Bread and breakfast cereals are at the heart of the British diet and provide the nation with a good source of essential nutrients such as calcium, iron, vitamin D and fibre. That's why achieving an adequate intake of these vital nutrients can be a challenge for people with coeliac disease, as so many staple foods contain gluten.
In recent months several misleading press article have appeared accusing gluten free food manufacturers of excessive charging for delivering prescription products. Members of the BSNA provide these products to the NHS at a fixed and consistent price and they never charge extra administration or delivery charges because these are already paid for by the manufacturers.
Findings from the latest national Nutrition Screening Week Survey and Audit published by the British Association of Parenteral and Enteral Nutrition (BAPEN) demonstrate that action is urgently needed to tackle malnutrition across all age groups and in all care settings.
The BSNA held our inaugural Annual Lecture at the Royal Society, London in March 2012. Liz Woodeson, Director of Health and Wellbeing at the Department of Health, gave the keynote address which provided an insight into nutrition in the new public health environment.
The National Prescribing Centre (NPC) has published new guiding principles for oral nutrition supplements (ONS) for adults . ONS are a critical form of nutritional support for patients who, for a variety of reasons, cannot meet their nutritional needs through food alone. They are an important tool for clinicians in tackling malnutrition – which affects more than 3 million people in the UK and is particularly common among the elderly.
Today's Mail Online reports on a small research study published last year by the University of Greenwich, which suggests that baby foods are not subject to tough regulations and lack nutrients.
In fact, this couldn't be further from the truth. Foods for babies and toddlers are nutritionally balanced, meet the highest standards of quality and safety and are governed by stringent regulations. Baby foods are manufactured to the highest standards and undergo extensive quality control throughout the production process.
Aberdeen University recently published qualitative research in BMJ Open that it carried out into the infant feeding experiences of women and their 'significant others' from pregnancy to 6 months after birth. It reached the conclusion that the adoption of 'idealistic global policy goals' such as breast feeding until 6 months are unhelpful and that more 'achievable' goals should be pursued.
The EFSA Panel on Dietetic Products, Nutrition and Allergies has provided a scientific opinion on the suitability of goats' milk protein in infant formulae and in follow-on formulae. The Panel concluded that as long as the final product complies with the compositional criteria in the Infant and Follow On Formula Directive (2006/141/EC), protein from goats' milk can be a suitable source of protein.
The process for approval of health claims is one that has been prolonged and has included many steps, form the submission of detailed scientific dossiers to EFSA, through to approval by the European Parliament. In recent weeks we have seen a number of key decisions voted upon, particularly by the European Parliaments 'Committee on the Environment, Public Health and Food Safety' (ENVI).
The recently revised Gluten-Free Prescribing Guidelines 2011 recommends that people with medically diagnosed coeliac disease should have access to a reasonable amount of basic staple gluten-free foods on prescription to assist them in managing their condition.
GlaxoSmithKline (GSK), the UK's largest pharmaceutical company, and a member of the BSNA Sports Nutrition group, have been named 'Official Laboratory Services Provider' for the London 2012 Olympic and Paralympic Games. There are strict regulations governing substances athletes are permitted to take managed by WADA, the World Anti Doping Authority and London 2012 are taking the matter of compliance with the regulations very seriously. Over 6000 drug tests will be carried out, more than any other Games has seen.
Carers UK and Nutricia have published a new report, Malnutrition and Caring: the hidden cost for families, which shows that without the right advice and support, families managing the health conditions of older and disabled family members end up struggling to cope with the consequences of malnutrition
Vitamin D remains high on the nutrition agenda as confirmed by recent communication from the UK's Chief Medical Officer, Dame Sally Davies, raising awareness of the problems of vitamin D deficiency with health professionals and encouraging them to take appropriate action.
Patient Safety First, a campaign group which focuses on improving patient safety in the health service, has announced that on 23 January it will be partnering with the National Patient Safety Agency (NPSA) to launch a week focused on nutrition and hydration: 'A taste of patient safety'.
