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Whether you're looking to be at a healthier weight, have recently been diagnosed with a medical condition which requires a special diet, or just wish to feel better, our registered dietitian is an acknowledged professional, uniquely trained to advise on diet, food and nutrition, and will guide you every step of the way. We are committed to providing quality information and service to our clients and the community.
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 (WHO, 2003).
Current dietary recommendations have been consistent for a number of years (SACN, 2008a) with the Eatwell Plate being the recommended pictorial representation of the recommended balanced diet (FSA, 2008).
It has been estimated that if diets matched nutritional guidelines, around 70 000 deaths in the UK could be prevented each year and that the health benefits (in terms of quality adjusted life years (QALYs) would be as high as £20 billion each year (Cabinet Office, 2008). In addition to the promotion of healthy eating, there is a need to consider nutritional adequacy of the diet and prevention of malnutrition.
Further work is required to support culturally appropriate interventions aimed at improving diet and nutrition, including reducing salt intake.
On average, low income households and those in the most deprived wards consume less fruit and vegetables, salads, wholemeal bread, wholegrain and high fibre cereals and oily fish and consume more white bread, full fat milk, table sugar and processed meat products. Only 1 in 5 adults in the city consume the recommended daily amount of fruit and vegetables. There are currently no known initiatives aimed at improving the diet and nutrition of the 19-24 year age group. Currently there are no suitable methods for collecting comprehensive local data on diet and nutrition and there are specific gaps in knowledge concerning intakes of fat, sugar and salt and issues relating to access to an affordable healthy diet. There are gaps in data regarding the uptake of targeted schemes to promote good nutrition such as Healthy Start vouchers and vitamins. Further work is required to develop approaches to improve maternal and childhood nutrition. A local study identified a high number of fast food and takeaway outlets in one area of the city which may affect dietary intake in the area. Interventions to improve diet should prioritise low income groups who have been shown to have the poorest diet. Take forward recommendations in the interim retail planning guidance and in relation to the NICE CVD Prevention guidance to use existing powers to regulate the opening times and number of take-away and other food outlets serving foods high in fat, sugar and salt in given areas and in particular near schools.
To work with take-away and other food outlets to improve the nutritional quality of food served.
Develop better understanding of local beliefs and attitudes to food and nutrition and use this insight as part of social marketing approaches to the commissioning of interventions to maximise behaviour change. Continue to develop interventions that improve the nutritional knowledge and food preparation skills of priority groups.
Develop a child nutrition strategy implementation plan and ensure integrated nutrition interventions through Children’s Centres, schools, and other community settings.
Increased promotion of Healthy Start including vitamin supplements to both professionals and parents, particularly to those in target groups and those who do not access Children’s Centres.
Further partnership working to increase school meal uptake, whilst also evaluating and further developing initiatives to improve nutritional standards of packed lunches. Adults in the UK tend to eat a diet that is too high in saturated fat, salt and added sugars, and low in fruit, vegetables, whole grains and oily fish (NHS Information Centre 2009, Food Standards Agency, 2001). Results from the first year of the National Diet and Nutrition Survey (Food Standards Agency 2010) shows that diet and nutrient intakes of the UK population were largely similar to findings from previous assessments of diet in Great Britain, for all age groups studied. Low intakes of vitamins and minerals, including vitamin A, riboflavin, iron, potassium and magnesium in those under 25 years. High salt intake is particularly prevalent with 82% of men and 65% of women consume more than the recommended maximum 6g of salt a day. Black and minority ethnic groups were not identified in the SACN report as analysis by ethnic group was not possible. A good picture of the diet and nutrition of low income groups has been obtained from the Low Income and Diet and Nutrition Survey (Food Standards Agency, 2008). 8% of men and 9% of women reported consumption of 5 portions of fruit and vegetables a day. Lower intakes of non-starch polysaccharides (fibre) than the general population (due to the lower consumption of wholewheat foods and vegetables). Similar level of consumption of vitamin and minerals with the exception of lower iron intake in women aged 19-64 years in low income groups compared with the general population.
