How to enhance a hospital foodservice: giving patients the gourmet treatment.
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Cooking↗
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Diet for Diabetes--new exchange lists.
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Diabetes Mellitus↗
Feeding the anorectic client: comfort foods and happy hour.
The anorectic patient presents a dilemma to the health care provider. As the patient refuses oral intake, quality of life diminishes, and health care costs increase. This article describes two approaches that have demonstrated effectiveness: comfort food and happy hour. "Comfort foods" describe foods associated with bygone years, intended to trigger recollections of pleasant childhood experiences and feelings of caring and healing. A second alternative described is the offering of a "happy hour" beverage, presented in a social milieu. These treatments are reproducible in a variety of clinical care settings and stimulate oral intake in the failure-to-thrive patient.
Aged↗
Building a case-based diet recommendation system without a knowledge engineer.
We present a new approach to the effective development of menu construction systems that allow to automatically construct a menu that is strongly tailored to the individual requirements and food preferences of a client. In hospitals and other health care institutions dietitians develop diets for clients which need to change their eating habits. Many clients have special needs in regards to their medical conditions, cultural backgrounds, or special levels of nutrient requirements for better recovery from diseases or surgery, etc. Existing computer support for this task is insufficient-many diets are not specifically tailored for the client's needs or require substantial time of a dietitian to be manually developed. Our approach is based on case-based reasoning, an artificial intelligence technique that finds increasing entry into industrial practice. Our approach goes beyond the traditional case-based reasoning (CBR) approach by allowing an incremental improvement of the system's competency during routine use of the system. The improvement of the system takes place through a direct expert user-system interaction while the expert is accomplishing their tasks of constructing a diet for a given client. Whenever the system performs unsatisfactorily, the expert will need to modify the system-produced diet 'manually', i.e. by entering the desired modifications into the system. Our implemented system, menu construction using an incremental knowledge acquisition system (MIKAS), asks the expert for simple explanations for each of the manual actions he/she takes and incorporates the explanations automatically into its knowledge base (KB) so that the system will perform these manually conducted actions automatically at the next occasion. We present MIKAS and discuss the results of our case study. While still being a prototype, the senior clinical dietitian involved in our evaluation studies judges the approach to have considerable potential to improve the daily routine of hospital dietitians as well as to improve the average quality of the dietary advice given to patients within the limited available time for dietary consultations. Our approach opens up a new avenue towards building highly specialised CBR systems in a more cost-effective way. Hence, our approach promises to allow a significantly more widespread development and practical deployment of CBR systems in a large variety of application domains including many medical applications.
Artificial Intelligence↗
Fat-sugar see-saw in school lunches: impact of a low fat intervention.
PURPOSE: To determine the long-term effects of a low fat intervention on sugar content in school lunches METHODS: We calculated contributions of total sugars, 6 specific sugars, and selected nutrients in National School Lunch Program meals served in 56 former intervention, 20 randomly selected control schools that had participated 3 years before in a low fat intervention, and 12 additional schools from neighboring school districts that had never been exposed to the intervention, whose goal was the lowering of total fat to under 30% of calories and saturated fat to under 10% calories. Analysis of variance adjusted for region was used to compare treatment groups. Pearson partial correlations controlling for the effects of region and treatment group were used to assess the strength of sugar and fat relationships. RESULTS: Three years after the low fat intervention, former intervention, control and unexposed schools lunches were similar in mean total sugars (25% of calories), and "added" sugars (e.g. sucrose, glucose, galactose, and maltose) at 15% of calories; and differed only in their lactose content. As percent of calories from fat or saturated fat in lunches decreased, that from sugars increased. Lunches that met reduced saturated fat goals were significantly higher than those not meeting goals in percent of calories from sugars both in meals as offered (27.6 +/- 0.3% vs. 26.2 +/- 0.3 SE p =.004) and as served (26.5 +/- 0.4 vs. 23.9 +/- 0.4 p =.009). Lunches meeting reduced total fat goals were significantly higher only in percent of calories from sugars as served. Seventy-five percent of total sugar in lunches offered was from chocolate milk, fruit/fruit juices, and white milk. More "added" sugar came from high micronutrient foods, such as fruit, fruit juices, and chocolate milk than from desserts and entrees. CONCLUSIONS: The existence of a fat-sugar "see-saw" makes it important to emphasize substitutions of fat and saturated fat with starches and fiber in school lunches.
