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Borkent JW, Manders M, Nijhof A, Naumann E, Feskens EJM, de van der Schueren MAE. Low micronutrient intake in nursing home residents, a cross-sectional study. Appl Physiol Nutr Metab 2023; 48:1005-1014. [PMID: 37890172 DOI: 10.1139/apnm-2023-0182] [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] [Indexed: 10/29/2023]
Abstract
Low intake of micronutrients is associated with health-related problems in nursing home residents. As their food intake is generally low, it is expected that their micronutrient intake will be low as well. The nutrient intake of 189 residents (mean age 85.0 years (SD: 7.4)) in five different Dutch nursing homes was measured based on 3-day direct observations of intake. Micronutrient intake, without supplementation, was calculated using the Dutch food composition table, and SPADE software was used to model habitual intake. Intake was compared to the estimated average requirement (EAR) or adequate intake (AI) as described in the Dutch dietary reference values. A low intake was defined as >10% not meeting the EAR or when the P50 (median) intake was below the AI. Vitamin A, thiamin, riboflavin, niacin, B6, folate, B12, C, D, E, copper, iron, zinc, calcium, iodine, magnesium, phosphorus, potassium, and selenium were investigated. Our data showed that vitamin and mineral intake was low for most assessed nutrients. An AI was only seen for vitamin B12 (men only), iodine (men only), and phosphorus. A total of 50% of the population had an intake below the EAR for riboflavin, vit B6, folate, and vitamin D. For reference values expressed in AI, P50 intake of vitamin E, calcium, iodine, magnesium, potassium, and selenium was below the AI. To conclude: micronutrient intake in nursing home residents is far too low in most of the nursing home population. A "food-first" approach could increase dietary intake, but supplements could be considered if the "food-first" approach is not successful.
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Affiliation(s)
- J W Borkent
- HAN University of Applied Sciences, Nijmegen, the Netherlands
- Wageningen University, Wageningen, the Netherlands
| | - M Manders
- HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - A Nijhof
- HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - E Naumann
- HAN University of Applied Sciences, Nijmegen, the Netherlands
| | | | - M A E de van der Schueren
- HAN University of Applied Sciences, Nijmegen, the Netherlands
- Wageningen University, Wageningen, the Netherlands
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2
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Antasouras G, Vasios GK, Kontogiorgis C, Ioannou Z, Poulios E, Deligiannidou GE, Troumbis AY, Giaginis C. How to improve food waste management in hospitals through focussing on the four most common measures for reducing plate waste. Int J Health Plann Manage 2023; 38:296-316. [PMID: 36193027 DOI: 10.1002/hpm.3586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Hospitals have a responsibility to link human health and the environment, but food waste in hospitals has traditionally been much higher than in other areas of food supply. The cause of this situation has many negative impacts on health, economy, society, and environment. As a result, food waste has become a topic of discussion in hospital food departments. Part of this problem is plate waste, the served food that remains uneaten by patients. Given the magnitude of the food problem, this systematic review is aimed to identify the most common measures used to reduce plate waste in hospitals. PubMed, Scopus, and Google Scholar databases were comprehensively searched to identify food waste studies worldwide using related search terms. Many approaches have been recommended to increase patient food intake and minimise plate waste in hospitals. Up to date, the four most common include flexible portion sizes, increased food choices through selective menus, additional nutritional support and a better ordering and delivery system. Among them, the most used and effective are flexible portion sizes which may increase the ability of patients choosing their menus and upgrade ordering and delivery system by electronic format. In most studies, plate waste covers the most significant percentage of food waste produced in hospitals, while more than one approach is recommended to minimise it. In this aspect, further well-design, multicenter, clinical studies are strongly required to highlight and establish novel and effective approaches for improving food waste management in hospitals by reducing plate waste.
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Affiliation(s)
- Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zacharias Ioannou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Efthymios Poulios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Georgia-Eirini Deligiannidou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andreas Y Troumbis
- Department of the Environment, School of Environment, University of the Aegean, Lesvos, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
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Pankhurst M, Yaxley A, Miller M. Measuring Food Service Satisfaction amongst Residents Living in Nursing Homes-A New and Valid Person-Centered Approach. Nutrients 2023; 15:nu15030508. [PMID: 36771215 PMCID: PMC9921588 DOI: 10.3390/nu15030508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Resident satisfaction with food services contributes to health and wellbeing. Measuring resident satisfaction is important; however, the small number of existing food service satisfaction questionnaires (FSSQs) are outdated, lack rigorous psychometric testing and do not reflect the shift to person-centered care. This study aimed to develop a valid and reliable FSSQ. Content validity was established by conducting interviews with residents, a systematic literature review and consultation with an expert panel. Data from 387 residents were used to establish construct validity (Principal Components Analysis), internal consistency (Cronbach's alpha) and temporal stability (Gwet's AC). The result was a three factor, 25-item scale with good/excellent internal consistency: Factor One (13 items-good food/service, α = 0.896), Factor Two (seven items-resident choice/food availability α = 0.648) and Factor Three (five items-resident participation/staff assistance, α = 0.729). Temporal stability was good/very good (Gwet's AC 0.6242-0.9799 (p < 0.001). This is the first FSSQ available to nursing homes that meets the COSMIN® standards for excellence and incorporates person-centered care. The questionnaire is simple to use and interpret, providing food service managers with an accurate and reliable measure of resident satisfaction and assisting them in providing a meal and dining experience that supports the health and wellbeing of residents.
