title: 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.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.
authors.affiliation: Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada. hkeller@uwaterloo.ca.
authors.forename: Heather H
authors.initials: HH
authors.lastname: Keller
authors.affiliation: École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB E1A 3E9, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Carrier
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, T6G 1C9, AB, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Slaughter
authors.affiliation: Faculty of Agricultural & Food, Sciences, University of Manitoba, 405 Human Ecology Building, Winnipeg, MB R3T 2N2, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Lengyel
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, #12-101, Toronto, M5G 2A2, ON, Canada.|Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada.
authors.forename: Catriona M
authors.initials: CM
authors.lastname: Steele
authors.affiliation: Department of Food Science, University of Guelph, Guelph, ON N1G 2W1, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Duizer
authors.affiliation: Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
authors.forename: K Steve
authors.initials: KS
authors.lastname: Brown
authors.affiliation: Department of Gerontology, Simon Fraser University, 2800-515 W. Hastings St, Vancouver, BC, V6B 5K3, Canada.
authors.forename: Habib
authors.initials: H
authors.lastname: Chaudhury
authors.affiliation: School of Dentistry, University of Alberta, 5-575, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
authors.forename: Minn N
authors.initials: MN
authors.lastname: Yoon
authors.affiliation: Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, N1G 2W1, Canada.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Duncan
authors.affiliation: Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada.|Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, #12-101, Toronto, M5G 2A2, ON, Canada.|Conestoga College, School of Health Sciences and Community Services, Kitchener, ON, N2G 4M4, Canada.
authors.forename: Veronique M
authors.initials: VM
authors.lastname: Boscart
authors.affiliation: Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Heckman
authors.affiliation: École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB E1A 3E9, Canada.
authors.forename: Lita
authors.initials: L
authors.lastname: Villalon
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004326:Drinking / Q000502:physiology; D004435:Eating / Q000502:physiology* / Q000523:psychology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D062407:Meals / Q000502:physiology* / Q000523:psychology; D009735:Nursing Homes; D009752:Nutritional Status / Q000502:physiology*; D010865:Pilot Projects; D011795:Surveys and Questionnaires
keywords: Determinants; Dietary reference intake; Food intake; Long term care homes