60% of adults lived in households where it was reported that salt was added during cooking and 30% of men, 22% of women, 13% of boys and12% of girls reported that they always added salt at the table.
Children were more likely than adults to consume processed meats such as sausages, coated chicken and turkey, and burgers and kebabs. It has also been found that the diets of the low income population are accompanied by higher levels of smoking, higher alcohol intake and lower physical activity compared with population as a whole (Food Standards Agency, 2008). Food poverty is a term used to describe when a household or individual are unable to obtain a nutritionally adequate diet.
A number of points emerged around social factors and food choice from the Low Income and Diet and Nutrition Survey (Food Standards Agency, 2008). Approximately 80% of boys and girls aged 11–17 reported they had cookery lessons at school, during which most of them had prepared food. Both communities: decreased total energy intake, decrease total fat, increase mono- and polyunsaturated fat, increase fibre and consumption of low glycaemic index foods and reduce obesity and weight gain.
A Health Needs Assessment of People with Learning Disabilities in Scotland cited evidence of nutritional concerns in relation to people with learning disability. Although only one fifth of children aged 5 – 15 years report that they eat 5 fruit and vegetables a day, 63% of boys and 73% of girls knew that five portions of fruit and vegetables a day was the recommendation. Amongst children in low income families surveyed (Food Standards Agency, 2008), boys were more likely to consume foods such as burgers, kebabs, meat pies and pastries than girls, whereas girls were more likely to eat foods such as rice, salad vegetables, fruit and fruit juice. There is very little information about the physical health of looked after children and young people despite evidence that they are at increased risk of ill health in adulthood. Vitamin D- Children aged less than 5 years had a mean intake from food at 18% of the recommended amount and 12% of children aged 11-18 years had low biochemical vitamin D status. Iron-16% of children under 5 years and 47% of girls aged 11-18 years had iron intakes below the minimum recommended amount. Other Minerals- Large proportions of females aged 11-18 years had mineral intakes falling below the minimum recommended amounts for magnesium (52%), potassium (28%), calcium (22%), zinc (24%) and iodine (12%). There is evidence of low intakes and status for a number of vitamins and minerals for older people living in institutions. Figures 2 shows estimated numbers of people eating more or less than the recommended 5 portions of fruit and vegetables in the city when this proportion is used. Multiple logistic regression analysis of the Nottingham data (Wilcox, J., 2010) showed that being a smoker and not knowing the 5 a day recommendations significantly increased the risk of having a low fruit and vegetable intake. Food poverty- An access to healthy food study 'Mapping Access to Healthy Food in Nottingham City' was produced by the Food Initiatives group in partnership with the Transport Strategy and Food Licensing teams at Nottingham City Council (FIG et al, 2008).
Black and minority ethnic groups – Local qualitative research has indentified high levels of salt use in cooking in African Caribbean and South Asian women in the City (DH Insight, 2007) (however there is no reason to assume this is higher than the general population or high income groups). Improving the diet of the local population is a priority in the context of improving the health of the city’s population and reducing health inequalities.
Work with Ecoworks to promote their locally grown fruit and vegetable box scheme to City Council staff. Pilot offering health and wellbeing support to parents and carers of disabled children who are at risk of becoming obese. The team also offers accredited Royal Society of Public Health training to workers and volunteers around the City which includes input from the Citihealth Nutrition and Dietetics team.

Food Initiatives Group (FIG) is a local food partnership project based in Groundwork Greater Nottingham and commissioned by NHS Nottingham City and NHS Nottinghamshire until March 2011.
The Nottingham Community Nutrition and Dietetic Service provides Community Dietetic Services to Nottingham City and the Southern Boroughs of Nottinghamshire County, and Public Health Nutrition interventions to Nottingham City. The work of this team encompasses delivery of a clinical dietetic service for a wide variety of diet-related medical conditions (e.g. The service also provides training and specialist support to help other health professionals to give first line dietary advice.
