Adult dietetic services

We provide a regional service offering specific dietary advice to adult patients with metabolic disorders, for conditions such as Phenylketonuria (PKU), Urea Cycle Disorders etc.

Should you require additional information contact the Dietetic Department on 01223 216 655

On other websites:

MSUD Family Support Group
Support website for people with Maple Syrup Urine Disease

The National Society for Phenylketonuria
A patients association for those affected by Phenylketonuria

Galactosemia Foundation
A patients association for those affected by Galactosaemia

The Association for Glycogen Storage Disease
A patients association for those affected by glycogen storage disease

Nutrition plays a crucial role in the care of people who have cancer. Maintaining a good nutritional status is often difficult for these patients as metabolic changes occur to influence appetite and the body’s use of nutrients. 

Treatments and their side effects can further exacerbate a poor dietary intake. Patients may experience symptoms such as nausea, vomiting, diarrhoea, sore mouth, taste changes and fatigue. These symptoms may contribute to a deterioration in nutritional status.

An adequate intake and good level of nourishment is important for each cancer patient both to improve their general health and to maintain their best possible state of health as they progress with their cancer treatments. To achieve this, the dietitian assesses the nutritional status of the patient, gives advice and provides support throughout their period of care.

Why we provide a service

• Nutrition plays an important role in the care of people who have cancer, from diagnosis onwards. Each Oncology patient will be given the opportunity to achieve his or her optimal nutritional status through access to a registered dietitian who can provide nutritional assessment, advice and support throughout their period of care.
• The dietitian can also give dietary interventions to help patients cope better with the disease itself and the therapies (such as chemotherapy, radiotherapy or surgery) that might affect their nutritional intake.
• Many people who have cancer may experience some level of eating difficulties and/or weight loss. Without care, up to 80% of patients who have cancer can become malnourished.
• The dietitian is able to see patients while they are inpatients and as outpatients attending clinic appointments or chemotherapy and/or radiotherapy treatments.
• The dietitian is an active member of the multidisciplinary team and liaises with many professionals about patients' nutritional care.
• The nutritional advice and support needed by people who have cancer will range from general advice about healthy eating, through to specific advice about overcoming eating difficulties and the use of specialist nutritional supplements.
• Some patients will require specialist help including intensive enteral (receiving nutrition through a feeding tube) or parenteral (receiving nutrition into the veins) nutritional support methods, or they will require specialist nutritional supplements to meet their requirements. 

Continuing education / professional development for health professionals.

Dietitians take part in this by:

• Supporting other Anglia Cancer Network dietitians
• Delivering a series of lectures to Homerton College students on diet in both the prevention and treatment of cancer
• Development of patient information for use across the network
• Training student dietitians, which gives them an insight into the work of an oncology dietitian and how they interact as part of the multidisciplinary team (MDT)
• Delivering presentations to clinicians and other multidisciplinary team members, to ward staff, to the catering department and the clinical oncology centre. Issues covered include management of feeding tubes, use of alternative and complementary diets and oral nutritional supplements
• Participating as members of the British Dietetic Association (BDA) Oncology Group and/or Haematology Dietitians Group and acting as a resource for advice to dietitians working in head and neck cancer, haematology, upper gastrointestinal and hepatobiliary.

Lifestyle management is an essential aspect of the management of cardiovascular disease.

A cardiology specialist dietitian assesses a patient holistically, including: nutritional intake, alcohol, physical activity and exercise etc. in order to reduce the risk of cardiovascular disease.

Addenbrooke’s cardiology specialist dietitians see patients who are under the care of the cardiac rehabilitation team and patients on ward K2/K3/coronary care unit.

Critical care dietitians specialise in the nutritional assessment and delivery of nutrition to patients with acute life threatening disorders on designated intensive care units.

This includes:

• John Farman Intensive Care Unit (JVFICU)
• Neuro Critical Care Unit (NCCU)

The Dietitians advise on dependent on patients clinical condition:

• The route and timing of nutrition support/feeding
• Regular assessment of nutritional requirements
• Use of specialised feed products
• Determine the volume and feeding rate required to meet nutritional requirements
• Monitoring and regularly updating of the nutritional care plan
• Educating other health professionals on critical care nutrition.

