title: Improving the dietary intake of under nourished older people in residential care homes using an energy-enriching food approach: a cluster randomised controlled study.
abstract: BACKGROUND
  To examine whether the nutritional status of aged undernourished residents in care could be improved through dietary modification to increase energy intake but not portion size.
  
  
  METHODS
  A 12-week cluster randomised controlled trial was carried out in 21 residential care homes. Participants comprised undernourished residents with a body mass index (BMI) <18.5 kg m(-2) . All menus were analysed to evaluate nutrient provision. Energy and macronutrient intakes of undernourished residents were estimated using 3-day weighed food intake diaries. Those resident in homes randomised to intervention had their usual meals enriched with energy-dense foods to a maximum of +1673 kJ day(-1) .
  
  
  RESULTS
  Of 445 residents screened, 41 (9%) had a BMI <18.5 kg m(-2) and entered the study. Despite adequate food provision, energy and macronutrient intakes were below UK dietary reference values. Mean (SEM) energy intake increased [+556 (372) kJ, P = 0.154] in residents allocated to intervention but fell in those residents in 'control homes' receiving usual care [-151 (351) kJ, P = 0.676]. Weight change [+1.3 (0.53) kg, P = 0.03] was seen in intervention residents but not in controls [-0.2 (1.5) kg, P = 0.536]. Between-group differences for changes in weight and energy intake were not significant (P = 0.08 and 0.20, respectively). Six residents allocated to the intervention increased their BMI >18.5 kg m(-2) (P = 0.018).
  
  
  CONCLUSIONS
  Achieving weight gain in frail older people is difficult. These results suggest that enriching food could help address undernutrition and slow chronic weight loss. Interventions of a longer duration are needed to confirm or exclude the value of food enrichment.
authors.affiliation: Life-course, Nutrition and Health, Centre for Population Health, University of Glasgow, Glasgow, UK.
authors.forename: W S
authors.initials: WS
authors.lastname: Leslie
authors.forename: M
authors.initials: M
authors.lastname: Woodward
authors.forename: M E J
authors.initials: ME
authors.lastname: Lean
authors.forename: H
authors.initials: H
authors.lastname: Theobald
authors.forename: L
authors.initials: L
authors.lastname: Watson
authors.forename: C R
authors.initials: CR
authors.lastname: Hankey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005527:Food, Fortified; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy*; D009735:Nursing Homes; D015596:Nutrition Assessment; D009752:Nutritional Status; D064787:Portion Size; D012016:Reference Values; D012112:Residential Facilities; D006113:United Kingdom; D015430:Weight Gain