The team’s overall aim is to improve nutritional health and wellbeing and reduce diet-related health inequalities.
Offers education and skills-related programmes to increase knowledge, skills and confidence to choose a healthier diet.
Provides training for NHS and Local Authority staff, community and voluntary groups on the principles of healthy eating and good nutrition. Raises awareness of key nutrition messages to help the local population make an informed choice.
Ensures nutrition messages are age appropriate, relevant to family circumstances and consistently promoted by health professionals and partner organisations. Works with partners to increase capacity and ensure consistent, evidence based nutrition messages reach beyond the activities delivered by NHS.
Develops evidence based resources and materials to promote healthy eating and good nutrition.
Responds to and support strategic developments and government initiatives concerning diet and nutrition.
The Adult Public Health Nutrition team provides targeted interventions and capacity building in relation to identified public health priorities.
A coordinated range of community based health improvement services has been commissioned through the Health and Wellbeing Partnership and funded by NHS Nottingham City and One Nottingham. Free community based cook and eat sessions provided by qualified community food workers and nutritionists.
This is a national programme where vouchers are provided to exchange for fresh fruit and vegetables as well as milk and infant formula milk. A local Vitamin D supplementation programme is in operation and supports the uptake of Healthy Start Vitamins. This is a multi-agency group which promotes and facilitates a whole school approach to healthy eating, the prevention of childhood obesity and the promotion of good nutrition.
School lunches provided by Nottingham City council comply with the new nutritional standards.
First line dietary advice is available via Primary Health Care Teams with onward referral to Registered Dietitians as appropriate (as stated in the Clinical Dietetic Service section above).
SACN identified a trend for improvements in diet nutrition over the last 15 years (SACN, 2008). There is an emerging concern in relation to dietary adequacy and malnutrition which could have an impact on future services if interventions are not in place to promote good nutrition alongside healthy eating (e.g.
As described in the CVD JSNA chapter the NHS Health Checks programme may increase demand for CVD prevention interventions which would include community nutrition intervention.
Increasing the consumption of fruit and vegetables can significantly reduce the risk of many chronic diseases. NICE (2010) Physical acitivty and dietary interventionf for weight management before, during and after pregnancy. Reducing sugar and saturated fats whilst increasing intakes of fats from oily fish, nuts and seeds. Promoting diets rich in non-starch polysaccharides (fibre) to reduce the risk of bowel disease.
A systematic review provided evidence to show the effectiveness of the use paraprofessionals or peer educators who are trained and supervised by nutritionists to deliver education and skill-based programmes to low-income populations. Consultation with people aged 50 years and over about physical activity and lifestyle has taken place through the Nottingham Local Exercise Action Pilot – Get Moving Nottingham (2003-2006), and the 2009 Nottingham City Lifestyle survey (IPSOS MORI, 2009). As described above, NHS Nottingham City commissioned focus groups with African Caribbean and South Asian women in 2007 to determine views about the use of salt in the diet (DH Insight, 2007) . There are no published equality impact assessments of diet and nutrition services commissioned by NHS Nottingham City. All of the community nutrition interventions and national interventions such as Healthy Start are targeted at deprived areas which have higher populations of low income groups.
There is no known service targeting this age group which focuses on good nutrition and healthy diet. The Community Nutrition and Dietetic Service provides support for nursing registered care homes in order to assess and advise on the nutritional needs and management of individual residents who are capable of consuming oral diet and fluids, following receipt of a written referral.
