bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see: http://pathways.nice.org.uk/pathways/diet NICE Pathway last updated: 30 August 2017 This document contains a single flowchart and uses numbering to link the boxes to the associated recommendations. Page 1 of 10
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1 Recommendations about training No additional information 2 Training for health professionals Nutrition for young children and pregnant women Who should take action? Professional bodies, skills councils and others responsible for setting competencies and developing continuing professional development programmes for health professionals, nursery nurses and support workers. What action should they take? Professional bodies should ensure health professionals have the appropriate knowledge and skills to give advice on the following: the nutritional needs of women and the importance of a balanced diet before, during and after pregnancy (including the need for suitable folic acid supplements) the rationale for recommending certain dietary supplements (for example, vitamin D) to pregnant and breastfeeding women the nutritional needs of infants and young children strategies for changing people's eating behaviour, particularly by offering practical, foodbased advice. Weight management before, during and after pregnancy Who should take action? Professional bodies and others responsible for setting competencies and developing continuing professional development programmes for health professionals, healthcare assistants and support staff. Training boards and organisations responsible for training health and fitness advisers and health trainers. Page 3 of 10
What action should they take? Ensure health professionals, healthcare assistants and support workers have the skills to advise on the health benefits of weight management and risks of being overweight or obese before, during and after pregnancy, or after successive pregnancies. Ensure they can advise women on their nutritional needs before, during and after pregnancy and can explain why it is important to have a balanced diet and to be moderately physically active. Ensure they have behaviour change knowledge, skills and competencies. This includes being able to help people to identify how their behaviour is affecting their health, draw up an action plan, make the changes and maintain them. Ensure they have the communication techniques needed to broach the subject of weight management in a sensitive manner. They should be able to give women practical advice on how to improve their diet and become more physically active. They should be able to tailor this advice to individual needs and know when to refer them for specialist care and support. Ensure they have the knowledge and skills to help dispel common myths. This includes myths about what to eat and what not to eat during pregnancy and about weight loss in relation to breastfeeding. Ensure they have knowledge, skills and competencies in group facilitation, are aware of the needs of minority ethnic groups and have knowledge of local services. Ensure their training is regularly monitored and updated. Training for primary care workers in preventing and managing obesity All primary care settings should: address the training needs of staff involved in preventing and managing obesity. Local health agencies should identify appropriate health professionals and ensure that they receive training in: the health benefits and the potential effectiveness of interventions to prevent obesity, increase activity levels and improve diet (and reduce energy intake) the best practice approaches in delivering such interventions, including tailoring support to meet people's needs over the long term Page 4 of 10
the use of motivational and counselling techniques. Training will need to address barriers to health professionals providing support and advice, particularly concerns about the effectiveness of interventions, people's receptiveness and ability to change and the impact of advice on relationships with patients. See also primary care and community health services. Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see what NICE says on obesity: working with local communities). 3 Training by health professionals Vitamin D See NICE's recommendations on training and professional development in relation to vitamin D supplement use in specific population groups. See also primary care and community health services, and advice on nutritional supplements in NICE's recommendations on antenatal care for uncomplicated pregnancies. Training for breastfeeding peer supporters Who should take action? Commissioners and managers of maternity and children's services. What action should they take? Consider training peer supporters and link workers to help mothers, parents and carers follow professional advice on feeding infants aged 6 months and over. The advice should promote an increasingly varied diet using food of different textures in appropriate amounts (in addition to milk), in response to the baby's needs. 4 Training for public sector catering staff Who should take action? Caterers. Page 5 of 10
Chartered Institute of Environmental Health (CIEH). Local authorities. Providers of hygiene training. The food and farming network (Feast). What action should they take? Ensure the links between nutrition and health are an integral part of training for catering managers. In particular, they should be made aware of the adverse effect that frying practices and the use of salt, industrial trans fats and saturated fats can have on health. Ensure they are aware of the healthy alternatives to frying and to using salt and sugar excessively, based on the 'eatwell plate'. See also public sector catering. Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see what NICE says on obesity: working with local communities). 5 Training teaching, support and catering staff in schools Head teachers and chairs of governors should ensure that teaching, support and catering staff receive training on the importance of healthy-school policies and how to support their implementation. See also schools, early years education and childcare. Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see what NICE says on obesity: working with local communities). Page 6 of 10
Reference nutrient intake is the amount of a nutrient needed to meet the needs of 97.5% of individuals in a group. Reference nutrient intake for a given nutrient may vary by gender, age and physiological status (for example during pregnancy and lactation). The reference nutrient intake is not a minimum target that all people need to achieve, but the risk of deficiency is minimised if the average population intake exceeds it. The current reference nutrient intakes (µg/day) for vitamin D are: 10 micrograms of vitamin D per day, throughout the year, for everyone in the general population aged 4 years and older 10 micrograms of vitamin D per day for pregnant and lactating women and population groups at increased risk of vitamin D deficiency. Although the entire population of the UK are at risk of having a low vitamin D status, evidence was only considered in regard to increasing the supplement use for these specific population groups: All pregnant and breastfeeding women, particularly teenagers and young women. Infants and children under 4 years (breast fed, non-breast fed and mixed fed). People over 65. People who have low or no exposure to the sun. For example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods. People who have darker skin, for example, people of African, African Caribbean and South Asian origin. All population groups are currently advised to take a supplement that meets 100% of the reference nutrient intake for their age group. All infants and young children aged 6 months to 3 years are advised to take a daily supplement containing vitamin D in the form of vitamin drops. But infants who are fed infant formula will not need them until they have less than 500 ml of infant formula a day, because these products are fortified with vitamin D. Breastfed infants may need drops containing vitamin D from 1 month of age if their mother has not taken vitamin D supplements throughout pregnancy. ('Vitamin D advice for supplements for at risk groups letter from the UK Chief Medical Officers' Department of Health). BMI body mass index Page 7 of 10
CVD cardiovascular disease IPTFAs industrially-produced trans fatty acids Sources Obesity prevention (2006 updated 2015) NICE guideline CG43 Weight management before, during and after pregnancy (2010) NICE guideline PH27 Cardiovascular disease prevention (2010) NICE guideline PH25 Maternal and child nutrition (2008) NICE guideline PH11 Your responsibility Guidelines The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Page 8 of 10
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Technology appraisals The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Medical technologies guidance, diagnostics guidance and interventional procedures guidance The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Page 9 of 10
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Page 10 of 10