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Wu XS, Yousif L, Miles A, Braakhuis A. A Comparison of Dietary Intake and Nutritional Status between Aged Care Residents Consuming Texture-Modified Diets with and without Oral Nutritional Supplements. Nutrients 2022; 14:nu14030669. [PMID: 35277028 PMCID: PMC8839380 DOI: 10.3390/nu14030669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
Oral nutritional supplements (ONS) are high-energy and protein-rich nutrition drinks that are commonly prescribed to individuals with compromised nutritional status. Aged care residents requiring texture-modified diets are exposed to poor oral intake and malnutrition. This study aimed to investigate the dietary intake and nutritional status of residents consuming texture-modified diets with and without ONS. This multicentre cross-sectional study included 85 residents consuming texture-modified diets (86.0 ± 8.7 y; n = 46 requiring ONS and n = 39 without ONS). A one-day dietary record was completed using a validated visual plate waste estimation method. To determine the adequacy, nutrition intake was then calculated using FoodWorks (Xyris Ltd., Brisbane, Australia) and compared to the recommended dietary intake for Australia and New Zealand. The Mini-Nutritional Assessment Short Form was collected to assess nutritional status. Residents receiving ONS had significantly higher energy, protein, carbohydrates and fat intake than those who did not consume ONS (p < 0.05). No significant differences were found in saturated fat, fibre or sodium intake. With the administration of ONS, residents were able to meet their protein requirement but fell short of their energy and carbohydrates requirements. Both groups had inadequate fibre intake and a high saturated fat intake. A total of 48% of the residents were at risk of malnutrition and 38% were malnourished. Aged care residents requiring texture-modified diets are at high risk of malnutrition as a result of inadequate dietary intake. Administration of ONS may be an effective strategy to optimise nutrition intake.
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Affiliation(s)
- Xiaojing Sharon Wu
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand; (L.Y.); (A.B.)
- Correspondence:
| | - Lina Yousif
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand; (L.Y.); (A.B.)
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, Auckland 1023, New Zealand;
| | - Andrea Braakhuis
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand; (L.Y.); (A.B.)
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AMARAL YG, PENAFORTE FRDO, ARAÚJO LBD, JAPUR CC. Can hospitalized patients adequately estimate their own food intake? A cross-sectional pilot study. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e210168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To assess and identify factors linked to the accuracy of patients’ food intake estimations through a self-monitoring instrument filled in by the patient. Methods This cross-sectional study approached adult hospital patients subjected to regular or therapeutic diets. The actual food intake percentage was obtained by the ratio between the actual food intake and the amount of food served x 100. Patients had to complete a food chart including 9 circles representing plates of food in percentages (increasing scale of 12.5%) to represent their food intake at lunch and/or dinner. The Bland-Altman method assessed the agreement between the actual and the estimated values. The associations between variables (age, sex, hospitalization day, diet prescription, amount of food served and actual food intake percentage) and the accuracy of the food intake estimation (adequate ±10%, overestimated and underestimated) were evaluated through univariate multinomial logistic regression. Results Ninety-six patients were evaluated (51.0% male; 44.0±15.8 years of age). The Bland-Altman analysis showed good agreement between the actual and the estimated food intake. The actual food intake percentage was the only variable associated with the accuracy of the food intake estimation. Conclusion Most patients (~70%) adequately estimated their food intake using the 9-point food chart tested. Furthermore, the only factor linked to the accuracy of the food intake estimation was the actual food-intake percentage. These findings provide preliminary support for the usefulness of this instrument. However, it must be tested in a representative sample of hospitalized patients.
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Sossen L, Bonham M, Porter J. 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. Int J Nurs Stud 2021; 124:104088. [PMID: 34717275 DOI: 10.1016/j.ijnurstu.2021.104088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/26/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Food fortification as part of the food-first approach in nursing homes is a strategy that may increase energy and protein intake. OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. STUDY REGISTRATION PROSPERO no. CRD42020162796.
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Affiliation(s)
- Lisa Sossen
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia.
| | - Maxine Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia.
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia; Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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Abstract
The rising aging population in India has led to an increased caregiving burden, and accordingly, the number of residential care facilities is also burgeoning. There is no regulatory framework or registration authority specifically for residential care homes in India. The article's objective is to understand the need for a regulatory framework in India in the context of historic and global experiences in the UK, USA, and Europe. Although there is a lack of literature comparing the community home-based care and residential care, one study reported a preference for home-based care in the South Asian context. Elder abuse and deprivation of rights of seniors are common, and there is a need to bring in more safeguards to prevent these from the perspective of the older adults, their family members, the care providers, and the state. While the main priority of meeting care needs in long-term care is a challenge given the lack of trained care staff, the quality control mechanisms also need to evolve. A review of adverse incidents, complaints, and litigations also highlights the need for regulation to improve the standards and quality of care. The article explores lacunae of residential care facilities in the Indian context and provides recommendatory parameters for evaluating the quality of care provided. Relevant sections of the statutory new Mental Healthcare Act of 2017 in India could provide a regulatory framework ensuring rights and liberties of the residents are upheld. The authors propose a state-run model for elderly care homes and commencement of framing regulations appropriate to the Indian context.
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Affiliation(s)
| | - Mahesh Gowda
- Spandana Healthcare, Nandini Layout, Bangalore, Karnataka, India
| | - Saraswati Tenagi
- Dept. of Psychiatry, Belgaum Institute of Medical Sciences, Belagavi, Karnataka, India
| | - Mina Chandra
- Dept. of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Keser I, Cvijetić S, Ilić A, Colić Barić I, Boschiero D, Ilich JZ. Assessment of Body Composition and Dietary Intake in Nursing-Home Residents: Could Lessons Learned from the COVID-19 Pandemic Be Used to Prevent Future Casualties in Older Individuals? Nutrients 2021; 13:1510. [PMID: 33947099 PMCID: PMC8146998 DOI: 10.3390/nu13051510] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022] Open
Abstract
The population of older adults, especially those living in the nursing homes, is growing. The sedentary lifestyle and possible poor nutrition in nursing homes place residents (NHRs) at risk for body composition impairments, malnutrition, and, subsequently, numerous chronic diseases. The aim of this study was to assess body composition (including body fluids) and dietary intake in NHRs. The association between osteosarcopenic adiposity syndrome (OSA) and its components, osteopenic adiposity (OA), sarcopenic adiposity (SA), and adiposity-only (AD), and specific macro- and micro-nutrients was evaluated as well. The study included 84 participants (82.1% women), aged 65.3-95.2 years. Body composition was assessed with an advanced bioelectrical impedance device BIA-ACC® and dietary intake was assessed via 24-h recall and analyzed using "Nutrition" software. The majority (95%) of participants were overweight with a high body fat and low muscle and bone mass, leading to a high prevalence of OSA (>50%), OA (13%), and AD (26%). There were only a few participants with SA, and they were not analyzed. The highest extracellular water/total body water ratio was observed in the OSA participants, indicating a heightened inflammatory state. Participants in all three body composition categories had a similar nutrient intake, with protein, fiber, omega-3 fatty acids, and almost all micronutrients being far below recommendations. In conclusion, a high prevalence of OSA among NHRs accompanied by a poor dietary intake, could place these residents at a very high risk for COVID-19 infections. Therefore, optimization of body composition and nutritional status should be included along with standard medical care in order to provide better health maintenance, particularly in the COVID-19 era.
