The Role of Nutrition in Health and Social Care

Introduction

Nutrition is a fundamental component of health, development and well-being. Good nutrition can strengthen people’s immune systems, prevent, treat and manage diseases and promote overall good health. It is also integral in patient care (Frost & Baldwin 2021).

In the UK, estimates suggest that almost three million people either live with malnutrition or are at risk due to not eating enough. People over 75 are at a higher risk (British Nutrition Foundation). Therefore, the importance of nutrition cannot be understated, especially in health and social care settings.

This blog post aims to provide readers with a comprehensive understanding of how nutrition impacts health and how health and social care professionals can integrate proper nutrition practices into their services.

The Foundations of Nutrition

Nutrition, according to the University of Leeds, is:

“A fast-moving discipline that focuses on understanding the role of foods, nutrients and the overall “diet” in maintaining health and preventing disease.”

Nutrients are substances that humans need to live, grow and stay healthy. People must have a healthy and balanced diet to provide the nutrients they need to maintain bodily functions. If their diet is unhealthy and does not include the correct nutrients, it can lead to malnutrition, development issues, ill health and disease. They can also become dehydrated if they do not have sufficient fluid intake.

People need certain amounts of specific nutrients, known as the nutrient requirement, divided into macronutrients and micronutrients.

Macronutrients

People must consume these nutrients in large amounts, as they provide energy in calories and maintain body functions. Macronutrients are:

• Carbohydrates – provide most of the energy people require, which includes energy for the basic actions to sustain life (called the Basal Metabolic Rate).
• Fats – provide energy and warmth and help absorb specific vitamins, e.g. A, D, E and K.
• Proteins – repair and replace the body’s cells and tissues and are needed for growth.

Micronutrients

People need these nutrients in smaller quantities. However, they are still essential for human health. Examples include:

• Vitamins – support various functions, such as maintaining an effective immune system, blood clotting and absorption of foods.
• Minerals – are inorganic substances, e.g. iron and calcium, that the body cannot make but are important for various bodily processes.

People can get vitamins and minerals from various foods or supplements. The British Nutrition Foundation has further information on vitamins, minerals, food sources and quantities needed here.

Water is also an essential nutrient for the body to function and sustain life. Insufficient fluid intake can lead to dehydration, which can be life-threatening. Those in health and social care, e.g. older people, are especially at risk.

Nutritional Assessment

As nutrition is fundamental to a person’s health and malnutrition is a significant risk to those admitted into health and social care, it is crucial to use screening to identify any nutritional problems.

Trained healthcare professionals conduct nutritional screening on admission. It is a simple risk assessment process that determines whether a person is at nutritional risk or potentially at risk and whether a nutritional assessment is required. According to the Social Care Institute for Excellence, nutritional screening is a key part of assessment and care planning.

The NICE Guideline states:

“Screening should assess body mass index (BMI) and percentage unintentional weight loss and should also consider the time over which nutrient intake has been unintentionally reduced and/or the likelihood of future impaired nutrient intake.”

Healthcare professionals use various tools and methods for screening and assessing nutritional status, and some common examples are as follows:

• The Malnutrition Universal Screening Tool (‘MUST’)
• A nationally recognised screening tool identifying malnourished or at-risk adults.
• It is used in various settings, such as hospitals, care settings and the community.
• MUST screening involves five steps. Further information is on the NHS and BAPEN.
• Anthropometry – measures and assesses different component parts of the human body, such as:
• Weight and percentage weight changes.
• Body Mass Index (BMI).
• Mid-upper arm circumference (MUAC).
• Skin fold thickness.
• Mid arm muscle circumference (MAMC).
• Other signs, e.g. loose clothing, skin and dentures.
• Blood tests – measure the levels of chemical substances in the blood and the functioning of vital organs. Healthcare professionals typically interpret results alongside clinical examinations.

Healthcare professionals should use the tools stated in their employer’s procedures or best practices for their particular setting.

If nutritional screening determines a service user has a risk of malnutrition or is malnourished, they will need a nutritional assessment. It identifies the necessary nutritional intervention while ensuring care is person-centred. Nutritional assessments are more in-depth, and the British Dietetic Association (BDA) defines them as:

“The systematic process of collecting and interpreting information in order to make decisions about the nature and cause of nutrition-related health issues that affect an individual.”

