Transcript
Sally Hogg
Deputy Director of Partnerships &
Engagement, NHS Suffolk
Better food. Better health.
Let’s get Suffolk cooking!
Sally Hogg
Deputy Director of Partnerships & Engagement
NHS Suffolk
Content
• Health in Suffolk
• Drivers – national & local
• Lifestyle barriers / challenges
• Market Segmentation
• HAS projects
• HAS community grants
• Weight Management
• How you can get involved?
Health in Suffolk
Health in Suffolk –
Coronary Heart Disease
• Coronary heart disease is the most common cause of
premature death in Suffolk.
• Risk factors include age, ethnicity, high fat diet, obesity
and diabetes.
• One of the main contributors to the gap in life expectancy
in deprived areas.
• 50% fall in people dying from CHD mainly attributed to
better lifestyle choices.
Health in Suffolk ─ Diabetes
• Estimated prevalence of diabetes expected to
increase by 32% between 2005 and 2025.
• Incidence of type 2 diabetes virtually unheard of in
children and young people 10 years ago.
• Diabetes is the third most prevalent long term
condition in Suffolk.
• Approximately 10% of people are unaware they
have diabetes.
• Prevalence is higher in Black Caribbean, Indian,
Pakistani and Bangladeshi populations.
Health in Suffolk ─ Obesity
• About two-thirds adults and a third of children are either
overweight or obese.
• 41% males in Suffolk classified as overweight (2008).
• More than half of all adults expected to be obese by
2050.
• In 2008/09, 15.3% of 11 year olds classed as obese.
• In 2008/09, 8.9% of 5 year olds classed as obese.
National and local drivers for change
Government reviews:
Marmot (2010)
Healthy Weight. Healthy Lives (2008)
Lifestyle barriers and
challenges • Culture
• Knowledge
• Communities
• Lifestyle
• Time
• Cost
Market segmentation
– family breakdown
• Overprotective
• Enabling
• Unaware / uninformed
• Preoccupied
• Reactive
Overprotective parents
I don‟t want to
make a big deal,
his weight isn‟t
really a problem.
It‟s just puppy
fat, and other
kids should
learn to stop
talking about it.
She started putting on weight
at about 11, but you know, I
didn‟t want to draw attention
to it, because I‟ve read about
the anorexia and that.
Children
shouldn‟t be
judged based on
their bodies.
HAS projects
HAS community grants
£58,000 has been awarded in
community grants to projects that
promote healthy eating.
Weight Management
How to get involved
• Business awards
• School awards
• Health Manager
Or visit the big orange HAS bus outside and
speak to the team!
John Stein
Professor for Neurophysiology,
University of Oxford,
and Chair, Dyslexia Trust
Why good nutrition
is important for
optimum cognition
and behaviour
John Stein
Magdalen College,
Oxford University, UK
Supported by: The Dyslexia Research Trust (www.dyslexic.org.uk),
Dyers & Colourists, Esmee Fairbairn,
Garfield Weston and Wellcome Trusts, BBC Children in Need
D R T
Nutrition &
Cognition
Fish & our evolution
Cognition & magnocellular neurones
Low fish intake → low cognition
Improved fish intake → improved cognition
Supported by: The Dyslexia Research Trust (www.dyslexic.org.uk),
Dyers & Colourists, Esmee Fairbairn,
Garfield Weston and Wellcome Trusts, BBC Children in Need
D R T
Botticelli – Venus emerges from the sea
• Alistair Hardy, Elaine
Morgan
• Humans evolved from
apes, living by water
• Naked ─ v. little hair
• Sweating, not panting
• Low Larynx
• Bipedal
• Vitamins A & D, iron,
iodine, zinc, EPA & DHA
from fish are essential
Fish Diet
• Adapting to a fish hunting /
gathering economy allowed
10 fold expansion of our
brain size and 100 fold
increase in connections
compared with chimps
• Modern diet is a disaster!
• Too much of the 3 S‟s:
Sugar, Salt, Saturated Fat
Not enough omega 3 from
fish together with vitamins
A&D, iron, iodine, zinc
Modern diet is appalling! Too much of the 3 S‟s: sugar, salt, saturated fat
Not enough omega 3 from fish; vits A&D, iron, iodine, zinc, fibre
An effect of the 3 S‟s
Fish oils
are also
important
for
focussing
attention.
