Preferences for different high-energy foods in elderly medical in-patients

Factors Affecting Adherence, Intake, and Perceived Palatability of Oral Nutritional Supplements: A Literature Review

Oral nutritional supplements (ONS) are a clinically effective and relatively inexpensive way to supplement the diet of patients with, or at risk of, undernutrition. Good adherence is a primary determinant of the effectiveness of ONS. However adherence can be problematic for those with the greatest clinical need, such as undernourished older adults. This review aimed to appraise the available literature for the factors (contextual, personal and product related) affecting patient adherence and perceived palatability of ONS, identify areas requiring improvement and uncover gaps in the evidence to guide the focus of future research. Contextual factors identified were healthcare staff and the timing of administration. Personal factors included sensory changes and motivation which alter experience of and desire to consume ONS. The product's sensory characteristics determined palatability and intake, but undesirable attributes, such as off-flavours, can stem from nutritional ingredients. The contribution made by aroma to older adults' experience of ONS was a comparatively under-researched area. Further research should address this evidence gap to optimise the flavour, aroma profile and palatability for undernourished older consumers, thereby optimising intake. A combined multidisciplinary effort involving strategic expansion of research, industry development and clinical practice should simultaneously address the factors identified, to provide the best approach to improve adherence.

Taste preferences for oral nutrition supplements in patients before and after pelvic radiotherapy: A double-blind controlled study

BACKGROUND & AIMS

No data exists about the effect of pelvic radiotherapy on taste preference for oral nutrition supplements, including elemental diet, which may prevent gastrointestinal symptoms if taken during pelvic radiotherapy. This double blind study aimed to: (1) examine the palatability of elemental, peptide and polymeric oral nutrition supplements in patients with pelvic malignancies compared with healthy controls (2) assess changes in taste preference following pelvic radiotherapy (3) develop a reliable scale to measure taste preference.

METHODS

Subjects blind tasted six 30ml oral nutrition supplement samples, one duplicated, before and after 5 weeks of treatment (or the same time interval for controls). A Likert scale was used to score preference.

RESULTS

Fifty patients and 50 controls were recruited. Before radiotherapy, patients had a lower mean preference for the peptide formulation than the other oral nutrition supplements (P<0.001). There were no significant differences in preferences between patients and controls (P>0.2 all supplements). Radiotherapy did not affect supplement preference.

CONCLUSIONS

Patients with pelvic malignancy and healthy controls rate elemental nutritional supplements as highly as polymeric supplements and significantly better than peptide supplements. This trend continues even after pelvic radiotherapy. A Likert scale is a reliable tool in this scenario.

Are we wasting our money on food supplements in elder care wards?

BACKGROUND

It is reported that undernutrition in older hospitalized patients is commonly found, but estimates of its prevalence vary. It is also not clear which treatment approaches are best because poor methodology prevents comparison of outcomes between different studies.

RATIONALE

The rationale of this observational study was to look at typical elder care wards in order to determine what food supplements were being prescribed. We wished to determine whether serum albumin and/or body mass index (BMI) were appropriately related to the prescription of sip feeds and also to determine the palatability of supplements provided.

METHOD

We monitored the wastage of sip feeds over a 24-hour period and extrapolated an estimated cost. Ninety-six patients were studied, including 23 patients with a BMI of less than 20, of whom 30% were on supplementary feeds.

RESULTS

Seventy percentage of prescribed sip feeds were being given to people with a BMI of 20 or more. The mean wastage in this 24-hour period was 63% ( pound 79.56) in four wards containing 96 older patients.

CONCLUSION

We concluded that there was no relationship between the numbers of patients with a low albumin and BMI and the prescription of sip feeds. We found compliance to be low (37%) because of poor palatability, with a large number of patients who appeared to require sip feeds not being prescribed them and those who received them wasting more than they drank.