Information for healthcare professional use only.

Nutrition: The factor that can make a difference

Hospital malnutritionMalnutrition in hospital patients is common with studies showing that around one third of adult inpatients are malnourished1 and approximately 80% of older inpatients are malnourished or at risk of malnutrition.2 Prevalence in nursing homes is just as high.

Malnutrition is associated with poor health outcomes including:3

¤ Impaired immune function. ¤ Poorer quality of life. ¤ Poor wound healing. ¤ Increased length of hospital stay. ¤ Increased mortality.

Managing malnutritionPatients identified as being at risk of malnutrition or malnourished should undergo a thorough nutritional assessment by a dietitian to determine the most appropriate interventions. Intervention may include one or more of the following:

¤ Fortifying usual food intake to increase nutrient content.

¤ Offering oral nutrition supplements. ¤ Modifying texture or consistency of diet

to ensure it is appropriate for the patient. ¤ Enteral nutrition if oral intake cannot

meet requirements.

Food fortification

Why Food Fortification?Many patients in hospital or aged care are unable to meet their energy, protein, vitamin and mineral requirements from the meals provided. This may be because of an acute illness, interrupted mealtimes, poor appetite, or treatment and medication side effects. One study of nursing home residents showed that their average intake from 3 meals per day did not meet the recommended dietary intake for a range of nutrients including energy, protein, calcium and fibre.4

If food intake is reduced due to a poor appetite, increasing the nutrient density means that the same amount of food will provide greater nutrition and assist in meeting the patients’ requirements. Food fortification has been shown to boost energy intake of patients by up to 40% without a change in food volume.5

80%of older inpatients are malnourished

or at risk of malnutrition

Which meals should be fortified?Any food offered to a patient who is malnourished or at risk of malnutrition should be as high in nutrients as possible. Studies have shown that breakfast is the best consumed meal by hospital patients,1,6 however it is often the lowest in energy and protein. Similarly mid meal snacks also tend to be low in energy. Fortifying breakfast foods and providing high energy/protein mid meal snacks offers an ideal opportunity to boost nutrient intake.

How can foods be fortified?Foods and fluids can be fortified using a number of options including:

¤ Standard food items such as skim milk powder, butter, cream, oil and cheese.

¤ Commercial ‘modular’ products such as BENEPROTEIN® or BENECALORIE.®

¤ Commercial nutritionally complete powders such as SUSTAGEN® Hospital Formula Neutral Flavour.

Fortifier Energy Protein Calcium Vitamin C Iron Usage suggestions

Skim Milk Powder7 1 tablespoon (8g) 117kJ 3g 100mg 0.16mg 0.02mg Milk, soup, custard.

Cream7 1 tablespoon (20g) 270kJ 0.6g 12mg 0 0 Soup, vegetables,

custard, desserts.

Butter7 1 tablespoon (20g) 580kJ <0.1g 3mg 0 0 Most sweet and

savoury dishes.

SUSTAGEN® Hospital Formula Neutral Flavour 1 scoop (20g)

314kJ 4.6g 134mg 6.6mg 1.2mg All texture modified meals, milk drinks, desserts.

BENEPROTEIN® 1 scoop (7g) 105kJ 6g 20mg 0 0

Scrambled eggs, soups, custards, mashed vegetables, wet dishes such as casseroles.

BENECALORIE® 1 cup (44mL) 1380kJ 7g 100mg 60mg 0 Porridge, cream cheese,

yoghurt, custard.

9000

8000

7000

6000

5000

4000

3000

2000

1000

0Usual diet Fortified diet

5295

8439 9180

100

60

40

20

0Usual diet Fortified diet

56

Nutritional supplements can only be of assistance where dietary intake is inadequate. Please seek advice on your individual dietary needs from an Accredited Practising Dietitian or your healthcare professional. SUSTAGEN® Hospital Formula is a formulated meal replacement and cannot be used as a total diet replacement.BENECALORIE® and BENEPROTEIN® are food for special medical purposes specially formulated for medical conditions where nutritional needs cannot be met by diet modification alone. Must be used under the supervision of a healthcare professional.® Reg. Trademark of Société des Produits Nestlé S.A. Nestlé Healthcare Nutrition, a division of Nestlé Australia Ltd, 8 Nexus Court, Mulgrave VIC 3170, Australia. For more information call 1800 671 628Information for healthcare professional use only.

References: 1. Agarwal E et al. Clinical Nutrition (Edinburgh, Scotland). 2012;31(1):41-7. 2. Holyday M, Daniells S, Bare M, Caplan GA, Petocz P, Bolin T. The Journal Of Nutrition, Health & Aging. 2012;16(6):562-8. 3. Norman K et al. Clin Nutr 2008;27:5-15. 4. Nowson C et al. Asia Pacific J Clin Nutr 2003;12(2):172-177. 5. Olin AO, Osterberg P, Hådell K, Armyr I, Jerström S, Ljungqvist O. JPEN 1996;20(2):93-7. 6. Barrington V. Nutr Diet 2012;69(Suppl 1):43. 7. Xyris FoodWorks 2009 Professional Edition v 6.0.

What does a fortified meal plan look like?There are a variety of ways that food fortifiers can be used to add nutrition to a meal plan when appetite is low. The table and graphs below demonstrate the potential impact fortification can have on energy and protein intake without increasing the quantity of food consumed (food fortifiers are shown in blue text).

Time Meals Extra energy (kJ) Extra protein (g)

Breakfast Porridge and milk + SUSTAGEN® Hospital Formula Neutral Flavour (1 scoop). 318 4.6

Morning Tea Scone with jam + cream (1 tablespoon). 270 0.6

Lunch Pumpkin soup + skim milk powder (1 tablespoon) and a ham sandwich. 117 3

Afternoon Tea Glass of milk + SUSTAGEN® Hospital Formula (3 scoops). 954 13.8

Dinner Beef stew and mashed potato + BENEPROTEIN® (1 scoop). 105 6

Dessert Custard + BENECALORIE® (1 cup). 1380 7

TOTAL 3144kJ 35g

Food fortification can significantly increase the nutrient density of meals

ENERGY PROTEIN

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