This is far
more
important
than you
might think! “My teacher said I don’t pay enough attention in class.
At least, that’s what I think she said.”
Focussing attention
Accurate automatic focussing
of attention is essential for:
• sequencing sounds for
speaking, understanding,
emotional tone
• sequencing letters visually
for reading
• sequencing skilled
movements
• emotional expression
(faces, gesture) for social
communication
Neurodevelopmental problems are
characterised by poor focussing of
attention:
• Specific language impairment
(developmental dysphasia)
• Developmental dyslexia
• Developmental dyspraxia
• Attention hyperactivity (ADHD)
• Asberger‟s, autism
• Schizophrenia
• Depression
• Antisocial behaviour
These are leading causes of ill health in
the developed world. $200 billion in
USA; £80 billion in UK
Magnocellular Neurones &
Attention
• Impaired m-cell development has been found in prematurity, foetal alcohol syndrome, developmental dyslexia, dyspraxia, dysphasia, ADHD, ASD, Williams, schizophrenia, depression, violent personalities?
• High dynamic sensitivity requires high membrane flexibility provided by local environment of essential fatty acids, particularly long chain omega 3s, found in fish oils
• Hence m-cells are very vulnerable to omega-3 deficiency
• A system of large neurones specialised for temporal processing – tracking changes in light, sound, position etc.
• Crucial for direction of attention
• Large, fast conduction, fast transmission, high anisotropy
• All express same surface antigen, CAT 301
• Found throughout the whole brain: visual, auditory, skin, muscle proprioceptors, cerebral cortex, hippocampus, cerebellum, brainstem
Role of magnocellular neurones
in developmental dyslexia,
dysphasia, dyspraxia, ADHD, autism,
antisocial behaviour?
Dyslexia – visual and auditory inattention, poor sequencing incoordination, unsteady eyes, reading and spelling difficulties
Dysphasia (specific language impairment) auditory inattention to sound sequences, incoordinated speech mispronunciations, lisps, stuttering
Dyspraxia – motor inattention, incoordination
ADHD – inattention, hyperactivity, impulsivity, incoordination
Autism – inattention to social cues, incoordination, poor communication skills
Antisocial behaviour, conduct disorder – inattention to social cues, Co morbidity.
All caused by impaired development of magnocells?
Some nerve cells are much
larger than others
(magnocellular) ─ rapid
responses for timing events,
high sensitivity to change:
motion, flicker.
Control attention and
eye movements.
Very vulnerable to
omega-3 deficiency
Most nerve cells are smaller
(parvocellular):
for static responses, eg.
colour, fine detail
Magnocellular
Neurones
Visual magnocellular system dominates
visuomotor pathway
Directs visual attention & eye movements
The visual magnocellular system is
impaired in poor readers
• 30% smaller LGN magnocells
post mortem
• Reduced and delayed evoked brain
waves
• Reduced visual motion sensitivity
• Lower sensitivity to flicker
• Lower sensitivity to low spatial, high
temporal frequency contrast gratings
• Reduced activation of cortical visual
motion areas (FMRI)
• Lower stereoacuity
• Unstable attention & eye control
• Poor visual sequential attention ─
slower visual search
These claims are vigorously
disputed ─ 3 problems:
• Definition of magno-system:
only anatomically distinct in
LGN and cortical layer 4
• Selectivity of stimuli
• Mild deficit requires highly
sensitive tests to reveal it
Nevertheless in the last 10 years
90% of new research papers have
supported magnocellular theory.
But Brent Skottun has written 20
papers criticising others‟ work!
