new logo

Dietetics

Dietitans AlexOur team of registered dietitians is based in the three hospitals across the Acute Trust.

We apply the latest scientific research associated with nutrition to devise appropriate dietary advice for those with specific medical and surgical problems.

This is achieved by implementing dietary changes that will help alleviate symptoms caused by certain diseases.

Your dietitian will assess your nutritional requirements. You will be offered practical advice on dietary changes that you can make to improve your intake of nutrients.

You and your dietitian will jointly agree your nutritional care plan taking into account individual food habits, cultural customs, social and financial situation.

Dietitians also guide people to make correct food choices to encourage a healthy lifestyle.

You will have the opportunity to ask questions and in most instances you will be provided with written information.

Inpatient services

Dietitians work closely with doctors, nurses and other health care professionals in different specialties to advise adults and children referred to us for specialist advice on therapeutic diets.

The Trust uses the Malnutrition Universal Screening Tool (MUST) to screen all adult inpatients for malnutrition and offer an appropriate nutritional care plan.

Dietitians  work with catering and nursing staff  to set up good nutritional practices for our patients.

Dietitians use their skills and knowledge to offer different ways of improving the nutritional intake of patients to help them maintain or gain weight.

Promoting good nutritional practice

We work as part of a Trust Nutrition and Hydration Steering Group to promote good nutritional practices throughout the Trust. We participate in training medical students, study days for Nutrition Link Nurses, Health Care Assistants and Registered nurses.

Outpatient services

Out-patient clinics for adults and children take place at Worcestershire Royal Hospital, Alexandra Hospital and Kidderminster Treatment Centre. All our clinics  run on an appointment system.

If you are referred to us as an outpatient we will usually ask you to keep a food diary for a week before your appointment. All the information you need will be included with the letter confirming your appointment details.

Referral to a dietitian

In order to see a dietitian in an outpatient clinic you will need to be referred by either your doctor at the Practice, by a Consultant or by a Specialist Nurse.

Dietetics - Frequently Asked Questions - Outpatients

We provide clinics at all three main sites and the Princess of Wales Community Hospital. They include general clinics, paediatric clinics and home enteral feed clinics.

Clinics are held on a regular basis and outpatients are assigned an appointment time.

Outpatients will be sent a letter inviting them to ring the department to organise an appointment time. This will be followed by a final letter detailing the agreed appointment time and the location.

Normal procedure will see the inclusion of a food diary with the final letter. It is expected that this food diary will be completed in the week prior to the appointment as this information is vital to the consultation as it provides the dietitian with the type, volume and frequency of foods that are usually consumed over a week.

What should I do if I would like an appointment with a dietitian?
You will need to ask your GP or another health professional e.g. practice nurse or consultant to refer you to the dietitian. We will then send you a letter inviting you to contact the department at your local hospital.

What should I do if I cannot attend the appointment slot allocated to me?
If you need to reschedule your appointment please ring the department as soon as possible. If you do not attend your appointment and have not contacted us you will be discharged. If you still wish to be seen you will need to organise another referral.

Do I need to bring anything to my clinic appointment?
If you have been sent a food diary with your final letter please complete this in the week prior to your consultation and bring it with you to your appointment.

If you are coming to a follow-up appointment you may have been asked to complete a new food diary issued at your previous appointment.

Please bring a list of any medications you use to your appointment as this informaiton will help us provide the best advice possible.

How long will my appointment last?
First appointments will last 30 minutes. Follow-up appointments usually last 15 minutes.

Other relevant information
Please let us know if you have any communication difficulties such as the need for an interpreter to be present at the appointment or you require informaiton in a large print format or in another language.

Dietetics - Frequently Asked Questions - Inpatient

How can I be referred to a dieitian as an inpatient?
All in-patients are nutritionally screened using the ‘Malnutrition Universal Screening Tool’ which is repeated weekly. This tool highlights if you are at a low, medium or high risk of malnutrition. You may be asked a few questions to help the nursing staff complete the tool e.g “What height are you?” “Have you lost any weight in the last three to six months?” “Are you eating ok?”.

