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11 to 17 March is Nutrition and Hydration Week: an annual event raising awareness of the importance of proper nutrition and hydration.

Malnutrition and dehydration are about so much more than just feeling hungry, thirsty, and losing weight. Being malnourished and dehydrated can impact almost every system in our body, delaying wound healing, making us more susceptible to falls, and making it harder for us to live independently.

Dietetics is one of the many important services we offer at NCH&C. We caught up with Meg Sanders, NCH&C’s Community Dietetics Service Lead, to talk about how our Dietitians and Dietetics Assistants support patients, and how patients and loved ones can look after their own nutrition and hydration.

 

Can you briefly explain the dietetics service we offer at NCH&C?

Dietitians play an important role in and patient care – the right nutrition and hydration can make a big impact in our recovery and long-term health. NCH&C’s Dietitians work with patients to promote the good practices that can help prevent malnutrition and dehydration and raise awareness of the risks of improper nutrition and hydration. Preventing malnutrition and dehydration improves health and wellbeing and helps to reduce the burden on the health and social care services in treating and supporting those suffering from under nutrition and dehydration.

NCH&C’s Dietetic Services are based at Thorpe Health Centre​. We provide care in:​

• Patients own homes.
• Outpatient clinics at Thorpe Health Centre, community locations, and our other community hospitals.
• Via telephone/video consultations.​
• Group sessions, for example for patients with IBS and newly diagnosed with coeliac disease.
• We cover central Norfolk, with broader cover area for our Learning Disability Dietetic Team.

Withing our service we have four smaller teams: outpatients/mainstream community dietetics, inpatients, Home Enteral Feeds, and Learning Disabilities.

Our four dietetics teams support patients with the following:

• Advise on healthy eating, specialist diets and enteral feeding​.
• Support staff, patients, and carers and provide necessary dietary information.​
• Undertake comprehensive nutritional assessments of patients who are identified as being at risk of malnutrition and advise accordingly. ​
• Assess and make recommendations when alternative feeding routes may need to be considered​.
• Prescribe/advise medical staff on enteral feeds, nutritional supplements, and foods for special diets​.
• Provide education and training to staff​ – proper nutrition and hydration is essential for all patients, even if they’re not under the care of a dietitian.
• Produce resources for training purposes and patient education​.
• Contribute to writing policies across the trust​.
• Support the Nutrition and Hydration Champion role.

NCH&C’s Dietetics Service operates from 8:30am to 4:30pm, Monday to Friday. ​

We can be reached via Central booking: 01603 216 021.

Colleagues in the Dietetics Service work flexibly depending on their workload and patient need. Sometimes they may work remotely, from home or in their car if they are doing community visits. Others may work in the office for meetings and paperwork, but most of the time we are face to face wherever our patients need us.

You can find out more about the role of NCH&C’s Dietetics Service on the trust website.

 

Meg, could you briefly explain your role within the Dietetics Service?  

My job title is Community Dietetics Service Lead. I am passionate about my work, and I am proud to lead an amazing team of 26 dietitians and dietetic assistants, including managing budget and resources. I ensure that dietetic services are reviewed on a regular basis, developing these to meet the needs of patients and commissioners. I communicate closely with other dietetic departments and other members of the wider MDT to support the promotion of the dietetic service across the trust. I am very lucky to be able to work in a job which I love with amazing, caring and highly skilled colleagues.   

 

Why is nutrition and hydration so important?

Malnutrition is ‘a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue/body form (body shape, size, composition), body function and clinical outcome’ (Marinos Elia, 2000).

It is a misconception that malnutrition just causes weight loss. There is plenty of research evidence that shows that malnutrition and dehydration affect every system in the body, resulting in:

• Reduced ability to fight infections.
• Increased risk of pressure ulcers.
• Inactivity and reduced ability to self-care.
• Inability to regulate salt and fluid, leading to over-hydration or dehydration.
• Falls.
• Heart failure.
• Impaired wound healing.
• Low mood, self-neglect, social deterioration.
• Reduced muscle mass.
• Impaired temperature regulation.
• Reduced fertility.
• Specific micronutrient deficiencies (BAPEN, 2016).

If a patient is showing warning signs or malnutrition and hydration, there is but a small window of opportunity to act swiftly and appropriately to prevent someone’s physical decline. Malnutrition can be life-threatening if poor nutritional intake or an inability to eat persists for several weeks (NICE, 2006).

 

Norfolk has previously been identified as having higher rates of malnutrition than it should – can you explain why that is?

There are several risk factors that increase a person’s risk of malnutrition. Social, physical, and medical factors and all can play a role. New research from Future Health, a health policy research centre, reveals the hidden cost of disease related malnutrition in England. This research shown that eight NHS Integrated Care Boards (ICBs) in the UK have estimated malnutrition rates of over 6%. Cornwall and the Isles of Scilly ICB and Norfolk and Waveney ICB have the highest estimated rates of 6.7%.

Norfolk has a high ageing population, so the high rate of malnutrition can be linked to the prevalence of conditions such as cancer, dementia, and COPD. Malnutrition and dehydration are linked to deprivation, but that is not the only social factor. Norfolk is very rural with inconsistent transport links, so this can prevent individuals from accessing food. While most of us would do an online supermarket delivery if we couldn’t get to the shops, that isn’t an option for our patients who are not digitally enabled. All of these factors contribute to the picture of malnutrition we see in the county.

 

Do you have any advice for patients who are concerned about their own nutrition and hydration, or loved ones who have concerns about someone else’s nutrition and hydration?

We ask to start having simple conversations about eating, drinking, appetite, and weight loss with their loved ones. Try asking questions such as:

• What’s on the menu tonight?
• Are you eating and drinking well?
• What kind of things do you like to cook?
• Have you lost weight without meaning to?
• Have you had a poor appetite, low energy or low mood?
• Do your clothes, shoes, jewellery or dentures look or feel loose?

This could help people, especially older people and their carers, to understand the options available to them and could break the cycle that could be leading to weight loss or dehydration. Losing weight is not a normal part of aging! There is a great guidance and information available on our website for more information