Abnormal magnocells in
dyslexic brain
Weak m-system causes unstable
vision ─ blur
Weak magnocellular system causes
unstable vision ─ oscillopsia
“The letters go all blurry”
“The letters move over each other, so I can‟t tell
which is which”
“The letters seem to float all over the page”
“The letters move in and out of the page”
“The letters split and go double”
“The c moved over the r, so it looked like another c”
“The p joined up with the c”
“d‟s and b‟s sort of get the wrong way round”
“The page goes all glary and hurts my eyes”
“I keep on losing my place”
Cod Liver Oil Queue, 1944
„Most Britons
were better fed
in 1942 at the
height of
the German
blockade than
they are now‟
Dr Hugh Sinclair,
Magdalen College,
Oxford
Fish is good for the heart & brain! • By increasing membrane
flexibility, speed up neuronal Na, K, NMDA, GABAa currents; ie. accelerate neuronal responses
• Thus improve magnocellular timing functions
• Increase neurogenesis; decrease apoptosis
• Increase neurite outgrowth (syntaxin) & synapse formation
• Hence improve memory (Alzheimer‟s)
• Strengthen hemispheric lateralisation
• Anti-inflammatory
• Reduce pain transmission (TRPV1 receptors)
• Prevent accumulation of insoluble amyloid precursor protein (Alzheimer‟s)
Fish oils
Omega-3s enable
membrane flexibility ─
50% of the membrane
enclosing this
magnocellular nerve
cell consists of
a single long chain
omega-3 fatty acid
(DHA)
● New Zealand (5.8%)
● Canada (5.2%)
● France (4.5%)
● Korea (2.3%)
Japan (0.12%)
● ●
Taiwan (0.6%)
● USA
(3.0%)
● Puerto Rico
(3.0%)
● West
Germany (5.0%)
Annual apparent fish consumption (lbs per person)
Fish consumption and prevalence of major depression
Annual pre
vale
nce o
f m
ajo
r depre
ssio
n (
rate
/100 p
eople
)
20 40 60 80 100 120 140 160
0
1
2
3
4
5
6
Changes in Hamilton
Depression Rating
scale (HDRS) over
time in patients
treated with:
- fluoxetine
- EPA
- or EPA+fluoxetine
0 2 4 6 8
0
5
10
15
20
25
30
35
EPA + fluoxetine
EPA
fluoxetine
TIME (weeks)
Fatty acid deficiencies in dyslexia and young offenders?
• Modern diet, particularly of the poor,
is highly deficient in essential
micronutrients, particularly omega-3s
• Many children with neurodevelopmental
problems and young offenders have
clinical signs of omega-3 deficiency
• Low blood and brain omega-3s
• Fish oil omega-3 supplements can
greatly improve m-function, attention,
reading and reduce violence
Gold standard
for evidence of
effect – double
blind, randomised
control trials
(RCTs)
Randomly allocate
to active treatment
or placebo groups;
then all other
factors should be
the same between
the groups. Hence
any difference in
outcome must be
due to active
treatment
Durham RCT ─ Omega 3 EPA supplements
helped dyspraxic children to improve their concentration
and their reading (Richardson & Montgomery)
Treatment effect sizes after 3 months
0.26
0.31
0.34
0.50
0.54
0.58
0.61
-0.60 -0.40 -0.20 0.00 0.20 0.40 0.60 0.80
Conners' Index
DSM Hyperactivity
Emotional Lability
Conners' Total
Restless-Impulsive
DSM Total
DSM Inattention
Global scales(Mean change / Baseline SD)
HUFA (n=15)
Placebo (n=14)
Richardson et al.
In violent offenders, poor visual perception reduces ability to read facial
expressions
1133 offences: ITT- Active vs Placebo: -26.3 % (p ‹ 0.03)
Supplementation for at least 2 weeks: -34.0%
Violent offences only: -37.0%
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Before Supplementation During Supplementation
Ratio
of
Rate
of
Dis
cip
linary
Incid
ents
S
up
ple
menta
tio
n/B
aselin
e
Active
Placebo
Error bars at 2SE to indicate the 95% confidence interval
Omega-3, vitamins & mineral supplements reduced
offences in Young Offenders by 1/3rd
(NJ - Gesch et al.)
0
2
4
6
8
10
12
voormeting nameting
voedingssupplementen
placebo-conditie
No of incidents in Dutch prison
per 1000 prisoner days
Supplements versus placebo.
• Low visual magnocellular sensitivity poor visual reading
& spelling, inaccurate interpretation of facial expressions,
poor theory of mind
• Low auditory magnocellular sensitivity inaccurate
phonology, poor interpretation of speech feeling
• Lower kinaesthetic magnocellular sensitivity poor
interpretation of gesture
• Low cerebellar (motor magnocellular) function low skill
• Lower prefrontal function poor self-inhibition, impulsivity
and inappropriate reactions – antisocial
• These may all be ameliorated by improving diet
Sensorimotor basis of poor
communication?
