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The main food groups are fruits and vegetables, carbohydrates, protein, fat and Dairy products. While carbohydrates provide energy, calcium and vitamin B and require 3 to 5 servings a day (Foodstandards.gov.scot, 2023); Fruits and vegetables group of food contains necessary vitamins, antioxidants and minerals along with fibres and requires 5 servings a day (Gosh.nhs.uk, 2023). This also includes protein which helps in muscle building of the body and requires 2 to 3 servings a day along with dairy products which contain calcium, protein and vitamins such as A, D, B12 and the suitable amount is 3 servings (Gosh.nhs.uk, 2023). Besides, fatty foods in the form of unsaturated acids are capable of lowering cholesterol and reducing the risk of heart disease.
The 6 essential nutrients are vitamins, minerals along with protein, fat, water and carbohydrates. A diet rich in vegetables and fruits along with lean proteins are considered significant to access the necessary vitamins (Nhsinform.scot, 2023a). The rich sources of minerals refer to red meat in a limited amount, seafood, iodised table salt milk and dairy, nuts and seeds, vegetables, leafy greens, fruits, beans and legumes as well as whole grains. The primary sources of protein are eggs, dairy products, fish, poultry, soy, nuts and some grains and millets (Medicalnewstoday, 2023). The primary source of fats are nuts, fish, vegetable oils and seeds along with grains and legumes are one of the significant sources of carbohydrates.
The primary role of essential nutrients refers to the provision of energy as well as contribution towards body structure and regulation of chemical processes (Cardenas et al. 2022). These are also essential for building and repairing body tissues alongside growing moving muscles and managing normal body functions.
The impact of poor diet can cause harm physically and mentally alongside the wellbeing of an individual. It can lead to weight gain along with malnutrition as well as low energy level, digestive issues, mental health issues, poor sleep and low self-esteem (Who.int, 2023). This is followed by impairing growth of individuals as well as dental caries, muscle cramp alongside obesity, poor memory and cognitive skills
This guideline recommends the consumption of five primary groups in the form of fruits and vegetables carbohydrates, protein, dairy and alternatives along with oil and seeds while managing weight on the basis of dietary restrictions or preference and ethnic origin (Culliford et al. 2023). This guideline is implied to identify the plan for foods alongside cooking and preparation of meals at home as well as food shopping and eating out while managing a balanced diet. It also identifies the approximate calorie intake every day for male with 2500 kcal and women with 2000 kcal with all foods and all drinks (Nhsinform.scot, 2023b).
Figure 1: Eatwell guide for balanced diet
As per the "Health and social care act 2008 with regulated activities of Regulation 2014 with 14th regulations", it can be stated that the providers are required to meet the nutritional and hydration needs of service users by including primary needs while making initial assessment of the care as well as treatment and support approaches (Croneri.co.uk, 2023). This also includes the provision of food and drink strategy by the care providers to address the nutritional needs of the people while using the services. On the basis of regulation 11, it can be stated that the service users’ consent is important here for the providers in terms of accessing nutrition and hydration for a based interest and decision making under the regulation of "Mental Capacity Act 2005" (Cqc.org.uk, 2023). On the basis of 14 (4) regulation, the needs are assessed with providers' skills and knowledge and maintained to manage a sustained life supporting the care and treatment and ongoing health of the users (Cqc.org.uk, 2023).
Here, the implementation of food safety act 1990 helps with the framework for food legislations in England, wale and Scotland and managing the safety on food hygiene, packaging, genome editing, temperature of storing as well as GM foods (Food.gov.uk, 2023). It also includes the role of "Health and safety executive" in the UK for managing food hygiene standards accompanied by "local authority environmental health officer" to identify the food hazards and keeping raw food as well as high risk food separately in order to maintain food safety (Hse.gov.uk, 2023).
