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Okkels SL, Christensen AS, Bjerring TS, Erichsen A, Rask IK, Frederiksen KG, Viggers L, Kristensen MB. Individualised nutritional treatment increases the positive effects of a novel á la carte hospital food service concept: Results of a quasi-experimental study. Clin Nutr ESPEN 2024; 59:225-234. [PMID: 38220380 DOI: 10.1016/j.clnesp.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS One-third of hospitalised patients are at nutritional risk, and limited choice regarding meals and meal times, and inadequate nutritional support may contribute to inadequate nutritional intake during hospitalisation. The aim was to test the effect of a novel á la carte hospital food service concept as a stand-alone intervention and combined with individualised nutritional treatment. METHODS Medical inpatients at nutritional risk were recruited for this three-arm quasi-experimental study. The control group received meals from the traditional bulk trolley food service system. Intervention group 1 (IG1) received meals from a novel á la carte food service concept with an electronic ordering system, whereas intervention group 2 (IG2) in addition to this received individualised nutritional treatment by a clinical dietitian. Nutritional intake and length of stay was measured, and patient satisfaction was assessed with purpose-designed questionnaires. RESULTS 206 patients were included: 67 in the control group, 68 in IG1, and 71 in IG2. The proportion of participants reaching ≥75 % of both their energy and protein requirement was higher in IG1 compared to the control group (34 % vs. 12 %, p = 0.002) and higher in IG2 compared to IG1 (53 % vs. 34 %, p = 0.035). Length of stay was shorter in IG2 compared to the control group (6.0 vs. 8.7 days, p = 0.005). It was important to participants to be able to choose when and what to eat, and this preference was met to a larger extent in the intervention groups. CONCLUSION The novel á la carte concept increases energy and protein intake in hospitalised patients, and the positive effects are increased, when the concept is used in combination with individualised nutritional treatment.
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Affiliation(s)
- Signe Loftager Okkels
- Department of Nutrition, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark.
| | | | | | - Alexander Erichsen
- Department of Nutrition, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark.
| | - Ingeborg Krarup Rask
- Department of Nutrition, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark.
| | | | - Lone Viggers
- Department of Nutrition, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark.
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Ferguson CE, Tatucu-Babet OA, Amon JN, Chapple LAS, Malacria L, Myint Htoo I, Hodgson CL, Ridley EJ. Dietary assessment methods for measurement of oral intake in acute care and critically ill hospitalised patients: a scoping review. Nutr Res Rev 2023:1-14. [PMID: 38073417 DOI: 10.1017/s0954422423000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Quantification of oral intake within the hospital setting is required to guide nutrition care. Multiple dietary assessment methods are available, yet details regarding their application in the acute care setting are scarce. This scoping review, conducted in accordance with JBI methodology, describes dietary assessment methods used to measure oral intake in acute and critical care hospital patients. The search was run across four databases to identify primary research conducted in adult acute or critical care settings from 1st of January 2000-15th March 2023 which quantified oral diet with any dietary assessment method. In total, 155 articles were included, predominantly from the acute care setting (n = 153, 99%). Studies were mainly single-centre (n = 138, 88%) and of observational design (n = 135, 87%). Estimated plate waste (n = 59, 38%) and food records (n = 43, 28%) were the most frequent assessment methods with energy and protein the main nutrients quantified (n = 81, 52%). Validation was completed in 23 (15%) studies, with the majority of these using a reference method reliant on estimation (n = 17, 74%). A quarter of studies (n = 39) quantified completion (either as complete versus incomplete or degree of completeness) and four studies (2.5%) explored factors influencing completion. Findings indicate a lack of high-quality evidence to guide selection and application of existing dietary assessment methods to quantify oral intake with a particular absence of evidence in the critical care setting. Further validation of existing tools and identification of factors influencing completion is needed to guide the optimal approach to quantification of oral intake in both research and clinical contexts.