These patients are at very high risk of becoming malnourished due to the stress placed on the body whilst critically ill.  The body’s priority is to use body tissue for defence and repair in an attempt to survive.  This is associated with muscle loss and it is common for patients to lose weight whilst critically ill.

Many patients on critical care units are on a ventilator, a machine to assist with breathing, and likely to be sedated. Being ventilated prevents a patient from eating normally. Therefore a temporary artificial route of feeding is required until the patient has been weaned from sedation and is off the ventilator.

Route of feeding

The first line of providing nutrition support is to feed into the gut as this helps to keep the gut healthy and functioning.  We aim to commence enteral feeds within 24-48 hours of admission to ICU.

If a patient is unable to eat and drink, a nasogastric, (NG) feeding tube is placed for feeding. This is passed through the nostril into the stomach and a liquid feed is delivered. The liquid feed delivered is nutritionally complete, containing energy from carbohydrate, protein and fat as well as vitamins and minerals required for good health.

On occasion patients may not tolerate or absorb feeds. In this instance medications may be given to help stomach emptying or the patient may require feeding into the small bowel via a nasojejunal tube to assist absorption.

If eating and drinking normally continues to be impaired due to swallowing difficulties, longer term feeding options will be considered such as percutaneous endoscopic gastrostomy  (PEG) feeding.

Sometimes feeding into the gut is not possible, as the gut may not be functioning adequately or not fully intact. Parenteral nutrition, (PN) may then be given. This is a special liquid feed directly administered and absorbed into the blood stream (intravenously).

On other websites

The Intensive Care Society
Includes section for patients and relatives

East Anglian Intensive Care Group
Education & information sharing for consultants, trainee Drs, nurses and other health professionals working in critical care in the east

There are a number of care of the elderly wards within Addenbrooke’s Hospital. Dietetic input is available to all patients admitted to these wards because nutrition is an essential part of their treatment. A good nutritional status has been shown to improve immune function, reduce muscle wasting, improve mood and reduce length of stay in hospital.

The role of the dietitian

Maintaining a good nutritional status can often become difficult as you get older. An adequate nutritional intake and good level of nourishment is important for every patient. The Dietitian can provide dietary interventions to help patients cope better with illness and treatment therapies that might change their nutritional intake.

All patients admitted to hospital are screened for malnutrition and those at risk are referred to the Dietitian for nutritional support.

What we do:

• Offer nutritional support ranging from general advice about healthy eating, through to tailored dietary information.
• Prescribe nutritionally high energy dense drinks/puddings where intake remains low following initial dietary therapy. Occasionally some patients will require specialist help including tube feeding methods.
• Provide appropriate information for food and fluid texture modifications based on recommendations by a Speech and Language Therapist (SALT) following a swallow assessment
• Aim to meet a patient’s daily requirements of all nutrients

Patients receiving nutritional support while they are in hospital will be followed up after discharge to review their progress.

On other websites

• Age UK
• Food standards agency
• The British Dietetic Association

Dietary therapy has long been recognised as a cornerstone in the management of diabetes. 

Our dietitians see patients with diabetes who are admitted onto the wards as well as offering a range of outpatient services including; Type 1 and Type 2 diabetes outpatient clinics, pre conception and antenatal pregnancy clinics, carbohydrate counting workshops, DAFNE (Dose Adjusting for Normal Eating) 5-day courses and the Severe Insulin Resistance clinics. Diabetes dietitians are also integral in the insulin pump service. They lead workshops that showcase the different insulin pumps for patients to make informed choices, provide education for patients starting on insulin pump therapy and support patients with intensive ongoing follow up.  The diabetes dietitians are also regularly involved in exciting clinical research trials.

​Patients who have conditions or surgery that affect their digestive (gastrointestinal) system usually have special dietary requirements. Gastroenterology dietitians specialise in identifying these requirements and working with patients to achieve and maintain optimum nutrition. 

For a number of conditions, dietary control reduces or eliminates a patient’s symptoms. Gastroenterology dietitians support patients to manage their condition through dietary modification, together with their medical treatment. They also provide nutritional counselling before and after gastrointestinal surgery for optimum health and recovery.

