Can fortified foods and snacks increase the energy and protein intake of hospitalised older patients? A systematic review

Background

Undernutrition affects over 44% of hospitalised older people, who often dislike oral nutritional supplements (ONS). This review summarises the evidence for an alternative strategy, using energy and protein dense meals (via fortification) or snacks (supplementation) to increase the dietary energy and protein intake of older inpatients.

Methods

A search was conducted through PubMed, EMBASE, CINAHL and the Cochrane database of systematic reviews (May 1996 to May 2016) that used fortification or supplementation to increase the energy or protein intake of patients (mean age ≥60 years) in hospitals or rehabilitation centres.

Results

Ten articles (546 patients, mean age 60–83 years) were identified. Compared with usual nutritional care, six studies using either energy or protein based fortification and supplementation significantly increased intake of energy (250–450 kcal day^?1) or protein (12–16 g day^?1). Two studies enriched menus with both energy and protein, and significantly increased both energy (698 kcal day^?1 and 21 kJ kg^?1) and protein (16 g and 0.2 g kg^?1) intake compared to usual care. ONS was similar to supplementation in one study but superior to fortification in another. Four studies reported good acceptability of enriched products and two studies that found they were cost‐effective.

Conclusions

Compared with usual nutritional care, energy‐ and protein‐based fortification and supplementation could be employed as an effective, well‐tolerated and cost‐effective intervention to improve dietary intake amongst older inpatients. This strategy may be particularly useful for patients with cognitive impairment who struggle with ONS, and clinical trials are required to compare these approaches and establish their impact on functional outcomes.

     

Food caregivers influence on nutritional intake among admitted haematological cancer patients – A prospective study

PurposeHaematological cancer patients have an increased risk of undernourishment due to their malignancy, treatment toxicity and severe infections. This study examines whether kitchen assistants working as food caregivers increase nutritional intake and knowledge among haematological cancer patients.MethodsComparison of two cross-sectional studies with dietary assessment of patients with haematological malignancies before (N = 42) and after (N = 45) implementation of food caregivers. Secondly, a questionnaire concerning dietary counselling performed before (N = 74) and after (N = 78) the implementation.ResultsThe energy requirements were fulfilled with 76.2% (CI 95% 64.6–87.9) and 93.3% (CI 95% 82.3–104.3) of the calculated need in the before-group and the after-group, respectively (p = 0.03). The improvement was mainly due to increased energy intake through between meal snacks served by the food caregivers. There was no difference in protein intake between the two groups. The study showed that more than two-thirds of the patients in both groups had side effects like fatigue, loss of appetite, vomiting, xerostomia or taste disorder to a degree that affected nutritional intake. When adjusted for side effects, patients in the after-group increased energy intake by 22% (CI 95% 6.1–38.0) (p = 0.007). After implementation of food caregivers significantly more patients stated that they were informed about their nutritional needs, 41% in the before-group and 67% in the after-group (p = 0.001).ConclusionsEducated and trained food caregivers working at the wards increase nutritional intake and knowledge among haematological cancer patients and play an important role in the multi professional nutritional management.     

Consumption of sweet foods among adolescents in Finland

Abstract The importance of sugar in the etiology of dental caries is well known but only few representative studies at population level have been carried out to analyze nutritional factors related to dentistry. As the main exposure to caries the frequency of the use of sugar-products should be known more exactly than we do. The purpose of this study was to analyze the frequency of consumption of sugar-containing products among Finnish adolescents. A representative sample of 3209 Finnish adolescents between the ages of 13 and 19 was drawn. The data were obtained by mail questionnaire in February and September 1977, and in February and September 1979. The separate sample was drawn in February 1978 to analyze the changes with time during 1977–79. The response rate to all the mailed questionnaires was close to 90%. The sugar-containing foods included in the study were sugar in codec or tea, hot chocolate, pastries and cookies, soft drinks, chewing gums, sweets and pastilles. In addition, the data on the consumption of artificial sweeteners were collected. According to current health behavior dogma, girls behaved better than boys. A clear relationship was observed between a householder's educational and occupational status and the children's sugar consumption. Children from homes of low social status consumed more sugar than the others. The percentage of children frequently consuming sugary products decreased with improved school success. It can be concluded that the use of sugar-containing products is especially frequent among young age groups, particularly among boys from low social background and children with poor school success. Health education should be especially directed towards them.     

