Malnutrition continues to be a problem, which is estimated to cost £13 billion per annum (British Association of Parenteral and Enteral Nutrition [BAPEN], 2010). The majority of those at risk of malnutrition are living in the community. When resources are limited, it is important to identify who is most at risk so that they can receive appropriate support. This article explains the malnutrition carousel, where malnutrition leads to poor health that then further increases the risk of malnutrition. It discusses the need for balanced diets to help maintain an adequate nutritional state, highlighting which disease states are likely to cause further problems — in particular, those with swallowing problems where texture-modified diets are required. Suggested solutions are also provided to help treat suspected poor nutritional intake.
In each issue we investigate a hot topic currently affecting you and your community practice. Here, we ask Can Community nurses take on obesity?
One in ten older people in the UK are suffering from, or at risk of malnutrition. This relatively unknown, yet significant issue, costs the NHS £19.6 billion per year (Elia, 2015). Often overshadowed by obesity as a public health issue, malnutrition impacts a person’s wellbeing; leading to further problems, such as an increase in hospital admissions, increased dependency and increased risk to life.
Irritable bowel syndrome (IBS) is a chronic and debilitating condition effecting over 10% of the UK population with a higher preponderance among adult Caucasian females. It places a significant economic burden on the NHS with annual cost projections ranging from £45 to £200 million. Misdiagnosis is common and is reflected in the high prevalence of gastrointestinal-related surgery within this cohort, and it is essential to obtain a detailed case history to ensure correct treatment. National guidelines now recommend diet as the first line approach, with research repeatedly advocating the use of the low FODMAP diet, particularly for those with diarrhoea dominant or mixed IBS. However, specialist dietetic support is essential to ensure nutritional adequacy and prevent the use of unnecessary or highly restrictive diets. Where access to dietitians may be limited, dietetic departments are now able to recommend technology, such as dietitian-led webinars, mobile phone apps and YouTube videos to increase patient access to reliable information.
This articles deals with the dietary advice that should be provided to people with type 2 diabetes by anyone working in the community (it does not cover advice on physical activity or prevention of type 2 diabetes). If a patient with type 2 diabetes is overweight or obese, the most important factor is to lose weight — even a 5–10% weight loss can improve insulin sensitivity and hence diabetic control. Other factors that are considered in this article are the type of carbohydrate that can be eaten, with wholegrain/high-fibre, lower glycaemic index starches being the best option (the glycaemic index measures the effect of carbohydrates on blood glucose level). Although sugar provides 'empty calories' (food that supplies energy but negligible nutrition) and can result in weight gain, it does not contribute to diabetes directly. Cholesterol levels should be reduced by eating the correct fats, and salt levels should be kept to below 6g a day.
This article examines the role of malnutrition in chronic obstructive pulmonary disease (COPD). Until recently, weight loss was considered an inevitable consequence of COPD, however, modern research has demonstrated that weight gain is in fact achievable and can result in functional improvements. It is important that community nurses are aware of the importance of nutrition in COPD, both in screening for malnutrition and developing appropriate treatment plans, including the use of oral nutritional supplements alongside dietary advice and counselling. The current NHS policy of moving care 'closer to home' is resulting in more complex COPD patients being managed in the community and with this comes the challenge of managing reduced weight and low oral intake. It is, therefore, essential that community nurses develop the necessary skills and resources to deal with this growing group of patients.
In an earlier article in this journal, the author looked at malnutrition in the community from the patient's perspective (JCN, 28(2): 40–4). Here, she examines some practical tips on how community nurses can provide help for patients in danger of becoming malnourished. Malnutrition may have been caused by a chronic problem that has resulted in years of gradual deterioration and prompt action can prevent malnutrition escalating further and affecting the patient’s overall health. In this case, more detailed and supportive treatment from family, friends and healthcare services may be required to help implement changes in a patient's routine. By using some of the ideas highlighted in this article, and with regular monitoring and support, nurses can better help patients in the community to recover quickly from, or avoid, malnutrition.
Obsession with weight has been identified as a significant problem in modern society, particularly among young women. Similarly, the phenomena of weight and shape preoccupation have been recognised as preliminary behaviours to the development of eating disorders. This study aimed to identify the current incidence of, and factors associated with, weight preoccupation, shape preoccupation, and eating disorder risk in female US university students aged 18 to 23 years. An online study was used and the findings demonstrated that 31% of respondents identified themselves as weight-preoccupied and 33% as shape-preoccupied. Overall, the study found that asking students whether they are weight-preoccupied could be an initial step in early intervention for those at risk of developing an eating disorder.
Samantha A Ramsay, Assistant Professor of Foods and Nutrition and Director of the Coordinated Programme
Laurel J Branen, Professor of Emeritus
Miranda L Snook, Research Assistant, School of Family and Consumer Sciences
All at University of Idaho, Moscow, USA
