Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

Abstract

BackgroundOlder adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study.MethodsA conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined.DiscussionThis rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake.Trial RegistrationClinicalTrials.gov ID: NCT02800291, retrospectively registered June 7, 2016.

Oral health status of long‐term care residents in Canada: Results of a national cross‐sectional study

“…This study was part of a national cross‐sectional study, Making the Most of Mealtimes (M3), examining the factors influencing food and fluid intake in long‐term care . Four provinces, Alberta, Manitoba, Ontario and New Brunswick, each contributed 8 long‐term care homes to the project.…”

“…Ethics approval was received from the University of Alberta (Pro00050002), University of Manitoba (J2014:139), University of Waterloo (ORE 20056) and Université de Moncton (1415‐022). A detailed protocol of the full M3 study has been published elsewhere and summarised below and focused on the data used in this analysis.…”

Nutritional quality of regular and pureed menus in Canadian long term care homes: an analysis of the Making the Most of Mealtimes (M3) project

“…Study sample and design M3 was a cross-sectional multi-site Canadian study; details on the primary research questions and comprehensive data collection can be found in the protocol [28]. This was a secondary study, based solely on the planned menus of the homes.…”

“…Nutrient analysis was completed using ESHA Food Processor software (Version 10.14.1) using the Canadian Nutrient File [29], where appropriate, for foods that varied in fortification practices with the United States Department of Agriculture Nutrient File [30]. A code-book was created per province to promote consistency in database choices for selected menu items [28]. A random check of menu items was completed by the first author to ensure accuracy in use of the Canadian Nutrient File for key foods among provinces; this check was especially focused for provinces that showed significant nutrient differences from others to confirm that differences in nutrient content were not a result of a provincial research assistant bias in recipe/food item selection from the database.…”

“…Further, not all commercial products, including pureed products provided a complete nutrient profile for all nutrients assessed in this study. Despite these limitations, a recipe analysis of LTC menus is an appropriate method because of the large sample size used in this study [28,39]. Use of the same software database and code-book supported consistency across the four provinces and research assistants who analyzed the menus.…”