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Affiliation(s)
- Irena Keser
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia; (I.K.); (A.I.); (I.C.B.)
| | - Selma Cvijetić
- Department of Occupational and Environmental Medicine, Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, 10000 Zagreb, Croatia;
| | - Ana Ilić
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia; (I.K.); (A.I.); (I.C.B.)
| | - Irena Colić Barić
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia; (I.K.); (A.I.); (I.C.B.)
| | | | - Jasminka Z. Ilich
- Institute for Successful Longevity, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
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Sossen L, Bonham M, Porter J. An investigation of recommended serve food portions and attaining energy and protein requirements in older adults living in residential care. J Hum Nutr Diet 2020; 34:374-383. [PMID: 33068454 DOI: 10.1111/jhn.12824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ageing populations show a propensity for reduced food intake, which impacts nutritional adequacy. Nutrition guidelines for residential care homes (RCHs) are currently based on serve size of core food groups and do not consider nutrient density. The present study aimed to investigate the weight of foods served/consumed compared to recommended serve sizes and to compare energy and protein intake with individual requirements. METHODS This was an observational study of older adults living in four RCHs. Dietary intake was estimated through the difference between weighed reference meals and a single, double-weighed 24-h food plate waste collected from each participant. FoodWorks9® (Xyris® Software, Brisbane, Australia) was used to calculate energy, protein and serves of core food groups from food intake and the menu provided to recommended serve sizes. Individual intake was compared with nutrition guidelines and estimated energy and protein requirements. RESULTS Across 420 participants, 9.8% completed a main meal (lunch or dinner). The servings provided [248 g; interquartile range (IQR) = 206-290 g] were less than the recommended servings for a main meal (306 g = protein/starch/two vegetables), with 157 g (IQR = 109-221 g) consumed. The menu provided for minimum serves of all core food groups except for dairy. Median energy intake (n = 389) (5272 kJ day-1 , IQR = 4229-6720 kJ) and protein intake (47.3 g day-1 , IQR = 35.9-60.8 g) were less than estimated requirements (8181 kJ day-1 , IQR = 7300-9338 kJ day-1 ; 76.7 g day-1 , IQR = 66.7-90.8 g). CONCLUSIONS Nutritional needs were not met in this cohort. The findings of the present study highlight the need for smaller, nutrient-dense meals and revised menu standards to ensure nutritional adequacy in this vulnerable population.
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Affiliation(s)
- L Sossen
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - M Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - J Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Nishida Y, Tanaka S, Nakae S, Yamada Y, Shirato H, Hirano H, Sasaki S, Katsukawa F. Energy Gap between Doubly Labeled Water-Based Energy Expenditure and Calculated Energy Intake from Recipes and Plate Waste, and Subsequent Weight Changes in Elderly Residents in Japanese Long-Term Care Facilities: CLEVER Study. Nutrients 2020; 12:nu12092677. [PMID: 32887378 PMCID: PMC7551170 DOI: 10.3390/nu12092677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/28/2022] Open
Abstract
Unintentional weight loss is a major frailty component; thus, assessing energy imbalance is essential for institutionalized elderly residents. This study examined prediction errors of the observed energy intake (OEI) against the actual energy intake obtained from the doubly labeled water (DLW) method and clarified the relationship between the energy gap obtained by subtracting total energy expenditure (TEE) from OEI and subsequent weight changes in elderly residents in long-term care facilities. Overall, 46 participants were recruited in Japan. TEE was measured using the DLW method, and OEI was calculated from recipes and plate waste simultaneously over a 14–15-day period at baseline. The total energy intake (TEIDLW) was determined on the basis of DLW and weight changes during the DLW period. The weight was longitudinally tracked monthly for 12 months in the 28 residents who still lived at the facilities. OEI was higher than TEIDLW by a mean of 232 kcal/day (15.3%) among 46 residents at baseline. The longitudinal data of 28 residents showed that the energy gap tended to be correlated with the slope of weight change (ρ = 0.337, p = 0.080) and the median value was significantly lower in the weight loss group (152 kcal/day) than in the weight gain group (350 kcal/day) (p < 0.05). In conclusion, weight loss could occur at Japanese long-term care facilities even if the difference obtained by subtracting TEE from OEI was positive because OEI was overestimated by more than 200 kcal/day.
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Affiliation(s)
- Yuki Nishida
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Sports Medicine Research Center, Keio University, Yokohama 223-8521, Japan;
| | - Shigeho Tanaka
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Faculty of Nutrition, Kagawa Nutrition University, Saitama 350-0288, Japan
- Correspondence: ; Tel.: +81-49-282-3722
| | - Satoshi Nakae
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Division of Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka 560-8531, Japan
| | - Yosuke Yamada
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 615-8577, Japan
| | - Hiroyuki Shirato
- Silverpia-Kaga Long-Term Care Health Facility, Tokyo 173-0003, Japan;
| | - Hirohiko Hirano
- Dentistry and Oral Surgery, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Fuminori Katsukawa
- Sports Medicine Research Center, Keio University, Yokohama 223-8521, Japan;
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11
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Lagacé C, Carrier N, Villalon L, Lengyel C, Slaughter S, Morrison J, Keller H. Provincial Differences in Long-Term Care Menu Variety and Food Intake for Residents who Consume a Regular Texture. CAN J DIET PRACT RES 2020; 81:8-14. [PMID: 31081686 DOI: 10.3148/cjdpr-2019-013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To determine regular-texture menu variety offered in Canadian long-term care (LTC) homes and its association with residents' food intake. Methods: Twenty-nine LTC menus from Alberta, Manitoba, New Brunswick, and Ontario were analyzed. Items offered during the regular-texture menu cycle were categorized according to Eating Well with Canada's Food Guide food groups and variety scores were calculated per day and per week. Residents' food intake was assessed by weighing and observing intake over 3 nonconsecutive days. Diet quality was determined using a mean adequacy ratio score (MAR) for regular and soft and bite-sized consumers (n = 394). Results: Average daily and weekly menu variety scores were 24 ± 5.8 and 78 ± 17.2, respectively, with significantly higher scores in Ontario (29 ± 2.7 and 102 ± 11.7). Of all the food groups, only the variety score for the "Other" food category was positively associated with protein intake. No associations were observed between variety and energy intake or MAR score. Conclusion: This study is the first in Canada to assess LTC menu variety. Although there was variability between provinces in menu variety, this was not associated with resident diet quality or intake.