Who we provide a service to

The gastroenterology dietitians at Addenbrooke's provide services for both inpatients and outpatients at the hospital, with conditions such as the following:

• Coeliac disease and dermatitis herpetiformis: a gluten-free diet is currently the only treatment for coeliac disease and dermatitis herpetiformis. Dietitians educate and support people who have these conditions to ensure they meet their nutritional needs without consuming gluten. Useful information can be found on the Coeliac UK website.
• Crohn’s disease: dietitians provides both therapeutic treatment and nutritional counselling to patients who have Crohn’s disease. They identify and manage malnutrition and can support people with Crohn’s Disease to achieve remission with specialised liquid diets. More information on Crohn’s disease can be found on the Crohn’s and Colitis UK and IBD Club websites.
• Ulcerative colitis: there is currently no established dietary treatment for ulcerative colitis. Support from a dietitian is important to ensure a nutritionally adequate diet. More information can be found on the Crohn’s and Colitis UK and IBD Club websites.
• Irritable bowel syndrome (IBS): dietitians advise on dietary modification to help improve symptoms such as abdominal pain, diarrhoea, constipation, wind and bloating.  More information can be found on The IBS Network website.
• Other gastrointestinal conditions: dietitians also provide individually tailored dietary advice and nutrition support for patients with pancreatitis, diverticular disease, intestinal failure, small bowel transplants and patients who have had surgery such as a bowel resection, gastrectomy, oesophagectomy.

The HEN dietitian works with patients who are fed via feeding tubes (nasogastric, nasojejunal or gastrostomy/jejunostomy) to ensure safe and effective feeding in the community. The patients are reviewed regularly by the dietitian by telephone or home visits. The HEN dietitian also holds a review clinic once a month accompanied by the nutrition nurse specialist.

Who we provide a service to

All adults who are discharged from Addenbrooke's/other hospitals into the community (Cambridge, Ely and Littleport) receiving home enteral nutrition support.

The HEN dietitian carries out nutritional assessment; formulation of feeding regimens.

The patients are monitored by reviewing weight gain or loss and evaluating the tolerance to the feed.

The condition of the feeding tube is monitored by the Home Feeding company nurse who accompanies the dietitian in Home visits or the Nutrition Nurse Specialist in HEN clinics.

Homeward contact numbers:

Working hours (9:00 am – 5:00 pm)
Peterborough: 08457 623683
East Cambs and Fenland: 08457 623632
Cambridge: 08457 623672

Out of hours advice line: 08457 623636

On other websites:

• Patients on intravenous and nasogastric nutritional therapy (PINNT)

The infectious diseases dietitian works with patients on the isolation wards (N2 and D10) [link to D10 page] to reduce the risk of them becoming malnourished.

We also see outpatients who attend clinic 1a (Genito-Urinary medicine).

• Clinic 1a

Nutrition is an essential part of treatment for the various illnesses, infections and conditions associated with infectious diseases. A good nutritional status has been shown to improve immune function, reduce muscle wasting, improve mood, and reduce length of stay in hospital.

Our role on the wards

Many patients who are admitted to the infectious diseases wards are at an increased risk of becoming malnourished. All patients admitted to hospital are screened for malnutrition and those at risk are referred to the dietitian for nutritional support.

The Dietitian will carry out a full nutritional assessment on the patient

• Working as a dietitian

The aims of nutritional management in infectious diseases patients are to:

• Achieve and maintain an ideal body weight
• Reduce muscle wasting
• Meet daily requirements of all nutrients
• Provide symptomatic relief

Patients receiving nutritional support whilst they are in hospital will be followed up after discharge to review their progress.

Our role in clinic 1a

Patients from this clinic may be referred to the dietitian for nutritional support if they are malnourished.

Patients who are on anti-retroviral medication for HIV are at an increased risk of cardiovascular disease. This is because the medication can cause an increase in their cholesterol levels. Diet plays an important role in controlling cholesterol levels.

Patients who are referred for cholesterol lowering advice will receive a full nutritional assessment and be provided with individualised diet and lifestyle advice. The dietitian will take int

The Cambridge Centre for Intestinal Rehabilitation and Transplant (CamCIRT) provides nutrition support and multidisciplinary treatment to patients with complex gut disorders both in our hospital and the community.

Read more by visiting the Intestinal rehabilitation webpage.

