Oct 19: Issue 148

Page 8 - Public health messages for a healthy diet by Dr Michele Sadler

Additional reading:

MESSAGES ON ALCOHOL CONSUMPTION

Public health messages on alcohol consumption are produced by the UK Chief Medical Officers and published by the DHSC. During her nine years in post, the Chief Medical Officer for England, Professor Dame Sally Davies updated the low-risk alcohol guidelines, published in January 2016.12 These are based on a review by the Committee on Carcinogenicity and their subsequent ‘Statement on Consumption of Alcoholic Beverages and Risk of Cancer’, advising that any level of alcohol intake increases risk.13 The new advice is to limit intake to 14 units a week (men and women), and to spread this evenly over three days or more.

MESSAGES ON PHYSICAL ACTIVITY

In 2016, the DHSC produced a series of infographics communicating public advice on the duration, frequency and type of physical activity for achieving general health benefits for different population groups. Adults are advised to achieve 75 minutes of vigorous intensity, or 150 minutes of moderate intensity activity each week. The infographics have since been updated to include advice for groups such as disabled adults and pregnant women.14

References
1 PHE, March 2016. The Eatwell Guide. www.gov.uk/government/publications/the-eatwell-guide
2 Department of Health. Nutritional aspects of cardiovascular disease. Committee on Medical Aspects of Food Policy. London: HMSO; 1994
3 Department of Health. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Committee on Medical Aspects of Food Policy. London: HMSO; 1991
4 The World Health Organisation (WHO). Diet, nutrition and the prevention of chronic diseases (2003). http://whqlibdoc.who.int/trs/WHO_TRS_916.pdf
5 The World Health Organisation (WHO) (1990) Diet, nutrition and the prevention of chronic diseases. www.who.int/nutrition/publications/obesity/WHO_TRS_797/en/index.html
6 Scientific Advisory Committee on Nutrition (SACN). Vitamin D and Health. London: TSO; 2016. www.gov.uk/government/publications/sacn-vitamin-d-and-health-report
7 Scientific Advisory Committee on Nutrition (SACN). Carbohydrates and Health. London: TSO; 2015. www.gov.uk/government/publications/sacn-carbohydrates-and-health- report
8 Scientific Advisory Committee on Nutrition (SACN). Dietary Reference Values for Energy. London: TSO; 2011. www.gov.uk/government/publications/sacn-dietary- reference-values-for-energy
9 Scientific Advisory Committee on Nutrition (SACN). Iron and Health. London: TSO; 2010. www.gov.uk/government/publications/sacn-iron-and-health-report
10 Scientific Advisory Committee on Nutrition (SACN). Advice on Fish Consumption: Benefits and Risks. London: TSO; 2004. www.gov.uk/government/publications/sacn-advice- on-fish-consumption
11 Scientific Advisory Committee on Nutrition (SACN). Salt and Health. TSO; London: 2003. www.gov.uk/government/publications/sacn-salt-and-health-report
12 Department of Health. UK Chief Medical Officers’ Alcohol Guidelines Review, January 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf
13 Public Health England. Statement on consumption of alcoholic beverages and risk of cancer. Committee on Carcinogenicity of Chemicals in food, consumer products and the environment, 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/490584/COC_2015_S2__Alcohol_and_Cancer_statement_Final_version.pdf
14 Department of Health and Social Care (DHSC). Physical activity Start active, stay active: infographics on physical activity. www.gov.uk/government/publications/start-active-stay-active-infographics-on-physical-activity
15 NHS Website: www.nhs.uk/live-well/
16 Change4Life. https://campaignresources.phe.gov.uk/resources/campaigns/17-change4life/overview
17 EU, 2006. Regulation (EC) No 1924/2006 of the European Parliament and of the Council of 20 December 2006 on nutrition and health claims made on foods. Official Journal of the European Union 30.12.2006, L 404
18 Sadler M. Authorised EU health claim for supplementary folic acid. In Foods, Nutrients and Food Ingredients with Authorised EU Health Claims, 2017, Volume 3. Ed MJ Sadler. Woodhead Publishing, 2017, Chapter 5, p 65-86
19 Public Health England/Food Standards Agency. National Diet and Nutrition Survey. Results form Years 5 to 6 combined of the Rolling Programme (2012/13-2013/14). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/551352/NDNS_Y5_6_UK_Main_Text.pdf
20 Public Health England. Statistical Summary: National Diet and Nutrition Survey: Years 1 to 9 of the Rolling Programme (2008/9–2016/7: Time trend and income analyses). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/772430/NDNS_Y1-9_statistical_summary.pdf
21 Heindel JJ and Vandenberg LN. Developmental Origins of Health and Disease: A paradigm for understanding disease etiology and prevention. Curr Opin Pediatr. 2015, 27(2): 284-253
22 Sadler MJ. Dried fruit and dental health. International Journal of Food Sciences and Nutrition 2016, 67(8): 944-959.
23 Department of Health and Social Care. Health 2040 – Better Health within Reach. Annual Report of the Chief Medical office, 2018. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/767549/Annual_report_of_the_Chief_Medical_Officer_2018_-_health_2040_-_better_health_within_reach.pdf

