorDErS

obstruction/blockage Patients undergoing pouch surgery for UC are at high risk for small bowel obstruction due to the combined abdominal and pelvic dissection.Postoperative adhesions, a twisted intestine, herniation of the bowel, or twisting of an ileostomy may result in partial or complete small bowel obstruction.after closure of a temporary ileostomy, obstruction may also occur due to luminal stenosis or adhesions at the closure site.7

Pouch leakage or bleeding Soon after surgery, leaks and bleeding may develop from any part of the newly formed pouch, along the suture lines and anastomosis site (ileum to anus).Elderly patients, males, and those on corticosteroids are at greater risk.Pouch ischemia is rare and is characterised by copious dark red blood with clots.7

Pouchitis. a longer-term complication, acute or chronic inflammation of the ileal reservoir (pouch).Symptoms include increased stool frequency and urgency, abdominal pain, bloody diarrhoea, fever, faecal incontinence.treated with antibiotic therapy, e.g. metronidazole and ciprofloxacin.antidiarrheal drugs to manage stool frequency and urgency.

Once again, Maria was advised by the stoma care nurse to alter her diet to manage any symptoms. This time she was more anxious about eating, as she was concerned she wouldn’t be continent. She opened her bowels for the first time almost two days after the reversal surgery. She passed a type 7 stool,5 but she was continent and pain free. She was extremely relieved by this. However, for five days after the surgery, Maria struggled to eat anything more than white bread toast and butter, tea with milk and salt and vinegar crisps. She was still anxious to introduce any higher fibre foods, fruits or vegetables. Her stoma care nurse asked her to speak to a fellow patient on the ward who had undergone similar surgery and who was eating well. Maria enjoyed speaking to this patient, an older woman, in her 40s. Hearing the positive experiences this patient had had when introducing foods back in to her diet gave Maria some confidence to try some different foods. She introduced porridge, ham and chicken, potatoes and cooked vegetable such as carrot, parsnip and butternut squash. She was discharged home after seven days on the ward. Although she needed to open her bowels eight to 12 times per day as she increased her dietary intake, she was able to maintain continence and her stools thickened, often passing type 5 stools.5 She continued to avoid many of the foods and drinks she hadn’t tolerated whilst she had her ileostomy. After three to four months, Maria’s pouch activity had settled and she was opening her bowels six to eight times per day, with continued type 5 stools.5 Once again she was managing five portions of fruit and vegetables per day; she was also including higher fibre version of breakfast cereals and bread. She considered her diet relatively normal. Her weight had improved again and she was now 56kg, BMI 20.5kg/m3. Three months after her reversal operation, Maria enrolled again at her local sixth form college. She was keen to return to her studies and she felt healthy for the first time in nearly three years. She was able to engage in all of the social and even sporting activities on offer with her peers. She started to play badminton at a local club and she enjoyed swimming two to three times per week. In the two years following her surgeries, Maria remained well for the majority of the time, but she experienced two episodes of pouchitis. See Table 2 for a more information on pouchitis and other complications of UC and pouch surgery. She was successfully treated with courses of antibiotic therapy, including metroniozole and ciprofloxacin. Ulcerative Colitis, like many chronic diseases, has a major impact on a patient’s life. Maria not only experienced significant health problems because of this condition, but her social and mental

Table 2 continued

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health was affected too. In addition, she confronted several dietary challenges, due to physical and psychosocial factors. There is little research available regarding the psychosocial factors of food and the impact that IBD has on quality of life. A study conducted by Hughes et al8 in 2013, found that in patients with active IBD disease, there were psychosocial issues relating to food and drink. Self-imposed dietary restraints influenced daily eating and drinking, as well as social relationships. Patients with IBD opt to make changes in their diet to control their symptoms and compromises are made when eating with friends and family. Quality of life is often reduced, but little was known about the strategies used by patients to manage these issues. Further research is underway to investigate this, with plans to develop a food-related quality of life questionnaire, which could be used in clinical and research settings. For more information visit - www.kcl.ac.uk/ioppn/depts/psychology/research/ResearchGroupings/healthpsych/research-group/IBD.aspx <accessed 03/03/16> The management of IBD is only successful through high quality MDT working. The Royal College of Physicians has recently published a report9 following an audit of IBD services across the UK, looking at areas for improvement in IBS services, but also areas where action has been take or starting to take place. The report includes data from eight regional workshops attended by 258 delegates (including eight dietitians) from 84 trusts and health boards. 125 individual action points were recorded and grouped into 24 themes. The five most common action themes were:1 patient pathways - biologics, diagnostic, inpatients, pregnancy, standardised care, policy/

protocol and shared care2 IBD nurses3 IBD Registry/database4 patient panel/group5 multidisciplinary team meetings

Dietetic and nutritional support improvement targets were included with some progress being made. This report is the work of The IBD programme team, which was established over 10 years ago. Their aim is to improve the quality and safety of care for people with IBD throughout the UK. Initially, the team audited IBD services to highlight variations across the UK. In recent years, the team has evolved and their work includes a wider range of quality improvement measures and supporting the development of national standards for IBD care. Find more information about the work of the IBD programme at www.rcplondon.ac.uk/ibd.