Gastrointestinal disorders, such as coeliac disease, are reported to account for around ten percent of NHS clinical work. However, despite being one of the most common long term chronic conditions, the prevalence of coeliac disease is still not formally recorded by the NHS. Consequently, it's not surprising that coeliac disease is not always well managed in general practice.
Sport nutrition is a growing area of expertise, highlighting the importance of accurate and up to date scientific information. In recognition of this, the UK's Nutrition Society, the professional association of nutritionists, has recently published a new book 'Sport and Exercise Nutrition'
The long awaited Food Information to Consumers Regulation was published in November 2011. This new Regulation will result in changes to most food and drink labels, including those of specialist nutrition products. The majority of these label changes will need to be made by December 2014 in accordance with the transition periods for the Regulation.
The European Commission's proposal to revise the current legislation for Foods for Particular Nutritional Uses (PARNUTs), known as the 'PARNUTs Framework Directive', has been under discussion by the European Council of Ministers since October 2011 and the Polish Presidency of the Council has issued a report on the progress to date as part of its handover to the new Danish Presidency which will take over from 1 January 2012.
The European Commission published a proposal to revise the current legislation for Foods for Particular Nutritional Uses (PARNUTs), known as the 'PARNUTs Framework Directive', in June 2011. The Commission proposal is now under discussion by the European Council of Ministers.
Representatives from the European Parliament, the Polish Presidency of the EU and other groups concerned about health and nutrition have come together to raise awareness of the problems of disease related malnutrition across the EU and subsequent consequences on healthcare. Disease related malnutrition affects around 20 million EU citizens per year at a cost of up to 120 billion Euros.
The Infant & Toddler Forum have recently published a new resource for health professionals providing guidance and suitable portion sizes for infants and young children.
Responding to the report on the Daily Mail about the findings of the Care Quality Commission's hospital spot-checks, Roger Clarke, Director General of BSNA says:
“Hospitals are still not getting the basics right and this is unacceptable. Nutritional care is not just a 'nice-to-have', it's essential for every patient. Without good nutrition, patients cannot be expected to recover well from illness or injury. We are deeply concerned that so many hospitals were identified by the CQC as needing to improve.
The largest ever survey of 3,500 people with coeliac disease found that 79% rated having access to a regular supply of essential gluten-free foods via the NHS helped them adhere to a life-long gluten-free diet. Overall the findings of this survey confirmed the long term value for the NHS in providing a foundation of support for coeliac patients.
The NHS White Paper, Equity and excellence: Liberating the NHS, published in July 2010, and subsequent consultations confirmed that in the future the NHS will focus on delivering improvements in patient outcomes rather than on processes and targets. BSNA asked its expert members to give thought to the key elements of a quality standard on nutrition to help to stimulate discussion among the nutrition community of what high quality nutritional care should look like in hospital and, indeed, in other care settings.
The UK's Patients Association have launched a new report 'Malnutrition in the community and hospital setting' which shows a lack of awareness of malnutrition, particularly how to prevent and treat it and where to seek advice. Over 3 million people in the UK are either malnourished or at risk of being so costing an estimated £13 billion to the NHS.
The UK Department of Health has launched a consultation on the proposals put forward by the European Commission for the revision of the current legislation for Foods for Particular Nutritional Uses (PARNUTs), known as the 'PARNUTs Framework Directive'.
Researchers at the University of Bristol have reviewed the sodium intakes of 8 month old infants, with results showing that 70% of the group had sodium intakes higher than the recommended level of 400mg a day.
World Breastfeeding Week event takes place this week (1 – 7 August 2011). This annual event is endorsed by WHO and UNICEF and is celebrated in more than 170 countries worldwide.
BSNA is pleased that the Welsh Government has refuted recent reports in the press which exaggerated the cost to the NHS of gluten-free products on prescription.
