None listed
Conditions
Brief summary
Malnutrition is a condition with negative implications affecting a substantial number of patients in healthcare facilities across Australia. It develops as a result of inadequate food intake, occurring due to factors associated with disease, illness and ageing and is often exacerbated by aspects of the hospital environment such as food provision. Preliminary data collected from subacute care inpatients (rehabilitation and Geriatric Evaluation and Management (GEM)) underpins this intervention trial. This research found that the 30% of patients were malnourished on admission and that overall, patients lost weight and muscle mass, demonstrating a decline in their nutritional status during inpatient stay. Additionally, less than 15% of patients consumed sufficient food or drink to provide 100% of their energy requirements and only half of all patients met 75% of their requirements. Well-nourished and malnourished patients alike experienced inadequate intake and nutritional decline. These data strongly suggest the need for more effective interventions to lower the risk of progression of malnutrition in healthcare facilities. Modifying or enhancing the nutritional value of food or drink or increasing the provision of items at meals and mid meals in hospital may be an approach that is more palatable and satisfying for patients and economically beneficial, compared to the provision of oral nutrition supplement drinks which are used widely in practice. There is some evidence from a handful of studies conducted across a range of healthcare settings that food based approaches result in greater dietary intake and patient centred outcomes, but there is a lack of evidence on clinical and functional benefits and cost. Additionally, previously high quality studies are lacking. The aim of this research is to implement a novel food service model to determine the effect of a nourishing menu compared to a usual menu on nutritional and clinical outcomes, patient satisfaction and cost among malnourished and well-nourished adult sub-acute care patients. This research will test the null hypotheses that there is no difference in weight change and cost of delivery between the intervention and the control. It is anticipated that the findings of this research, including data on cost of food service interventions, will have clinical relevance for the operation of the food service systems and dietetic practice.
Interventions
The intervention is a novel food service model comprising of a nourishing hospital menu that includes food and beverage meal items and mid meal snacks with a higher nutrient density than those provided on the standard menu. The nourishing menu will be developed to provide an additional 2mJ per day at minimum, consistent with the energy content of oral nutritional supplements provided frequently to treat or prevent malnutrition part of standard care. Key aspects of the nourishing menu include li
The intervention is a novel food service model comprising of a nourishing hospital menu that includes food and beverage meal items and mid meal snacks with a higher nutrient density than those provided on the standard menu. The nourishing menu will be developed to provide an additional 2mJ per day at minimum, consistent with the energy content of oral nutritional supplements provided frequently to treat or prevent malnutrition part of standard care. Key aspects of the nourishing menu include limiting low energy dense menu options such as broth, tea, coffee, replacing standard soups and desserts with higher energy dense options (e.g. cream, meat or legume based soups; dairy based desserts), providing higher energy dense mid meal snacks and fluids to all patients (e.g. cakes, scones, chocolate biscuits, hot chocolate). Participants in the intervention group will receive the nourishing menu in place of the standard menu for the duration of their inpatient stay. Participants in the intervention group will receive nursing, medical and allied health care, including dietetic services, as usual. Dietetic care related to malnutrition or malnutrition risk may involve standardised provision of oral nutritional supplements, dietary advice, education or other strategies, as appropriate.
Sponsors
Dr Judi Porter
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adult patients admitted to the GEM ward at a single hospital in metropolitan Melbourne will be eligible for inclusion. Inclusion will not be limited by provision of consent as ethical approval was granted to conduct this research under a waiver of consent.
Exclusion criteria
1. Patients not receiving oral nutrition (e.g. solely enteral or parenteral nutrition) 2. Patients receiving only palliative care 3. Patients with significant food allergies or intolerances which cannot be catered for with the nourishing menu 4. Patients receiving texture modified food or fluid which cannot be catered for with the nourishing menu 5. Patients with other dietary restrictions which cannot be catered for with the nourishing menu 6. Patients with weight loss as a documented rehabilitation goal
Outcome results
None listed