The hepatology dietitian works with patients who have liver problems to reduce the risk of them becoming malnourished. Patients who have liver problems have special dietary requirements. The dietitian cares for the patient, making regular visits and assessments to help the patient to optimise their health through their choices of what to eat and drink.

Who we provide a service to

• The hepatology dietitians provide a service to all hepatology inpatients including those who will go on to have a liver transplant.
• The liver transplant dietitians are an integral part of the liver transplant team.
• The dietitians carry out nutritional assessments on all patients who are referred to Addenbrooke's for a liver transplant assessment. Patients who are accepted on to the waiting list often require pre-operative nutritional counselling and monitoring. This is provided for inpatients and in the waiting list clinic once discharged.
• After a liver transplant, the dietitians provide nutritional support and monitoring to patients on the ward and afterwards in the post-transplant clinic. This support is provided until the patient is well nourished and has no other nutritional issues.

Education

• The hepatology dietitians provide ongoing education to other health professionals within Addenbrooke's
• The hepatology dietitians provide specialist education nationally to other dietitians
• The hepatology dietitians are active members of the  Liver subgroup of the GSG (Gastroenterology Specialist Group) of the BDA

Dietary advice

There are several widespread myths about diet and liver disease.  If these are followed they may lead to malnutrition. It is important to receive accurate and up to date information from a dietitian to prevent malnutrition. If you have liver disease and would like to see a dietitian, please ask your doctor or specialist nurse to refer you. Below is some useful information for people with liver disease.

The aim for people with liver disease is the same as for the general population, to have a good nutritional status, a healthy weight and no deficiencies.

It is common for people to lose muscle stores when they develop cirrhosis. Between eating our bodies normally access stores (glycogen) in our livers to give us energy. When your liver is not working well, you cannot access these stores and your body instead breaks down your muscles to give you energy. When you don’t feel well you may eat less and move about less, these will both decrease your muscle stores but it will happen more quickly when your liver is not working well.

However this can be prevented and you can even build up your muscle stores again. This can be done by reducing the gaps between eating (the times when your body steals from your muscles for energy). It is recommended to have some carbohydrate food every 2-3 hours.

Examples of carbohydrate foods are:

• Rice
• Breads/ toast
• Pasta
• Potatoes
• Breakfast cereal
• Crackers/crispbreads
• Plain biscuits  
• Crumpets
• Teacakes  

The longest time between eating is likely to be when you are asleep at night. Therefore having a starchy (carbohydrate) snack before bed aids muscle preservation.

If you have specific symptoms such as ascites (fluid accumulated on the abdomen), oedema (fluid accumulated on the ankles or legs), steatorrhoea (fatty/ floaty stools), then you may require other specific dietary advice please ask to be referred to a dietitian for these details.

Patients who have chronic liver disease have a range of nutritional issues including malnutrition and morbid obesity.

Many patients require advice to increase the energy and protein in their diet through dietary modification and nutritional supplements. Those unable to meet nutritional requirements with food drink and specialised supplements require artificial nutritional support via a feeding tube.

During the pre- and post-transplant periods a patient can experience a poor appetite and eat much less than they need to meet their nutritional requirements. Meeting these requirements helps to avoid complications such as infections, frequent hospital admissions and a longer stay in hospital.

Some time after a liver transplant people may experience excessive weight gain, diabetes or high cholesterol (hypercholesterolaemia) you can be referred to a dietitian to help you manage these issues.

On other websites

• British Liver Trust
• Organ donation

Major trauma often precipitates malnutrition due to increased energy expenditure and enhanced protein losses. Providing adequate nutritional support to trauma patients is essential.

Cambridge University Hospitals has been designated as the major trauma centre (MTC) for the East of England.

Up to 800 people every year receive major traumatic injuries in this region – in a car crash, for example. Major trauma is the leading cause of death for people under the age of 40 in the UK.

The major trauma centre is the core of the regional trauma network, and provides specialist services for major trauma patients.

Major trauma often precipitates malnutrition due to increased energy expenditure and enhanced protein losses. Providing adequate nutritional support to trauma patients is essential.