Nursing staff will then follow the appropriate care plan.

In addition, if you have a medium or high risk of malnutrition the nursing staff will keep a food chart to monitor your food intake and you will be referred to the dietitian if your malnutrition score indicates that this is necessary.

Other reasons why you might be referred include:

  • if you have various gastro intestial problems which may effect your nutrition,

  • if you have pressure ulcers

  • if you are newly diagnosed with diabetes.

You can also ask for a referral to a dietitian if you wish to speak about any dietary concerns.

What do I do if I have a special dietary requirement?
We cater for peole who have special dietary requirements e.g gluten free diets, low potassium diets, no added salt diets. We also provide soft, puree and healthy eating options which can be chosen from the menu.

If you have a special dietary requirement please inform a member of staff upon admission.

What information is available for patients?
We have a wide variety of leaflets offering dietary infromation and advice. Some of these are available on the ward such as ‘A guide to Healthy Eating’ others will be issued by the dietitian or you can request information.

If you have problems reading please let us know.

Risk of Cardiovascular Disease

Cardiovascular disease (CVD) is a term which includes coronary heart disease, stroke, and peripheral vascular disease.  These conditions are caused by fatty deposits on the walls of blood vessels, which  restrict the blood flow and the supply of oxygen.   This is known as atherosclerosis, which can cause angina symptoms, such as pain and breathlessness.  Over time the blood vessels can become damaged and result in the formation of a blood clot.  This can stop the blood supply reaching the heart or brain resulting in a heart attack or stroke.  The build up of atherosclerosis is a gradual process that is associated with a variety factors.

There are many aspects which can effect this process, all have an impact on the risk of developing heart disease, stroke and peripheral vascular disease. These risk factors are divided into two categories modifiable, or lifestyle components that you can change to reduce risk of cardiovascular disease and unmodifiable, or aspects which you cannot alter.

Unmodifiable risk factors

  • The older you are the greater your risk of heart disease becomes.

  • Men have a greater risk of heart disease than women.

  • A family history of heart disease increases your risk.

  • Some people are more at risk to heart disease because of their genes.

Modifiable risk factors

Smoking

Smoking causes your veins and arteries to narrow, harden and coat with fatty deposits.  Giving up is the most effective way to reduce your risk of heart disease.
Advice and support is available from the following:

  • The specialist team in clinic

  • Your GP

  • Some pharmacies

  • NHS smoking advice - 01562 513225

  • National help line - 0800 022 4332

Support is available on the variety of nicotine replacement products which can help you find the combination that works best for you to succeed. 

Diabetes

Diabetics have an increased risk of heart disease, it is important to manage your condition and maintain good control with your blood glucose levels. Eating a healthy well balanced diet that includes low glycaemic index (GI) carbohydrates can help you achieve good control.

High blood pressure (hypertension)

Hypertension increases the risk of heart disease, this can be managed with medication and following a healthy diet low in salt (sodium).

Raised cholesterol

Too much cholesterol in the body causes blood vessels/arteries to become narrowed with fatty deposits. The deposits build up to a material called plaque.

Understanding cholesterol and your blood results

Cholesterol is an essential fat /lipid that your body requires for cell structure and hormones. It is naturally produced by the liver and is also present in some foods. Evidence shows it is the amount of saturated fat in your diet which has the biggest impact on your blood cholesterol levels.

Triglycerides are the fats formed from calories unused by foods eaten such as fat, sugar and alcohol.

Total cholesterol - This provides a guide to the amount of cholesterol that is in your blood. If you have been asked to fast for 12 hours prior to your blood being taken, this will produce a more accurate result. You should aim to keep your total cholesterol below 4 mmol/L.