These reports in the national press had suggested that a loaf of gluten free bread costs the NHS in Wales £32. This figure appears to have been arrived at following a misinterpretation of NHS prescribing statistics - which show the total number of prescriptions dispensed, rather than the total number of loaves prescribed.
The BSNA gluten-free working group has produced a new document entitled 'A guide to the role of the gluten-free prescription in the management of coeliac disease'. The guide was compiled to inform key stakeholders and healthcare professionals, involved in the provision of care for patients with coeliac disease, of the importance of a gluten-free prescription in the successful management of this lifelong disease.
The BSNA gluten-free working group has produced a new document entitled 'A guide to the role of the gluten-free prescription in the management of coeliac disease'. The guide was compiled to inform key stakeholders and healthcare professionals, involved in the provision of care for patients with coeliac disease, of the importance of a gluten-free prescription in the successful management of this lifelong disease.
The European Commission published new proposals for the Dietetic foods sector on 20 June 2011. These proposals suggest that slimming foods (meal replacements), sports nutrition products and gluten-free foods become “general” foods.
The Generation R Study, undertaken in the Netherlands and published in Archives of Paediatric and Adolescent Medicine, followed almost 7000 infants up to four years of age assessing incidence of eczema and wheezing. The results showed that the introduction of milk, eggs, peanuts, tree nuts, soy and gluten before six months of age were not significantly associated with eczema or wheezing at any age,
The World Anti-Doping Agency has clarified its position, following a request from the BSNA, on the use of glycerol in food products for athletes, confirming that normal levels of intake from foodstuffs is not an issue.
The Infant Feeding Survey undertaken in 2010 has shown that initial breastfeeding rates have increased from 76% in 2005 to 81% in 2010 in the UK. Breastfeeding is best for babies and the BSNA welcomes the increase in the rates of initial breastfeeding shown in the 2010 Survey.
The Care Quality Commission are publishing a series of reports from their inspection programme assessing the care of the elderly in the NHS in England. Key elements of the programme include ensuring dignity and respect as well as ensuring an adequate and appropriate nutritional intake for elderly patients in hospital.
The UKs Scientific Advisory Committee on Nutrition published their review of Iron and Health in Spring 2011. The report represents a scientific review of all aspects of iron in health, including infants and young children.
Researchers from Oxford University have published a new paper in the journal 'Archives of Disease in Childhood' assessing the links between method of infant feeding and behaviour. Whilst their findings suggest that exclusive breastfeeding beyond four months of age may show a benefit in terms of behaviour in children at age 5, they are clear to point out that it is difficult to draw firm conclusions as to whether any difference relates to the composition of breastmilk or other factors including maternal contact.
A new series of fact sheets reviewing each of the specialist nutrition categories from a European view has been published by IDACE. IDACE is the European Trade Association for specialist nutrition products and is based in Brussels. The fact sheets cover infant and follow-on formula, complementary foods, medical foods, gluten free foods, sport foods and slimming foods. These categories are governed by the PARNUTs Framework Directive (Foods for PARticular NUTritional purposes). The PARNUTs Framework Directive is currently undergoing review and redrafting in Brussels and these fact sheets provide information on each category and show the importance of clear regulation for these important products.
On Wednesday 6 April 2011, the European Parliament voted to accept a nutrition and health claim for DHA (docosahexaenoic acid, an omega 3 fatty acid) and visual development to be made on follow on formula for infants older than 6 months of age.
BSNA welcomes the outcome of the vote. By voting to accept the DHA claim, the Members of the European Parliament have demonstrated their support for the expert scientific review and assessment that the European Food Safety Authority (EFSA) and the European Commission undertake.
In accordance with the Nutrition and Health Claims Regulation (1924/2006/EC), all nutrition and health claims undergo expert scientific review and assessment by EFSA and the Commission to ensure that all claims, including those referring to children's development, are safe, scientifically justified on the totality of the scientific evidence, and do not mislead consumers.
