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

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.Canadian Institutes of Health Research (CIHR) , The PI is an endowed research chair with the Schlegel-University of Waterloo Research Institute for Aging; half of her salary is provided by this non-profit organizatio

Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.jamda.2017.05.003 © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Poor food intake is known to lead to malnutrition in long-term care homes (LTCH), yet multilevel determinants of food intake are not fully understood, hampering development of interventions that can maintain the nutritional status of residents. This study measures energy and protein intake of LTCH residents, describes prevalence of diverse covariates, and the association of covariates with food intake. Multisite cross-sectional study. Thirty-two nursing homes from 4 provinces in Canada. From a sample of 639 residents (20 randomly selected per home), 628 with complete data were included in analyses. Three days of weighed food intake (main plate, estimated beverages and side dishes, snacks) were completed to measure energy and protein intake. Health records were reviewed for diagnoses, medications, and diet prescription. Mini-Nutritional Assessment-SF was used to determine nutritional risk. Oral health and dysphagia risk were assessed with standardized protocols. The Edinburgh-Feeding Questionnaire (Ed-FED) was used to identify eating challenges; mealtime interactions with staff were assessed with the Mealtime Relational Care Checklist. Mealtime observations recorded duration of meals and assistance received. Dining environments were assessed for physical features using the Dining Environment Audit Protocol, and the Mealtime Scan was used to record mealtime experience and ambiance. Staff completed the Person Directed Care questionnaire, and managers completed a survey describing features of the home and food services. Hierarchical multivariate regression determined predictors of energy and protein intake adjusted for other covariates. Average age of participants was 86.3 ± 7.8 years and 69% were female. Median energy intake was 1571.9 ± 411.93 kcal and protein 58.4 ± 18.02 g/d. There was a significant interaction between being prescribed a pureed/liquidized diet and eating challenges for energy intake. Age, number of eating challenges, pureed/liquidized diet, and sometimes requiring eating assistance were negatively associated with energy and protein intake. Being male, a higher Mini-Nutritional Assessment–Short Form score, often requiring eating assistance, and being on a dementia care unit were positively associated with energy and protein intake. Energy intake alone was negatively associated with homelikeness scores but positively associated with person-centered care practices, whereas protein intake was positively associated with more dietitian time. This is the first study to consider resident, unit, staff, and home variables that are associated with food intake. Findings indicate that interventions focused on pureed food, restorative dining, eating assistance, and person-centered care practices may support improved food intake and should be the target for further research.Canadian Institutes for Health Research || 201403MOP-326892-NUT-CENA-2546

Physiological measures related to crispness perception of extruded snacks : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Food Technology at Massey University, Albany, New Zealand

Published research for understanding crispness perception has relied on correlations of sensory results to objective measurements. This research was undertaken to evaluate the contribution of physiological responses to the perception of crispness of corn based puffed snacks. Predictive models published in literature relate crispness perception to instrumental force and sounds produced during biting and compression. These models were used as the basis for this research. Air-conducted and bone-conducted sounds were measured using both consumer and trained panelists. A novel analysis technique, fractal analysis, was used to analyse the jagged sound wave patterns produced during biting into extruded snacks. A specialised bite force apparatus was designed for measuring bite forces produced by the incisors. All physiological results were then related to panelists' perception of crispness. To minimise sample variability, extruded snack samples were prepared and used throughout the entire trial. A range of crispness levels were achieved by equilibrating the extrudates over various water activities. Consumer panelists and trained panelists consistently agreed on the relative crispness of the extruded snacks. Air-conducted sounds and bite force showed significant correlations with crispness, while bone-conducted sounds did not. Bite force measures were also shown to relate to instrumental measures of force. For statistical validity, the physiological data from the 39 consumers were used to develop predictive equations for crispness. Analysis of the data showed no significant correlation between the physiological data and crispness. Therefore, it was not possible to develop a predictive equation for crispness based on the physiological measures collected from consumers. While there are reports linking crispness to various instrumental measures, this is the first time in-vivo physiological measures have been collected from a large group of individuals for development of statistically viable models for crispness. The lack of a relationship between crispness and physiological measures indicates that crispness perception across consumers is complex and not adequately explained by bite force and sounds alone

Characterizing the Dynamic Textural Properties of Hydrocolloids in Pureed Foods—A Comparison Between TDS and TCATA

Pureed foods, a compensatory diet for dysphagia, require the incorporation of hydrocolloids in order to be swallowed safely. The effect of hydrocolloid addition on textural dynamics of pureed foods has not yet been investigated. Starch and xanthan were added to levels that allowed products to meet the criteria of the International Dysphagia Diet Standardization Initiative. Nine pureed carrot matrices made with two concentrations of starch, xanthan, and their blends were characterized for textural evolution using two dynamic sensory techniques: Temporal Dominance of Sensations (TDS) and Temporal Check-All-That-Apply (TCATA). Each test, with four replications, was conducted with 16 panelists. Results indicate that purees were divided into two groups based on sensory responses−−grainy and smooth were the primary differentiating attributes for these two groups. Grainy was associated with starch-added samples, while samples with xanthan (alone and in blends) were smooth and slippery. For both groups, thickness was perceived during the first half of processing, adhesiveness in the second half of oral processing, and mouthcoating was perceived toward the end of processing. A comparison of results from these tests showed that both TDS and TCATA gave similar information about texture dynamics and product differentiation of pureed foods