Adolescent↗
Marital interactions in the process of dietary change for type 2 diabetes.
OBJECTIVE: To explore how couples adjust to dietary management of type 2 diabetes. DESIGN: Couples were interviewed, first together and then separately, during the first year after diagnosis and 1 year later. SETTING: Qualitative interviews conducted in hospital classrooms using a semistructured interview guide. PARTICIPANTS: Couples (N = 20) with a recently diagnosed spouse who met the study criteria were purposefully selected from volunteers solicited from hospital-based diabetes classes. PHENOMENON OF INTEREST: Processes used by the couple to address the prescribed diet. ANALYSIS: Thematic analysis of interview transcripts using grounded theory to identify patterns of adaptation processes used over time. RESULTS: Three couple categories emerged (cohesive, enmeshed, and disengaged), representing adaptation to the diabetic diet. Initially, 5 couples were cohesive (teamwork approach), 7 were enmeshed (nondiabetic spouse responsible for the diet; spouse was dependent), and 8 were disengaged (spouses functionally separate; spouse was solely responsible for the diet management). A year later, the majority of couples were disengaged (n = 14), 1 couple remained cohesive, and 4 couples remained enmeshed. Themes of flexibility, roles, rules, and communication varied across categories. CONCLUSIONS AND IMPLICATIONS: Understanding categories of marital adjustment to the diabetic diet may improve nutrition-based diabetes interventions. Further study is needed to verify these findings in larger and more diverse populations.
Adaptation, Psychological↗
Recipe development project using commodity food products.
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Cooking↗
Are green caterers more likely to serve healthy meals than non-green caterers? Results from a quantitative study in Danish worksite catering.
OBJECTIVE: The present study aimed to investigate whether organic conversion in catering has positive effects on the nutritional quality of menus offered. DESIGN: The methodology was based on a self-administered questionnaire. The self-declared priority given to the use of organic foods was measured as the basis for assigning catering managers to one of two groups: 'green' or 'non-green' caterers. These groups were then compared with regard to the relative nutritional quality of the menu options offered to customers. SETTING: The study was carried out among randomly selected Danish worksite catering outlets. SUBJECTS: The subjects participating in the study comprised 526 Danish worksite catering managers. RESULTS: The results showed a strong correlation between caterers' 'green-ness' and the nutritional quality of the menu options offered. Green caters had more healthy options in their menus than non-green caters, which is likely to result in improved nutritional quality of the diets of end consumers. The reason for this may partly be the increased service training efforts that green caterers practise in order to be able to implement organic foods successfully. It may also be associated with the fact that the price premiums and availability of the organic products forces caterers to serve menus with higher amounts of root and non-green leafy vegetables, pulses and seasonal vegetables. CONCLUSION: The present findings suggest that organic conversion of public canteens may be a good opportunity to promote healthier eating in public catering.
Agriculture↗
Dietary management of food allergy in children.
Currently, the only treatment for any food hypersensitivity (including food allergy) is the dietary avoidance of the causative allergen, using an elimination diet. In addition to being used for the management of food hypersensitivity, an elimination diet may also be used in the diagnosis of food allergy. Dietary exclusion should be managed by a dietitian or other health professional with nutritional expertise to ensure that the exclusion does not lead to a nutritionally-deficient diet. There are three main types of elimination diets: single-food exclusion; multiple-food exclusion; the 'few-food' diet, which requires the avoidance of a large number of allergens and therefore concentrates on the foods that can be included rather than the foods that need to be avoided. Any sort of elimination diet is hard to manage. Thus, as well as ensuring that the diet is nutritionally adequate, it is essential that families are given advice and support relevant to their circumstances to aid them in the day-to-day management of the diet, so that it remains varied and enjoyable for food-allergy sufferers. This approach involves advice about which alternative foods are available, provision of 'free-from' recipes and guidance on which nutritional supplements are needed to meet their nutritional needs.