The European Parliament's approval of the nutrition and health claim for DHA in infant follow on formula means that those products that contain the required level of DHA are legally able to make nutrition and health claims on DHA and visual development. Consumers should have a right to scientifically validated information in order to make informed choices.
As many as three million individuals in the UK are either malnourished or at risk of malnutrition i. However, malnutrition remains an under-recognised and under-treated condition. Malnutrition has a significant economic impact on both hospitals and other care settings. In the UK, an estimated 93% of those individuals who are malnourished, or at risk of malnutrition, live in the community.i
SACN and COT were asked by the Department of Health and the Food Standards Agency to review the evidence on the timing of introduction of gluten into the infant diet and subsequent risk of developing coeliac disease and Type 1 Diabetes Mellitus. Their report has been published and states that introduction of gluten before 13 weeks is not appropriate but the evidence is not strong enough to give specific advice about the timing of introduction of gluten beyond three months of age.
The Department of Health and the Food Standards Agency have issued their updated 'Guide to bottle feeding' for parents and carers on the safe preparation and storage of powdered infant formula milk.
A new report published by the School Food Trust again confirms previous evidence showing issues of obesity and nutritional inadequacies in the diets of young children in the UK.
The National Audit of Dementia published their preliminary findings in December 2010. The report reviews the care for sufferers of dementia at hospital level in the UK.
Of particular interest to the BSNA is the information on nutrition and hydration status in dementia patients.
The British Artificial Nutrition Survey, BANS, has published a review of artificial nutrition support in the UK during the years 2000 – 2009. The data has shown a decline in home feeding during this period, a significant proportion of which is due to a reduction in new registrations and reporting centres.
The International Olympic Committee (IOC) statement reiterates the importance of an appropriate diet for athletes, and discusses the use of supplements. They acknowledge that to enjoy the benefits of sport, athletes, whether elite or recreational, should adopt nutrition strategies to optimise performance and support good health. Diet does influence athletic performance, and choosing appropriate foods and drinks in the correct quantities is important before, during and after training and competition. The IOC reaffirms the important role of qualified sports nutrition professionals in giving appropriate and specific advice and support.
The British Specialist Nutrition Association (BSNA) acknowledges the review, 'Six months of exclusive breastfeeding: how good is the evidence?' published by Dr. Mary Fewtrell in the British Medical Journal on 14 January 2011. BSNA welcomes any new research that continues to develop our understanding of infant nutrition. This research will add to the scientific evidence being currently reviewed on infant feeding by the UK Scientific Advisory Committee on Nutrition (SACN), part of the Department of Health. It is for the Department of Health to review this research in order to bring clarity to the guidance to mothers and parents.
BSNA welcomes the campaign led by the Patients Association to end the neglect of the elderly and combat the burden of malnutrition in the NHS. Official figures reveal that a record 13,500 patients fell victim to some form of nutritional deficiency last year after entering hospital for treatment. Sadly, vulnerable groups such as the elderly, cancer patients and those who suffer from dementia are most at risk.
The British Society of Gastroenterology (BSG) has produced updated guidance on the 'Management of Adults with Coeliac Disease'. It is intended to assist in the diagnosis and clinical management of adults with coeliac disease within the UK and was compiled following a comprehensive literature search.
The UKs Scientific Advisory Committee on Nutrition have announced a review of complementary and young child feeding. BSNA welcome the review which is long overdue and hope that the summary will provide health professionals, baby food companies and others with valuable up to date information on this important area.
The 2010 BAPEN 'Malnutrition Matters' conference launched further evidence that the fight against malnutrition in the UK is far from over. According to preliminary results of BAPEN's Winter Nutrition Screening Week, there was a recorded increase in annual data on malnutrition on admission to hospital and care, with 1 in 3 of all patients of all ages admitted into hospital and care homes at risk of malnutrition.