There are trauma specialist dietitians that provide a service to the neurocritical care unit (NCCU), trauma high dependency unit (HDU) and the rapid access to acute rehabilitation ward (J2). Predominantly patients require nutritional support advice. The dietitian advises on:

• The route and timing of nutrition support/feeding
• Regular assessment of nutritional requirements based on different clinical needs for each patient
• Use of specialised feed products or oral nutritional supplements depending on clinical need.
• Educating other health professionals on nutrition in trauma
• Nutritional plan for home and where appropriate transferring care to local dietitians

The dietitian is an integral part of the Trauma Multidisciplinary Team (MDT). They are actively involved in MDT meetings, ward rounds, goal planning and discharge planning. MDT working ensures that the multifactor causes of poor nutrition are assessed and that advice given is effective and appropriate.

On other websites

East of England Trauma Network
A network for the east of England, that aims to increase chances of survival and recovery for the most seriously ill patients.

Headway
Help and support for those affected by a brain injury.

Spinal Cord Injury Association
Help and support for those affected by a spinal injury.

Nutritional advice in MND, generally aims to prevent weight loss, reduce the risk of aspiration and ameliorate symptoms of malnutrition and dehydration.  

Motor Neurone Disease (MND) is a progressive neurodegenerative disease that leads to weakness and wasting of muscles causing progressive disability. Its progress is unpredictable and leads to a complex variety of difficulties involving the loss of mobility and limb function as well as difficulties with speech, swallowing and breathing. It is a condition that is comparatively rare and incurable but there are many advances in treating the difficulties that individuals experience.

Everyone who is diagnosed with MND experiences different combinations of symptoms and not everyone will have every symptom. Approximately 25% of patients with MND present with bulbar symptoms, and around 80% will develop symptoms due to bulbar weakness as their disease progresses. The onset of bulbar weakness will lead to difficulty with speech and swallowing and increase the risk of choking and aspiration. MND does not affect the ‘senses’, so people with MND can still see, hear, smell, feel touch and taste food like they used to do.

Nutritional advice in MND, generally aims to prevent weight loss, reduce the risk of aspiration and ameliorate symptoms of malnutrition and dehydration. 

The dietitian is part of the MND Multi-disciplinary team (MDT) based at Addenbrooke’s MND Care Centre. The clinic team also includes the Consultant Neurologist, Speech and Language Therapist, Occupational Therapist and Physiotherapist. We work closely with the other MDT members, as well as colleagues within the community and other hospitals within the East Anglia Region. A team approach is advocated to ensure that the multifactor causes of poor nutrition are assessed and that advice given is effective and appropriate.

Prior to each patient’s initial clinic visit, a Food Diary is usually sent out with the clinic letter and asked to be completed and sent back before clinic appointment for dietary analysis. This helps to make the assessment more time efficient.

Patients requiring dietetic input, will be seen at the MND MDT clinic. In between clinic appointments, further dietetic advice can be provided via telephone or email. For patients living outside of Cambridge, referrals may be made for local dietetic follow up in addition to seeing the Dietitian within the MND Care Centre. If it is no longer convenient to attend the MND Care centre then home visits can usually be arranged.

On other websites:

• Motor Neurone Disease Association
• Eating and Drinking (MNDA)

The neurology and neurosurgical dietitians work with patients within the A block. The neurological effects of brain injury can have significant complications on nutritional status and oral intake. Patients are at risk of becoming undernourished as a result of increased protein and energy requirements and difficulties eating and drinking. It is believed that early nutritional input may improve survival and preserve physical strength for rehabilitation.

Our role on the wards

All patients admitted to hospital are screened for malnutrition and those at risk are referred to the dietitian for nutritional support.

The aims of nutritional management in neurology and neurosurgical patients are to:

• Achieve and maintain an ideal body weight
• Reduce muscle wasting
• Meet daily requirements of all nutrients

Nutritional supplements may be provided where intake is low, and sometimes patients may need to be tube fed or receive diets of different textures to ensure eating and drinking is safe.. 
Patients receiving nutritional support whilst they are in hospital will be followed up after discharge to review their progress.

On other websites:

• Jacobs and Garden Neuro Rehabilitation Centres
• Royal Hospital for Neuro-disability
• NHS Choices - Severe head injury
• Headway the brain injury association

Obesity is considered a chronic disease that requires long-term management.  Lifestyle advice and support with behavioural change is essential in achieving successful weight loss and weight maintenance.  Our specialist dietitians support those struggling with obesity in the Specialist Medical Obesity Service

The aim of the dietitian is to devise and deliver dietetic weight management care, based on current evidence and best practice, which helps the individual to make and maintain positive lifestyle changes that are best suited to their particular needs and expectations.