Take forward recommendations in the interim retail planning guidance and in relation to the NICE CVD Prevention guidance to use existing powers to regulate the opening times and number of take-away and other food outlets serving foods high in fat, sugar and salt in given areas and in particular near schools. Develop better understanding of local beliefs and attitudes to food and nutrition and use this insight as part of social marketing approaches to the commissioning of interventions to maximise behaviour change. Further partnership working to increase school meal uptake, whilst also evaluating and further developing initiatives to improve nutritional standards of packed lunches. We will advise you on what foods to eat, when to eat them, and even provide you with tips on how to transform them into tasty meals and snacks. Keep up to date with the latest developments in our fields of expertise, as well as the various activities and events in our clinic. The survey will only take 2-3 minutes to complete and your feedback will be used for quality assurance purposes and help us to improve our services. 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 through into adult life. It is recommended that babies should be offered a gradually increasing amount and variety of solid foods, in addition to milk, from 6 months. For breastfeeding and maternal nutrition see the pregnancy and maternities chapter, and for obesity the adult obesity and childhood obesity chapters. However groups with the highest risk of poor health due to diet include: Children aged 18 years and under, young adults aged 19-24 years, smokers, people in lower socio-economic groups, adults aged 65 years and over living in institutions and black and minority ethnic groups.
However, there were some indications of trends in intake in a direction towards recommendations and guidelines for healthy eating.
These are described in detail in the Nutritional Wellbeing of the Population report (SACN, 2008).
On average, low income households and those in the most deprived wards consume less fruit and vegetables, salads, wholemeal bread, wholegrain and high fibre cereals and oily fish and consume more white bread, full fat milk, table sugar and processed meat products. Although there were no consistent associations between these and overall diet, results do give a preliminary indication of the relative importance of the different factors. Men and women with a lower level of educational attainment ate fewer vegetables and more chips, fried and roast potatoes. Overall, 22% reported reducing or skipping meals and 5% reported not eating for a whole day, because they did not have enough money to buy food.
This included increased risk of swallowing and feeding problems which are risk factors for choking and secondary complications.
2007) confirmed that low maternal age, low educational attainment and low socioeconomic position continue to have a strong impact on patterns of infant feeding. Smaller proportions of males in this age group had intakes below the LRNI for magnesium (24%), potassium (12%), calcium (11%), zinc (12%) and iodine (2%). In October 2006, the Food Standards Agency issued nutrient and food-based guidance for UK institutions.

However this is based on the Health Survey for England which only asks about fruit and vegetable intake.
However, it should be noted that slightly different dietary assessment methods were used in the 2 surveys.
As highlighted other specific concerns maybe a relatively higher intake of fat amongst Pakistani communities, low vitamin D status and exposure to the sun. In particular it contributes to reducing cardiovascular disease mortality, and obesity in children and adults which are priorities in the Nottingham Plan. FIG brings together the agendas of the promotion of a healthy diet, the development of the local food economy and wider environmental issues in relation to food policy such as the impact of food production and procurement on climate change.
Services are targeted at geographic areas and demographic groups most in need, in order to tackle health inequalities. Weaning sessions which run in Children’s Centres promote Healthy Start and also offer practical support in implementing good weaning practice and the incorporation of fruit and vegetables.
NHS Nottingham City provides additional funding so that Healthy Start vitamins are available universally fro all pregnant women and children up to their 4th birthday.
Children and families are given information and advice around nutrition and healthy eating by midwives, health visitors, school nurse and other professionals.
However there is no known future predictions and it is estimated both and nationally and locally that without significant intervention there will be increased obesity and resulting diabetes which will increase demand for NHS services which would require a dietary intervention (see child obesity, adult obesity and diabetes JSNA chapters for predictions in relation to these areas). Eating at least 5 portions of fruit and vegetables a day is estimated to reduce the risk of deaths from chronic disease, stroke, and cancer by up to 20%.
Promotion of vitamin D rich foods, outdoor activity and supplementation for high risk groups (dark-skinned ethnic minorities, people who cover their skin, young children and pregnant and breastfeeding women) especially during winter months. Eatwell Plate model] in the context of a healthy lifestyle particularly targeted at young people, older adults living in institutions and people in lower socioeconomic groups. There was no specific reference to additional policy documents relating to diet and nutrition. The review stated that managers will also need to ensure that the intervention has been developed from a theoretical base, has a specific message about increasing fruit and vegetable consumption, and has a component about behaviour change (Cilska, D. The rationale for this targeting is in relation to the link between deprivation and higher prevalence of child obesity and adult obesity (in women), and mortality from CVD and cancer. However it is known that in order to significantly improve the health of the population of Nottingham, improvements in the mean intakes of nutrients is required and therefore population level interventions are needed. Improving the diet of the general population in line with dietary recommendations would therefore have significant health benefits as described above.