Child↗
Controlled study of critical parent and family factors in the obesigenic environment.
OBJECTIVE: Critical gaps remain in our understanding of the obesigenic family environment. This study examines parent and family characteristics among obese youth presenting for treatment in a clinic setting. RESEARCH METHODS AND PROCEDURES: Families of 78 obese youth (BMI z-score = 2.4; age, 8 to 16 years; 59% girls; 49% African-American) were compared with 71 non-overweight (BMI z-score = -0.02) demographically matched comparisons. Parents completed measures assessing family demographics, psychological distress (Symptom Checklist 90-Revised), and family functioning both broadly (Family Environment Scale: Conflicted, Support, Control) and at mealtimes (About Your Child's Eating-Revised: Mealtime Challenges, Positive Mealtime Interaction). Height and weight were obtained from all participants. RESULTS: Compared with mothers and fathers of non-overweight youth, parents of obese youth had significantly higher BMIs (p < 0.001). Mothers of obese youth reported significantly greater psychological distress (p < 0.01), higher family conflict (p < 0.05), and more mealtime challenges (p < 0.01). Less positive family mealtime interactions were reported by both mothers (p < 0.01) and fathers (p < 0.05) of obese youth. These group differences did not vary by child sex or race. Logistic regression analyses indicated that maternal distress and mealtime challenges discriminated between obese and non-overweight youth after controlling for maternal BMI. Family conflict was explained, in part, by maternal distress. DISCUSSION: Obese youth who present for treatment in a clinic setting are characterized by psychosocial factors at the parent and family level that differ from non-overweight youth. These data are critical because they identify factors that may be serving as barriers to a family's or youth's ability to implement healthy lifestyle behaviors but that are potentially modifiable.
Adolescent↗
Do recommendations for institutional food service result in better food service? A study of compliance in Danish hospitals and nursing homes from 1995 to 2002-2003.
BACKGROUND: Since 1995, significant efforts by authorities and researchers have been directed towards addressing the nutritional problems in Danish hospitals and nursing homes. AIM: The purpose of this study was to investigate whether the increased focus on nutritional problems in patients and nursing home residents has resulted in measurable progress. DESIGN: A questionnaire-based study was carried out among foodservice managers in Danish hospitals (n=96) and nursing homes (n=898) in 1995 and 2002/3 (n=90) and (n=682), respectively. The study used compliance with selected issues in the official Danish recommendations for institutional food service as an indicator for progress. The issues included: using nutrient calculated recipes/menus, offering menu choice options, using feedback routines on acceptability of menus, maintaining nutritional steering committees, employing food and nutrition contact persons, employing official recommendations and offering choice between three different menu energy levels. RESULTS: Hospitals had a higher compliance compared to nursing homes. In 1995, this was the case for all questions asked and differences were statistically significant. Also in 2002/3, hospitals had a higher compliance, except in the case of established feedback routines. Differences were statistically significant. The results indicate that nutritional care is higher on the agenda in hospital, than in nursing homes. However, very little progress can be seen in compliance when results are analysed over the 8-year period. The only progress for nursing homes was that more homes had implemented feedback routines on acceptability of food service in 2002/3 than in 1995. The difference was statistically significant. For hospitals, however, no progress was found between 1995 and 2002/3. CONCLUSION: The attempts to improve the nutritional status of hospital patients and nursing home residents seem to have failed. Still, the initiatives taken to improve the situation seem relevant. Especially the nursing homes might benefit from advantage of these experiences.
Denmark↗
Energy and nutrient intake of patients in acute care.
There have been numerous reports that the nutritional intake of many hospitalized patients is sub-optimal, but there is little published information about patients' diets in Australian hospitals. In this study, the nutritional intake of patients in general medical wards of an Australian acute care hospital was assessed. Although the hospital diet can provide adequate energy and nutrients, many patients may not consume sufficient food to meet their needs. The estimated energy intake of about one-third of patients was very low, and vitamin C, calcium and zinc intakes were also of concern. The implications are discussed and recommendations for improved nutritional care are suggested.