Page 11 - Dietetic clinics and the obese patient by Alice Fletcher RD

FURTHER READING

The BDA Obesity Specialist Group document: Dietetic Obesity Management Interventions in adults: Evidence Review and Clinical Application. It’s a very thorough and easy-to-read overview of WM in practice.17

For training on awareness and prevention of weight bias, along with self-assessment tools, a free online training course is available via the University of Connecticut Rudd Centre for Food Policy and Obesity: Preventing weight bias: helping without harming in clinical practice at www.uconnruddcenter.org.
References
1 Wang Z (2016). Body Mass Index and all-cause mortality. Jama, 316(9), 991. doi:10.1001/jama.2016.10288
2 Wardle J and Johnson F (2002). Weight and dieting: examining levels of weight concern in British adults. Int J Obes 26: 1144-9
3 www.telegraph.co.uk/women/life/obese-mannequins-selling-women-dangerous-lie/
4 www.theguardian.com/profile/nikki-stamp
5 www.cancerresearchuk.org/about-cancer/causes-of-cancer/obesity-weight-and-cancer
6 https://metro.co.uk/2019/07/03/cancer-researchs-obesity-campaign-isnt-just-misguided-its-dangerous-10108310/
7 Bhaskaran K et al. Body-mass index and risk of 22 specific cancers: A population-based cohort study of 5·24 million UK adults. Lancet 384, 755-765 (2014)
8 Price JH, Desmond SM, Krol RA, Snyder FF, O'Connell JK (1987). Family practice physicians’ beliefs, attitudes and practices regarding obesity. Am J Prev Med 3: 339-345
9 Foster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB, Kessler A (2003). Primary care physicians' attitudes about obesity and its treatment. Obes Res; 2003, Oct; 11(10): 1168-77
10 Harvey EL, Summerbell CD, Kirk SF, Hill AJ. Dietitians' views of overweight and obese people and reported management practices. J Hum Nutr Diet 2002; 15(5): 331-47
11 Foresight. Tackling obesities: future choices – project report. The Stationery Office, London; 2007. www.foresight.gov.uk/Obesity/obesity_final/Index.html
12 Bouchard C, Tremblay A, Despres JP et al. The response to long-term overfeeding in identical twins. N Engl J Med. 1990; 322(21): 1477-82
13 Meisel SF, Wardle J. Responses to FTO genetic test feedback for obesity in a sample of overweight adults: a qualitative analysis. Genes Nutr. 2014; 9(1): 374
14 Meisel SF, Wardle J. 'Battling my biology': psychological effects of genetic testing for risk of weight gain. J Genet Couns. 2014; 23(2): 179-86
15 The UK Obesity Care Pathway (2013). Department of Health
16 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/484115/Final_Weight_Management_Mapping_Report.pdf
17 BDA Obesity Specialist Group document (2018). Dietetic Obesity Management Interventions in adults: Evidence Review and Clinical Application
18 Wing RR et al. Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals with Type 2 Diabetes. Diabetes Care. 2011 Jul; 34(7): 1481-1486
19 Astrup A, Rossner S. Lessons from obesity management programmes: greater initial weight loss improves long-term maintenance. Obes Rev. 2000; 1: 17-19
20 Nackers LM, Ross KM, Perri MG. The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race? Int J Behav Med. 2010; 17: 161-167
21 Rapoport L, Pearson D. Health Behaviour Change In: Thomas B, Ed. The Manual of Dietetic Practice. Oxford Blackwell Science 2007
22 Pearson D, Grace C. Weight Management: A Practitioners Guide. Wiley Blackwell 2012
23 Wing R. Behavioral approaches to the treatment of obesity. In: Bray G, Bouchard C, eds. Handbook of Obesity: Clinical Applications New York Marcel Dekker; 2004: 147-67
24 Wadden T, Wingate B. Behavioural assessment and treatment of markedly obese patients. New York Guildford Press; 1992
25 Hartmann-Boyce J, Johns DJ, Jebb SA, Aveyard P. Behavioural Weight Management Review G. Effect of behavioural techniques and delivery mode on effectiveness of weight management: systematic review, meta-analysis and meta-regression. Obes Rev. 2014; 15(7): 598-609
26 Middleton KM, Patidar SM, Perri MG. The impact of extended care on the long-term maintenance of weight loss: a systematic review and meta-analysis. Obes Rev. 2012; 13(6): 509-17
27 Ahern AL, Wheeler GM, Aveyard P et al. Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial. Lancet. 2017; 389(10085): 2214-25
28 https://pathways.nice.org.uk/pathways/obesity
29 Tarrant C, Stokes T, Baker R. Factors associated with patients' trust in their general practitioner: a cross-sectional survey. Br J Gen Pract. 2003; 53(495): 798-800
30 Howie JG, Heaney DJ, Maxwell M, Walker JJ, Freeman GK, Rai H. Quality at general practice consultations: cross sectional survey. BMJ 1999; 319(7212): 738-43
31 Saultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004; 2(5): 445-51
32 Ridd M, Shaw A, Salisbury C. 'Two sides of the coin' – the value of personal continuity to GPs: a qualitative interview study. Fam Pract. 2006; 23(4): 461-8