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Affiliation(s)
- Christine Lagacé
- École des sciences des aliments, de nutrition et d'études familiales, Université de Moncton, Moncton, NB
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Université de Moncton, Moncton, NB
| | - Lita Villalon
- École des sciences des aliments, de nutrition et d'études familiales, Université de Moncton, Moncton, NB
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB
| | | | - Jill Morrison
- Faculty of Health Sciences, University of Waterloo, Waterloo, ON
| | - Heather Keller
- Faculty of Health Sciences, University of Waterloo, Waterloo, ON.,Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON
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12
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Buckinx F, Paquot N, Fadeur M, Bacus L, Reginster JY, Allepaerts S, Petermans J, Biquet S, Bruyère O. Assessment of the energy expenditure of Belgian nursing home residents using indirect calorimetry. Nutrition 2018; 57:12-16. [PMID: 30099232 DOI: 10.1016/j.nut.2018.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 04/24/2018] [Accepted: 05/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess the energy expenditure of Belgian nursing home residents using indirect calorimetry and compare the energy expenditure with energy intake. METHODS Indirect calorimetry was performed in nursing home residents to estimate their basal metabolism. The basal metabolism was multiplied by a physical activity level coefficient and energy expenditure that was related to thermogenesis (i.e., 10% of the total amount of energy ingested over 24 h) was added. In this way, we obtained the total energy expenditure of each nursing home resident. The nutritional intake of each resident was calculated using the precise food-weighing method over a 3-d period. The difference between energy expenditure and consumption was calculated for each patient and the mean of the difference in the population was calculated. These quantitative variables were compared by means of analysis of variance. RESULTS A total of 25 subjects were included in this study (88.1 ± 5.8 y; 84% women). The estimated mean basal metabolism was 1087.2 ± 163.2 kcal. The physical activity level was 1.29 ± 0.1 on average and the energy expenditure due to thermogenesis was 163.1 ± 28.9 kcal. Thus, the mean daily energy expenditure was 1575.2 ± 210.6 kcal, which was within the range of the actual calculated energy intake of the residents (1631.5 ± 289.3 kcal; P = 0.33). CONCLUSIONS The estimated energy intake of Belgian nursing home residents seems appropriate for their energy expenditure.
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Affiliation(s)
- Fanny Buckinx
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium; Department of Public Health, Support Unit in Epidemiology and Biostatistics, University of Liège, Belgium.
| | - Nicolas Paquot
- Diabetes, Nutrition, and Metabolic Diseases, Centre Hospitalier Universitaire of Liège, Liège, Belgium
| | - Marjorie Fadeur
- Diabetes, Nutrition, and Metabolic Diseases, Centre Hospitalier Universitaire of Liège, Liège, Belgium
| | - Lucas Bacus
- Nutrition and Dietetics, Haute Ecole de la Province de Liège, Liège, Belgium
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium; Department of Public Health, Support Unit in Epidemiology and Biostatistics, University of Liège, Belgium
| | - Sophie Allepaerts
- Geriatrics Department, Centre Hospitalier Universitaire of Liège, Liège, Belgium
| | - Jean Petermans
- Geriatrics Department, Centre Hospitalier Universitaire of Liège, Liège, Belgium
| | - Sabine Biquet
- Nutrition and Dietetics, Haute Ecole de la Province de Liège, Liège, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium; Department of Public Health, Support Unit in Epidemiology and Biostatistics, University of Liège, Belgium; Diabetes, Nutrition, and Metabolic Diseases, Centre Hospitalier Universitaire of Liège, Liège, Belgium
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Barrington V, Maunder K, Kelaart A. Engaging the patient: improving dietary intake and meal experience through bedside terminal meal ordering for oncology patients. J Hum Nutr Diet 2018; 31:803-809. [DOI: 10.1111/jhn.12573] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- V. Barrington
- Department Dietetics and Human Nutrition; College of Science, Health and Engineering; Latrobe University; Melbourne VIC Australia
| | - K. Maunder
- The CBORD Group Inc.; Chatswood NSW Australia
| | - A. Kelaart
- Cancer Council Victoria; Melbourne VIC Australia
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Abstract
This study determines the prevalence of inadequate micronutrient intakes consumed by long-term care (LTC) residents. This cross-sectional study was completed in thirty-two LTC homes in four Canadian provinces. Weighed and estimated food and beverage intake were collected over 3 non-consecutive days from 632 randomly selected residents. Nutrient intakes were adjusted for intra-individual variation and compared with the Dietary Reference Intakes. Proportion of participants, stratified by sex and use of modified (MTF) or regular texture foods, with intakes below the Estimated Average Requirement (EAR) or Adequate Intake (AI), were identified. Numbers of participants that met these adequacy values with use of micronutrient supplements was determined. Mean age of males (n 197) was 85·2 (sd 7·6) years and females (n 435) was 87·4 (sd 7·8) years. In all, 33 % consumed MTF; 78·2 % (males) and 76·1 % (females) took at least one micronutrient pill. Participants on a MTF had lower intake for some nutrients (males=4; females=8), but also consumed a few nutrients in larger amounts than regular texture consumers (males=4; females =1). More than 50 % of participants in both sexes and texture groups consumed inadequate amounts of folate, vitamins B6, Ca, Mg and Zn (males only), with >90 % consuming amounts below the EAR/AI for vitamin D, E, K, Mg (males only) and K. Vitamin D supplements resolved inadequate intakes for 50-70 % of participants. High proportions of LTC residents have intakes for nine of twenty nutrients examined below the EAR or AI. Strategies to improve intake specific to these nutrients are needed.
