Some of these effects of poor nutrition include:

1. Cardiovascular disease (CVD): High blood cholesterol can clog arteries, leading to cardiovascular disease. Poor nutrition choices that can lead to CVD include fatty diets, excessive alcohol intake, and smoking.
2. Hypertension: Excessive sodium consumption and insufficient potassium in the diet can cause hypertension.
3. Diabetes: occurs as a result of a metabolic disorder in the body. It can occur when the body does not make enough insulin to break down glucose (type 1 diabetes), or when the insulin present cannot be used (type 2 diabetes). Type 1 and 2 diabetes both lead to extreme amounts of blood glucose and medical complications. Type 1 diabetes is hereditary, but type 2 diabetes can occur as a result of obesity which is directly related to poor nutrition.
4. Cancer: In addition to genetics, dietary choices can affect the development of some cancers such as prostate cancer in men. Obese individuals are more at risk of prostate cancer.
5. Osteoporosis: Osteoporosis-related fractures can be a result of inadequate nutrition and lack of physical activity.
6. Problems of being overweight or obese: Poor nutrition can cause individuals to be overweight or obese. Solutions such as decreasing sodium intake and calories from solid fats and added sugars can help with issue of weight or obesity health-related issues.
7. Mental health: What you eat ultimately affects your emotions, brain functioning and mental health. Our mood can also affect the way we eat and things we choose to eat. For example, when we feel stressed or our mood is low, we are more likely to crave high fat foods, and may overeat.
8. Sleep: When we eat and how much we eat, can be an important factor in the quality and quantity of sleep

Reasons for an imbalanced diet:

• There are many possible reasons why some people have imbalanced diets.
• It may be the result of some other conditions that can impact a person’s diet or ability to eat.
• Some people with learning disabilities may have multiple conditions, which complicates matters further.
• These conditions include:
  • Oral motor difficulties such as dysphagia, which is a reduced capacity to chew and swallow that may require the texture of foods to be modified (Hamzaid et al, 2020);
  • Frequent choking episodes;
  • Gastro-oesophageal reflux disease;
  • Dental issues;
  • Food allergies;
  • Side-effects of medication;
  • Specialised diets
• It is important when speaking to GPs, health care staff or dieticians that they are made aware of these conditions and how they may affect the person’s diet.

What can we do to help support a balanced diet:

• It may not always be clear if the person who you care for is having a balanced diet.
• This self-assessment tool might be useful. (please note this tool is based on the diet of an adult, some may not be appropriate for children) Worried About Weight Loss – Self-Screening for Malnutrition (malnutritionselfscreening.org)

Eating well

A good healthy diet should include:

• Plenty of starchy food
  Bread, breakfast cereals, potatoes and pasta are a good source of energy. Always choose wholegrain varieties where you can.
• Plenty of fruit and vegetables
  Aim for five portions a day to provide you with a good source of vitamins and minerals. 1 portion is equivalent to: 1 apple, 1 medium banana, 7 strawberries, 1 handful of grapes, 150ml glass of unsweetened orange juice, dessert bowl of salad, 3 heaped tablespoons of mixed vegetables.
• Some protein
  Meat, fish, eggs, beans are a good source of protein.
• Some milk and dairy foods
  Cheese, yogurt or choose low-fat options if trying to reduce fat in your diet.
• Limit the amount of foods high in fat or sugar
  Such as crisps, chocolate, sweets.

Eating well in a time of raised costs of living

• We are currently seeing rising prices in shops. Wages and benefits are not keeping up.
• However, eating a balanced diet does not necessarily you need to spend more money.
• Carers UK recommend some useful tips to help make some savings on your food shopping:
  • Look out for offers on foods that keep, such as tins of pulses or tomatoes.
  • Use supermarket own brands as a cheaper alternative to branded products
  • Dried, frozen or canned fruit (in juice) and vegetables are cheaper than fresh varieties – and just as healthy.
  • When you buy fresh fruit and vegetables, it can be cheaper to buy them loose rather than pre-packaged. In addition, it is usually cheaper to buy fruit and vegetables when they are in season.
  • Supermarkets often reduce prices on products that are close to their sell by date and this can be a great way to pick up a bargain. But be sure you can cook or eat everything you buy (or are able to freeze it) before it goes off.
  • When making meals, prepare large quantities and freeze the extra portions. This can be a cost and time effective way of maintaining a balanced diet.
• You might find it useful to keep a dietary dairy to let you see not just the balance in a diet but also how these foods are sourced and their costs.
• The Heart Foundation has developed a dietary worksheet that might be useful here Eating well | Food diary worksheet |British Heart Foudnation (bhf.org.uk)

PEG (percutaneous endoscopic gastrostomy) feeding

PEG feeding gives food, fluids and medicines directly into your stomach through a thin tube that runs through your skin and into your stomach.

PEG stands for percutaneous endoscopic gastrostomy:

• Percutaneous – means through your skin
• Endoscopic – a long, thin and flexible tube (endoscope) is used to position the PEG feeding tube in your stomach.
• Gastrostomy – is the making of an opening in your stomach.
• Someone may be tube feed because they are;
  • unable to take on enough food to grow and stay healthy;
  • at risk of food or drink going into the airway, also known as aspiration;
  • choking during feeding;
  • or experiencing severe reflux.
• This may be due to stroke or other brain injury, problems with the esophagus, surgery of the head and neck, or other conditions.
• When PEG feeding at home you may have a lot of equipment, which will all be provided by your health care team. Some required equipment might include:
  • A feeding pump to deliver the feed through the giving set at a controlled rate recommended by the dietitian.
  • A giving set is a flexible tube which helps to deliver the feed.
  • Syringes to administer feed, water, medication.
• There are two types of feed that might be used when tube feeding; ready to use tube feeds only or a combination of tube feeds, oral nutritional supplements and diet.
• It is important to speak to your dietitian and health care about the right feed and feeding routine.
• Ready to use tube feeds are a liquid form of nutrition, which are tailored and specific to an individual’s nutritional needs. They are designed to be sterile, convenient and to easily flow through the feeding tube, so that there are less blockages when feeding.
• Tube feeding routine will be decided by the family and the health care team, based on the individuals needs and nutritional requirements. Different types of feeding routines include:
  • Continuous feeding: Feed is given slowly over a number of hours.
  • Bolus feeding: Feed is given in smaller volumes, several times throughout the day.
• PEG feeding will require ongoing care. Some things that you may need to consider are:
  • Skin care: the skin around the gastrostomy opening should be cleaned every day. You should not rub at the gastrostomy, or use special cleaning solutions or ‘wipes’ as this may irritate the opening. The skin around the opening should be checked regularly to make sure it is not infected or sore.
  • Some leaking and mucus from the gastrostomy is normal. This may look like the ‘sleep’ crusts around the eye on waking. If the opening continues to leak once cleaned, has an odour, or the surrounding area looks inflamed or feels hot to touch, you should speak to your doctor or community team.
  • Equipment and supplies: You will be supplied with all the equipment and supplies you need, however, you will need to re-order some new equipment, such as tubes, feed, syringes etc. Order new supplies in good time before you run out and only use equipment for the length of time specified by the manufacturer. Using or re-using equipment against the advice of the manufacturer could lead to infection.
  • Mouth care: Even if your child/person you care for, is no longer eating and drinking by mouth, they should still be brushing their teeth twice a day and visiting the dentist regularly.