食品中铝的测定方法及铝对人体健康影响的探讨

目的:为保证食品中铝测定结果的准确可靠及提高铝对人体健康影响的认识。方法:采用《食品中化学污染物及有害因素检测手册》,用两种不同的样品处理方法测定。结果:方法线性范围为0.25μg/ml～6.0μg/ml,线性方程为Y=0.0068+0.18X,相关系数r=0.9994,RSD湿法为2.9%～3.8%,干法为3.0%～4.8%,回收率湿法92.0%～100.8%,干法82.7%～93.7%,样品结果面制品合格率40%,油炸小食品83.3%。结论:用此方法测定铝,结果准确可靠,重现性好。实验结果表明,目前面制品中铝超标较为严重,应引起足够重视。     

Reducing snacks when switching from conventional soluble to lispro insulin treatment: effects on glycaemic control and hypoglycaemia

The lack of significant improvement in HbA_1c during insulin lispro treatment in previous studies may have been due to inadequate dietary adjustments. We tested whether reduction of snacks and a compensatory increase in main meals results in improved metabolic control when switching to lispro treatment. One hundred and forty-one Type 1 diabetic patients, mean ± SD age 36 ± 9 years, diabetes duration 14 ± 10 years, had two daily NPH injections throughout the study. After a baseline visit, the patients used conventional soluble insulin preprandially thrice daily for 12 weeks. Thereafter they were switched to lispro insulin and advised to transfer ≥50 % of their snack carbohydrates to preceding main meals. Mean HbA_1c at baseline was 8.05 %. After the conventional period and the 12-week lispro period, HbA_1c was 7.81 and 7.70 % (p = 0.088), respectively. In those patients who diminished their snacks as advised (n = 67), HbA_1c decreased from 7.91 to 7.66 % (p = 0.014) during lispro, whereas no change was observed in patients not compliant with the dietary change. The number of hypoglycaemic episodes was lower during lispro period (blood glucose <2.5 mmol l⁻¹: 1.43 vs 2.19 episodes, p = 0.004; symptomatic nocturnal hypoglycaemia 1.16 vs 1.67 episodes, p<0.001). When switching from conventional soluble to lispro insulin, reduction of snack carbohydrates is safe and results in slightly improved HbA_1c in patients who are fully compliant with the dietary change. © 1998 John Wiley & Sons, Ltd.     

家长对小学生零食消费相关行为的影响

[目的]了解上海市静安区小学生家长零食消费相关知识和态度及其对小学生零食消费行为的影响。[方法]采用整群抽样的方法,对1446名小学生家长进行自填式问卷调查。数据采用统计描述及单因素和多因素线性回归分析。[结果]分别有57．61％、42．19％、11．00％的家长不反对用零食鼓励（奖励）孩子,饭前（后）半小时吃零食,孩子利用零食代替正餐;多因素线性回归分析结果显示,小学生零食消费相关行为与家长零食消费知识、态度[如零食可否用来鼓励（奖励）孩子、广告宣传的零食可否任意食用、每天吃零食的次数等]有密切联系（P〈0．05）。[结论]家长的零食消费相关知识、态度对小学生零食消费行为有影响,在合理引导小学生进行消费零食过程中,必须加强针对家长上述问题的官传教育。     

江西省赣州市农村地区学龄儿童生长及零食消费现状

目的 了解江西省赣州市农村地区学龄儿童生长及其零食消费现状,为制定营养政策提供依据。方法 抽取赣州市某农村地区1 305名学龄儿童,开展问卷调查,描述现状并作简要分析。结果 34.18%的被调查儿童体质指数(BMI)不达标,其中中重度消瘦者达18.47%,轻度消瘦者占11.38%,超重儿童占3.31%,肥胖儿童为1.60%;被调查儿童普遍喜欢吃零食,主要由学生自己购买零食,累计87.96%的被调查儿童购买零食的零花钱数<2元/d,所买零食的单价普遍较低,67.8 %的零食单价低于1元,35.29%的学生因感觉渴或饿而购买零食。结论 被调查儿童生长状况堪忧,零食消费不理性,应为农村地区儿童开展学校营养与食品安全教育,提高认知以促进健康成长。