You may be given a breakdown of your blood results, detailing the types of cholesterol and the levels. Cholesterol is mainly transported around the body on proteins, the two forms are:-

Low density lipoprotein or LDL cholesterol - carries cholesterol to cells in the body, often called “bad cholesterol”. Aim for below 2 mmol/L.

High density lipoprotein or HDL cholesterol - this helps remove cholesterol deposits, often called “good cholesterol” Aim for above 1mmol/L. 

Triglycerides - Aim to keep this below 2mmol/L.

Obesity

Being overweight increases your risk of heart disease, diabetes and stroke. If your Body Mass Index (BMI) is above 30 this could increase your risk. BMI is calculated by: Your weight (kg) divided by your height multiplied by itself (m2 ).

Losing weight can help improve your overall risk as well as other medical conditions such as hypertesion, diabetes and raised cholesterol. Gradual weight loss that can be maintained is recommended, this can be achieved by:

  • Reducing your food portions

  • Cutting down on dietary fat

  • Reducing your alcohol intake

  • Cut out any snacks eaten in between meals

  • Increase activity by aiming for 30 minutes per day

Lack of exercise

  • Regular moderate exercise will benefit your health in many ways, both physically and mentally

  • Exercise reduces your risk of heart disease, stroke, high blood pressure and cancer

  • Exercise reduces your risk of bone and joint problems

  • Exercise helps you manage your weight

  • Exercise helps prevent and control diabetes

30 minutes every day will benefit your health.  This can be broken down to three 10 minute or two 15 minute sessions.  As you start to get fitter you can increase the length of your sessions.

Dietary advice

A balanced diet is recommended to everybody to keep healthy. A diet that consists of regular meals and a variety of foods from the five main food groups in the proportions as shown in the picture below.

Eat Well Plate

  • Eat less saturated fat (animal fat) and trans fats
  • Include oily fish
  • Eat at least five portions of fruit and vegetables per day
  • Choose more high fibre foods
  • Reduce your salt intake
  • Reduce your sugar intake
  • Moderate alcohol intake

Understanding Glycaemic index (GI)

Starchy foods are broken down into ‘sugar’ during digestion. The effect that this has on the body’s blood glucose is known as the Glycaemic Index (GI) of the food. Foods with a high GI cause blood glucose levels to rise higher than foods with a low GI which release energy more slowly.

Eating low GI foods of an appropriate portion size has been shown to reduce the risk of getting diabetes and improve blood glucose control in those with existing diabetes. Listed below are some tips for low GI.

  • Choose breakfast cereals based on oats or bran.

  • Choose wholegrain breads with plenty of visible seeds or grains.

  • Eat plenty of fruit and vegetables - aim for at least five portions per day.  Spread fruit  portions out throughout the day.

  • Include plenty of pulses in your meals, add beans and lentils to casseroles and other dishes.

  • Avoid foods which have glucose, maltose or dextrose listed as one of the first four ingredients.

  • Choose durum wheat  and wholewheat pasta, cook al dente. The best choice of rice is basmati rice. 

  • Choose new potatoes or sweet  potatoes (moderate portion) over older varieties.

  • If you plan to eat a high GI food, try to eat  with a low GI food and this will reduce the GI of the overall meal  e.g. add baked beans to a jacket potato.

Foods to lower your cholesterol

Foods containing soluble fibre are oats, beans, peas, lentils, chickpeas, fruit and vegetables. These foods can help to reduce cholesterol by preventing cholesterol being absorbed.

Stanols

These are fats found in certain spreads or yoghurts, (e.g. Benecol, Flora Proactive) which prevent dietary cholesterol being absorbed therefore helping to reduce blood cholesterol. They can be expensive and have to be consumed in a dose of 2-2.5g per day. If you are unable to tolerate statins, then stanols are an effective means of reducing your cholesterol by 10%. If you are able to make dietary changes discussed in this leaflet, stanols may not be necessary.