BAPEN has further information on assessments here.

Nutrition in Preventive Healthcare

According to the British Nutrition Foundation, a healthy and balanced diet has different foods and nutrients for good health and well-being. Not only does a healthy and balanced diet enable the body to function optimally daily, but it also reduces the risk of developing long-term (chronic) diseases and can promote overall health by:

• Preventing malnutrition, which can have detrimental impacts on body functions.
• Maintaining a strong immune system and promoting quicker recovery.
• Supporting children’s growth and development, which can reduce the risk of chronic disease later in life.
• Improving people’s mood and overall well-being.
• Maintaining a healthy weight and reducing the risk of obesity.
• Increasing physical activity and fitness, which can lead to other physical and mental health benefits.

Some examples of health conditions that are preventable through a healthy diet are as follows:

• Obesity
• Consuming excess calories and a lack of exercise can lead to obesity and other health conditions, such as type-2 diabetes, heart disease, certain cancers and stroke.
• According to the NHS, around one in every four adults and around one in every five children aged 10 to 11 are living with obesity in the UK.
• Type-2 diabetes
• Type-2 diabetes is caused by a person’s blood sugar (glucose) being too high due to a lack of insulin.
• It usually correlates with obesity, being overweight or inactive, or a family history of this condition.
• More than 2.4 million people are at an increased risk of type-2 diabetes in the UK based on blood sugar levels (Diabetes UK).
• Certain cancers
• Poor nutrition and being overweight or obese can lead to certain cancers.
• According to Macmillan Cancer Support, up to one-third of cancers (30%) in the UK could be preventable by healthier diets.
• Cancer Research UK has information on how obesity causes cancer here.
• Stroke
• A stroke occurs due to a cut off of the blood supply to part of the brain because of high blood pressure or a blood clot.
• Strokes can be caused by being overweight or obese, a lack of exercise, increased blood pressure and high cholesterol levels.
• Overweight people showed a 22% greater probability of ischaemic stroke, and obese people had a 64% increased probability compared to normal-weight subjects (the Brain Injury Association).
• Heart disease
• Poor nutrition can increase the risk of many heart conditions, e.g. coronary heart disease, where a build-up of fatty substances can block or interrupt blood supply to the heart.
• An unhealthy diet, poor lifestyle, being overweight, and obesity can increase blood pressure and cholesterol, which can lead to heart disease.

A healthy and balanced diet can help maintain a healthy weight, blood pressure and cholesterol levels and reduce the risk of these chronic diseases.

The British Nutrition Foundation has a health of information on these conditions and tips on reducing the risks here.

Nutrition in Disease Management

Good nutrition is also important in disease management. Eating a healthy and balanced diet and getting the correct amount of nutrients can help people with their health conditions by:

• Controlling and reducing symptoms.
• Reducing the need for medications.
• Avoiding complications.
• Preventing diseases from worsening or developing co-morbidities.

According to Ojo (2019), “The role of nutrition in chronic disease management is particularly crucial as diet is a modifiable risk factor for most chronic conditions that exist either as single conditions or in comorbid states”.

Dietary recommendations for specific health conditions

Type-2 diabetes

People with type-2 diabetes can actually reduce their blood sugar levels and go into remission by losing weight, especially soon after a diagnosis (Diabetes UK).

Some dietary recommendations include:

• Eat a balanced diet high in fibre with more whole grains, nuts, pulses, fish, fruit and vegetables.
• Include some starchy foods, such as pasta.
• Limit intake of alcohol, salt, sugar and fat, including saturated fats.
• Reduce processed foods, red meat and refined sugars.
• Avoid missing meals and have at least three daily, e.g. breakfast, lunch and dinner.

Here is some further dietary advice for type-2 diabetes:

• The NHS.
• Diabetes UK.
• The Association of UK Dieticians (BDA).

Cancer

People with cancer need good nutrition, especially when undergoing treatments such as chemotherapy and radiotherapy. Their exact dietary requirements will depend on their medical needs, specific situations and whether they have dietary restrictions, e.g. those with bowel cancer may need to avoid certain foods.