Acute Disease↗
Individually adjusted meals for older people with protein-energy malnutrition: a single-case study.
The objective of this study was to investigate the effect of a 3-month intervention programme consisting of meals based on individual nutritional requirements in residents assessed as protein-energy malnourished on admission to a municipal care Institution. Using a single-case design, 11 malnourished residents were given individual care aimed at fulfilling their personal requirements for energy intake during a period of 12 weeks. The residents were selected from a sample of 261 newly admitted older adults of whom 87 were assessed to be malnourished on admission. Nutritional status, including anthropometric and biochemical variables and functional capacities were assessed before, during, and after the intervention. Energy intake was recorded every day. Body weight, and serum concentration of albumin and transthyretin were measured every other week. During a 3-month period, the mean value of energy intake reached the calculated energy requirement in 10 residents. Eight residents increased in weight, triceps skin-fold thickness, and transthyretin concentration. Nine residents increased in arm muscle circumference, and 10 showed increased serum albumin concentration and functional capacity. We conclude that nursing care based on individual nutritional requirements, resources, and desires improves nutritional status and functional capacity in a group of malnourished residents.
Activities of Daily Living↗
An audit of nutritional care delivered to elderly inpatients in community hospitals.
BACKGROUND: There is continuing concern over the lack of attention to the nutritional needs of older people in hospitals. A 2-year audit project was undertaken to examine the nutritional care of inpatients in Leicestershire Community Hospitals. METHOD: The methods used included analysis of menu cycles; observation of meal and drink provision, wastage, supplement usage and portion sizes; and patient satisfaction questionnaire examination. RESULTS: Patient menus were nutritionally inadequate for energy, fibre and vitamin D, and protein levels were variable. The percentage of meal wastage and inadequate portion sizes were of concern. Patient satisfaction results were overall positive. CONCLUSION: Patient energy intakes are a major concern with low calorie provision from menus exacerbated by a deficit in recommended portion sizes and a high percentage of meal wastage. Routine audits need to be implemented to monitor both portion size and meal wastage, and to address patient satisfaction issues to improve the overall intakes of patients. Multidisciplinary team input is required to address the above issues and additional recommendations to promote nutrition as a key component in clinical care.
Aged↗
Trend to better nutrition on Australian hospital menus 1986-2001 and the impact of cook-chill food service systems.
OBJECTIVE: To assess trends in the nutritional quality of hospital menus and examine differences between menus used in hospitals with cook-chill or cook-fresh food services. DESIGN: Standard patient menus were analysed against 28 criteria to assess nutritional standards and compared with results from similar studies in 1986 and 1993. SETTING: Menus were collected from 80 hospitals in New South Wales (NSW), Australia, including 36 using cook-chill food service systems. STATISTICAL ANALYSIS: Chi-squared analysis was used to assess differences between the proportions of hospitals meeting the criteria in 1993 and 2001, and between different types of hospitals. RESULTS: In 2001, compared with 1993, significantly many hospitals offered more than one hot choice at the evening meal, more menus highlighted low fat items and more calcium-rich foods were available. More than 90% of hospitals allowed patients to select their own menu, offered wholemeal breads and high-fibre breakfast cereals, fresh fruit, polyunsaturated margarine, a milk dessert at least once a day and two or more hot options at the midday meal. Hospitals with cook-chill food services had menus that were more likely to meet nutritional recommendations, although they were less likely to offer a choice of serving size. A high proportion of unpopular choices were offered in menus, especially meat dishes and desserts. APPLICATIONS/CONCLUSION: Since 1986, NSW hospital menus have improved to offer choices that conform better to dietary guidelines. Cook-chill food services may have positive and negative impacts on meal choices. The assessment criteria are useful in hospitals to assess their menus.
Australia↗
Patient education. Food lists for patients with kidney disease.
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Diet↗