Page 16 - Eosinophilic oesophagitis by Rebecca Gasche
References
1 Lucendo A, Molina-Infante J, Arias Á, von Arnim U, Bredenoord A, Bussmann C, Amil Dias J, Bove M, González-Cervera J, Larsson H, Miehlke S, Papadopoulou A, Rodríguez-Sánchez J, Ravelli A, Ronkainen J, Santander C, Schoepfer A, Storr M, Terreehorst I, Straumann A and Attwood S (2017). Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterology Journal, 5(3), pp 335-358
2 Lomer M and Stuart A (2014). Advanced nutrition and dietetics in gastroenterology. Chichester, England: Wiley Blackwell
3 Immunology org (2019). Eosinophils. British Society for Immunology [online]. Available at: www.immunology.org/public-information/bitesized-immunology/células/eosinophils [Accessed 1 June 2019]
4 Guts UK (2019). Eosinophilic Diseases – Guts UK [online]. Available at: https://gutscharity.org.uk/advice-and-information/conditions/eosinophilic-diseases/#section-2 [Accessed 1 June 2019]
5 Arias A, Gonzalez-Cervera J, Tenias J, Lucendo A. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic oesophagitis: A systematic review and meta-analysis. Gastroenterology 2014; 146: 1639-48
6 Wolf W, Jerath M, Sperry S, Shaheen N, Dellon E. Dietary elimination therapy is an effective option for adults with eosinophilic oesophagitis. Clin Gastroenterol Hepatol 2014; 12: 1272-79
7 Kagalwalla A, Wechsler J, Schwartz S and Amsden K (2014). Elimination diets in the management of eosinophilic esophagitis. Journal of Asthma and Allergy, p85.
8 Bda.uk.com (2019). Living with a food allergy [online]. Available at: www.bda.uk.com/foodfacts/living_with_a_food_allergy [Accessed 1 June 2019]

