1. A Healthy Diet in AKU Shirley Judd RD Royal Liverpool University Hospital Trust

2. Consider evidence base  Bone  Joints  Heart  Body Weight  Protein Intake  Consider our AKU patients  Conclusions for all Key aspects of a healthy diet and lifestyle in AKU

3. Factors Protecting Bone Mass Non-Modifiable  Gender, age, sex, ethnicity Modifiable  Activity, smoking, alcohol, & diet Current evidence: bone health

4. Minerals & Vitamins  How much Ca and how well its absorbed  Vitamin D deficiency is a major contributor to Osteoporosis  Need Calcium, Magnesium, Zinc, Vitamin D & Vitamin K Bone health

5. Phyto-oestrogens:  Iso-flavones in Soy  Inulin- fibre found in fruit, vegetable & pulses Chinese Health Study (63,000)  Showed plant rich diets may reduce risk of fractured hips Bone health

6. Alcohol Wine may be protective in post menopausal women No effect seen from beer or spirits (Identical Twin study) Bone health

7. Omega 3 & 6 fatty acids  Evidence of improved immune response in RA is strong  Dose 2.7g/day = 2 portions of fish weekly, (1 oily)  Not enough evidence for fish body oils in RA or OA  No liver oils (xs Vit A) Current evidence: Joint health

8. Glucosamine +/- chondroitin Effect on cartilage (in animals)  Delays breakdown  Improves repair Study design- 1500mg for 3/12  Impact on pain, stiffness & function  1 in 5 will benefit (2005 Cochrane review )  Side effects heartburn/itching/anti- coagulant therapy Joint health

9. Selenium & Vitamin E  Evidence associated as a powerful anti-oxidant (Cancer & CVD prevention)  From that found naturally in food  Rich sources: brazil nuts, seeds, meat, mushrooms & fish  No evidence of effectiveness in large doses, taken as supplements Joint health

10. Side effect of NSAIDS medication  Iron deficiency associated with risk of bleeding  Need Vitamin C to support absorption of iron Joint health

11. Risks you can do something about  High blood pressure  Abnormal cholesterol  Smoking  Diabetes  Over weight  Physical inactivity Current evidence: Heart health

12. DASH programme (American study 2003)  Use the calories you take in  Exercise plan (10 minutes daily)  A diet including all healthy components → Reduced BP in every case (all races, ages, genders, BMI’s, incomes & education levels) Heart health

13. Abdominal visceral fat  Not inert, but bio-medically active, making oestrogen Insulin resistance Blood Pressure risk Current evidence: Weight

14. Non weight bearing exercise  Lowers cholesterol,  Reduces insulin resistance  Reduces blood pressure  Burns up Calories  Strengthens and develops muscle Weight

15. Impact of exercise Tai chi  Improved strength, balance, mobility Meditation  Improved response to stress & enhanced capability. Yoga  Improved core body strength  Muscle strength improved Weight

16. Early years  Extra needs relative to size Adulthood  1.0g/Kg sufficient for maintenance & repair Older age  Extra needs as 2% reduction in muscle capacity each year after 50 Limiting amino acids  Vegetarian options  If limiting protein intake there is a risk of low iron, zinc, selenium & Vitamin B complex.. Protein

17. Risks for our NAC patients at visit 1  39% over weight & 20% obese  9% with osteoporosis treated with calcium & Vit D  2% with diabetes/pre-diabetes  16% with Vitamin D insufficiency  2% with Vitamin D deficiency (3 patients 1 vegan, 2 vegetarian)  15% needing vitamin & mineral supplements Our AKU patient profile

18. Conclusion  Exercise where ever and when ever possible, avoiding weight loss  Make sure your diet has enough dairy(or substitute), oily fish (or substitute), fruit, vegetables and meat free days using pulses & tofu.  Get out in the fresh air in the summer for 10 minutes without sunscreen.  Take Vitamin D3 & Ca supplement in winter

19. Future Plans at the NAC  Recipe file using ingredients encouraged for AKU health  Photo library of protein portions within diet sheet  Standardised care plan based on serum tyrosine levels using prescribed protein supplements

20. Thank You Any Questions