References1. The Ileostomy and Internal Pouch Support Group (2016). Ileostomies and Eating Habits. www.iasupport.org/about/publications/factsheets/ileostomies-

and-eating-habits2. NHS Choices (2016). Living with an ileostomy. www.nhs.uk/Conditions/Ileostomy/Pages/Recommendations.aspx3. Ramakrishnan K, Scheid D (2002). Opening Pandora’s Box: The Role of Contrast Enemas in Abdominal Imaging. The Internet Journal of

Gastroenterology. Volume 2 Number 1. Available at http://ispub.com/IJGE/2/1/13573 <accessed 03/03/16>4. Bickston SJ and Bloomfeld RS (2011). Handbook of Inflammatory Bowel Disease. Lippincott Williams & Wilkins, Philadelphia. Chapter 22, pp 235. Heaton KW and Lewis SJ (1997). Stool form scale as a useful guide to intestinal transit time. Scandinavian Journal of Gastroenterology, Vol 32, no 9,

pp 920-9246. Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho G, Satsangi J, Bloom S. On behalf of

the IBD Section of the British Society of Gastroenterology (2011). Guidelines for the management of inflammatory bowel disease in adults. Available at www.bsg.org.uk/images/stories/docs/clinical/guidelines/ibd/ibd_2011.pdf <accessed 03/03/16>

7. Gorgun E and Remzi FH (2004). Complications of Ileoanal Pouches. Clin Colon Rectal Surg. Feb; 17(1): 43-558. Hughes LD, Lindsay J, Lomer M, Myfanwy M, Ayis A, King L and Whelan K (2013). Psychosocial impact of food and nutrition in people with

Inflammatory Bowel Disease: A qualitative study. British Society of Gastroenterology conference. Abstract available at https://kclpure.kcl.ac.uk/portal/en/publications/psychosocial-impact-of-food-and-nutrition-in-people-with-ibd-a-qualitative-study(1ab5dafc-3035-49e3-918f-ccd6f99370b4).html <accessed 03/03/16>

9. Royal College of Physicians (2016). Inflammatory Bowel Disease Programme. Improving quality in IBD services: UK inflammatory bowel disease audit. PDF available at http://s3-eu-west-1.amazonaws.com/files.crohnsandcolitis.org.uk/Publications/PPR/improving-quality-in-IBD-service.pdf <accessed 03/03/16>

8www.NHDmag.com April 2016 - Issue 113

EVENTS

BDA LIVE 2016 - EDITOR'S REPORT

Emma CoatesNHD Editor

Emma has been a Registered Dietitian for nine years, with experience of Adult and Paediatric dietetics. She specialised in clinical paediatrics for six years, working in the NHS. She has recently moved into industry and currently works as Metabolic Dietitian for Dr Schar UK.

The 16th and 17th March 2016 saw the return of BDA Live, an extra special couple of information-packed days heldat the QEII Conference Centre in London. This year the BDA is celebrating its 80th birthday!

In order to celebrate 80 years of Dietetics, the BDA provided a broad ranging agenda for delegates over the two days, which was supported by a wealth of experienced dietitians and numerous exhibitors, including Abbott, Nutricia, SMA, Vitaflo International Ltd, Yakult Ltd and Oatly, plus many more.

Finally, Sue Perry, Deputy Head of Dietetics in Hull and East Yorkshire Hospitals NHS Trust, provided an insightful session on defining a safe workload. Sue’s session focused on the results of two national questionnaires which were given to dietitians (clinicians) and dietetic managers, which looked at the current workload of employees. ‘Workload’ was defined as the total amount of work a clinician manages on a daily basis. A ‘caseload’ refers to the amount of patients a clinician manages. This included daily activities and capacity, the mean number of patients seen per week and the perception of own workload safety. Perceived safety concerns for managers regarding their service were included in the management questionnaire too. It was interesting to learn about the results, as they were likely to be consistent with current trends in Dietetic workloads across the UK. The largest concerns from clinicians included being unable to see patients in a timely manner, not having sufficient time for CPD and patient documentation. Most participants reported that they were working above their contracted hours to achieve their current management of their caseload. Concerning the safety of their caseload management, 43% of clinicians did not feel safe with current workloads. The questionnaires did highlight differences in safety perspectives between clinicians and dietetic management. The session closed with a panel discussion where the framework for safe practice was considered.

The event overall highlighted the strength of current Dietetic practice and our vital contribution to the modern health and social care service. However, there are many ways to improve our position and ensure our place as ambassadors of health in the future and the BDA supports innovation and development for driving forward Dietetics. Be proud of Dietetics and join the #standingupfordietetics movement!

The 16th and 17th March 2016 saw the return of BDA Live, an extra special couple of information-packed days held at the QEII Conference Centre in London. This year the BDA is celebrating its 80th birthday!

The key messages throughout the event clearly encouraged all dietitians to be proud of their profession and to share our unique knowledge and expertise whenever we see the opportunity. This year, the BDA was not only looking back at its achievements, but was also looking forward, with many sessions focusing on innovation, driving services forward and ensuring that Dietetics has a strong future within our healthcare system.