Page 19 – Dysphagia by Martha Jackson
References
1 Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S (2011). Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus; 24: 476-80
2 McGinnis CM, Homan K, Solomon M, Taylor J, Staebell K, Erger D and Raut N (2019). Dysphagia: Interprofessional Management, Impact and Patient‐Centred Care. Nutrition in Clinical Practice, 34: 80-95. doi:10.1002/ncp.10239
3 Malagelada JR, Bazzoli F, Boeckxstaens G et al (2015). World gastroenterology organisation global guidelines: Dysphagia ̶ global guidelines and cascades update September 2014. J Clin Gastroenterol; 49: 370-8
4 Ronkainen J, Talley NJ, Aro P et al (2007). Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population-based Kalixanda study. Gut, 56, 615-20
5 Alzheimer’s online. Recognising and managing swallowing difficulties for people with dementia. Available at: www.alzheimersonline.org/page/about-us/whats-on/blog/recognising-and-managing-swallowing-difficulties-for-people-with-dementia/
6 NHS. Dysphagia Overview. Available at: www.nhs.uk/conditions/swallowing-problems-Dysphagia/
7 National Institute for Health and Care Excellence (NICE) CG32 (2006). Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Available at: www.nice.org.uk/guidance/cg32/resources/nutrition-support-for-adults-oral-nutrition-support-enteral-tube-feeding-and-parenteral-nutrition-pdf-975383198917
8 Teasell R et al. EBRSR, 2018; 15: 1-74. 6. Clavé P, Shaker, R. Nat Rev Gastronenterol, 2015; 12: 259-70
9 Saito T, Hayashi K, Nakazawa H et al (2018). A Significant Association of Malnutrition with Dysphagia in Acute Patients. Dysphagia. 33(2): 258-265
10 Royal College of Speech and Language Therapy. Guidance on the Management of Dysphagia in Care Homes
11 Paik N (2018). Medscape. Dysphagia Treatment & Management. Available at: https://emedicine.medscape.com/article/2212409-treatment#d11
12 Hospital Caterers Association. A Premier Foods guide to International Dysphagia Diet Standards. Available at: www.hospitalcaterers.org/media/2153/international_dysphagia_diet_standards.pdf
13 Guidelines: Summarising clinical guidelines for primary care. Guideline for the identification and management of swallowing difficulties in adults with learning disability (2018). Available at: www.guidelines.co.uk/Dysphagia/swallowing-difficulties-management-in-adults-with-learning-disability/236036.article
14 https://iddsi.org/

Page 23 - Undernutrition by Farihah Choudhury
References:

1 World Bank (2016). Prevalence of undernourishment (% of population) – United Kingdom figures https://data.worldbank.org/indicator/SN.ITK.DEFC.ZS?end=2016&locations=GB&start=2000
2 BAPEN (2018). Increased cost of malnutrition in England. www.bapen.org.uk/screening-and-must/78-media-centre/economic-report/471-new-data-reveals-increased-cost-of-malnutrition-in-england
3 Food and Agriculture Organisation of the United Nations (FAO 2018). The State of Food Security and Nutrition in the World. Accessed July 30th 2019: www.fao.org/3/I9553EN/i9553en.pdf
4 Norwegian Refugee Council (2018). Yemen: Eating leaves to survive article. Accessed July 30th 2019: www.nrc.no/news/2018/october/yemen-eating-leaves-to-survive/
5 Food and Agriculture Organisation of the United Nations (FAO 2019). The State of Food Security and Nutrition in the World. Accessed July 30th 2019: www.fao.org/3/ca5162en/ca5162en.pdf
6 Morley JE (2012). Undernutrition in older adults. Family Practice, 29(1), 89-93
7 Roberts HC, Lim S, Cox NJ and Ibrahim K (2019). The Challenge of Managing Undernutrition in Older People with Frailty. Nutrients, 11(4), 808
8 Stroebele N, de Castro JM (2004). Effect of ambience on food intake and food choice. Nutrition, 20: 821-838
9 Schenker S (2003). Undernutrition in the UK. Nutrition Bulletin, 28: 87-120
10 BAPEN (2012). Hospital Food as Treatment. Accessed July 30th 2019: www.bapen.org.uk/resources-and-education/education-and-guidance/clinical-guidance/hospital-food-as-treatment?showall=1
11 Smink FR, van Hoeken, D and Hoek HW (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current psychiatry reports, 14(4), 406-414
12 Marshall S, Agarwal E, Young A, Isenring E (2017). Role of domiciliary and family carers in individualised nutrition support for older adults living in the community. Maturitas, 98, 20-29

