Impact of serving method on the consumption of nutritional supplement drinks: randomized trial in older adults with cognitive impairment.

AIM: To analyse the influence of serving method on compliance and consumption of nutritional supplement drinks in older adults with cognitive impairment. BACKGROUND: Oral nutritional supplement drinks have positive benefits on increasing nutritional status in undernourished older people leading to weight gain. However, consumption of these drinks is low and therefore limits their effectiveness. DESIGN: This study was a non-blind randomized control trial where participants either consumed nutritional supplement drinks in a glass/beaker or consumed them through a straw inserted directly into the container. METHOD: Participants with long-standing cognitive impairment were recruited from nursing homes (n = 31) and hospitals (n = 14). Participants were randomized to serving method. Nursing and care staff were instructed to give the supplement drinks three times per day on alternate days over a week by the allocated serving method. The researcher weighed the amount of supplement drink remaining after consumption. Data were collected over 12 months in 2011-2012. RESULTS: Forty-five people participated in this study, mean age 86·7 (sd 7·5) years. After randomization, there was no significant difference between the baseline characteristics of the two groups. Participants randomized to consume nutritional drinks from a glass/beaker drank statistically significantly more than those who consumed them via a straw inserted directly into the container. However, supplements allocated to be given in a glass/beaker were more frequently omitted. CONCLUSION: Nutritional supplement drinks should be given to people with dementia who are able to feed themselves in a glass or a beaker if staffing resources allow (NIHR CSP ref 31101).

The effect of macro- and micro-nutrient fortification of biscuits on their sensory properties and on hedonic liking of older people.

BACKGROUND: Under-nutrition in older adults is widespread. Oral nutritional supplement beverages (ONS) are prescribed, yet consumption by older people is often insufficient. A variety of supplement formats may improve nutrient intake. This study developed protein and micro-nutrient fortified biscuits and evaluated their sensory attributes and liking by older people. Two micro-nutrient strategies were taken, to match typical ONS and to customise to the needs of older people. RESULTS: Oat biscuits and gluten-free biscuits developed contained over 12% protein and over 460 kcal 100 g(-1). Two small (40 g) biscuits developed to match ONS provided approximately 40% of an ONS portion of micro-nutrients and 60% of macro-nutrients; however, the portion size was considered realistic whereas the average ONS portion (200 mL) is excessive. Biscuits developed to the needs of older adults provided, on average, 18% of the reference nutrient intake of targeted micro-nutrients. Sensory characteristics were similar between biscuits with and without micro-nutrient fortification, leading to no differences in liking. Fortified oat biscuits were less liked than commercial oat biscuits, partly attributed to flavour imparted by whey protein fortification. CONCLUSION: Macro- and micro-nutrient fortification of biscuits could provide an alternative fortified snack to help alleviate malnutrition in older adults.

The effect of nutrient fortification of sauces on product stability, sensory properties, and subsequent liking by older adults.

There are potential nutritional and sensory benefits of adding sauces to hospital meals. The aim of this study was to develop nutrient fortified sauces with acceptable sensory properties suitable for older people at risk of undernutrition. Tomato, gravy, and white sauce were fortified with macro- and micronutrients using food ingredients rich in energy and protein as well as vitamin and mineral premixes. Sensory profile was assessed by a trained panel. Hedonic liking of fortified compared with standard sauces was evaluated by healthy older volunteers. The fortified sauces had higher nutritional value than the conventional ones, for example the energy content of the fortified tomato, white sauce, and gravy formulations were increased between 2.5- and 4-fold compared to their control formulations. Healthy older consumers preferred the fortified tomato sauce compared with unfortified. There were no significant differences in liking between the fortified and standard option for gravy. There were limitations in the extent of fortification with protein, potassium, and magnesium, as excessive inclusion resulted in bitterness, undesired flavors, or textural issues. This was particularly marked in the white sauce to the extent that their sensory characteristics were not sufficiently optimized for hedonic testing. It is proposed that the development of fortified sauces is a simple approach to improving energy intake for hospitalized older people, both through the nutrient composition of the sauce itself and due to the benefits of increasing sensorial taste and lubrication in the mouth.

Use of nutritional complete supplements in older adults with dementia: systematic review and meta-analysis of clinical outcomes.

BACKGROUND & AIMS: Malnutrition is prevalent in people diagnosed with dementia however ensuring adequate oral intake within this group is often problematic. It is important to determine whether providing nutritionally complete oral nutritional supplements (ONS) drinks is an effective way of improving clinical outcomes for older people with dementia. This paper systematically reviewed clinical, wellbeing and nutritional outcomes in people with long-term cognitive impairment. METHODS: The CINAHL, Medline and EMBASE databases were searched from their inception until January 2012. Reference lists of the included papers, foreign language papers and review articles obtained were manually searched. RESULTS: Twelve articles were included in the review containing 1076 people in the supplement groups (intervention) and 748 people in the control groups. Meta-analysis shows there was a significant improvement in weight (p = <0.0001), Body Mass Index (BMI) (p = <0.0001) and cognition at 6.5 ± 3.9 month follow-up (p = 0.002) when supplements were given compared to the control group. CONCLUSIONS: Providing ONS drinks has a positive effect on weight gain and cognition at follow-up in older people with dementia. Additional research is required in both comparing nutritional supplements to vitamin/mineral tablets and high protein/calorie shots and clinical outcomes relevant to people with dementia.

Ageing and taste.

Taste perception has been studied frequently in young and older adult groups. This paper systematically reviews these studies to determine the effect of ageing on taste perception and establish the reported extent of sensory decline. Five databases were searched from 1900 to April 2012. Articles relating to healthy ageing in human subjects were included, reviewed and rated (Downs and Black scoring system). Sixty-nine studies investigated the effect of ageing on taste perception; forty examined detection thresholds of which twenty-three provided sufficient data for meta-analysis, eighteen reported identification thresholds and twenty-five considered supra-threshold intensity perception. Researchers investigating detection thresholds considered between one and thirteen taste compounds per paper. Overall, the consensus was that taste detection thresholds increased with age (Hedges' g = 0·91, P < 0·001), across all taste modalities. Identification thresholds were reported to be higher for older adults in seventeen out of eighteen studies. Sixteen out of twenty-five studies reported perception of taste intensity at supra-threshold levels to be significantly lower for older adults. However, six out of nine studies concerning sucrose found perceived intensity of sweet taste not to diminish with age. The findings of this systematic review suggest taste perception declines during the healthy ageing process, although the extent of decline varies between studies. Overall, the studies reviewed had low Downs and Black scores (mean 16 (SD 2)) highlighting the need for more robust large scale and longitudinal studies monitoring the impact of ageing on the sensory system, and how this influences the perception of foods and beverages.