A call to revisit the vision and spirit of the WHO International Code of
Marketing Breast-Milk Substitutes has been published in the international and peer-reviewed journal, 'Archives of Disease in Childhood'.
The article by JS Forsyth outlines the publication of the WHO Code almost three decades ago, explaining the intention to provide a fair and open way for all interested parties to manage and monitor the marketing of breast milk substitutes.
EFSA were requested by the Commission to assess the safety of BPA in packaging materials.
In their recent review of scientific evidence published in September 2010 EFSA stated that “based on the comprehensive evaluation of recent human and animal toxicity data, the Panel concluded that no new study could be identified, which would call for a revision of the current Tolerable Daily Intake (TDI) of 0.05 mg/kg b.w./day." This reinforces the previous views that the current exposure to BPA is not considered harmful.
A review of recent research on nutrition in 'small for gestational age' babies.
EFSA conclude there is no common lactose tolerability limit
The final scope for the Crohn's disease: The management of Crohn's disease clinical guideline has now been published on the NICE website.
The development of the guidance recommendations will begin in September 2010.
The European Food Safety Authority (EFSA) has published its Annual Report on Pesticide Residues, which provides an overview of pesticide residues in food in the European Union during 2008.
A study conduced by the University of Coventry's Department of Bio-molecular Study and Sports Science has shown potential benefits of caffeine consumption for those involved in endurance events such as long-distance runners.
The European Food Safety Authority (EFSA) opinion on Bisphenol A (BPA) has been postponed until September 2010 (initially it was expected at the end of May). The CEP Panel did not manage to finalise and adopt a full opinion on BPA due to the high number of publications to review.
In the meantime the EFSA CEP Panel provided the following information:in a letter to the European Commission, EFSA has indicated that the Panel, in its deliberations to date, would maintain the Tolerable Daily Intake (TDI) for BPA at 0.05 mg/kg bw per day. The Panel has also considered the Stump study, which was the scientific basis on which Denmark banned BPA in materials in contact with food for children aged 0-3 years. The Panel has concluded that the study does not provide evidence of BPA affecting neurobehavioural endpoints included in the study design and would therefore not lead the Panel to consider changing the TDI for BPA. The Panel ruled out the possibility of a low dose effect on learning ability as expressed in the Danish DTU Food Institute risk assessment.
The first reading of the Food Information to Consumers proposal has been postponed.
The aim of the Food Information to Consumers proposal is to improve the legibility of food labels and to include key nutritional information on the front of packs to help consumers make informed choices for a healthy balanced diet. The proposal will bring EU rules on general and nutrition labelling together into a single regulation which will simplify and consolidate existing labelling legislation, it will replace the Directive 2000/13/EC of the European Parliament and of the Council on the labelling, presentation and advertising of foodstuffs and Council Directive 90/496/EEC on nutrition labelling for foodstuffs. Eventually the regulation will be applicable in all Member States, and replace current UK law.
The proposal will be discussed by co-decision in which the European Parliament and the European Council, in liaison with the European Commission, debate and agree the legislation. The first reading of the Food Information to Consumers proposal has been postponed to the 14-17 June 2010 session of the European Parliament.
The 'Infant and Dietetic Foods Association' (IDFA Ltd.) has changed its name to the 'British Specialist Nutrition Association Ltd.' (BSNA Ltd). As the pre-eminent dietetic Trade Association in this country, we continue to represent the manufacturers of specialist dietetic foods organised in the following key specialist sectors: sports foods, gluten-free foods, slimming foods, medical Foods, and foods for infants and young children. Over the past five years, however, the balance of our membership and our partnerships with linked organisations has evolved to have two important elements: infant and young children nutrition on one side and adult specialist nutrition on the other. Because of this change in membership and emphasis we have chosen a new name for our organisation which more accurately reflects these developments.