Page 31 - Bacteria, the good, the bad and the UGLY by Priya Tew and Naomi Leppitt

References
1 Valdes AM, Walter J, Segal E, Spector TD. Role of the gut microbiota in nutrition and health. BMJ [Internet]. 2018. Jun 13 [cited 2019 Jul 27]; 361: k2179. Available from: www.ncbi.nlm.nih.gov/pubmed/29899036
2 Bull MJ, Plummer NT. Part 1: The Human Gut Microbiome in Health and Disease. Integr Med (Encinitas) [Internet]. 2014. Dec [cited 2019 Jul 27]; 13(6): 17-22. Available from: www.ncbi.nlm.nih.gov/pubmed/26770121
3 Soto A, Martín V, Jiménez E, Mader I, Rodríguez JM, Fernández L. Lactobacilli and bifidobacteria in human breast milk: influence of antibiotherapy and other host and clinical factors. J Pediatr Gastroenterol Nutr [Internet]. 2014. Jul [cited 2019 Jul 27]; 59(1): 78-88. Available from: www.ncbi.nlm.nih.gov/pubmed/24590211
4 Baumann-Dudenhoeffer AM, D’Souza AW, Tarr PI, Warner BB, Dantas G. Infant diet and maternal gestational weight gain predict early metabolic maturation of gut microbiomes. Nat Med [Internet]. 2018. Dec 29 [cited 2019 Jul 27];.24(12): 1822-9. Available from: www.nature.com/articles/s41591-018-0216-2
5 Stinson LF, Payne MS, Keelan JA. A Critical Review of the Bacterial Baptism Hypothesis and the Impact of Cesarean Delivery on the Infant Microbiome. Front Med [Internet]. 2018 [cited 2019 Jul 27]; 5: 135. Available from: www.ncbi.nlm.nih.gov/pubmed/29780807
6 Fallani M, Amarri S, Uusijarvi A, diger Adam R, Khanna S, Aguilera M et al. Determinants of the human infant intestinal microbiota after the introduction of first complementary foods in infant samples from five European centres. Microbiology [Internet]. 2011 [cited 2019 Jul 27]; 157: 1385-92. Available from: www.gla.ac.uk/departments/
7 Krajmalnik-Brown R, Ilhan Z-E, Kang D-W, DiBaise JK. Effects of gut microbes on nutrient absorption and energy regulation. Nutr Clin Pract [Internet]. 2012. Apr [cited 2019 Jul 28]; 27(2): 201-14. Available from: www.ncbi.nlm.nih.gov/pubmed/22367888
8 Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature [Internet]. 2006 Dec [cited 2019 Jul 28]; 444(7122): 1027-31. Available from: www.nature.com/articles/nature05414
9 Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Human gut microbes associated with obesity. Nature [Internet]. 2006 Dec 21 [cited 2019 Jul 28]; 444(7122): 1022-3. Available from: www.nature.com/articles/4441022a
10 Council for Agricultural Science and Technology (CAST). Probiotics: Their Potential to Impact Human Health. [Internet]. Ames, Iowa; 2007 [cited 2019 Jul 27]. Report No: Issue Paper 36. Available from:
www.castscience.org/download.cfm?PublicationID=2930&File=f030d2d5777f5676ed033b112a7e65524518
11 Long SL, Gahan CGM, Joyce SA. Interactions between gut bacteria and bile in health and disease. Mol Aspects Med [Internet]. 2017. Aug 1 [cited 2019 Jul 28]; 56:54-65. Available from: www.sciencedirect.com/science/article/pii/S0098299716301200