LEADING THE WAY

Day one opened with an excellent plenary session looking at malnutrition and dehydration across the healthcare system and how Dietetics is leading the way forward. Keynote presentations focused on the implications of new guidance, commissioning services, the role of

nutrition in cancer care and gluten-free food provision in healthcare. Concluding the session, Kirstine Farrer Consultant Dietitian from Royal Salford NHS Trust Foundation, gave a talk regarding the piloting of a Malnutrition Task Force in the Salford area. This was followed by a panel discussion involving the session speakers, where effective strategies for optimal nutritional care were considered.

After lunch, a choice of two specialist group-led breakout sessions were available. Sports and Exercise Nutrition Register (SENr) hosted one of these sessions, which included presentations on performance nutrition, the role of milk proteins in sport training and exercise, also how biomarkers can be used in the modification of elite athlete’s nutritional programs.

The Parenteral and Enteral Nutrition Specialist Group (PENG) hosted and alternative session, where the importance of outcomes and communicating those outcomes were highlighted and discussed. The PENG group session also included presentations, which looked at the successes and experiences of others when looking at outcomes.

This year’s Creina Murland Memorial Lecture was presented by Professor Anita MacDonald OBE, PhD, Consultant Dietitian in Inherited Metabolic Disorders, Birmingham Children’s Hospital.

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THE EARLY BIRD CATCHES THE WORM!

Day 2 saw an (optional) early start with a breakfast session, ‘Putting fibre back on a pedestal’, which was hosted by Cereal Partners, Nestle Breakfast Cereals. During the workshop, Professor Chris Seal from Newcastle University presented the latest information on fibre and wholegrains in the diet. The 2015 Scientific Advisory Committee on Nutrition Report on Dietary Carbohydrates and Heath was central to the session.

The final part of the research was to computer-plan individual diets for 26 willing subjects, with a view to more modest post-prandial glycaemia.

Pre-lunch, Abbott offered delegates an opportunity to learn more about the psychological factors which influence compliance and patient behaviour when using oral nutritional support products. The ‘Power of taste’ session was hosted by Philip Graves, Consumer behaviour expert and provided a valuable insight in some basic techniques which may help to improve patient perception of ONS and consequently improve overall compliance and experience with ONS.

For the afternoon breakout sessions, delegates could choose between a BDA Education Board session to discover the future direction of dietetic practice and the implications for dietetic education. Alternatively, the Public health and Paediatric Specialist Group were offering an update on a joint approach to the challenge of childhood obesity. In this session, Dr Julie Lanigan RD PhD, Principle Research Associate, Chair of Paediatric Specialist Group and Horary Specialist Dietitian at Great Ormond Street Hospital for Children NHS Trust discussed current research and thinking in early intervention for childhood obesity. Pip Collings, a Public Health Dietitian, provided a second presentation to share the work she has been conducting within schools to improve nutrition and food.

Anita shared her experiences and thoughts on leadership in Dietetics. Day one was rounded off with a drinks reception to celebrate the BDA’s 80th birthday which included a number of award presentations including, the annual Dame Barbara Clayton award, along with special memorial awards for Pamela Brereton and Pat Judd.

The morning plenary session for Day 2 was firmly looking ahead for Dietetics and its potential to embrace technology and innovative ways of working. Titled ‘The future: Transforming care’, the session included some diverse keynote presentations on remote teleswallowing assessments for dysphagia patients. Here, Veronica Southern, Clinical Lead in Telesolutions at Blackpool Teaching Hospitals NHS Foundation, shared her experiences in setting up a teleswallowing assessment service and the successful outcomes that this service has achieved. Judyth Jenkins MBE, Head of Nutrition and Dietetics Services and Julie Myers, Head of Occupational Therapy Services, both at Cardiff and Vale University Health Board, explained how an integrated workforce could benefit patients and staff in the current prudent healthcare climate. Both asked how the current skill mix of the MDT could be challenged to ensure satisfactory patient care is delivered. Personalised nutrition is an area of much interest for the future of Dietetics. Dr Eileen Gibney, Lecturer in Nutrition and Genetics at University College Dublin Institute of Food and Health gave delegates an overview of current research and practical application of nutrigenomics. To end the session, a panel discussion focused on the factors that are shaping the future of healthcare.

The final plenary session of the event devoted time to a key area for the future success of Dietetics. Safe practice in Dietetics came under the spotlight with valuable three keynote presentations. The first coming from Suzette Woodward, National Campaign Director for Sign up to Safety. Suzette explained her three things to achieve the best and safest care. Jayne Lavin, Clinical Manager for Nutrition and Dietetics at Aneurin Bevan University Health Board shared the success her department had had with practical supervision. Presenting staff feedback via video during her talk, Jayne highlighted the advantages of changing department culture and the importance of open communication amongst staff at all levels both within and beyond the Dietetic department.Finally, Sue Perry, Deputy Head of Dietetics in Hull and East Yorkshire Hospitals NHS Trust, provided an insightful session on defining a safe workload. Sue’s session focused on the results of two national

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EVENTS

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