Nutritional quality of regular and pureed menus in Canadian long term care homes: an analysis of the Making the Most of Mealtimes (M3) project

Abstract

Background: Long term care (LTC) menus need to contain sufficient nutrients for health and pureed menus may have lower nutritional quality than regular texture menus due to processes (e.g., recipe alterations) required to modify textures. The aims of this study were to: determine adequacy of planned menus when compared to the Dietary Reference Intake (DRI); compare the energy, macronutrients, micronutrients and fibre of pureed texture and regular texture menus across LTC homes to determine any texture, home or regional level differences; and identify home characteristics associated with energy and protein differences in pureed and regular menus.

Diet quality is associated with malnutrition and low calf circumference in Canadian long-term care residents

“…This likely explains the divergence in findings from the main analysis and that from prior research [26]. Further, as noted in prior M3 analysis, persons requiring eating assistance are commonly prescribed MTDs, which are often lower in key nutrients as compared to regular texture diets [16]. Few studies have yet to examine the influence of eating assistance on protein intake and micronutrient intake in LTC residents [38].…”

“…Food fortification, especially with vitamin D and calcium, has been shown to increase intake of fortified nutrients in LTC [42][43][44]. A prior analysis of this dataset demonstrates that recipe standardization and enhancement in some provinces improved nutrient density for MTD and specifically for these nutrients [16]. Few nutrients were lower for ONS consumers than nonconsumers, yet vitamins E and C were higher in users than nonusers.…”

“…Resident data, such as diagnosis, prescription of ONS, and dietary prescription were collected from health charts. In addition, modified texture diets (MTD) were classified for analysis using the International Dysphagia Diet Standardisation Initiative (IDDSI) [16,28] as more than 60 diet textures were represented in the data. Specifically, five categories of the IDDSI continuum were used to categorize food texture (3 = liquidized, 4 = pureed, 5 = minced and moist, 6 = soft and bite-sized, and 7 = regular texture).…”

“…Hierarchical regression analysis accounted for clustering at the home and unit levels; linear regression tested the association with MNA-SF score while logistic regression estimated the odds ratios for PG-SGA risk and low CC. In addition to the simple models adjusted for age and sex, fully adjusted models also included three residentlevel covariates (i.e., MTD (IDDSI categories 3-5), ONS use, requiring physical assistance (sometimes or often)) that are prevalent in this sample and demonstrated to be associated with malnutrition [5,[16][17][18][19][20][21][22][23][24][25]. Statistical significance was set at p < 0.05.…”

“…Without careful menu planning and the use of standardized recipes and portion sizes, diet quality of menus can be poor [16]. Modified texture menus, especially those for pureed consumers, are typically lower in energy and micronutrients than regular menus [16][17][18]. Diet quality may also be further exacerbated for specific residents in LTC.…”