However, women in households that shopped at a large supermarket consumed significantly higher amounts of fruit and vegetables compared with other women. Women with lower levels of educational attainment also consumed less fruit and fruit juice. They described this as being more associated with profound learning disability and often linked with physical disability. The mother’s own health, both in the short and long term, also depends on how well-nourished she is before, during and after pregnancy (DH 2004a).
There is some local survey data on fruit and vegetable consumption in the city which is discussed below. It used a methodology combining GIS analysis, a shopping basket survey into the availability of affordable food and focus groups with residents. 41% of children and 28% of people aged 60 and over are affected by income deprivation and Nottingham ranks 346th out of the 354 districts in England in the 2009 Child Wellbeing Index.
Groundwork Greater Nottingham employs a FIG officer who runs and coordinates a network of local voluntary, public and private sector organizations. Individuals with special dietary needs can be referred to this service by their GP or health professional for advice from a Registered NHS Dietitian. It may be that it is increased prevalence and awareness of these conditions that drives up demand for services rather than national or local awareness raising campaigns such as Change4Life. Research has shown that an increase of one portion of fruit or vegetables a day lowers the risk of coronary heart disease by 4% and the risk of stroke by 6%, and can help lower blood pressure. New Leaf does have information available on healthy eating but it is important to ensure that brief intervention with smokers also includes appropriate brief intervention about diet. Our approach to nutrition focuses on optimizing and maintaining one's capacity to absorb all the nutrients needed, and is aimed at both those with specific medical conditions, and those who wish to accomplish maximum health or performance. 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.
Trans fatty acid intakes were also lower than in the past and fell within recommended levels. The main other issue cited is the higher prevalence of obesity and underweight in this population.
Women from disadvantaged groups have a poorer diet and are more likely either to be obese or to show low weight gain during pregnancy (Food Standards Agency 2007; Heslehurst et al. The study found that availability of a range of healthy food representing a healthy shopping basket was limited in small local shops and food prices were generally higher in these shops than in supermarkets.
It is therefore expected that many of the specific dietary issues identified in the Low Income and Diet and Nutrition Survey (Food Standards Agency, 2008), which are described above apply in the local population. Activity includes the production of a local newsletter on food issues and delivery of a small grants scheme.
Mothers who are on a low income and all pregnant women under the age of 18 are eligible for free vitamins. This evidence supports the local use of trained and supervised community food workers and health trainers (paraprofessionals). This is in line with for example the CVD prevention strategy which targets areas of the city with the highest CVD mortality and within this specific groups most likely to be at high risk of developing CVD  or how are living with CVD.
By 5 years, children should be consuming a diet consistent with the general recommendations for adults (Department of Health, 1994b).
A study in Newcastle found that the key predictors of healthy eating overall were dietary knowledge and a healthier lifestyle, rather than physical access to food in shops. The prevalence of fast food outlets and their use by school children at lunchtimes was also highlighted. Some of these problems include heart disease, type 2 diabetes, high blood pressure, and some cancers.
Although this research was only done in one city it challenges the assumption that access to food is a significant issue in the diet of low income groups in deprived areas (Food Standards Agency, 2003). A woman’s weight is affected by how much physical activity she does, her diet, and her genes.
There was some evidence of an increase in consumption of fruit, and to a lesser extent vegetables, in children, but there was little change in adults.
However, it was found that most residents should be able to access the shops which do sell affordable food in a reasonable time but this may be limited to some groups such as the elderly and compounded by relatively low car ownership. So having a healthy diet is one of the most important things you can do to help your overall health.
Research in an inner city area has found low iron status to be of particular concern particularly amongst African women and those on low income. Psychosocial factors were noted as non-physical barriers to good nutrition, such as lack of cooking skills and low incomes.

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