Some dietary recommendations include:

• Eat small portions of nutritious food often if suffering from appetite loss.
• Eat plenty of fruits and vegetables of all colours (at least five portions every day).
• Eat starchy foods and plenty of whole grains, e.g. brown rice, wholemeal bread and wholewheat pasta.
• Limit foods high in fat, salt, sugar, red and processed meats.
• Eat ‘good fats’, e.g. nuts, seeds, olive oil and rapeseed oil.
• Choose low-fat dairy products or non-dairy alternatives (calcium-containing).
• Eat protein-rich foods, e.g. meat, fish, beans and pulses.
• Drink plenty of fluids.
• Limit alcohol consumption.
• Avoid foods that increase the risk of food poisoning with a weakened immune system, e.g. pates, ripe cheeses and raw/undercooked eggs.

Here is some further dietary advice for cancer.

• Macmillan Cancer Support.
• Cancer Research UK.
• NHS University Hospitals Bristol.

Stroke

Stroke survivors can prevent further strokes by eating a healthy and balanced diet. It can be challenging for stroke survivors to stay nourished, as the stroke can affect how they eat, depending on how it affects their brain. They may also have difficulty swallowing or feeding themselves.

Some dietary recommendations include:

• Reduce salt intake to a teaspoon daily (or 6g), including those in processed foods. According to the NHS, salt is the single biggest dietary risk factor for stroke.
• Eat less saturated fat, e.g. butter, cream, lard, cheese, fatty meat, ghee, palm oil and cakes.
• Have at least five portions of fruit and vegetables a day.
• Eat more starchy foods and whole grains that are high in fibre.
• Eat some healthy proteins, e.g. lean meat, nuts, seeds, tofu, fish, pulses, etc.
• Eat oily fish rich in omega-3 twice a week, e.g. salmon, trout, sardines, mackerel, etc.
• Drink plenty of fluids and monitor alcohol intake.

Here is some further dietary advice for stroke:

• The British Heart Foundation (BHF).
• Oxford Health NHS Foundation Trust.
• The Stroke Association – eat a healthy diet and Healthy Eating and Stroke Guide.

Heart disease

People with heart disease must maintain their blood pressure and cholesterol levels to prevent further episodes, so healthy eating and regular exercise are vital.

Some dietary recommendations include:

• Limit the amount of saturated fats, sugar and salt.
• Eat at least five portions of fruit and vegetables a day.
• Choose low-fat dairy products instead of high-fat ones.
• Eat oily fish high in omega-3 fatty acids twice a week.
• Choose high-fibre starchy and wholegrain foods.
• Eat some proteins, e.g. lean meat, nuts, seeds, beans, pulses, etc.
• Go for healthier oils, e.g. unsaturated, such as rapeseed, olive or sunflower.
• Drink plenty of water and other healthy drinks, and limit alcohol.

Here is some further dietary advice for heart disease:

• British Nutrition Foundation.
• HEART UK.
• The NHS.

Obesity

If a person is obese, they must change their lifestyle to reduce the risk of developing other health conditions. To treat obesity, a person must have a healthy, balanced, calorie-controlled diet and exercise to lose weight.

Some dietary recommendations for obesity are:

• Eat plenty of fruit and vegetables.
• Limit processed, fast, high-fat and high-sugar foods, and also sugary drinks and alcohol.
• Choose high-fibre and wholegrain starchy foods.
• Eat low-fat dairy or non-dairy.
• Eat some protein-containing foods, e.g. lean meat, fish, eggs and beans.
• Have smaller portions at meal times, especially for children.
• Avoid foods that are high in salt, as this can increase blood pressure and the risk of stroke and heart disease.

Here is some further dietary advice for obesity:

• Bupa UK
• The NHS.
• NICE.
• NHS inform.

