BAPEN Conference


environment that is also of importance but this has yet to be demonstrated in humans.


Ageing and Appetite


PROFESSOR GARY FROST, Imperial College, London


As with may conditions, the process of age and appetite is multi-factorial and is affected by illness/surgery, gastrointestinal function along with social issues including alcohol, inactivity, poor diet and dementia. Research indicates that feelings of hunger decrease and feelings of fullness increase with increasing age; although the evidence is scant. More research is being published investigating the link between gastrointestinal hormones and appetite. In older people the levels of peptide YY released after a meal are higher compared to younger people. Patients suffering a fractured neck of femur showed high levels of peptide YY during their hospital stay which is known to suppress intake. Gary concluded that a number of mechanisms act


to reduce food intake during hospital admission and therefore strategies to combat the variety of effects are required.


Ageing and the Gut


PROFESSOR JOHN MCLAUGHLIN, Manchester University


This was an excellent lecture which took delegates on a journey from the top to the bottom of the gastrointestinal tract and described the two conflicting roles of the gut, absorption verses defense. John outlined the phenomenal turnover of the gut epithelium which replaces itself every 4- 7 days reflecting its resistance to ‘wear and tear’. John highlighted the reduced acid production in ageing which can lead to an atrophic gastritis and how the elderly have a high incidence of H.Pylori due to the long-term use of Proton Pump Inhibitors (PPIs) which can result in bacterial overgrowth. This has the consequence of reducing B12 and iron absorption. Gastric emptying also reduces with age as levels of CCK increase. This


results in a slower delivery of nutrients which can lead to increased satiety. Age has no effect on small bowel nutrient absorption and small bowel motility is maintained but colonic transit time is reduced often contributing to constipation. Gut adaptation after injury (due to infection/inflammation/surgery or due to medications) is impaired and, therefore, has consequences for hospitalised elderly patients. There is conflicting data regarding changes to the microbiota during ageing with some research suggesting an increase in pathological bacteria and reduction in beneficial bacteria due to overuse of antibiotics. Finally, it is well known that there is a reduction in the gut associated lymphoid tissue with ageing and impaired T-cell function which may predisposed the elderly to systemic infections. Therefore, in conclusion, the changes that take place with ageing can place elderly patients at risk of sarcopenia and complications due to changes in gastrointestinal function. These need to be considered when developing care plans for elderly patients.


Pre-Conference Teaching Days are a great success again


On Monday 28th November, the day before conference, BAPEN Medical held a very successful Teaching Day for 149 participants, ‘Demystifying Parenteral Nutrition – An approach for all clinical disciplines’. The day included the ESPEN ‘Approach to Parenteral Nutrition Module’ – taken and passed by 64 delegates.


BSPGHAN/BAPEN also held a highly successful Teaching Day ‘Nutrition in Developmental Delay & Hands-on Management of Parenteral Nutrition’. The morning session focused on the practical and ethical issues in feeding children with significant neurological problems and the afternoon included a practical session addressing the benefits and problems of administering parenteral nutrition. One of BAPEN’s core groups, the Parenteral and Enteral Nutrition Group (PENG) of the British Dietetic Association also held a successful meeting attended by 76 delegates. Topics centered on the content of the newly updated PENG Pocket Guide to Clinical Nutrition and were delivered by authors of the updated sections who highlighted the evidence underpinning dietetic practice and approaches in clinical nutrition. Sales of the pocket guide subsequently soared through purchases made by those attending the BAPEN conference.


Satellite Symposium – Mappmal: Multisdisciplinary approach to develop a prototype for the prevention of malnutrition in older people


The conceptualization for the mappmal project to address malnutrition in older people in hospital came from the recognition that a joined up approach not just to identify malnutrition but also to address or prevent malnutrition required attention to all stages of food provision including the environment that food is eaten. BAPEN 2011 provided the environment for the launch of the mappmal hospital foodie project. Professor Margot Gosney set the scene and provided the background and rationale behind the mappmal project which aims to develop a new service prototype for food provision with the aim of preventing and treating malnutrition. Claire Bamford, Senior Research Associate from the University of Newcastle, followed Margot’s presentation, to provide further detail on the ethnographic study that took place in four hospital sites to explore the provision of meals by various methods; cook-chill, in house, bulk and plated services on wards for older patients with stroke, fractured femur and dementia. Through semi-structured interviews with a variety of


stakeholders, hospital staff and patient representatives, three key themes emerged which influenced the nutritional care of older patients: the emphasis on nutritional care at both ward and individual level, the lack of easily accessible and accurate information on nutritional status and intake and, finally, the limited flexibility and personalisation of foods and routines. These initial findings highlighted the importance of a holistic approach encompassing all aspects of the food journey and the status of food.


A third member of the mappmal multidisciplinary team, Professor Alastair Macdonald, Senior Researcher at the Glasgow School of Art, illustrated how service innovation arose from combining ideas and tacit knowledge from multiple sources to design a new prototype of food service. Alastair showed how ‘thinking outside of the box’, using ‘narratives’ from the studies and ‘iterative prototyping’ facilitated the development of the hospital food service prototype which ultimately aims to both monitor and advise on actions necessary to respond to an older person’s


nutritional requirements and eating experience. Dr Lisa Methven, Lecturer in Food and Sensory Science at the University of Reading, rounded off the session with the finding that whilst older persons rated food quite highly, intakes remained poor due to poor appetite. Patients identified that food portions were too large and choices inappropriate and that six mini meals were preferred. Food based solutions were developed to deliver micronutrient and macronutrient dense foods which to date include specially formulated ice cream, biscuits, cakes, sauces and soups, that have the capacity to provide a diverse range of micronutrients and in some cases a third of the daily reference intake of protein per portion. And to see this in practice, delegates were able to visit the mappmal hospitalfoodie stand in the exhibition area which permitted delegates to witness first hand the IT ward-based programs in prototype stage, the process of identifying and recording nutritional status and recommendations, and taste some of the nutrient dense foods developed for the older hospital population.


BAPEN In Touch No.63 January 2012 8


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