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Vucea V, Keller HH, Morrison JM, Duncan AM, Duizer LM, Carrier N, Lengyel CO, Slaughter SE. Nutritional quality of regular and pureed menus in Canadian long term care homes: an analysis of the Making the Most of Mealtimes (M3) project. BMC Nutr 2017; 3:80. [PMID: 32153857 PMCID: PMC7050785 DOI: 10.1186/s40795-017-0198-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/03/2017] [Indexed: 12/03/2022] Open
Abstract
Background Long term care (LTC) menus need to contain sufficient nutrients for health and pureed menus may have lower nutritional quality than regular texture menus due to processes (e.g., recipe alterations) required to modify textures. The aims of this study were to: determine adequacy of planned menus when compared to the Dietary Reference Intake (DRI); compare the energy, macronutrients, micronutrients and fibre of pureed texture and regular texture menus across LTC homes to determine any texture, home or regional level differences; and identify home characteristics associated with energy and protein differences in pureed and regular menus. Methods Making the Most of Mealtimes (M3) is a cross-sectional multi-site study that collected data from 32 LTC homes in four Canadian provinces. This secondary analysis focused on nutrient analysis of pureed and regular texture menus for the first week of the menu cycle. A site survey captured characteristics and services of each facility, and key aspects of menu planning and food production. Bivariate analyses were used to compare menus, within a home and among and within provinces, as well as to determine if home characteristics were associated with energy and protein provision for both menus. Each menu was qualitatively compared to the DRI standards for individuals 70+ years to determine nutritional quality. Results There were significant provincial and menu texture interactions for energy, protein, carbohydrates, fibre, and 11 of 22 micronutrients analyzed (p < 0.01). Alberta and New Brunswick had lower nutrient contents for both menu textures as compared to Manitoba and Ontario. Within each province some homes had significantly lower nutrient content for pureed menus (p < 0.01), while others did not. Fibre and nine micronutrients were below DRI recommendations for both menu textures within all four provinces; variation in nutritional quality existed among homes within each province. Several home characteristics (e.g., for-profit status) were significantly associated with higher energy and protein content of menus (p < 0.01). Conclusions There was variability in nutritional quality of menus from LTC homes in the M3 sample. Pureed menus tended to contain lower amounts of nutrients than regular texture menus and both menus did not meet DRI recommendations for select nutrients. This study demonstrates the need for improved menu planning protocols to ensure planned diets meet nutrient requirements regardless of texture. Trial registration ClinicalTrials.gov ID: NCT02800291, retrospectively registered June 7, 2016. Electronic supplementary material The online version of this article (10.1186/s40795-017-0198-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vanessa Vucea
- 1Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1 Canada
| | - Heather H Keller
- 1Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1 Canada.,2Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2 Canada
| | - Jill M Morrison
- 1Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1 Canada
| | - Alison M Duncan
- 3Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - Lisa M Duizer
- 4Department of Food Science, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - Natalie Carrier
- 5École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB E1A 3E9 Canada
| | - Christina O Lengyel
- 6Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 2N2 Canada
| | - Susan E Slaughter
- 7Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9 Canada
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Peters A, Van Name MA, Thorsted BL, Piltoft JS, Tamborlane WV. POSTPRANDIAL DOSING OF BOLUS INSULIN IN PATIENTS WITH TYPE 1 DIABETES: A CROSS-SECTIONAL STUDY USING DATA FROM THE T1D EXCHANGE REGISTRY. Endocr Pract 2017; 23:1201-1209. [PMID: 28704103 DOI: 10.4158/ep171813.or] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the prevalence and characteristics of patients with type 1 diabetes (T1D) who dose bolus insulin postprandial (PostP) versus preprandial (PreP). METHODS Data for this cross-sectional study were obtained from 21,533 participants in the T1D Exchange Registry. Data were drawn from the enrollment questionnaire. Patients who dosed 'immediately before meal' or 'several minutes before meal' were classified as PreP. Patients who dosed 'during meal' or 'after meal' were classified as PostP. Data reported (PostP vs. PreP) are mean ± SD and percentage, as appropriate. RESULTS After exclusion of patients who did not answer the dose-timing question or who selected 'not given regularly' or 'depends on glucose level prior to meal,' (4,229 of 25,762), 21,533 patients were included in the study. Ninety-nine percent of patients used rapid-acting insulin analogues; 32% dosed insulin PostP. Compared to PreP, children <18 years of age dosing PostP were characterized by higher glycated hemoglobin (HbA1c) (8.7 ± 1.5% [72 ± 16.4 mmol/mol] vs. 8.4 ± 1.7% [68 ± 18.6 mmol/mol]), larger insulin dose (1.2 ± 0.7 IU/kg/day vs. 1.1 ± 0.7 IU/kg/day), greater prevalence of history of hypoglycemia, and diabetic ketoacidosis. Adults who dosed PostP were characterized by younger age (33.0 ± 15.3 years vs. 39.5 ± 16.6 years), higher HbA1c (8.3 ± 1.5% [67 ± 16.4 mmol/mol] vs. 7.8 ± 1.5% [62 ± 16.4 mmol/mol]), and larger insulin dose (1.0 ± 0.6 IU/kg/day vs. 0.9 ± 0.5 IU/kg/day) than PreP. CONCLUSION This study reveals that a large proportion of patients dose bolus insulin PostP. Despite the use of current rapid-acting insulin analogues, patients who dose PostP are characterized by poorer glycemic control in all patients and a greater prevalence of history of severe hypoglycemia and diabetic ketoacidosis in children. ABBREVIATIONS BMI = body mass index; CGM = continuous glucose monitoring; DKA = diabetic ketoacidosis; HbA1c = glycated hemoglobin; PostP = postprandial; PreP = preprandial; SMBG = self-monitored blood glucose; T1D = type 1 diabetes.