Special Nutritional Considerations

Nutrient requirements vary between individuals and depend on age, sex, activity levels and health (FAO). Specific groups also have unique nutritional needs to prevent malnutrition and stay healthy. These are:

• Infants (0-1 year) – require more nutrients and energy for their growth and development (UNICEF Parenting). Not meeting their nutritional needs can lead to developmental issues, deficiencies and other health problems.
• Children (under 18) – require more energy as they rapidly grow, are more physically active, and need good nutrition for healthy brain development and learning. Their nutritional needs will be age-specific, e.g. toddlers, school-aged children and adolescents.
• Older people (over 65) – will have reduced energy requirements, meaning fewer calories are needed. Their appetites can lower, so their food needs to be nutritious, as they are at a higher risk of malnutrition. They will also need to reduce and monitor fat, salt and sugar, as they are at a higher risk of developing diet-related diseases.
• Individuals with dietary restrictions – some have restricted diets because of certain medications and existing health conditions, such as food allergies, Coeliac disease, food intolerances, diabetes, high blood pressure, high cholesterol, etc. If they have certain foods, it can worsen symptoms, increase the risk of other diseases and be life-threatening in some cases, e.g. severe allergic reaction or stroke.

The British Nutrition Foundation has further information on the nutritional needs at different life stages here.

Some people have cultural and religious dietary preferences, for example:

• They may have certain religious needs, e.g. fasting, food restrictions and fluid restrictions on stimulants (caffeine and alcohol). Some examples include Kosher in Judaism and Halal in Islam.
• They may choose not to eat certain foods for ethical and moral reasons, e.g. vegetarians or vegans.
• They may have both religious and cultural needs, e.g. Kosher and vegetarian.

In health and social care, it is important to accommodate cultural and religious dietary preferences for the following reasons:

• It is a basic human right and essential to person-centred care to treat people with respect and dignity. People should have access to appropriate, nutritious and appetising food, whatever their dietary preferences. Food is essential to people’s identities. It can upset them and their families and carers if not treated with dignity.
• It ensures compliance with the law (the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 14), which requires providers to meet service user’s nutrition and hydration needs. For example, “people’s religious and cultural needs must be identified in their nutrition and hydration assessment, and these needs must be met”.
• It can increase the risk of nutritional deficiencies and malnutrition if the correct foods are unavailable, as people are likely to refuse food, skip meals or eat an unvaried diet if food does not meet their preferences.

The Association of UK Dieticians (BDA) has further information on religious and cultural considerations here.

Nutrition in Health and Social Care

Nutrition is a fundamental aspect of health and social care provision. Good nutrition and the correct nutrients can help service users thrive, improving their physical and mental health and well-being. It can also:

• Help tackle malnutrition, which can be prevalent in older people.
• Strengthen immunity to reduce the risk of infections.
• Prevent diet-related diseases.
• Support recovery from illnesses, injuries and surgeries.
• Manage chronic health conditions and reduce the risk of complications.
• Enhance cognitive function and prevent decline.
• Provide social interaction and improve service user’s quality of life.

The role of nutrition will also differ depending on the type of setting, for example:

• In group homes – nutrition is pivotal in homes with many residents, as their nutritional and hydration needs, health conditions and dietary preferences will vary, and older people have a higher risk of malnutrition. Service providers must provide healthy and balanced food that meets individual needs.
• In hospice care – nutrition is essential in palliative/end-of-life care, as terminally ill patients will need additional help to avoid malnutrition and dehydration. They usually lose their appetite and become distressed when struggling to eat properly. Their needs are complex and varying, and service providers must maximise nutrition by ensuring they enjoy their food and minimise any food-related discomfort.
• In assisted living facilities – nutrition is pivotal in residents’ health and well-being and helps them to live as independently as possible. Not meeting their nutrition needs can result in admission to care facilities due to the risk of malnutrition. Service users may need additional help with shopping, food preparation and cooking to help them eat a healthy and balanced diet that meets their requirements.

Some individuals will have specialist needs and require nutritional support, which providers must consider in meal planning. Professionals must regularly assess their dietary requirements, allergies and preferences, and they will need individualised meal plans to meet their nutritional requirements. For example, a resident with swallowing or chewing difficulties may need a texture-modified diet.

People may need additional help with eating and drinking, and even nutritional support where they struggle to eat or drink, e.g. artificial nutrition and hydration and nutritional supplements. Whatever support people need must be covered in their meal plans and followed by all staff.

It is also necessary to monitor service users’ nutritional status frequently and adjust meal plans, where necessary, to continually meet their nutrition and hydration needs.

Malnutrition and Its Consequences

According to the NHS, malnutrition is when an individual’s diet does not contain the correct amount of nutrients. It is a serious condition that can lead to ill health, diseases, and long-term (chronic) health conditions and can be life-threatening if left untreated.