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Affiliation(s)
- Clare E Ferguson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Oana A Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Jenna N Amon
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lauren Malacria
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ivy Myint Htoo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Division of Clinical Trials and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
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Geny A, Petitjean M, Van Wymelbeke-Delannoy V, Sulmont-Rossé C. Impact of food-based fortification on nutritional outcomes and acceptability in older adults: systematic literature review. Front Nutr 2023; 10:1232502. [PMID: 37964932 PMCID: PMC10641731 DOI: 10.3389/fnut.2023.1232502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Background "Do it yourself" (DIY) food-based fortification involves adding fortificants into everyday foods. It is a flexible solution that allows older people with reduced appetite to meet their nutritional needs. Objectives The aims of the systematic review are (a) to describe DIY fortified recipes, (b) to evaluate their acceptability, and (c) to evaluate whether they are effective levers to improve nutritional outcomes in older people. Methods A systematic search of 3 databases (Web of Science, PubMed, Scopus, last searched on January 2022) was undertaken. Main eligibility criteria include older adults aged ≥60 years living at home, in an institution or in hospital. Studies carried out for a specific medical condition or targeting only micronutrient fortification were excluded. After reviewing all titles/abstracts then full-text papers, key data were extracted and synthesized narratively. The quality of included studies was assessed using Kmet et al. Results Of 21,493 papers extracted, 44 original studies were included (3,384 participants), with 31 reporting nutritional outcomes, 3 reporting acceptability outcomes and 10 reporting both nutritional and acceptability outcomes. The review highlighted a wide variety of DIY fortified recipes, with additional energy ranging from 23 to 850 kcal/d (M = 403; SE = 62) and/or protein ranging from 4 to 40 g/d (M = 19; SE = 2). Compared to a standard diet, DIY fortification seems to be a valuable strategy for increasing energy and protein intake in older people. However, no strong evidence was observed on the nutritional status. Implication for future Further acceptability studies are crucial to ensure that DIY fortified foods are palatable and thus have a significant impact on the nutritional status. In addition, it would be useful for studies to better describe DIY recipes. This information would result in a better understanding of the factors that maximize the impact of DIY fortification on nutritional outcomes. Study registration: PROSPERO no. CRD42021244689.Systematic review registration: PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244689.
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Affiliation(s)
- Alexia Geny
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
| | - Maité Petitjean
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
| | - Virginie Van Wymelbeke-Delannoy
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
- CHU Dijon Bourgogne, Unité de recherche Pôle Personnes Âgées, Dijon, France
| | - Claire Sulmont-Rossé
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
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Trinca V, Duizer L, Keller H. The Hospital Food Experience Questionnaire Predicts Adult Patient Food Intake. CAN J DIET PRACT RES 2023; 84:17-27. [PMID: 36412505 DOI: 10.3148/cjdpr-2022-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: Describe food/beverage intake among all patients and those with low meal intake and determine if the Hospital Food Experience Questionnaire (HFEQ), or its shorter version (HFEQ-sv), predicts food intake while considering patient (e.g., gender) and hospital characteristics (e.g., foodservice model).Methods: Cross-sectional study of 1087 adult patients from 16 hospitals in Ontario, Canada. The valid and reliable HFEQ assessed patients' meal quality perceptions. Visual estimation determined overall meal and food/beverage intake using the Comstock method. Binary logistic regressions tested the association between patient and hospital characteristics and whether HFEQ or HFEQ-sv scores added utility in predicting overall meal intake (≤50% vs. ≥75%).Results: Approximately 29% of patients consumed ≤50% of their meal. Models assessing patient and hospital characteristics and either the HFEQ or the HFEQ-sv were significant (LRT(43) = 72.25, P = 0.003; LRT(43) = 93.46, P < 0.001). Men and higher HFEQ or HFEQ-sv scores demonstrated significantly higher odds of ≥75% meal consumption. Considering HFEQ or HFEQ-sv scores explained greater variance in meal intake and resulted in better model fits.Conclusions: The HFEQ and HFEQ-sv predict patient meal intake when adjusting for covariates and add utility in understanding meal intake. Either version can be confidently used to support menu planning and food delivery to promote food intake.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, ON
| | - Lisa Duizer
- Food Science Department, University of Guelph, ON
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, ON.,Schlegel-UW Research Institute for Aging, ON
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Promoting Protein Intake in an Ageing Population: Product Design Implications for Protein Fortification. Nutrients 2022; 14:nu14235083. [PMID: 36501113 PMCID: PMC9735980 DOI: 10.3390/nu14235083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Protein is a macronutrient of interest for an ageing population and intake requirements increase with age. Accordingly, protein is often fortified into products for older adults to help alleviate malnutrition and impede sarcopenia. However, more emphasis needs to be placed upon designing protein-fortified products to ensure suitability for older adults. This study involved a two-stage approach: (1) an initial review of products commonly fortified with protein and (2) two questionnaires for younger and older adults (n = 73; 18-30; 65+) to investigate optimal portion sizes (drinks and cakes) as well as attitudes, consumption habits and preferences towards protein fortification. The initial literature and market review demonstrated protein-fortified products are typically in liquid or snack format; however, there is considerable variability in terms of product types, serving size and protein sources. There were no age-related differences found for ideal cakes portion size whereas there were for liquids. Older adults are typically not consuming protein-fortified products; therefore, more importance should be placed on the consumption moment (breakfast or as snacks between meals) and on cereals, pasta, porridge, cakes, and biscuits. Older adults need increased awareness of, and more education on, the benefits of protein consumption, coupled with products tailored and designed to encourage intake.