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Buckinx F, Allepaerts S, Paquot N, Reginster JY, de Cock C, Petermans J, Bruyère O. Energy and Nutrient Content of Food Served and Consumed by Nursing Home Residents. J Nutr Health Aging 2017; 21:727-732. [PMID: 28537340 DOI: 10.1007/s12603-016-0782-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare energy and protein content of the served food with the actual intake from the food consumed by nursing home residents. This study also aimed to compare food intake and dietary allowances. DESIGN This is a cross sectional study. SETTING This study was performed in nursing homes. PARTICIPANTS Residents of these 2 nursing homes were eligible for the study if they agreed to participate and if they meet the selection criteria (to be older than 65 years and have a regular texture diet). MEASUREMENT Nutrient content of the served food and real food consumption was calculated for all meals during a 5-day period by precise weighting method. Difference between consumed and served dietary content was evaluated by the Chi² test. RESULTS Seventy-four Belgian nursing home residents (75% of women, 85.8 ± 7.04 years on average) were included in this study. These subjects had a mean body mass index of 24.9 ± 4.83 kg/m². The mean energy content of the served food was 1783.3 ± 125.7 kcal per day. However, residents did not eat the whole of the meals and the actual energy content of the consumed food was significantly less (1552.4 ± 342.1 kcal per day; p<.001). The average protein content of the food served was equal to 0.96 ± 0.20 g/kg/day and the average consumption of protein by the residents was 0.88 ± 0.25 g/kg/day. The difference between protein served and consumed was also significant (p=.04). Moreover, people considered as well nourished, eating significantly more energy than the others (p=.04). CONCLUSION Meals served in nursing homes are not entirely consumed by their residents. As expected, the energy consumed are lower in subjects considered as malnourished or at risk of malnutrition.
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Affiliation(s)
- F Buckinx
- Fanny Buckinx, M.SC., Ph.D., University of Liège, Department of Public Health, Epidemiology and Health Economics, CHU - Sart Tilman, Bât. B23, Quartier Hôpital, Avenue Hippocrate, 13, 4000 Liège, Belgium,Tél : +32 43 66 49 33, Fax : +32 43 66 28 12, E-mail :
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Okabe Y, Furuta M, Akifusa S, Takeuchi K, Adachi M, Kinoshita T, Kikutani T, Nakamura S, Yamashita Y. Swallowing Function and Nutritional Status in Japanese Elderly People Receiving Home-care Services: A 1-year Longitudinal Study. J Nutr Health Aging 2016; 20:697-704. [PMID: 27499302 DOI: 10.1007/s12603-015-0645-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Malnutrition is a serious health concern for frail elderly people. Poor oral function leading to insufficient food intake can contribute to the development of malnutrition. In the present study, we explored the longitudinal association of malnutrition with oral function, including oral health status and swallowing function, in elderly people receiving home nursing care. DESIGN Prospective observational cohort study with 1-year follow-up. SETTING Two mid-sized cities in Fukuoka, Japan from November 2010 to March 2012. PARTICIPANTS One hundred and ninety-seven individuals, aged ≥ 60 years, living at home and receiving home-care services because of physical disabilities, without malnutrition. MEASUREMENTS Oral health status, swallowing function, taking modified-texture diets such as minced or pureed foods, nutritional status, cognitive function, and activities of daily living were assessed at baseline. The associations between malnutrition at 1-year follow-up and these related factors were analyzed using a logistic regression model. RESULTS Swallowing disorders [risk ratio (RR): 5.21, 95% confidence interval (95% CI): 1.65-16.43] were associated with malnutrition. On the other hand, oral health status did not have a direct association with malnutrition. CONCLUSION Swallowing disorders may be associated with the incidence of malnutrition in elderly people receiving home-care. The findings indicate that maintaining swallowing function may contribute to the prevention of malnutrition in frail elderly people.
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Affiliation(s)
- Y Okabe
- Yoshihisa Yamashita, Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Kyushu University Faculty of Dental Science, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. E-mail:
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21
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Influence of flavour enhancement on food liking and consumption in older adults with poor, moderate or high cognitive status. Food Qual Prefer 2015. [DOI: 10.1016/j.foodqual.2015.04.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ofei K, Holst M, Rasmussen H, Mikkelsen B. Effect of meal portion size choice on plate waste generation among patients with different nutritional status. An investigation using Dietary Intake Monitoring System (DIMS). Appetite 2015; 91:157-64. [DOI: 10.1016/j.appet.2015.04.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
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Lam IT, Keller HH, Duizer L, Stark K. Micronutrients on the Menu: Enhancing the Quality of Food in Long-term Care for Regular, Nontherapeutic Menus. CAN J DIET PRACT RES 2015; 76:86-92. [DOI: 10.3148/cjdpr-2014-036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ivy T. Lam
- Department of Kinesiology, University of Waterloo, Waterloo, ON
| | - Heather H. Keller
- Professor and Schlegel Research Chair, Nutrition and Aging, Schlegel-University of Waterloo, Research Institute for Aging and Department of Kinesiology, University of Waterloo, Waterloo, ON
| | - Lisa Duizer
- Department of Food Science, University of Guelph, Guelph, ON
| | - Ken Stark
- Department of Kinesiology, University of Waterloo, Waterloo, ON
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Huang CS, Dutkowski K, Fuller A, Walton K. Evaluation of a pilot volunteer feeding assistance program: influences on the dietary intakes of elderly hospitalised patients and lessons learnt. J Nutr Health Aging 2015; 19:206-10. [PMID: 25651447 DOI: 10.1007/s12603-014-0529-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Malnutrition is a serious concern in hospitals and is known to be associated with increased complications for patients, increased hospital costs and length of stay. Trained volunteers that assist 'at risk' and malnourished patients at lunch meals have been shown to effectively increase nutritional intake in a suburban hospital in Sydney. The pilot study reported here aimed to evaluate and share learnings from a similar, newly implemented program, comparing energy and macronutrient intakes on days with no volunteer assistance, to days with volunteers. DESIGN Dietary intakes were determined by visual estimation of meal trays before and after meals, for two days without volunteers, and two days with volunteer assistance at lunch. Macronutrient and energy intakes were compared and data such as weight, height, diet type and medical history were obtained from medical records. Questionnaires were completed by nurses and volunteers in regards to their views and experiences with the program. SETTING Hospital based. RESULTS Eight patients (83±4.5 years) participated in the study. When volunteers were present at lunch, the average macronutrient and energy intakes increased, though not statistically significantly. The mean increases were 316 kJ (p=0.175) for energy, 3.1 g (p=0.468) for protein, 1.4 g (p=0.418) for fat and 11.6 g (p=0.084) for carbohydrates. Non-significant increases in macronutrients were also noted for the average daily intakes. CONCLUSION Although not statistically significant, energy and macronutrient intakes increased when volunteers were present. The implementation of a volunteer feeding assistance program is one strategy to assist dietary intakes but requires a ready team of volunteers, training, acceptance and significant time to develop.