12 Gupta N, Martin PM, Prasad PD, Ganapathy V. SLC5A8 (SMCT1)-mediated transport of butyrate forms the basis for the tumor suppressive function of the transporter. Life Sci [Internet]. 2006. Apr 18 [cited 2019 Jul 28]; 78(21): 2419-25. Available from: www.sciencedirect.com/science/article/abs/pii/S0024320505011276
13 Meganathan R, Kwon O. Biosynthesis of Menaquinone (Vitamin K2) and Ubiquinone (Coenzyme Q). EcoSal Plus [Internet]. 2009. Aug [cited 2019 Jul 27]; 3(2). Available from: www.ncbi.nlm.nih.gov/pubmed/26443765
14 Barrett JS, Gearry RB, Muir JG, Irving PM, Rose R, Rosella O et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010; 31(8): 874-82
15 Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR et al. Manipulation of dietary short-chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010; 25(8): 1366-73
16 Rodiño-Janeiro BK, Vicario M, Alonso-Cotoner C, Pascua-García R, Santos J. A Review of Microbiota and Irritable Bowel Syndrome: Future in Therapies. Adv Ther [Internet]. 2018. Mar 1 [cited 2019 Jul 28]; 35(3): 289-310. Available from: http://link.springer.com/10.1007/s12325-018-0673-5
17 Zhuang X, Xiong L, Li L, Li M, Chen M. Alterations of gut microbiota in patients with irritable bowel syndrome: A systematic review and meta-analysis. J Gastroenterol Hepatol [Internet]. 2017. Jan 1 [cited 2019 Jul 28]; 32(1): 28-38. Available from: http://doi.wiley.com/10.1111/jgh.13471
18 Watanabe K, Petri WA. Environmental Enteropathy: Elusive but Significant Subclinical Abnormalities in Developing Countries. 2016 [cited 2019 Jul 28]; Available from: http://creativecommons.org/licenses/by/4.0/
19 Tang WHW, Kitai T, Hazen SL. Gut Microbiota in Cardiovascular Health and Disease. Circ Res [Internet]. 2017. Mar 31 [cited 2019 Jul 28]; 120(7): 1183-96. Available from: www.ncbi.nlm.nih.gov/pubmed/28360349
20 Food and Agriculture Organisation of the United Nations, World Health Organisation. Guidelines for the Evaluation of Probiotics in Food: Report of a Joint FAO/WHO Working Group on Drafting Guidelines for the Evaluation of Probiotics in Food [Internet]. London Ontario, Canada; 2002 [cited 2019 Jul 27]. Available from: www.fao.org/es/ESN/Probio/probio.htm
21 Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic [Internet]. Vol 11, Nat Rev. Gastroenterol. Hepatol. 2014 [cited 2019 Jul 27]. Available from: www.nature.com/nrgastro
22 Guarner F, Sanders ME, Eliakim R, Fedorak R et al. World Gastroenterology Organisation Global Guidelines Probiotics and prebiotics [Internet]. 2017 [cited 2019 Jul 30]. Available from: www.worldgastroenterology.org/UserFiles/file/guidelines/probiotics-and-prebiotics-english-2017.pdf
23 NICE. Irritable bowel syndrome in adults: diagnosis and management. Clinical Guideline [CG61] [Internet]. NICE; 2008 [cited 2019 Jul 30]. Available from: www.nice.org.uk/guidance/cg61/chapter/1-Recommendations
24 McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J, O’Sullivan NA et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016; 29(5): 549-75.