Currently, there are two ways to access a dietitian in weight management services at Addenbrooke's hospital:

Level two dietitian-led weight reduction clinic (dietitian only)

The overall aim of this service is to help patients achieve and maintain a clinically significant weight loss over a 6-12 month period helping patients to develop skills and support networks to facilitate the change and aid weight maintenance. These are accepted and realistic targets of 5-10 % weight reduction from baseline for those with a BMI less than 35kg/m2. Patients with a BMI more than 35 kg/m2 have a target weight reduction of 15-20% from baseline in order to provide significant benefits to health.

Referral criteria:

• A BMI more than 28 Kg/M2 with co-morbidities for example diabetes, sleep apnoea, high blood pressure, and heart disease
• A BMI more than 30 Kg/M2 without co-morbidities
• The patient needs to be referred by a consultant within the hospital via letter and not by their GP.

Level three obesity services (multi disciplinary team approach)

Further information on the Level 3 obesity services at Addenbrooke’s Hospital can be found on the obesity section of this website:

• Obesity services

BMI

BMI stands for body mass index and is the most common method of measuring obesity. It is a measure of weight status at an individual level and takes account of the expected differences in weights in adults of different heights. When BMI rises above 30 kg/m2 increased mortality and higher incidence of disease are likely to be found.

Classification

BMI (kg/m2)

Healthy weight

18.5–24.9

Overweight

25–29.9

Obesity I

30–34.9

Obesity II

35–39.9

Obesity III

40 or more

We are a team of four specialist renal dietitians who assess nutritional requirements and food intake of renal (kidney) patients. Diet is an important part of the management of kidney disease and we support patients with kidney disease pre-dialysis and on dialysis as well as those patients who have received a kidney and/or pancreas transplant.

The kidneys remove waste products from the body in the urine. These waste products can be affected by foods that are eaten. Patients who have kidney failure may be required to avoid or limit certain foods and drinks. Individually tailored advice is provided based on blood results, nutritional status, medical condition and treatment.

Patients who have had a kidney and/or pancreas transplant require nutritional advice post transplant to aid their recovery in the early stages and long term to maintain health and wellbeing.

The renal dietitians also support and facilitate education and continuing professional development within the hospital and East Anglia Region.

Close links are maintained with the renal satellite haemodialysis units at Kings Lynn, Hinchingbrooke and West Suffolk Hospitals.

Why we provide a service

• Patients who are having dialysis are at a greater risk of malnutrition. During the pre-dialysis and dialysis periods, a patient can experience a poor appetite. Malnutrition in patients starting dialysis is a strong indicator of poor clinical outcome.
• The renal dietitian works to reduce or remove the risk of malnutrition, which can contribute to a reduced length of stay in hospital, reduced frequency of admissions, reduced infection rates and a reduced need for the use of special dietary products.
• As the kidneys lose their ability to filter waste, high phosphate and calcium levels can result in bone complications over time. Nutrition intervention, in conjunction with medication, can help control serum phosphate and calcium levels.
• Renal diets are very complex and require a lot of motivation and patient education to maintain the quality of life and current lifestyle practices. An experienced renal dietitian is required for the development of effective patient information.
• Renal dietitians are well placed to provide nutrition counselling to patients. Patient who have chronic renal failure are often long-term patients, and regular liaison with a renal dietitian provides good continuity of care. When the dietitian works as part of the multidisciplinary team, this enables referrals to be made to other professionals (eg doctors, nurses, social workers and counsellors) who are involved with other aspects of patient care in order to achieve nutritional requirements.
• Following a kidney or kidney/pancreas transplant patients have a suppressed immune system due to the anti-rejection medications they are on. To reduce the risk of getting food related infections such as Listeria and Salmonella, food safety information is provided.  
• Many patients would have been on dietary restrictions due to their kidney disease prior to the transplant (outlined above) and the Dietitian advises on what and how to reintroduce these foods.  
• Patients have a tendency to gain weight after a kidney transplant and, therefore, regular monitoring of their body weight at subsequent clinic appointments is important.

