Regular ArticleA recipe for improving food intakes in elderly hospitalized patients
Abstract
Background & Aims: The aim of this study was to compare food wastage and intake between the normal hospital menu and one where more energy dense but smaller portions were provided. Methods: This study was carried out on an Elderly Rehabilitation ward in a University hospital. Patients were randomly allocated to receive either a normal or a reduced portion size fortified menu for a 14 day cycle and then swapped-over at the end of each cycle for the 56 day study. One group received a cooked breakfast and normal menus throughout the study. Results: All the menu combinations could meet the patients recommended intake. The fortified menu provided 14% more energy than the normal menu. Food wastage was highest in the cooked breakfast group (32%) and lowest in the Fortified group (27%). The total weight of wasted food was less than in the previous study. Nutritional intakes were 25% higher on the fortified menu compared with the normal menu. The mean protein intakes were still below that recommended. All patients had higher energy intakes on the Fortified menu compared with their intake on the normal menu despite being served a lower weight of food. Conclusions: We conclude from our own data and that of others that it is possible for elderly patients to achieve their nutritional targets using a combination of smaller portions of increased energy and protein density and between-meal snacks. The needs of other groups of patients also needs to be assessed in a similar way to make hospital food appropriate to the needs of the sick.
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Cited by (127)
Better hospital foodservice – aspects highlighted in research published 2000–2023: A scoping review
2024, Clinical Nutrition Open ScienceVarious initiatives have been taken and recommended to improve foodservice and nutritional care to hospitals patients. However, a broad description and analysis of what has been done to reach a better foodservice is lacking. Consequently, the aim of this paper is to map aspects highlighted as important in scientific articles pertaining to the improvement of foodservice for hospital inpatients.
A scoping review was conducted, including literature searches in four databases (CINAHL, PubMed, Scopus, Web of Science) and an article selection process. Included studies were peer reviewed primary research written in English, published in 2000–2023, focusing on quality and improvement work in organisations and practice concerning provision of food and meals to hospital inpatients. Besides data charting of article characteristics, data were obtained for qualitative synthesis.
Out of the 103 included articles, almost all (n=102) contained aspects associated with systems of different kinds. Foremost were systems for ordering, production, delivery and menus. Additionally, there were systems for structures, evaluation, and control. Other frequently occurring aspects concerned patients (n=84), e.g. considering their nutritional requirements, preferences, and cultural habits, as well as empowering patients with freedom of choice, information and guidance. Aspects concerning professional development, e.g. training, competence and teamwork were scarcer (n=46) and even fewer articles entailed aspects regarding leadership (n=21).
The broad spectrum of aspects that were identified may provide guidance to quality improvement of hospital foodservice. It also indicated research gaps in this field, foremost concerning relational competence and leadership.
Can fortified, nutrient-dense and enriched foods and drink-based nutrition interventions increase energy and protein intake in residential aged care residents? A systematic review with meta-analyses
2021, International Journal of Nursing StudiesFood fortification as part of the food-first approach in nursing homes is a strategy that may increase energy and protein intake.
This review aimed to determine the effect of nutrition interventions using fortification, nutrient-dense or enriched food and/or drinks on energy and protein intake in residents living in nursing homes, compared to the standard menu with or without oral nutritional support products. The secondary aim was to identify and synthesise outcomes of these interventions on weight change, nutritional status, acceptability, cost-effectiveness, and cost-benefit.
A systematic search of seven databases was undertaken. After reviewing all titles/abstracts then full-text papers, key data were extracted and synthesised narratively and through meta-analysis. The quality of included studies was assessed using the Quality Criteria Checklist for Primary Research.
Of 3,098 articles retrieved, 16 were included, 13 in the meta-analysis. There were 891 participants, with the study duration ranging from four to 26 weeks. The groups receiving the fortified diet had a significantly higher energy intake (Hedges’ g = 0.69 (CI 0.36–1.03), p < 0.0001) and protein intake (Hedges’ g = 0.46 (CI 0.17–0.74), p = 0.003) compared with the groups receiving the standard menu +/- ONS. The meta-analysis revealed I2 values of 77% for energy (p < 0.0001) and 60% for protein (p = 0.003), indicating considerable statistical heterogeneity across included studies. Benefits to weight and nutritional status of residents were recorded in some studies. Where reported, cost-effectiveness and cost-benefit of menu fortification/supplementation were variable.
This systematic review with meta-analyses has shown that fortified menus may significantly increase energy and protein intakes compared with standard menus in nursing homes. As such, the findings of this review support further use of fortified diets in this setting. Further research is warranted comparing food fortification to standard menus, with a particular focus on evaluating the effect on weight, nutritional status and cost-effectiveness of the intervention.