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Affiliation(s)
- C S Huang
- Dr Karen Walton, School of Medicine University of Wollongong, NSW, Australia 2522, tel +61+2-4221 5197,
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Kenkmann A, Hooper L. The restaurant within the home: experiences of a restaurant‐style dining provision in residential homes for older people. QUALITY IN AGEING AND OLDER ADULTS 2012. [DOI: 10.1108/14717791211231184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mila R, Abellana R, Padro L, Basulto J, Farran A. High consumption foods and their influence on energy and protein intake in institutionalized older adults. J Nutr Health Aging 2012; 16:115-22. [PMID: 22323344 DOI: 10.1007/s12603-011-0151-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The elderly, and especially those attending nursing homes, are at great risk from certain nutritional deficiencies. OBJECTIVE The aim of this study was to determine which food groups present the highest rates of consumption among the institutionalized elderly and study the energy density of each food group and the number of calories and amount of protein in the total diet of each resident. DESIGN This was a multicentre observational study of a sample of the institutionalized population over the age of 65. The sample of patients was drawn from four Spanish nursing homes (Santa Coloma Gramanet, Barcelona, Madrid and Bilbao). Our final sample comprised a total of 62 individuals, of whom 22 were men and 40 women, aged between 68 and 96 years. METHODS Dietary data were collected using the double weight method for each main meal (breakfast, lunch, afternoon snack and dinner), including food type, the quantity of food served and the amount of plate waste for each of the main meals served during 21 days. STATISTICAL ANALYSES The characteristics of the study population were compared by Student's t-test and χ2 test. The results are expressed in terms of their median values and the interquartile range. To analyse the overall differences between sites, gender and food groups we used Kruskall-Wallis test combined with the Mann-Whitney U-test with Bonferroni correction for multiple comparisons. RESULTS The food group that was served most was milk products (376.25 g/day). A large amount of potatoes were also served (109.64 g/day) as were sweets and pastries (62.14 g/day). The daily serving of fruit (138.34 g/day) and vegetables (239.47 g/day) was equivalent to no more than that of a daily ration in each case. Milk was the food group with the highest consumption (311 g/day). Most of the energy was provided by groups with a higher energy density like as fats and sauces, sweets and pastries and bread. The mean protein consumption was 82,6 g/day (Table 5) and no significant differences were recorded in this consumption between men and women. CONCLUSIONS We conclude that there is a need to improve the residents' energy intake and to redistribute their energy and protein intake among the various food groups. An alternative to increasing food portions so as to improve energy intake might involve enriching certain food types.
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Affiliation(s)
- R Mila
- Unit of Biostatistics of Department of Public Health, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Grieger JA, Nowson CA. Use of calcium, folate, and vitamin D₃-fortified milk for 6 months improves nutritional status but not bone mass or turnover, in a group of Australian aged care residents. ACTA ACUST UNITED AC 2011; 28:236-54. [PMID: 21184368 DOI: 10.1080/01639360903140130] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In residential care, inadequate calcium and folate intakes and low serum vitamin D (25(OH)D) concentrations are common. We assessed whether daily provision of calcium, folate, and vitamin D₃-fortified milk for 6 months improved nutritional status (serum micronutrients), bone quality (heel ultrasound), bone turnover markers (parathyroid hormone, C-terminal collagen I telopeptide, terminal propeptide of type I procollagen), and/or muscle strength and mobility in a group of Australian aged care residents. One hundred and seven residents completed the study (mean (SD) age: 79.9 (10.1) years; body weight: 68.4 (15.4) kg). The median (inter-quartile range) volume of fortified milk consumed was 160 (149) ml/day. At the end of the study, the median daily vitamin D intake increased to 10.4 (8.7) μg (P < .001), which is 70% of the adequate intake (15 μg); and calcium density (mg/MJ) was higher over the study period compared with baseline (161 ± 5 mg/MJ vs. 142 ± 4 mg/MJ, P < .001). Serum 25(OH)D concentrations increased by 23 ± 2 nmol/L (83 (107)%, P < .001), yet remained in the insufficient range (mean 45 ± 2 nmol/L). Consumption of greater than the median intake of milk (160 ml/day) (n = 54, 50%) increased serum 25(OH)D levels into the adequate range (53 ± 2 nmol/L) and reduced serum parathyroid hormone by 24% (P = .045). There was no effect on bone quality, bone turnover markers, muscle strength, or mobility. Consumption of fortified milk increased dietary vitamin D intake and raised serum 25(OH)D concentrations, but not to the level thought to reduce fracture risk. If calcium-fortified milk also was used in cooking and milk drinks, this approach could allow residents to achieve a dietary calcium intake close to recommended levels. A vitamin D supplement would be recommended to ensure adequate vitamin D status for all residents.
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Affiliation(s)
- Jessica A Grieger
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Beck AM, Hansen KS. Meals served in Danish nursing homes and to Meals-on-Wheels clients may not offer nutritionally adequate choices. ACTA ACUST UNITED AC 2010; 29:100-9. [PMID: 20391045 DOI: 10.1080/01639360903574742] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Underweight is a significant problem among older Danish nursing home residents and home-care clients. The aim of this study was to evaluate the nutritional composition of the meals prepared for older adults in nursing homes and receiving Meals-on-Wheels deliveries, focusing on the menus most commonly served, including the standard menu (most commonly prepared), the energy and protein dense menu, and two types of texture modified menus (chopped and blended). Also, one portion of a homemade energy and protein dense drink was collected and analyzed. For each of the participating kitchens (N = 10), extra portions of different menus were made (3 days in a row). The meal samples (total n = 389) were analyzed for content of energy, protein, fat and carbohydrate. The findings were compared with recommendations regarding the foods to be served in Danish institutions. The nutrient content of the meals-on-wheels and nursing home meals, as well as that of the homemade energy and protein dense drink, varied considerably. The nursing home menus seldom or never fulfilled the recommendations. Our findings support the conclusion that meals served in Danish nursing homes and to meals-on-wheels clients do not consistently offer adequate nutritional intakes.
