Micronutrient Food Fortification for Residential Care: A Scoping Review of Current Interventions

Lam, Ivy T.Y.; Keller, Heather; Pfisterer, Kaylen J.; Duizer, Lisa; Duncan, Alison

doi:10.1016/j.jamda.2016.03.010

Cited by 15 publications

(22 citation statements)

References 50 publications

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“…Literature about food fortification with micronutrients was recently summarized in a scoping review for residential care [118] but evidence is presently insufficient to derive specific recommendations in this regard.…”

Section: Commentarymentioning

confidence: 99%

ESPEN guideline on clinical nutrition and hydration in geriatrics

et al. 2019

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Section: Commentarymentioning

confidence: 99%

ESPEN guideline on clinical nutrition and hydration in geriatrics

et al. 2019

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“…Given the ongoing high rates of malnutrition in Australian RACFs and potentially improved awareness of the issue despite an increased supplement spend, we are clearly not solving the expensive problem of malnutrition . 5 While increasing choice and food quality appears a logical strategy and the benefits of the 'food first' approach have been documented, [24][25][26] this study demonstrates that 'let fresh food be thy medicine' is perhaps not the adage currently followed in the Australian aged care industry. [24][25][26] Increasing the aged care profit margin by reducing food spend impacts the quality of resident care and can contribute to malnutrition rates in aged care.…”

Section: Discussionmentioning

confidence: 85%

“…5 While increasing choice and food quality appears a logical strategy and the benefits of the 'food first' approach have been documented, [24][25][26] this study demonstrates that 'let fresh food be thy medicine' is perhaps not the adage currently followed in the Australian aged care industry. [24][25][26] Increasing the aged care profit margin by reducing food spend impacts the quality of resident care and can contribute to malnutrition rates in aged care. A recent study completed by the authors (Hugo, Isenring) has demonstrated a reversal of trends in supplement use, and an increase in food-first strategies has not only led to improved quality of life measures for aged care residents but improvements in weight and overall nutritional status and with savings in terms of food budgets (unpublished data).…”

Section: Discussionmentioning

confidence: 85%

What does it cost to feed aged care residents in Australia?

Hugo

Isenring

Sinclair³

et al. 2017

Nutrition & Dietetics

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Aim: Funding cuts to the aged care industry impact catering budgets and aged care staffing levels, which may in turn affect the nutritional status of aged care residents. This paper reports average food expenditure and trends in Australian residential aged care facilities (RACFs). Methods: This is a retrospective study collecting RACFs' economic outlay data through a quarterly online survey conducted over the 2015 and 2016 financial years. Results: Data were compiled from 817 RACFs, representing 64 256 residential beds and 23 million bed-days Australia-wide. The average total spend in Australian Dollars (AUD) on catering consumables (including cutlery/ crockery, supplements, paper goods) was $8.00 per resident per day (prpd) and $6.08 prpd when looking at the raw food and ingredients budget alone. Additional data from over half the RACFs (n = 456, 56%) indicate a 5% decrease in food cost ($0.31 prpd) in the last year, particularly in fresh produce, with a simultaneous 128% ($0.50 prpd) increase in cost for supplements and food replacements. Current figures are comparatively less than aged care food budgets internationally (US, UK and Canada), less than community-dwelling older adults ($17.25 prpd) and 136% less than Australian corrective services ($8.25 prpd). Conclusions: The current spend on food in RACFs has decreased compared with previous years, reflecting an increasing reliance on supplements, and is significantly less than current community food spend.

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“…The new Guide does not specify servings to be consumed per day and as a result the Dietary Reference Intake is recommended for menu development to avoid micronutrient deficiency [45]. Enhancement of the diet for protein and energy are relatively common practices in LTC [46], but micronutrient enhancement or fortification has been nominally studied or used in practice [46,47]. Development of enhanced recipes that go beyond energy and protein are needed to support improved nutritional status of residents.…”

Section: Discussionmentioning

confidence: 99%

Diet quality is associated with malnutrition and low calf circumference in Canadian long-term care residents

et al. 2019

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Background: Older adults living in long-term care (LTC) are nutritionally vulnerable. The purpose of this study was to determine diet quality of Canadian LTC residents and its association with malnutrition and low calf circumference. Methods: A cross-sectional study was undertaken in 32 LTC homes across four Canadian provinces. Nutrient adequacy ratios (NARs) were calculated for seventeen nutrients; mean adequacy ratio (MAR) was calculated to describe overall diet quality. Malnutrition risk was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF) and diagnosis of protein/energy malnutrition with the Patient-Generated Subjective Global Assessment (PG-SGA). Calf circumference (CC) was also assessed. Linear and logistic regressions for these outcomes with diet quality as the predictor were conducted adjusting for covariates. Results: Average MNA-SF score was 10.7 ± 2.5. Residents (43.5%) had mild/moderate to severe malnutrition based on the PG-SGA and 32.6% had a CC of < 31 cm. Mean MAR score was 0.79 ± 0.09 with significant differences between those requiring eating assistance (0.77 ± 0.11) and those that did not require assistance (0.80 ± 0.07) (p < .05). MAR score was significantly associated with malnutrition in fully adjusted models: MNA-SF scores [β = 5.34, 95% Confidence interval (CI) (2.81, 7.85)] and PG-SGA [Odds ratio (OR) = 0.49, 95% CI (0.38, 0.64)]. Those who had better diet quality were more likely to be well nourished or not at risk. Although several individual nutrients were associated with low CC (< 31 cm), there was no association between overall diet quality (MAR) and low CC. Conclusions: Diet quality is associated with malnutrition and individual nutrients (NARs) with a low CC. In addition to calories and protein, nutrient dense diets that promote adequate micronutrient intake are required in LTC.

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Micronutrient Food Fortification for Residential Care: A Scoping Review of Current Interventions

Cited by 15 publications

References 50 publications

ESPEN guideline on clinical nutrition and hydration in geriatrics

ESPEN guideline on clinical nutrition and hydration in geriatrics

What does it cost to feed aged care residents in Australia?

Diet quality is associated with malnutrition and low calf circumference in Canadian long-term care residents

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