As per NICE guidelines on nutritional support, the adult patients are required to be screened at their first clinic appointment with the aim of identifying their malnourishment status and the risk of malnourishment (Chauhan et al. 2017). The patient is required to screen by using "malnutrition universal screening tool (MUST)" and it addressed BMI less than 18.5 kg/metre square are considered malnourished and score 2 and 18.5 to 20 who score 1 and more than 20 is 0 (Bapen.org.uk, 2023a). This is followed by identifying weight loss scores by understanding past 3-6 months weight loss (Bapen.org.uk, 2023a).
Figure 2: MUST score
The role of team members in the case of assessing and managing nutritional and hydration needs of individuals refers to collaborating with an interdisciplinary team with the aim of providing high-quality care while reflecting patients' need of assessment, intervention of needs as well as health promotion and improving the overall health outcomes (Roigk, 2018). This is followed by the responsibility of other colleagues maintaining coordination and preventing the complication of poor nutrition and dehydration. For those who maintain their own health and social care services, it can be done by identifying nutritional guidelines in local areas and developing simple strategies with the aim of improving diet and fluid intake (Druml et al. 2016). The collaboration with family members and other careers alongside discussing with the patient in regards to the assessment and intervention plan is crucial here while identifying the need of artificial nutrition or respecting the principle of bioethics in the form of beneficence or non-maleficence in case of consulting with patients and ensuring the treatment of service user within the discharge management (Druml et al. 2016).
The additional support and information in regards to the given context can be accessed from "health and safety executive" as well as the "British safety Council" and from the "chartered institute of environmental health" on the basis of guidance on health and safety issues alongside legislation publication and safety (Yuan and Lo, 2022). In addition, the "health and safety at work magazine" also provides health updates on the basis of health and safety in the identified field. Besides, the supporting materials are available on the basis of "Public Health England and Eatwell guide booklet as well as the importance of hydration from unit 003" (Nhsinform.scot, 2023b).
In the case of the UK, the prevalence of malnutrition among elderly in the care service centre is found to be 17.9% and approximately 58.8% are considered at risk of malnourishment which were assessed by using Mini nutritional assessment (Malnutritiontaskforce.org.uk, 2023). The prevalence of obesity is considered to be 32.5% and approximately 38.4% of the population develop obesity due to the inadequate consumption of vegetables and fruits (Malnutritiontaskforce.org.uk, 2023). Approximately 35% of children who are residents and admitted in care homes for the past 6 months pose a social care burden and are identified as malnourished by conducting a MUST assessment (Hansard.parliament.uk, 2023).
Culture and religion impact individual preference and habits which have significant impact on identifying food groups and cooking methods and as lead to malnourishment (Healthknowledge.org.uk, 2023). On the other hand, the role of psychological determinants in the form of mood or stress or guilt can impact the changes in human behaviour which affects their health as well as food choices and impacting the number of consumptions while making unhealthy choices. Anxiety on reducing weight and appetite can change eating opportunities for individuals as well as availability of food choices and meal preparation. Besides, the cost of food alongside the affordability of an individual to purchase specific food impacts on their unbalanced diet and can cause malnourishment (Healthknowledge.org.uk, 2023).
Risk factors such as dysphagia can lead to the inability of an individual to meet their food and fluid requirements while impacting their capabilities of eating and drinking to maintain the body requirements (De Sire et al. 2022). This factor impacts the overall health and the quality of life of individuals and can lead to malnutrition as well as weight loss and dehydration. Medications are capable of impacting nutrient absorption which leads to malnourishment among individuals. For example, Laxatives can impact on absorbing vitamins and minerals (Healthknowledge.org.uk, 2023). On the other hand, anxiety, stress and other psychological factors are capable of affecting the body and senses of smell and taste which directly impact on food consumption and can lead to malnutrition. For example, dementia patients lose their capabilities of smelling and tasting along with reducing spatial recognition that affects their appetite and consumption of nutrients (Healthknowledge.org.uk, 2023). Besides, poor oral health impacts on the capabilities of chewing and swallowing which impact the nutritional status of individuals alongside identifying the requirements of balanced diet by individuals to reduce the risk of malnourishment.