Lowering your triglyceride levels

Raised triglycerides (above 2mmol/L) increases your risk of CVD. There are three main dietary areas to target to reduce triglycerides in your blood:-

Increase oily fish or alternative omega 3 products
Reduce alcohol consumption
Reduce sugar consumption

Reduce high sugar foods such as: sweets, chocolates, cakes, biscuits and pastries. Avoid high sugar drinks such as coke, lemonade, energy drinks, high juice squash and keep fruit juice to one glass per day. Choose diet varieties of fizzy drinks, no added sugar and sugar free squash.

Oily fish

Oily fish lower triglycerides, blood pressure and reduce clotting, therefore having a positive impact on other heart disease risk factors. Aim for fish twice a week of which one should be oily and the other white fish, to help prevent CVD.

One portion of oily fish yould be:

  • 1 small  can of sardines/mackerel 100g

  • 1 medium round can salmon/pilchards 150g

  • 1 portion of fresh salmon 100g

  • 1 portion of fresh mackerel 125g

If you have existing CVD you should aim for two to three portions of oily fish per week to keep your heart healthy.

Omega 3 supplements

0.5g (or 500mg)/day of omega 3 can be taken if you do not like oily fish. Make sure it is an omega 3 supplement not cod liver oil. Doses above 1g/d are not advised.

Alternative omega 3 products 

Soya, hemp, flax and pumpkin seeds and oils, walnuts and leafy green vegetables.

Enriched omega 3 products

These are products with added omega 3. For example: columbus eggs, fruit juices, breads, margarines/spreads and children’s drinks. They can be expensive and may not contain enough omega 3. These products are useful for vegetarians or people who do not like fish but need to be consumed daily to achieve recommended amounts (0.5g/day of omega 3) to promote the beneficial result.

Alcohol

Moderate alcohol consumption - between one and two units daily - has a protective effect on the heart, however, alcohol is not an essential part of  dietary intake. Alcohol may need to be avoided in certain conditions or with certain medications.

Government recommendations are a maximum of:

  • Men - three units per day

  • Women - two units per day

One unit is:

  • 1/2 pint (250mls) beer, lager, ale  or cider (below 5.2%)

  • 1 pub measure of spirit (25mls)

  • 100mls of  wine

  • 1 pub measure of sherry (50mls)

Heavier drinking will contribute to raised blood pressure, weight gain, raisedtriglycerides and increased risk of stroke.

High blood pressure (hypertension)

Control of your blood pressure is an important part of reducing your risk of heart disease and stroke. The following dietary factors can help to lower your blood pressure:

  • Avoid weight gain, or aim for gradual weight reduction if you are overweight.

  • Most of us eat far more salt than we need, because it is added to most processed foods. The recommendations are for less than 6g of salt per day. Salt is often labelled as sodium, this value needs to be multiplied by 2.5.

  • For example a food labelled sodium 1.9g per  100g would contain 4.75g salt per 100g.

Reduce your salt (sodium) intake by:

  • Avoiding using salt in cooking and not adding at the table.

  • Flavour dishes with herbs, spices, pepper, vinegar and lemon juice.

  • Try to replace processed foods with fresh wherever possible.

  • Your tastes will adjust if you reduce the amount of salt used gradually.

  • Salt alternatives are not recommended as they can contain high levels of potassium.

There has been evidence to show that some people may have low levels of this vitamin and some medication is also associated with an increased risk of osteoporosis.  In clinic we carry out an annual review of your risk for osteoporosis this is called a FRAX assessment and considers the following factors:

  • Age

  • BMI (body mass index)

  • If you are a smoker

  • Amount of alcohol consumed

  • Any family history of fractured hips

  • Use of steroid medication

  • Previous fractures

If you would like to know more information on your score please speak to the dietitian who can show you how this has been calculated.

Vitamin D deficiency

Why are we checking vitamin D levels in clinic?