When a person is malnourished, their diet does not have the correct balance of nutrients their body requires to function optimally. It can include:

• Undernutrition – when a person does not get enough nutrients. It can occur because of a poor/unvaried diet or a person’s body not properly absorbing nutrients from their food (malabsorption).
• Overnutrition – when a person has more nutrients than they require, e.g. people who are overweight or obese. It can be caused by overeating and eating too many macronutrients, e.g. excess protein, carbohydrate and/or fat, and sugars.

Unfortunately, malnutrition is common, especially in people with chronic health conditions, and it is prevalent in health and social care settings.

• Estimates show that 1.3 million people over 65 in the UK suffer from malnutrition, and the vast majority (93%) live in the community (Malnutrition Task Force).
• In England, in 2011/12, the estimated cost of malnutrition was £19.6 billion per year, which is more than 15% of health and social care public expenditure (The Association of British Dieticians (BDA)).
• People over the age of 65 years old are the age group that is more likely to be malnourished (The Association of British Dieticians (BDA)).
• A BAPEN Survey 2021 found a high prevalence of malnutrition (42%) in health and social care settings, which was higher than previous national surveys (35% in care homes; 29% in hospitals).

Malnutrition can have detrimental effects, and symptoms can include:

• Unintentional weight loss.
• Vitamin and mineral deficiencies.
• Muscle loss and weakness.
• No desire to eat or drink.
• Feeling tired all of the time.
• A lack of energy.
• A low body weight, i.e. a Body Mass Index (BMI).
• Increased infections and longer recoveries.
• Gaining or losing weight.
• Changes in behaviour.
• Depression.
• Poor wound healing.
• More falls.
• Constipation.

In children, a symptom of malnourishment is not putting on weight or growing at the expected rate.

Promoting Healthy Eating Habits

Promoting healthy eating habits within health and social care settings is crucial to prevent malnutrition and improve service users’ health and overall well-being. Here are some practical tips on how to achieve this:

• Involve people in decisions about their food and drink, as they are more likely to eat healthier if they have had input.
• Provide an environment conducive to eating, e.g. no distractions, comfortable, clean and tidy. There should be options for socialising at mealtimes and eating quietly alone.
• Give people the time, help and encouragement to eat healthier food, especially older people with no teeth or dentures, as some healthy foods can be harder to chew.
• Encourage people with a poor appetite or nausea to eat healthy snacks and smaller meals more regularly.
• Provide healthy food in adequate amounts and quality that looks appealing. Ensure meals are balanced and include the main food groups.
• Give people a variety and choice of foods that meet their preferences and any specific dietary needs. No one wants to eat the same foods every day.
• Ensure healthy food is accessible between mealtimes if someone wants a snack. Some may prefer finger foods they can snack on instead of meals.
• Provide adaptive equipment and simplify eating processes for people who struggle to eat and drink, as they will be unlikely to choose healthy food if they have difficulty.

Making healthy and nutritious food choices can be difficult, especially for patients and clients in health and social care. Some strategies to encourage them to make nutritious food choices are as follows:

• Show them what healthy eating looks like and some examples of appetising healthy meals. Providers could arrange for taste testing to show that healthy foods do not have to be boring and can be tasty.
• Encourage them to make healthy choices with others if they like to socialise and make eating a social event. Being healthy as a group can often be easier than doing it alone. They may want to form a committee that decides on food choices and menus.
• Ask them what healthy foods they enjoy. Providers could create a survey or questionnaire to identify what they want to eat and create nutritious menus based on what they like.
• Make it easier for them to make nutritious food choices by putting healthy foods where they are easier to see and accessible and making unhealthy choices less accessible. If they are hungry, they are more likely to choose the healthy option if it is closer.
• Adopt nudge-type interventions, which use behavioural change techniques to influence behaviour and decision-making (Warwick University). The aim is to steer people from unhealthy foods to healthy and nutritious ones.
• For people in the community or assisted living, help them create grocery lists with healthy foods and support them in preparing and cooking nutritious foods.