The primary symptoms are lacking interest in food and drink, fatigue, reduced appetite, poor concentration and tiredness as well as irritability while always feeling cold and continuous mood swings (Nhs.uk, 2023).
MUST is considered a five-step nutritional screening tool that helps to identify the malnourishment status of an adult in the form of identifying undernutrition or obesity (Bapen.org.uk, 2023a). It also includes the provision of a care plan and is generally used in hospital, community and other care settings. Besides, the BAPEN is considered a charitable association that helps with raising awareness of malnutrition for care home patients and identifying the risk for the wider community (Bapen.org.uk, 2023b). The NICE guideline helps the clinical professionals and care providers to identify the patients with malnourishment and requirements of nutritional support while associating them to identify suitable nutrition support at the appropriate time (Stewartnutrition.co.uk, 2023).
It can be monitored by the presence of various food choices along with a balanced food plan as well as supervising the meal times and managing care plans in order to meet the dietary requirements while monitoring body weight and offering supplements for long term nutritional plan (Kalantary et al. 2022). The management of hydration is also required while monetary the overall nutritional and fluid intake.
Malnourishment has a severe impact on weaker immune systems and reduces the susceptibility to infection and diseases (Bell et al. 2022). Long-term suffering from malnourishment can lead to frequent infection and causing standing which impact on delaying motor and cognitive development for children. For adults, it results in illness, long term hospital stay infection along with falls and fracture while losing muscle mass and strength.
Food fortification helps to add high energy foods in meals with the aim of increasing calories and significant nutrients to promote weight gain. For example, the implementation of butter or margarine in the diet can lead to promoting the consumption of unsaturated fatty acid (Drewnowski et al. 2022) alongside using foods in the form of roast potatoes that provide high calorie and energy. This process can also be used for adding vitamins and minerals in commonly consumed food items while increasing the overall nutritional values and is considered a safe and cost-effective strategic plan in terms of improving the diet plan and the prevention of micronutrients deficiencies (Todkar et al. 2022).
Food supplements are used for correcting nutritional deficiency with the aim of maintaining intake of adequate nutrients while supporting the overall physiological activities (Silva et al. 2022). This can be taken before workout in terms of improving energy alongside the post workout with the aim of better recovery and muscle growth. In the morning in an empty stomach, the intake of supplements leads to the prevention of muscle breakdown and maintaining the body's anabolic state.
Referrals are considered one of the easiest ways in terms of increasing patient volume and monitoring supervision. The referrals are necessary when a patient requests expertise in comparison with general treatment and specific treatment as well as access to specialised tests and investigation (Singh et al. 2022). The presence of relevant medical records alongside the reason for referral and applicable parameters of treatment are required in terms of maintaining reference in healthcare.
Individual knowledge along with personal taste preference as well as mood hunger level health status special diet requirements ethnicity personal income can impact their health and well-being alongside the affordability of accessing healthy meal plans (Otterbring and Folwarczny, 2022). The cognitive and emotional influence can lead to decreasing the overall intake of short-term meals alongside distractions of brain structure while changing in portion. Values and family beliefs can lead to prohibition of the consumption of specific food groups while increasing the number of others which creates a disbalanced meal plan and leads to the deterioration of health status. Culture and religion have significant influence on development of diet plans and food preparation in care setting and that changes their methods of food preference, habits, nutritional status and intakes of nutrients for the patients (Healthknowledge.org.uk, 2023)
The barriers to healthy eating for individuals referred to limited access to healthy foods along with lack of time in terms of cooking and preparing healthy and balanced mail due to the busy lifestyle. This also includes the cost of healthy foods in comparison to the unhealthy food options and lack of choice on healthy food items in the working area or residential places (Verain et al. 2022). Besides, lack of time, overwhelming feeling, diet confusion and deprived emotional state create issues if healthy eating for individuals.