There has been evidence to show that some people may have low levels of this vitamin and some medication is also associated with an increased risk of osteoporosis.  In clinic we carry out an annual review of your risk for osteoporosis this is called a FRAX assessment and considers the following factors:

  • Age

  • BMI (body mass index)

  • If you are a smoker

  • Amount of alcohol consumed

  • Any family history of fractured hips

  • Use of steroid medication

  • Previous fractures

If you would like to know more information on your score please speak to the dietitian who can show you how this has been calculated.

What is the role of vitamin D and does this affect you?

Vitamin D is a fat soluble vitamin that is required for your body to absorb calcium and is also important in helping to maintaining a healthy immune system.  Vitamin D deficiency can develop when there is inadequate exposure to sunlight or a lack of vitamin D in the diet and usually takes a long time to develop because of the slow release of the vitamin from body stores

Where do you get vitamin D from?

The major (over 90%) of vitamin D is produced from skin exposure to sunshine.  Ultraviolet B (UVB) rays in sunlight convert cholesterol in the skin into vitamin D.   
The amount of vitamin D you make depends on how strong the sunlight or ultraviolet light is. You will make more in the middle of the day than early morning or late afternoon. Similarly you will make more when you are indirect sunlight than in the shade or on a cloudy day. 

Note: Too much exposure to the sun's rays can be damaging. Sunburn should be avoided at all costs (mainly because it can increase your risk of skin cancer).

You do not have to sunbathe to make enough vitamin D in the summer some bare skin such as hands, face, arms or legs can be sufficient. It is estimated that most people make enough vitamin D by spending some time around 20 - 30 minutes of sunlight two to three times a week during the months of April to September to last the year. 

You may make less vitamin D if you:

  • If you have a dark skin

  • If you always cover up when you go outdoors

  • If you are housebound, or rarely leave work during lunch breaks

  • The further north you live

  • If the air is quite polluted

  • When you use sunscreen above factor 8.

It is possible to make a smaller amount of vitamin D when the skin is covered by fine material, such as fine silk, or 10-20 denier tights.

Which foods contain vitamin D?

The best dietary source of vitamin D is oily fish (approximately 5mcg) for:

  • 2 teaspoons of cold liver oil

  • 70g sardines

  • 100g tinned salmon, pilchards or tuna

  • 110g of cooked mackerel, trout or herring

  • 130g cooked kipper

Other sources that are not so high in vitamin D include:

  • Eggs

  • Meat contain

  • Margarine

  • Fortified breakfast cereals

Supplements

Most general multi vitamin and mineral supplements will contain some vitamin D.  If you have been advised by the team your vitamin D is low it will be recommended that you have specific vitamin D supplement for a period of 12 weeks.  Your levels will be re-checked and in some cases a maintenance dose may be required.

Pregnancy

Pregnant women require 10 mcg daily of a vitamin D supplement.  This is often available in a Healthy Start vitamin for pregnant and breastfeeding women and contains Vitamin C, D and folic acid.  For further information discuss with your midwife or the dietitian in the team.

Contact us

Please leave a brief message on the answering service with your name and telephone number so that someone can contact you.

Worcestershire Royal Hospital

Dietitians : 01905 760136

For Outpatient appointments :01905 760742

Alexandra Hospital

Dietitians : 01527 512043

For Outpatient appointments : 01527 512043

Kidderminster Hospital

Dietitians : 01562 512305

For Outpatient appointments : 01562 512304

Nutrition and dietetics Alexandra Hospital

01527 512043

Nutrition and dietetics Kidderminster Hospital and Treatment Centre

01562 512304

Nutrition and dietetics Worcestershire Royal Hospital

01905 760692

Some useful links to other websites

The British Dietetic Association produces several leaflets which can be downloaded on a number of nutrition related subjects and diets. Click on 'Food Facts' on the British Dietetic Association website.

If you wish to follow a weight reduction programme, the BDA's Weight Wise website offers useful practical guidance.

Taking PRIDE in our health care services