Page 35 - Breastfeeding ˗̶̶̶ our duty as hcps to give the balanced picture by Priya Tew and Naomi Leppitt
References
1 NHS England. Maternity and Breastfeeding Statistics [Internet] (2017) [cited 2019 Sep 5]. Available from: www.england.nhs.uk/statistics/statistical-work-areas/maternity-and-breastfeeding/
2 Mcandrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ. UK Data Archive Study Number 7281-Infant Feeding Survey [Internet] (2010) [cited 2019 Sep 5]. Available from: www.ic.nhs.uk
3 Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J et al. Breastfeeding in the 21st century: epidemiology, mechanisms and lifelong effect. Lancet [Internet] (2016) Jan 30 [cited 2019 Sep 5]; 387(10017):475-90. Available from: www.ncbi.nlm.nih.gov/pubmed/26869575
4 BDA Paediatric Specialist Group. Breastfeeding [Internet] (2018) [cited 2019 Sep 5]. Available from: www.bda.uk.com/foodfacts/breastfeeding

Page 39 - Weaning an infant with cow’s milk protein allergy (cmpa) by Paula Hallam
References
1 Luyt D et al (2014). BSACI guideline for the diagnosis and management of cow’s milk allergy. Clinical and Experimental Allergy; 44, 642-672
2 Lifschitz C and Szajewska H (2015). Cow’s milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr 174:141-150
3 National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries (2015). Cow’s milk protein allergy in children. Available at: https://cks.nice.org.uk/cows-milk-protein-allergy-in-children#!management (Accessed on 30th May 2018)
4 Katz et al (2013). Cow’s milk allergy: A new approach needed? J Peds; 163 (3): 620-622
5 Koletzko S et al (2012). Diagnostic approach and management of cow’s milk protein allergy in infants and children: ESPGHAN GI committee practical guidelines. JPGN; 55 (2): 221-6
6 Skypala et al (2015). The development of a standardised diet history tool to support the diagnosis of food allergy. Clin Transl Allergy; 5 (7): 1-9
7 Muraro A et al and EAACI Food Allergy and Anaphylaxis Guidelines Group. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014, 69:1008-1025
8 Venter C et al (2013). Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy ̶ a UK primary care practical guide. Clinical and Translational Allergy, 3:23
9 Venter et al (2017). Better recognition, diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy: iMAP ̶̶ an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy 7:26
10 World Health Organisation (2018). Breastfeeding. Available at: www.who.int/nutrition/topics/exclusive_breastfeeding/en/ (Accessed on 5th June 2018)
11 Forbes JD, PhD et al (2018). Association of Exposure to Formula in the Hospital and Subsequent Infant Feeding Practices with Gut Microbiota and Risk of Overweight in the First Year of Life. JAMA Pediatr. Published online June 4, 2018. doi:10.1001/jamapediatrics.2018.1161
12 Dieterich CM et al (2013). Breastfeeding and Health Outcomes for the Mother-Infant Dyad. Pediatr Clin North Am.; 60(1): 31-48
13 Adam Fox et al. An update to the Milk Allergy in Primary Care guideline. Clinical and Translational Allergy (2019) 9: 40

Page 43 - New study into weaning and PKU

References
1 Sharon Evans, Anne Daly, Jo Wildgoose, Barbara Cochrane, Satnam Chahal, Catherine Ashmore, Nik Loveridge and Anita MacDonald (2019). Growth, Protein and Energy Intake in Children with PKU Taking a Weaning Protein Substitute in the First Two Years of Life: A Case-Control Study. www.mdpi.com/2072-6643/11/3/552
2 Portnoi P, MacDonald A, Watling R, Clarke BJ; Barnes J, Robertson L, White F, Jarvis C, Laing S, Weetch E et al. A survey of feeding practices in infants with phenylketonuria. J Hum Nutr Diet. 1999, 12, 287-292
3 MacDonald A, Rylance GW, Asplin DA, Hall K, Harris G, Booth IW. Feeding problems in young PKU children. Acta Paediatr Suppl. 1994,407, 73-74
4 Evans S, Daly A, MacDonald J, Pinto A, MacDonald A. Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study. J Hum Nutr Diet. 2017, 31, 349-356

Page 44 - KUVAN OR SAPROPTERIN: A PHARMACOLOGICAL TREATMENT FOR PKU - by Suzanne Ford

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