Improved macronutrient composition of meals delivered to people with diabetes in hospital: a pre-post, mixed-methods observational study.

BACKGROUND: Providing meals which meet diverse needs of hospital inpatients is complex, contributing to challenges in optimising glycaemia. We developed menus that improved the appropriateness of macronutrient composition of meals for inpatients with diabetes. METHODS: Qualitative feedback from patients and healthcare professionals prompted the implementation of two new menus: 'diabetes lifestyle' and 'diabetes high energy'. Quantitative nutrition analysis of meals provided to inpatients using new menus was compared to the regular menu. Qualitative surveys were repeated after the implementation of the new menus. RESULTS: Nutrition analysis demonstrated that meals ordered from the diabetes lifestyle menu (mean energy: 7.85 MJ) comprised less total fat (71 vs. 74 vs. 64 g, p < 0.001), saturated fat (34 vs. 36 vs. 31 g, p < 0.001), carbohydrate (246 vs. 249 vs. 217 g, p < 0.001) and sugar (125 vs. 121 vs. 102 g, p < 0.001) compared to the regular (mean energy: 8.46 MJ) and diabetes high energy menus (mean energy: 8.70 MJ). Meals ordered from the diabetes lifestyle menu provided greater protein (91 g) than the regular (85 g) and diabetes high energy (88 g) menus (p < 0.001) and equivalent fibre (33 vs. 31 vs. 33 g, respectively). After implementation of the new menus, more patients reported that meals met their nutritional needs (19 [95%] vs. 14 [70%], p = 0.04), and more healthcare professionals reported menus for inpatients with diabetes were appropriate (16 [100%] vs. 11 [41%], p < 0.001). CONCLUSION: Using the diabetes lifestyle menu improved the macronutrient composition of meals for inpatients with diabetes not at risk of malnutrition.

Malnutrition is associated with poor trajectories of activities of daily living in geriatric rehabilitation inpatients: RESORT.

Malnutrition is associated with poor functional performance in geriatric rehabilitation inpatients. However, it is unclear if malnourished patients have poor functional trajectories over time. This study aimed to determine the association between (the risk of) malnutrition at admission and trajectories of Activities of Daily Living (ADL) and Instrumental ADL (IADL) from pre-admission to post-discharge in geriatric rehabilitation inpatients. An observational, longitudinal study was conducted in the REStORing health of acutely unwell adulTs (RESORT) cohort of geriatric rehabilitation inpatients. A total of 618 patients (mean age 82.1 ± 7.8 years, 57.4 % females) were included. The prevalence of the risk of malnutrition, by Malnutrition Screening Tool (MST) was 41.3 % (n = 255) and malnutrition by the Global Leadership Initiative on Malnutrition (GLIM) and European Society for Clinical Nutrition and Metabolism (ESPEN) criteria were 53.5 % (n = 331) and 13.1 % (n = 81) respectively. Malnutrition by the GLIM criteria but not the ESPEN criteria nor the risk of malnutrition, was associated with ADL trajectories of 'remained poor' (OR: 3.33, 95 %CI: 1.21-9.19) and 'deteriorated' (OR: 1.68, 95 %CI: 1.13-2.52) compared to the 'recovered' trajectory. The risk of malnutrition and malnutrition were not associated with IADL trajectories. Malnutrition at admission was associated with poor ADL trajectories but not IADL trajectories in geriatric rehabilitation inpatients.