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Osman NS, Md Nor N, Md Sharif MS, Hamid SBA, Rahamat S. Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review. Nutrients 2021; 13:3649. [PMID: 34684649 PMCID: PMC8537902 DOI: 10.3390/nu13103649] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
This review aims to identify hospital food service strategies to improve food consumption among hospitalized patients. A systematic search that met the inclusion and exclusion criteria was manually conducted through Web of Science and Scopus by an author, and the ambiguities were clarified by two senior authors. The quality assessment was separately conducted by two authors, and the ambiguities were clarified with all the involved authors. Qualitative synthesis was used to analyze and summarized the findings. A total of 2432 articles were identified by searching the databases, and 36 studies were included. The majority of the studies applied menu modifications and meal composition interventions (n = 12, 33.3%), or included the implementation of the new food service system (n = 8, 22.2%), protected mealtimes, mealtime assistance and environmental intervention (n = 7, 19.4%), and attractive meal presentation (n = 3, 8.3%). Previous studies that used multidisciplinary approaches reported a significant improvement in food intake, nutritional status, patient satisfaction and quality of life (n = 6, 16.7%). In conclusion, it is suggested that healthcare institutions consider applying one or more of the listed intervention strategies to enhance their foodservice operation in the future.
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Affiliation(s)
- Noor Suzana Osman
- Faculty of Health Sciences, Puncak Alam Campus, Universiti Teknologi MARA, Puncak Alam 42300, Malaysia; (N.S.O.); (S.B.A.H.)
- Kulliyyah of Allied Health Sciences, Kuantan Campus, International Islamic University Malaysia, Kuantan 25200, Malaysia
| | - Norazmir Md Nor
- Faculty of Health Sciences, Puncak Alam Campus, Universiti Teknologi MARA, Puncak Alam 42300, Malaysia; (N.S.O.); (S.B.A.H.)
- Integrative Pharmacogenomics Institute, Puncak Alam Campus, Universiti Teknologi MARA, Puncak Alam 42300, Malaysia
| | - Mohd Shazali Md Sharif
- Faculty of Hotel and Tourism Management, Puncak Alam Campus, Universiti Teknologi MARA, Puncak Alam 42300, Malaysia;
| | - Syahrul Bariah Abdul Hamid
- Faculty of Health Sciences, Puncak Alam Campus, Universiti Teknologi MARA, Puncak Alam 42300, Malaysia; (N.S.O.); (S.B.A.H.)
| | - Syafiqah Rahamat
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia;
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Factors associated with patient weight loss and prescribed diet during hospitalization. NUTR HOSP 2021; 38:749-757. [PMID: 33966443 DOI: 10.20960/nh.03249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Objective: the aim of this study was to assess weight loss, diet prescribed, and nutritional status in hospitalized patients, as well as their associated factors. Methods: weight loss during hospitalization, nutritional status, disease type, and prescribed diet were investigated in a retrospective study in 621 hospitalized patients. The chi-squared, Fisher's, Mann-Whitney, and Kruskal-Wallis tests were used for statistical analysis. To identify factors associated with weight loss a logistic regression analysis was performed. The significance level adopted for statistical tests was 5 %. Results: patients who experienced weight loss during hospitalization were associated with longer hospital stays (p < 0.0001; OR = 1.052; 95 % CI = 1.030 to 1.073), malnourishment according to the subjective global assessment (p = 0.0358; OR = 1.520; 95 % CI = 1,028 to 2,248), digestive disorders (p = 0.0081; OR = 3.177; 95 % CI = 1.351 to 7.469), and digestive neoplasms (p = 0.0407; OR = 2.410; 95 % CI = 1.038 to 5.597). Conclusion: weight loss during hospitalization was associated with neoplasms, digestive diseases, malnutrition, and length of stay.
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