PROSPERO no. CRD42020162796
Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review
2020, Journal of the Academy of Nutrition and DieteticsCitation Excerpt :The remaining studies found no statistical significance or did not report on statistical significance when patients were allowed meal selection.81-83 A strategy used by two studies was energy-dense meals and reduced portion sizes and identified less waste as a result.85,86 Absence of between-meal snacks also reduced food waste.87
Hospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal).
To systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice.
Eight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively.
From 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients’ intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this.
The literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.
Unwrapping nutrition: Exploring the impact of hospital food and beverage packaging on plate waste/intake in older people
2020, AppetiteFood and beverage packaging is increasingly used in hospital food service provision. Previous research has identified that the packaging used in New South Wales hospitals can be difficult to open by older adults. As older adults experience high rates of malnutrition, it is important to understand the effects of packaging on actual consumption of food and fluids. The aim of this study was to explore the impact of hospital food and beverage packaging on dietary intakes of 62 independently living older people (65 years and over) in a university simulated hospital ward in NSW, Australia. Participants were allocated to either a breakfast and snack meal or a lunch and snack meal on two occasions one week apart. Meals were served in a shared ward environment and each participant experienced a ‘sealed’ and ‘pre-opened’ meal and snack condition. The nutritional status of participants was measured using the Mini Nutritional Assessment - Short Form (MNA®-SF) and intake was estimated through an aggregated plate waste method. Overall findings were not significant for dietary intakes and the ‘sealed’ versus ‘pre-opened’ conditions. However, for the seven participants classified by the MNA®-SF as ‘at risk’ of malnutrition, packaging impeded intake for breakfast (η2 = −0.34) and the high protein snack (cheese and biscuits) (η2 = −0.24) meals. This finding has implications for the provision of packaged high protein snacks (cheese portions) and breakfast meals for the older inpatient. Further research is required for nutritionally compromised and frail older people in the hospital environment to investigate the impact of packaging on food and beverage consumption in detail.
The Currently Available Literature on Inpatient Foodservices: Systematic Review and Critical Appraisal
2019, Journal of the Academy of Nutrition and DieteticsAn adequate hospital foodservice is important to optimize protein and energy intake and to maintain or improve a patient’s nutritional status. Key elements that define an optimal foodservice have yet to be identified.
To systematically describe the effects of published foodservice interventions on nutrition and clinical outcomes and determine which elements should be considered essential. Secondly, to describe the outcome measures used in these studies and evaluate their relevance and validity to guide future research.
PubMed, Embase, the Cochrane Library, and the Web of Science databases were searched. Studies that included assessment of nutrition and/or clinical outcomes of hospital foodservice up to December 2017 were eligible. The details of the subject population, the type of intervention, and the effects on reported outcomes were extracted from each study.
In total, 33 studies that met inclusion criteria were identified, but only nine (27%) were rated as having sufficient methodologic quality. These nine studies concluded that various elements of a foodservice can be considered essential, including using volunteers to provide mealtime assistance, encouraging patients to choose protein-rich foods, adding protein-enriched items to the menu, replacing existing items with protein-enriched items, giving patients the ability to order food by telephone from a printed menu (room service concept), or a combination of these interventions. The interstudy heterogeneity was high for both outcome measures and methods.
Various foodservice interventions have the potential to improve outcome measures. Recommendations are made to facilitate future research.
Protein and energy intake improved by in-between meals: An intervention study in hospitalized patients
2019, Clinical Nutrition ESPENDisease related malnutrition is a major problem in hospitals. Malnutrition in hospitalized patients is caused by many factors. Among these factors are decreased appetite and early satiety, and reaching nutritional requirements in nutritional risk patients is a challenge when using ordinary energy and protein dense food. The aim of this study was to examine if total protein and energy intake in medical and surgical patients at nutritional risk could be improved by protein fortified and energy rich in-between meals.
An assortment of fortified in-between meals including 10 g of protein was developed based on patient preferences and served in the Departments of Lung Medicine and Abdominal Surgery for a period of three months. Nutrition intake was recorded before and after intervention.
Food intake records were collected from a total of 92 patients, (46 before and 46 after intervention). The total amount of protein intake per in-between meal was increased from 2,6 g to 10,3 g. Total daily protein intake increased from 49% to 88% (p < 0.00) and total energy intake from 74% to 109% (p < 0.00) of requirements.
Protein and energy intake for surgical and medical patients at in-between meals as well as total daily intake increased significantly. Recommended average level for individually measured requirements was reached.
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Correspondence to: Mrs Arlene Barton, Senior Dietitian, Department of Dietetics and Nutrition, Queen's Medical Centre, Nottingham, England NG7 2UH, UK