Smell and taste recognition in early stages of late-onset Alzheimer’s disease

Problems of inadequate nutrition and energy intake are common in the aging population. Smell and taste deficits associated with Late-Onset Alzheimer’s Disease (LOAD) may accentuate the decline in nutritional status of elderly individuals and indirectly enhance progression of cognitive problems in LOAD. The objective of this study was to explore and characterize smell and taste recognition abilities in early stages of LOAD, beyond that of normal healthy aging. A total of 29 healthy-younger subjects aged 18-40 (HY), 13 healthy-elderly (HA) and six elderly adults diagnosed with LOAD (AD) aged 60-85, were recruited from the Guelph community. The Sniffin’ Sticks Screening Test (SSST) and Taste Strips were used to test olfactory and gustatory functions, respectively. Participants also completed the mini-mental state examination (MMSE), clock test and word recall tests to assess cognitive/memory skills. Compared to HA individuals, people with AD had significant odour recognition impairment. Correlation analysis also revealed an age-associated decline in overall taste ability. When specific tastes were examined, impairments in sour and bitter identification were observed with increasing age. However, no significant differences in specific taste abilities were found between HA and AD individuals. In predicting health status (ie. presence or absence of LOAD), an assessment of all variables in this study was conducted using Generalized Linear Model (GLM). Results showed that sweet recognition and clock test scores were the best predictive variables of health status. However, this is a preliminary model that needs refinement through further research using more individuals

Sensory Perception and Food-Evoked Emotions of Older Adults Assessing Microwave-Processed Meals with Different Salt Concentrations

This study employed a home-use test to explore the sensory perception and evoked emotions of older adults in the assessment of chicken pasta meals with different salt concentrations. Ready-to-eat (RTE) meals with three salt levels (100%, 75%, and 50%) and two treatments—with and without added herbs—were tested. Multiple sensory attributes and overall meal liking were evaluated by participants (n = 54; 60–86 years of age) with hedonic and just-about-right scores. Twenty-five food-evoked emotions were also tested. Sensory results suggested a 50% salt reduction is possible with minimal impact on the overall liking, while a 25% salt reduction did not affect the saltiness and flavor liking of the meals. Herb addition positively impacted the aroma, flavor, and spiciness liking of the meals. The emotions that differed (p < 0.05) among meals were active, aggressive, bored, calm, happy, and wild, with the meals with herbs added eliciting more positive emotions. A questionnaire elicited information about participants’ interest in healthy eating, food technology neophobia, and picky behaviors to determine the influence of these factors on participants’ salt consumption habits. Sensory acceptance data combined with questionnaires explored what influenced this group of older adults in their acceptance of and interest in RTE meals

Nutrition in Disguise: Effects of Food Neophobia, Healthy Eating Interests and Provision of Health Information on Liking and Perceptions of Nutrient-Dense Foods in Older Adults

Older adults (60+ years) are at higher risk of malnutrition. Improving the nutrient-density of their diets is important but presents challenges due to the introduction of new ingredients, liking implications and heterogeneity of older consumers. Ten nutrient-enhanced foods were evaluated for liking (9-point hedonic scale) and sensory perception (check-all-that-apply) by 71 older adults. Three foods were re-evaluated after participants were provided with information about their healthy ingredients and benefits. Participants were also segmented based on their degrees of food neophobia and interests in healthy eating, using questionnaires. The results showed that eight foods had adequate sensory appeal (overall hedonic score of &ge;6) to be pursued for residential care menus. Segmentation based on food neophobia and healthy eating interests did not yield any meaningful differences between groups. The effect of health information on liking for the overall sample and subgroups was product-specific: liking scores only increased for the raspberry banana smoothie in the overall test population and higher healthy eating interest subgroup. Health information may lead to the experience of more positive attributes in some foods. Overall, eight foods that were tested could be accepted by a wide range of consumers and providing them with health information may further improve acceptance

Change in color and volatile composition of skim milk processed with pulsed electric field and microfiltration treatments or heat pasteurization

Non-thermal processing methods, such as pulsed electric field (PEF) and tangential-flow microfiltration (TFMF), are emerging processing technologies that can minimize the deleterious effects of high temperature short time (HTST) pasteurization on quality attributes of skim milk. The present study investigates the impact of PEF and TFMF, alone or in combination, on color and volatile compounds in skim milk. PEF was applied at 28 or 40 kV/cm for 1122 to 2805 µs, while microfiltration (MF) was conducted using membranes with three pore sizes (lab-scale 0.65 and 1.2 µm TFMF, and pilot-scale 1.4 µm MF). HTST control treatments were applied at 75 or 95 °C for 20 and 45 s, respectively. Noticeable color changes were observed with the 0.65 µm TFMF treatment. No significant color changes were observed in PEF-treated, 1.2 µm TFMF-treated, HTST-treated, and 1.4 µm MF-treated skim milk (p ≥ 0.05) but the total color difference indicated better color retention with non-thermal preservation. The latter did not affect raw skim milk volatiles significantly after single or combined processing (p ≥ 0.05), but HTST caused considerable changes in their composition, including ketones, free fatty acids, hydrocarbons, and sulfur compounds (p &lt; 0.05). The findings indicate that for the particular thermal and non-thermal treatments selected for this study, better retention of skim milk color and flavor components were obtained for the non-thermal treatments

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

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 &lt; 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 &lt; 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 &lt; 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