Tag Archives: WHO

Adults fluid consumption impacts on risk chronic disease

28 Monday Mar 2016

Posted by in Nurse Convo, Research

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image66% of adults exceed the World Health Organisation (WHO) free sugar recommendation solely from fluid consumption.

 

A WHO study of 16,276 participants across 13 countries published in 2015 found that 66% adults exceeded the free sugar recommendation (free sugars <10% of total energy intake) from beverages alone without taking into account their food consumption.

Exceeding WHO recommendations for free sugar is associated with higher risks of

  • Weight gain image
  • Obesity
  • Metabolic syndromes
  • Type 2 diabetes and
  • other health problems

WHO estimates that by the year 2030 diabetes will be the seventh leading cause of death worldwide. Diabetes is associated with complications affecting the kidneys, eyes, feet, and cardiovascular system.

In Australia it is estimated that over 13% people with diabetes have lower limb nerve damage and 15% experience retinopathy. Diabetes is now considered the leading cause of end-stage kidney disease.

In people with diabetes, cardiovascular disease (CVD) is the primary cause of death, with around 65% of all CVD deaths in Australia occurring in people with diabetes or pre-diabetes. Furthermore, 41% of people with diabetes also report poor psychological well-being with reports of anxiety, stress, depression and feeling ‘burned-out ‘ from coping with their diabetes. Moreover, diabetes is ranked in the top 10 leading causes of death in Australia.

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National Diabetes Strategy Advisory Group Consultation Paper

Risk of chronic kidney disease has already been demonstrated to be linked to the types of beverages consumed. Kidney Health Australia has adopted the viewpoint that there is

  • lack of evidence to suggest that drinking water in excess of thirst is beneficial
  • water is the preferred option to satisfy thirst
  • recommended fluid intake is proportional to thirst and individual circumstances
  • from the kidney perspective all fluids consumed counts towards the daily fluid intake and
  • drinking fluids when first sensation of thirst registers (thirst is a sign of dehydration)

Daily fluid intake is influenced by many factors. Fluid intake requirements are increased if

  • living in hot or tropical environments
  • increased activity and exercise
  • medical conditions causing excess obligatory fluid loss ie diabetes insipidus or conditions requiring increased urine flow ie renal calculi.

Fluid intake requirements are decreased in patients with end stage kidney disease and also those patients with certain cardiac and respiratory conditions ie cardiac heart failure.

Dehydration signs and symptoms include some of the following

  • headachesimage
  • fatigue and lethargy
  • slow reaction times
  • dark coloured urine
  • dry cracked lips.

Unfortunately fruit juice is still perceived as a healthy option despite the low water, high sugar content. Public health education programs encouraging adults to increase water consumption in preference to sweetened fluids so as to decrease their risk of chronic disease (ie CKD, T2DM, obesity) is required.

Nurses continue to play a significant role in educating patients and reinforcing health information. To be successful in effecting health change the message must be consistent, evidence based and current.

References :

Guelinck I, Ferreira‐Pêgo C, Moreno L A, Kavouras S A, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Ma G, Carmuega E, Babio N, Salas‐Salvadó J 2015 Intake of water and different beverages in adults across 13 countries Eur J Nutr 54 Suppl (2):S45-S55 DOI:10.1007/soo394-015-0952-8

 

Salt – the good, the bad and the confusion

13 Thursday Aug 2015

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75% of the daily consumption of dietary sodium intake are from prepared, packaged and processed foods. Added salt from the salt shaker accounts for a further 6%.

A successful Australian health promotion campaign in the 1970s was aimed at consumers to reduce salt in their diet during cooking processes and from adding additional quantities at the table for better health outcomes.

The word salt and sodium is used interchangeably in health language which has created some confusion within the community. Salt is made up of 40% sodium. Our body requires sodium for the maintenance of extracellular and serum osmolarity.

Excess sodium intake is excreted by the kidneys as sodium build up in the body is fatal. The kidneys excrete excess sodium more rapidly in the presence of higher blood pressure.

Sustained high blood pressure over a long period of time affects blood vessels by causing stiffening of the wall of the vessels. The damage to the blood vessels increases the risk for cardiovascular disease and stroke.

Sodium is naturally occurring in unprocessed foods – fresh fruimageit, vegetables, meat and dairy products. Australian dietary sodium recommendation for adults is 1.2 g/day. Currently the Australian adult daily average consumption is 3.5g/day.

Sodium does not act alone. Potassium works very closely alongside sodium. The ideal sodium:potassium ratio has not yet been clearly established, however it is thought to influence blood pressure more strongly than sodium on its own.

A study published in 2014 suggests that whilst a diet high in sodium (>6 g/day) is unhealthy, so too is a diet too low in sodium (<3 g/day). The ideal range of dietary sodium intake was considered to be between 3 g – 6 g/day.

A 2013 World Health Organisation (WHO) study found that almost all countries inhabitants exceeded the recommended sodium daily intake of 1.5g/day.

More than 25% of the world’s population over the age of 25 years suffer from hypertension. Hypertension is ranked as the leading cause of cardiovascular disease.

Concensus amongst hypertension experts is that the beneficial effect of salt reduction starts at daily intake levels of 5 gms or less and relatively high levels potassium in the low salt diets may have additional effects on
blood pressure.

Debate around sodium and salt intake is not around the effect on blood pressure and consequences to health, but around determining the right level of sodium intake to maintain optimal health.

Use of Cranberries in Urinary Tract Infections – What’s the Evidence

06 Monday Apr 2015

Posted by in Alternative Therapy, Nurse Convo

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It’s estimated that as many as 50% of women suffer from an episode of urinary tract infection at least once in their lifetime with as many as 10% -15% experiencing an episode of urinary tract infection (UTI) in the past

12 months. 30% of women experiencing a UTI in their lifetime will suffer from recurrent urinary tract infections.

For many years alternative therapists have recommended to their patients the regular use of cranberries for prevention of urinary tract infections. At the time there were few scientific studies which fully supported their claims. Originally the benefits of cranberries in regards to urinary tract health was thought to be due to its acidic properties similar to Vitamin C which was also recommended at the time for urinary tract health.

A United States study comparing the effectiveness of 5 prevention and management strategies in women with recurrent urinary tract infections published late 2013 concluded daily doses of cranberry were found to be as effective as daily oestrogen in post menopausal women in reducing reoccurrence of UTI in those women at high risk for recurrent UTIs. In this particular study high risk was described as those women experiencing 3 or more urinary infections in the previous 12 months. In the same study daily doses of an antibiotic as a prophylaxis was found to be much more effective.

In high risk premenopausal women low dose prophylactic antibiotic therapy is generally recommended. In 2014, World Health Organisation (WHO) published its first global report on surveillance of antimicrobial resistance. Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it. Widespread prescribing and use of antimicrobials is putting at risk the ability to treat common infections in the community and hospitals. WHO recommend health professionals across the globe  “prescribe and dispense antibiotics only when they are truly needed”.

The active ingredient in cranberries is A-type proanthocyanidins (PACs) which can affect the ability of bacteria from adhering to the bladder wall. Due to the minimal regulation of dietary supplements the amount of A-type proanthocyanidins (PACs) in cranberry juices, extracts and tablets is wildly variable. This makes it difficult in prescribing an appropriate dose of cranberry with any certainty.

Taking into account the World Health Organisations’ strong recommendation regards antimicrobial stewardship it’s important that alternative approaches be considered in treating infections. Scientific research does seem to support the use of cranberries in high risk women experiencing recurrent urinary tract infections.