Dataset Information

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

ABSTRACT: Background:Long term care (LTC) menus need to contain sufficient nutrients for health and pureed menus may have lower nutritional quality than regular texture menus due to processes (e.g., recipe alterations) required to modify textures. The aims of this study were to: determine adequacy of planned menus when compared to the Dietary Reference Intake (DRI); compare the energy, macronutrients, micronutrients and fibre of pureed texture and regular texture menus across LTC homes to determine any texture, home or regional level differences; and identify home characteristics associated with energy and protein differences in pureed and regular menus. Methods:Making the Most of Mealtimes (M3) is a cross-sectional multi-site study that collected data from 32 LTC homes in four Canadian provinces. This secondary analysis focused on nutrient analysis of pureed and regular texture menus for the first week of the menu cycle. A site survey captured characteristics and services of each facility, and key aspects of menu planning and food production. Bivariate analyses were used to compare menus, within a home and among and within provinces, as well as to determine if home characteristics were associated with energy and protein provision for both menus. Each menu was qualitatively compared to the DRI standards for individuals 70+ years to determine nutritional quality. Results:There were significant provincial and menu texture interactions for energy, protein, carbohydrates, fibre, and 11 of 22 micronutrients analyzed (p < 0.01). Alberta and New Brunswick had lower nutrient contents for both menu textures as compared to Manitoba and Ontario. Within each province some homes had significantly lower nutrient content for pureed menus (p < 0.01), while others did not. Fibre and nine micronutrients were below DRI recommendations for both menu textures within all four provinces; variation in nutritional quality existed among homes within each province. Several home characteristics (e.g., for-profit status) were significantly associated with higher energy and protein content of menus (p < 0.01). Conclusions:There was variability in nutritional quality of menus from LTC homes in the M3 sample. Pureed menus tended to contain lower amounts of nutrients than regular texture menus and both menus did not meet DRI recommendations for select nutrients. This study demonstrates the need for improved menu planning protocols to ensure planned diets meet nutrient requirements regardless of texture. Trial registration:ClinicalTrials.gov ID: NCT02800291, retrospectively registered June 7, 2016.

SUBMITTER: Vucea V

PROVIDER: S-EPMC7050785 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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

Vucea Vanessa V Keller Heather H HH Morrison Jill M JM Duncan Alison M AM Duizer Lisa M LM Carrier Natalie N Lengyel Christina O CO Slaughter Susan E SE

BMC nutrition 20171023

<h4>Background</h4>Long term care (LTC) menus need to contain sufficient nutrients for health and pureed menus may have lower nutritional quality than regular texture menus due to processes (e.g., recipe alterations) required to modify textures. The aims of this study were to: determine adequacy of planned menus when compared to the Dietary Reference Intake (DRI); compare the energy, macronutrients, micronutrients and fibre of pureed texture and regular texture menus across LTC homes to determin ...[more]

PMID: 32153857

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Project description:BACKGROUND:Older 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. METHODS:A 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. DISCUSSION:This 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 REGISTRATION:ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.

Project description:Research has demonstrated the importance of physical environments at mealtimes for residents in long term care (LTC). However, a lack of a standardized measurement to assess physical dining environments has resulted in inconsistent research with potentially invalid and unreliable conclusions. The development of a standardized, construct valid instrument that assesses dining rooms is imperative to systematically examine physical environments in LTC. The purpose of this study was to determine the construct validity of the new Dining Environment Audit Protocol (DEAP) tool.Secondary data collected from the Making Most of Mealtimes (M3) study was used for this analysis. Data were collected in 32 long term care homes, which included 82 dining rooms and 639 residents. A variety of resident and dining room level constructs were compared to the summative scales found on the DEAP using Spearman correlations and Student t-tests. A regression analysis identified individual characteristics assessed with DEAP that were associated with the summative scales of homelikeness and functionality.Regression analysis (p < 0.05) identified that the DEAP homelikeness scale was positively associated with a view of the garden/green space, presence of a clock and a posted menu. The functionality scale was positively associated with number of chairs and lighting, while negatively associated with furniture with rounded edges and clutter. Additionally, the functionality scale was positively associated (p < 0.05) with the Mealtime Scan physical scale (? = 0.52), the dining room Mealtime-Relational Care Checklist (M-RCC) (? = 0.25), the DEAP total score (? = 0.56), and the Mini Nutritional Assessment- Short Form (? = 0.26). Homelikeness was positively associated (p < 0.05) with the DEAP total score (? = 0.53), staff Person Directed Care score (? = 0.49) and the resident Cognitive Performance Scale (t = 2.56), while negatively associated with energy (? = -0.26) and protein intake (? = -0.24). The homelikeness and functionality scales were also associated with one another (? = 0.26).The construct validity of the DEAP was supported through significant correlations with a variety of measures that are theoretically related to the homelikeness and functionality of LTC dining rooms. This secondary analysis supports the use of the DEAP in future research to quantify the physical environment of LTC dining rooms. Protocol registered with ClinicalTrials.gov ID: NCT02800291; Registered retrospectively June 7, 2016.

Dataset Information

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

Publications

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

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