Conclusions
• Impaired magnocellular function causes
defective allocation of visual & auditory attention
(also cutaneous, proprioceptive, motor intention)
• Hence impaired cognition, social interaction,
impulsivity, lack of self control
• May result from:
Genetic vulnerability
Fish omega 3 deficiency
• This knowledge is exciting because these
weaknesses can be remedied
John Stein
Visit
The Dyslexia Research Trust
(www.dyslexic.org.uk)
Good nutrition is
indeed important
for optimum cognition
and behaviour
D R T
Mike Duckett
Catering Service Manager,
Royal Brompton Hospital and
Harefield Foundation Trust
Good Fresh Food /
Healthier Patients
Sustainable Service at the
Royal Brompton Hospital
Mike Duckett
Catering Service Manager Royal Brompton Hospital &
Harefield Foundation Trust
Benefits of Change
Improving the patients hospital experience by providing good basic freshly cooked meals through healthier tastier menus
Tastier well cooked food increases appetite and contentment reduces patient stress levels
Cooking on site to a recognised recipe and local sourced known ingredients
Fresh food cooked daily enhances the nutritional content of food
Healthier food and lifestyle reduces the high levels of obesity and diabetes
Children eat familiar food but served healthier
Good food reduces expensive waste
Royal Brompton Kitchen
Royal Visitor
Well fed satisfied
Less stressful
Patients
Well nourished
Patients get well
Reducing hospital
time
reduces
cost
to health service
Good local food
equals healthier
patients
Local food
Supportive
To community
Encourages
Farming
community
Fresh
Food
Cooked on
site
Investment
In small
businesses
Quality
Food Value
for
Money
The Key to Local Procurement
Identify and support the local farmer and supplier, what they can provide and how. Look for quality and taste
Change the menu to what is being grown and available year round
Negotiate local agreements. Unwieldy national contracts are restrictive and costly.
Commodities should be led by quality and taste rather than cost. Value for money is “what is eaten on the plate” not necessarily the bottom line
Seasonal food is paramount and frequent menu changes imperative
Sourcing local food reduces air miles and carbon foot printing
Purchasing directly from the source of the food costs less cuts out the middle man
Make payments on time (if possible on delivery)
Local Food,
at its best
Venison, game and wild rabbit
Free range eggs and local bacon
Organic milk and organic porridge oats
Seasonal orchard Kent fruit and juices
Soups are freshly made daily
Forequarter meat butchered for roasting
Freedom food chicken
Organic burger and additive free sausages
Whole breast meat chicken nuggets
Asparagus
Food with no preservatives or modified ingredients
What the NHS procures
Annually
250,000 litres of orange juice
12.3 million loaves of bread
62 million litres of milk
1.3 million chicken legs
17 trusts in London ─
69 Hospitals responsible for
food ordering
Just 20% of food ordered locally
would provide a boost of
£3 million to farming and small
business in the South East
Royal Brompton Hospital
7,000 litres orchard juice
40,000 kilos Kent potatoes
25,000 litres of organic milk
800 kilos local bacon
900 kilos local sausages
9,600 Chicken legs freedom food
50,000 free range eggs
Government Spending
and Support
Government needs to change the 120 pages of
rules and regulations on how to procure food.
Public catering should support regional British
food to be sustainable for the future. This is
being achieved through the Chelsea cluster in
London.
£2.2 billion is spent annually in the public sector
on food -- a £300 million on hospital meals.
Collaboration on local procurement would save
£50 million per year.
The menu ingredients
checked
Typical patients menu
Lunch
Roasted red pepper soup ─ roll & butter
Haddock fillet in batter with lemon wedge
Baked shoulder lamb herb crust
Mozzarella, tomato & avocado salad
Cheese, onion & potato pie
Creamed and chipped potatoes
Garden peas and cauliflower florets
Lemon sponge and custard
Sago pudding
Fresh fruit
Patient satisfaction is 20% higher than the NHS Hospital average
Meals go to the wards 20 mins prior to serving
Sustainability future –
reducing Carbon Foot printing
All food waste is now collected for composting and returned to the gardens
Reduction in the use of plastic cups and replaced recyclable paper
Deliveries reduced to three per week instead of daily, saving 60,000 food miles
Marine stewardship fish used oil collected for bio diesel
Healthier staff meals to reduce absenteeism
Shortlisted as a finalist to the national recycling awards 2010
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