The common conditions are vegan and vegetarians along with peanut allergies, lactose intolerance and gluten intolerance among individuals that create the requirement of special dietary needs. While vegan food excludes the consumption of animal products, the vegetarians access foods without any animal products and sometimes without any onion and garlic (Dominguez et al. 2022). For them, the dietary needs revolve around the maintenance of protein, fat soluble vitamins and minerals. On the other hand, gluten free food reduces the access to flour foods and whole wheat items and the primary dietary needs refer to the reduction of whole grain food consumption. Besides, the lactose intolerant individuals need to focus on eliminating whole milk and maintain the consumption of fermented milk products to reduce the amount of lactose (Longo and Anderson, 2022).
This includes reading the food levels alongside the avoidance of cross contamination and cross reactivity while recognising own symptoms to the foods (Shroba et al. 2022). This also includes the preparation of an emergency action plan along with the knowledge of using an auto injector during an emergency can help individuals to deal with their food allergies.
The primary activities to deal with food intolerance refers to the changes of the overall diet with the aim of limiting intolerant products alongside the elimination of problem attic foods. This also includes identifying the portion and the limits of foods that can cause symptoms (Santos et al. 2022). This is followed by gathering information on over-the-counter medications that can lead to help with the situation.
For food allergies, the inclusion of natural allergy free foods such as meat, poultry along with legumes without peanuts as well as seeds, grains without wheat, fruits and vegetables for managing the dietary requirements (Chey et al. 2022). However, the identification of allergens and related food groups are important before following dietary plans. For DM patients, the inclusion of whole grains, protein alongside low fat dairy and products are important (Kumar et al. 2022). Dysphagia diet requires the inclusion of soft and liquid diets while coeliac disease requires to include gluten free foods in the form of dairy products, fruits and vegetables as well as meat and fish and rice products.
Diet can be adopted by modifying the existing diet of an individual due to the presence of a medical condition or in preparation of a procedure or any surgery. This is considered a significant day for many medical procedures and can be adjusted by starting with a clear liquid diet which includes water, fruit juice without pulp, sports drink, broths or vegetable juice along with plain tea or coffee (Noort et al. 2022). Then a full liquid diet consists of milk, pureed soup, card without fruit, pudding or melted cheese. Then a soft diet includes mashed vegetables, food paste, rice with sauces or gravies, custard or smoothies, then proceeding through a regular diet.
While malnutrition and dehydration are capable of causing ill health, the understanding of individuals' requirements and the history towards nutrition is important in terms of managing a healthy level of nutrition and hydration while preventing illness (Volkert et al. 2022). It also helps with the identification of symptoms of dehydration and malnourishment among individuals along with improving the treatment outcome for those patients and managing hydration status under review.
The variety of food and drinks in diet helps with accessing nutrients from major five food groups while promoting good health along with the reduction of the risk of disease (de Queiroz et al. 2022). It also maintains the flexibility for individuals to identify food and drinks depending on their food preferences.
A person-centred approach in diet plan can lead to providing the right to choose food for the individuals which helps them to control over their servings alongside making decisions on recognising their basic requirements of nutrients and accessing those from the preferred food choices (Liu et al. 2022).
The concept of protected mealtimes helps to ensure the patients consume their meals on dedicated time and without any interaction. This also helps the patient to access an acquired and relaxed atmosphere while enjoying their meal during the protected meal time and maintain a good diet throughout the week (Smith et al. 2023).
While the mealtime environment can be calm and relaxed, it can also create for meeting nutritional needs of individuals. The fixed meal time can impact on their hunger which can fluctuate on the set Times and can impact them to lose their appetite or being rushed to finish the overall meals (Wu et al. 2022). This factor is capable of causing indigestion or incomplete consumptions of the meal that leads to limited nutrient intake and lead to malnourishment.
This can be promoted by an awareness program with the help of social media influencers along with personal service plans as well as appointment with dietitians during medical check-up can lead to positive health outcomes in regards to the eating proportions and drinking habits of individuals (Rafanomezantsoa et al. 2022). Besides, the provisions of a calm environment without destruction during meal time alongside increased awareness of meal preference can lead to a positive health outcome.
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