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BackgroundFood intake varies among long‐term care (LTC) residents and, as a result, some residents are at risk for protein‐energy malnutrition and its consequences, such as sarcopenia. The present study aimed to determine whether eating occasions, as well as other factors that may vary with eating occasions (e.g. family/volunteer presence), were associated with energy and protein intake at meals and snacks.MethodsThe present study comprised a secondary analysis of the cross‐sectional Making the Most of Mealtimes study, including 630 residents (median age 88.00 years, range 62–107 years; 197 males) from 32 Canadian LTC homes. An analysis of variance compared protein and energy intake at meals and snacks. Mixed repeated measures linear regression testing for meal and relevant covariates (e.g. family/volunteer presence) was also conducted.ResultsEnergy and protein intake was significantly associated with eating occasions (F = 44.31, P < 0.001; F = 12.72, P < 0.001), with the greatest energy intake at breakfast, and the greatest protein intake at dinner. Regression analysis confirmed these findings when considering other factors. Covariates associated with higher intake included: being male (+79 kcal; +3.4 g protein), living on a dementia care unit (+39 kcal; +2.1 g protein) and family/volunteer presence at meals (+58 kcal; +2.5 g protein). Intake was lowest in the oldest age group (−59 kcal; −3.6 g protein) and for those sometimes requiring eating assistance (−36 kcal; −2.0 g protein).ConclusionsEnergy and protein intake appears to be associated with eating occasions. Based on these exploratory findings, LTC homes may consider providing more protein‐dense foods at breakfast. Protein and energy dense snacks could also be used more extensively to support intake.

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Background: Food quality influences patient food satisfaction, which may subsequently affect food intake and recovery, influencing hospital costs. The present qualitative study aimed to gain an understanding of hospital staff/ volunteers experiences of serving food in Ontario hospitals, perceptions of food quality and challenges to quality food provision. Methods: Sixteen Ontario hospitals participated. Semi-structured interviews (n = 64 participants) and focus groups (n = 24; 150 participants) were conducted. Transcripts were analysed using inductive thematic analysis. Results: Four themes emerged: (1) Providing Good Quality Food (e.g., attributes that comprise the construct of meal quality, patients' expectations and desires from meals); (2) Individualising the Food and Mealtime Experience (e.g., processes to identify and cater to patients' needs and preferences); (3) Acknowledging Organisational Constraints (e.g., staffing, budget, etc.); and (4) Innovating Beyond Constraints (e.g., identifying innovation within potential modifiable and unmodifiable organisational constraints). Conclusions: Serving meals in hospital is complex because of organisational and patient factors; however, current efforts to serve quality food despite these complexities were uncovered in our investigation. Discussions highlighted current practices that promote food quality and strategies for improvement. Improving food quality and the hospital meal experience can support food intake and patient outcomes, as well as reduce waste and hospital associated costs. The findings can be used to support quality improvement measures aiming to serve high quality food that meets patients' expectations and nutritional needs.clinical nutrition, food service, food service and management, meals, food and drink, qualitative, study design and analysis, research Key points • Staff described quality hospital food as having favourable sensory attributes (e.g., flavour) in addition to food-related attributes such as freshness and variety. • Various organisational constraints such as foodservice budget, staffing and foodservice processes influence the capacity to serve high-quality hospital food. • Despite constraints, current practices such as facilitating opportunities for patients to choose their meals support quality food provision in hospital.