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Affiliation(s)
- Anne Marie Beck
- Department of Nutrition, National Food Institute, Technical University of Denmark, DK-2860 Soeborg, Denmark.
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Kenkmann A, Price GM, Bolton J, Hooper L. Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision. BMC Geriatr 2010; 10:28. [PMID: 20507560 PMCID: PMC2890011 DOI: 10.1186/1471-2318-10-28] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 05/27/2010] [Indexed: 01/24/2023] Open
Abstract
Background Food and drink are important determinants of physical and social health in care home residents. This study explored whether a pragmatic methodology including routinely collected data was feasible in UK care homes, to describe the health, wellbeing and nutritional status of care home residents and assess effects of changed provision of food and drink at three care homes on residents' falls (primary outcome), anaemia, weight, dehydration, cognitive status, depression, lipids and satisfaction with food and drink provision. Methods We measured health, wellbeing and nutritional status of 120 of 213 residents of six care homes in Norfolk, UK. An intervention comprising improved dining atmosphere, greater food choice, extended restaurant hours, and readily available snacks and drinks machines was implemented in three care homes. Three control homes maintained their previous system. Outcomes were assessed in the year before and the year after the changes. Results Use of routinely collected data was partially successful, but loss to follow up and levels of missing data were high, limiting power to identify trends in the data. This was a frail older population (mean age 87, 71% female) with multiple varied health problems. During the first year 60% of residents had one or more falls, 40% a wound care visit, and 40% a urinary tract infection. 45% were on diuretics, 24% antidepressants, and 43% on psychotropic medication. There was a slight increase in falls from year 1 to year 2 in the intervention homes, and a much bigger increase in control homes, leading to a statistically non-significant 24% relative reduction in residents' rate of falls in intervention homes compared with control homes (adjusted rate ratio 0.76, 95% CI 0.57 to 1.02, p = 0.06). Conclusions Care home residents are frail and experience multiple health risks. This intervention to improve food and drink provision was well received by residents, but effects on health indicators (despite the relative reduction in falls rate) were inconclusive, partly due to problems with routine data collection and loss to follow up. Further research with more homes is needed to understand which, if any, components of the intervention may be successful. Trial registration Trial registration: ISRCTN86057119.
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Affiliation(s)
- Andrea Kenkmann
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
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Kaiser MJ, Bandinelli S, Lunenfeld B. The nutritional pattern of frailty - Proceedings from the 5th Italian Congress of Endocrinology of Aging, Parma, Italy, 27-28 March 2009. Aging Male 2009; 12:87-94. [PMID: 19909201 DOI: 10.3109/13685530903296706] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Frailty has become one of the 'hot spots' in geriatric research. Frailty has multifactorial origin, and is regarded as a fundamental risk factor for deteriorating health status and disability in elderly people and is highly prevalent in the population above the age 65. It is estimates that prevalence rates up to 27% and pre-frailty rates up to 50% qualify for the term "epidemic". Although the role of nutritional deficiency in the development of age-related frailty was suggested long ago, research conducted in this area is relatively recent. The critical role of micronutrients in this context suggests the need to improve the quality of food eaten by elderly people whereas quantity of food appears to be less relevant. This review summarizes the recent literature on the nutritional pathways to frailty with particular focus on the effect of energy, protein and micronutrients.
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Affiliation(s)
- M J Kaiser
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nuremberg, 90419 Nuremberg, Germany.
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Woods JL, Walker KZ, Iuliano Burns S, Strauss BJ. Malnutrition on the menu: nutritional status of institutionalised elderly Australians in low-level care. J Nutr Health Aging 2009; 13:693-8. [PMID: 19657552 DOI: 10.1007/s12603-009-0199-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most studies reporting malnutrition in the elderly relate to high-level care. However, one third of Australians in aged care reside in low-level care facilities. Data is limited on their nutritional status. OBJECTIVE To investigate the nutritional status of elderly in low-level care facilities. DESIGN A cross sectional study design. SETTING 14 low-level aged care facilities in metropolitan Melbourne. PARTICIPANTS Convenience sample of 103 ambulatory elderly (86 +/- 6.6 years (mean +/- SD), 76% female, comprising 15% of the hostel population) able to perform daily functions of living. MEASUREMENTS Nutritional intake assessed by three-day weighed food records, and nutritional status by haematological and biochemical markers and body composition (dual energy X-ray absorptiometry). RESULTS FOOD served did not supply the estimated average requirements (EAR) for 5 of the 14 nutrients analysed. Compared with EAR, 34% of participants were protein malnourished and 62% had energy intake deficits. Micronutrient intake was low for calcium, magnesium, folate, zinc (for men) and dietary fibre. Vitamin D deficiency (serum 25OH Vitamin D < 50 nmol/L) was present in 58% of residents. More men than women had low haemoglobin (P < 0.000), low red blood cells (P < 0.000), and a raised white blood cell count (P = 0.004). Forty three percent of men and 21% women had sarcopenia, 28% of men and 44% women had excess body fat (> 28% and >40%, respectively) and 14% of men and 12 % of women were sarcopenic-obese. Only 12% showed no sign of undernutrition using seven different nutritional indicators. Around 65% had two or more indicators of undernutrition. CONCLUSION These findings highlight the need for the supply of more, better quality, nutrient dense food to residents and better detection of undernutrition in aged care facilities. Maintenance of nutritional status has the potential to reduce morbidity and delay the transition to high-level care.
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Affiliation(s)
- J L Woods
- Nutrition and Dietetics Department, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.
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Cherniack EP, Florez H, Roos BA, Troen BR, Levis S. Hypovitaminosis D in the elderly: from bone to brain. J Nutr Health Aging 2008; 12:366-73. [PMID: 18548173 DOI: 10.1007/bf02982668] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- E P Cherniack
- Geriatric Research, Education and Clinical Center and Research Service, Miami Veterans Affairs Healthcare System, Miami, FL 33125, USA.
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Grieger JA, Nowson CA, Jarman HF, Malon R, Ackland LM. Multivitamin supplementation improves nutritional status and bone quality in aged care residents. Eur J Clin Nutr 2007; 63:558-65. [DOI: 10.1038/sj.ejcn.1602963] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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