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Obesity is now one of the most important global public health issues and preventable causes of disease and mortality. Worldwide, its prevalence continues to increase, with some of the most rapid increases occurring in developing countries. An ever-increasing range of diseases and health problems have been linked to obesity. In 2004, increased BMI alone was estimated to account for 2.8 million deaths,...
Undernutrition is common in hospital in-patients and should be detected by routine nutritional screening on admission. Nutritional requirements can be estimated by an expert dietitian and decisions to supplement hospital diet or to supply completely artificial nutritional support should be made based on whether intake is adequate and the gut functioning. If possible, enteral nutrition is preferred...
Developing rational nutrition policy depends on information on desirable intakes of nutrients and consumption of foods, and on the current levels of consumption in the population. Government has systems to obtain formal scientific advice from independent expert committees whose advice is published. In addition, in the UK, several survey programmes provide a regular indication of the diets, physical...
The last two decades have been witness to huge advances in medical technology and pharmacology. One area of progress has been in the administration of artificial nutrition and hydration (ANH). This can be used to sustain life in various patient groups that would have previously succumbed to the effects of malnutrition. The complexity of these clinical cases often causes healthcare professionals great...
Obesity is now a common childhood disease and is widely acknowledged as having become a global epidemic. There are well-recognized health consequences of childhood obesity, both during childhood and adulthood, affecting health and psychological welfare. Clinicians working with obese children should have knowledge of the components of a healthy lifestyle and understand the importance of interacting...
The epidemic of obesity is already having major effects on population health. Obesity develops in an individual when energy intake exceeds energy expenditure over a long period. The biological processes regulating energy balance are very tightly regulated. However, these mechanisms of appetite control can easily be overwhelmed by a willingness to eat when not hungry if attractive food is provided...
Normal infants and children from around the world, when placed in a healthy environment, grow and develop at a similar rate as a matter of course by effectively utilizing the energy and nutrients derived from the diet. The form in which food is best provided varies with age. Infants should be given human milk as the sole source of dietary intake for the first 6 months of life, and as part of an increasingly...
The metabolic syndrome is a condition characterized by the co-existence of several major risk factors for cardiovascular disease (CVD) – high blood pressure, hyperglycaemia, and dyslipidaemia (reduced high-density lipoprotein cholesterol or raised triglycerides). These components are related to insulin resistance and appear to be aetiologically linked, probably by genetic factors. The appearance of...
Traditional lifestyle and dietary interventions in severely obese patients seldom lead to maintained weight loss and reduced co-morbidity. Bariatric surgery offers both effective weight loss and maintenance with co-morbidity benefit for this group. Diseases benefiting from such surgery include diabetes, cardiovascular disease and cancer, and there is an associated 29–40% mortality reduction 10 years...
Obesity has become a worldwide epidemic. The prevalence among adults and, especially, children has risen dramatically in a single generation. A high prevalence affects nearly all affluent countries and is rapidly increasing among more affluent populations of poorer countries. The burden of ill health that results is already significant and due to rise – with high and rising costs to hard-pressed health...
Modern weight management incorporates optimization of health and risk factors, short-term weight loss, and long-term weight maintenance and prevention of regain. Patients in need of professional weight management can be identified by a large waist (>102 cm for men, >88 cm for women). A structured programme addressing diet and physical activity, and behavioural management, as used in the UK Counterweight...
The term malnutrition is used to describe a deficiency, excess or imbalance of a wide range of nutrients, resulting in measurable adverse effects on body composition, function and clinical outcome. 1 As such it can refer to individuals who are either over- or under-nourished although it is frequently used synonymously with undernutrition, as is the case in this article. Although it is well...
Foods need to provide all the building blocks for metabolism, tissue growth at reproduction, the energy required for all functions and activities, and some ‘essential’ compounds that cannot be synthesized. Nutritional science covers all the processes involved in achieving a healthy balance between requirements and the supply of nutrients, at the right time and in appropriate proportions, at cellular,...
Limitation on the available epidemiological data means that most health economic analyses have provided incomplete estimates of the total financial burden of obesity on healthcare. Figures from UK Primary Care indicate that the total healthcare costs of BMI 20–21 (ideal body weight) are half those of BMI 40 kg/m 2 . Cost-effectiveness of a structured weight management programme (Counterweight)...
Primary cilia are hair-like organelles expressed by almost every cell in the body. Although they were first recognized at the end of the 19th century, their functions remained obscure until the last decade. It is increasingly recognized that disorders of cilia structure or function underlie a number of rare human genetic diseases that affect the kidney and other organs, the so-called ‘ciliopathies’...
Toxic megacolon (TM) is defined as total or non-segmental obstructive dilatation of the colon to an external diameter of 6.0 cm or greater, associated with systemic toxicity. It is a potentially fatal condition that represents the end of a spectrum of severe colitis. Typically a complication of ulcerative colitis, it is increasingly seen as a consequence of infective colitis. This reflects the increasing...
Most anal diseases can be diagnosed by a careful history and examination. Management of haemorrhoids involves exclusion of more serious pathology, adequate explanation of the disorder, and dietary and defecatory advice. Moderate haemorrhoids may be treated with out-patient procedures, such as injection sclerotherapy or rubber-band ligation. Surgical haemorrhoidectomy is usually indicated in patients...
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