The areas we provide a service to:

• Nephrology outpatient clinics
• Low clearance outpatient clinic
• Haemodialysis outpatient clinic
• Unit haemodialysis and home haemodialysis patients
• Peritoneal dialysis patients
• Hinchingbrooke Hospital renal satellite haemodialysis unit
• Renal inpatients
• Kidney transplant patients (regional centre for East Anglia)
• Kidney and pancreas transplant patients (regional centre for East Anglia and further afield)
• Encapsulating Peritoneal Sclerosis (EPS) patients (One of two National centres)
• Pre-dialysis and post transplant patient group education sessions

Education

The renal dietitians provide ongoing education in the following areas:

• Healthcare professionals both locally and regionally
• Student dietitians
• Participation as members of the British Dietetic Association Renal Nutrition Group and the East Anglian Renal Dietitians Interest Group.

On other websites

Addenbrooke’s Kidney Patients Association (AKPA)
Information and useful links to Hospital information and other useful websites.

Kidney patient guide
Provides information for renal patients, their partners and families, health care professionals and anyone else who is interested in kidney disease.

Patients with breathing problems may have increased difficulties eating and drinking and thus lose weight, putting them at an increased risk of malnutrition.

Someone who is underweight is more likely to get chest infections and find it harder to breathe because their lung muscles are weaker. A good nutritional status has been shown to improve immune function, reduce muscle wasting, improve mood, and reduce length of stay in hospital.

The dietitian uses their knowledge of diet and nutrition to help manage respiratory illness and prevent unintentional weight loss.

The aims of nutritional management in respiratory patients are to:

• Maintain or improve body weight
• Reduce muscle wasting
• Meet daily recommended requirements of all nutrients

On the ward, nursing staff will screen each patient for risk of malnutrition and if appropriate, refer them to a dietitian.

The role of the dietitian on the ward

• Offer nutritional support: This involves giving tailored advice regarding an appropriate diet for a nutritionally “at risk” individual
• Provide appropriate information for food and fluid texture modification based on speech and language therapist (SALT) recommendations.
• Nutritional high energy and protein drinks/puddings may be provided where nutritional intake is low to help prevent/treat malnutrition
• If patients are unable to meet their nutritional requirements through eating and drinking, they may need to be given additional food and fluid via a tube: this will be monitored by the ward dietitian

Patients receiving nutritional support whilst they are in hospital will be followed up after discharge to review their progress.

On other websites

• British Lung Foundation

Acute stroke patients are usually admitted to ward R2. Rehabilitation (stroke and neurology) patients are usually admitted/ transferred to the Lewin rehabilitation unit. The Lewin stroke and rehabilitation Unit are covered by the specialist stroke dietitian. 

Swallowing may be affected in as many as a third of all patients with strokes. Fortunately, the swallow often improves quickly and it is a temporary problem that resolves within three weeks in over half of those affected. Other patients have a problem with swallowing that can last for months or even years before resolving and some never regain their swallow. Long term feeding options are available for these patients.

Every stroke patient will have their swallow screened on admission by a ward swallow test completed at the bedside, by nursing staff. If the patient fails the swallow test, a full assessment by a speech and language therapist (SLT) is carried out.

Initially after a stroke, patients are often deemed nil by mouth following swallow screen/ assessment and are placed on intravenous fluids. This is because if swallowing has been affected food may ‘go down the wrong way’ and into the lungs causing an aspiration pneumonia or infection. During this period, patients are often fed by a nasogastric tube. This is a thin, flexible tube inserted via the nose, down the throat into the stomach.

SLT’s can make recommendations based on their swallow assessment for safe oral intake and can suggest different textured diets and fluids to help the patients swallow safely, such as a pureed or soft diet and/or thickened fluids.

Dietitians can prescribe high energy supplement drinks/puddings for patients to help boost their intake if needed, as well as dietary support on different textured diets. If tube feeding is necessary the dietitian will ensure that the patient has an individual feeding regime to provide the patient with adequate fluid, energy and protein.

On other websites:

• The Stroke Association

The Rosie hospital provides women's and maternity services. There is a dietitian that provides a dietetic service to the inpatients here that may need nutritional support, have diabetes in pregnancy or be on a special diet. Referrals to dietetics can be made by any member of the ward staff.