The Role of Nutrition Education

To successfully meet the nutrition and hydration needs of those in health and social care settings, healthcare professionals need nutrition education to:

• Give an understanding of basic nutritional needs.
• Help spot the early signs of malnutrition and dehydration in patients and clients and prevent further complications.
• Help prevent and manage diet-related diseases.
• Help assess patients and clients to identify any nutritional problems and requirements and to take appropriate actions.
• Provide the skills and competencies to meet service users’ needs.
• Help adapt services and respond to changing needs, e.g. weight and dietary requirement changes.
• Inform patients and clients and educate them on their role in meeting their nutrition and hydration needs and why it is crucial.

The law requires health and social care providers to meet service user’s nutrition and hydration needs in health and social care settings. A part of meeting this requirement is ensuring that anyone working with service users has appropriate nutrition knowledge and skills, as they will need to assess, evaluate and review needs and know when to take further action. They will also advise and educate patients and clients on good nutrition.

During CQC checks and inspections, inspectors may ask staff about people’s food and drink needs, as well as their preferences and beliefs. Therefore, it is vital to demonstrate nutrition knowledge and skills to avoid falling foul of the law and to get a good or outstanding rating. The Eatwell Guide/plate is an illustration that can help staff understand healthy eating for over 5s, adolescents, adults and healthy older people.

Nutrition education for professionals is only half of the story. It will also require patients and clients to understand nutrition. Educating them about good nutrition also has many benefits, such as:

• It empowers them to take responsibility for their nutrition and overall health and well-being and helps them to take control of their lives.
• It encourages them to choose healthier foods, recognise poor ones, and make informed decisions about their nutrition.
• It provides an awareness of how unhealthy and unbalanced diets can affect their health and lead to disease.
• It teaches them what they need to do and how to act to improve their nutrition to be healthier and have longevity.

Collaborative Care Approach

Collaborative care is “the cooperation regarding the diagnosis and/or treatment of an individual patient among two or more practitioners from different health fields” (Cummings, 2002). It is often known as a multidisciplinary approach or integrated care, where various healthcare and social care professionals work together to support people’s nutrition needs and provide optimal care. It may involve (this list is not exhaustive):

• GP’s
• Hospital doctors.
• Nurses.
• Dieticians.
• Nutritionists.
• Pharmacists.
• Physiotherapists.
• Social care workers.
• Speech and language therapists.
• Health and social care providers.

Patients, clients, families and caregivers must also be involved in collaborative care.

A collaborative care approach is important to address people’s nutritional needs, and it:

• Allows for care to be coordinated between various healthcare and social care professionals to provide the best possible care and support based on the unique needs of each patient and client. It is about putting people at the centre of their care and it is a holistic approach that looks at the whole person.
• Helps healthcare and social care professionals make shared decisions and be consistent with patients/clients and their families and caregivers, and improves the health and social care experience.
• Prevents nutrition and hydration errors that could lead to malnutrition and dehydration, and other mistakes that could cost lives, e.g. giving a patient with a food allergy the wrong meal or providing a stroke survivor with high-salt foods.
• Helps improve the health and well-being of patients and clients and makes them feel valued and cared for if healthcare and social professionals work together to meet their needs.
• Reduces healthcare costs through better patient outcomes and efficiencies, e.g. using the same sources in decision-making and avoiding duplication and delays.

Health Education England has further information on integrated care here.

Conclusion

Nutrition is fundamental for growth, development, health and well-being, to prevent and manage disease and reduce the risk of malnutrition. Therefore, people need to have a healthy and balanced diet to get the nutrients they need, which will depend on their age, sex, activity levels and health.

Good nutrition is pivotal in health and social care settings to meet service users’ nutrition and hydration needs. It is essential to provide healthy food and drinks that meet their dietary needs and preferences to provide person-centred care that treats them with respect and dignity.

Collaboration with multidisciplinary healthcare and social care teams is vital in providing optimal care. Screening on admission and assessments to identify nutritional problems such as malnutrition is crucial to meeting nutrition needs. Any issues should be managed and detailed in individual care plans. Healthcare providers must follow and revise care plans to ensure service users get the nutrition they need and to promote health and well-being.

Numerous resources on nutrition and professionals can advise on dietary choices for a healthy and balanced diet. Readers can also use the comment sections to share experiences, questions, or additional insights on nutrition in health and social care to foster a supportive and informative community.