The Nutrition Mission

Transcription

1 The Nutrition Mission First and Second Line Dietary Advice for Clients with a Poor Appetite/Unintentional Weight Loss Publication Date: January 2014 Review Date: January 2016 Become a member of our Trust. Have a say, make a difference. 1

2 Introduction This booklet is for nurses and carers to help assist with food enrichment and appropriate food choices for residents who have experienced unintentional weight loss or who have a poor dietary intake. Providing good nutrition assists in preventing weight loss. Ensuring residents are receiving a nutritious diet can reduce the risk of complications. Those who have a poor appetite or have experienced weight loss are at risk of becoming malnourished and experiencing deficiencies. This can potentially lead to the following: Infections Reduced mobility Dehydration Poor concentration Organ failure Weakness Poor wound healing Lethargy Iron deficiency anaemia Increased hospital admissions Adaptation to a person s diet is what is recommended as first line treatment. Small amendments can make big changes with regards to people s calorie and nutrient intake and therefore reduce the prevalence of the above. 2

3 Advice General Tips Ensure the patient s diet is tailored to meet their individual needs take into consideration preferred meal times/patterns, if the patient requires assistance and correct modified consistencies given. Make sure that when a patient feels like eating, maximum amount of nutrition is offered. Encourage the person to eat regularly and frequently, at least every 4 hours. Offer snacks between meals if the person doesn t feel like eating very much at meal times. Avoid using products which contain the word diet or low fat ; For example use whole milk, full fat mayonnaise and full fat spread. IMPORTANT!! An extra kcal per day is required for weight gain 3

4 Foods to Include Protein foods Why are they important? Protein foods help the body to grow and repair itself. It is particularly important to have good sources of protein during periods of illness or where our bodies need to repair damage, for example when recovering from an infection or a pressure sore. In addition, protein helps to avoid muscle wasting. Residents should be aiming for 2-3 portions of protein rich foods per day. Sources of Protein White fish Cod, haddock, plaice, coley, whiting, lemon sole, skate and halibut Oily fish Salmon, trout, mackerel, herring, sardines, pilchards, kipper, eel, whitebait, tuna (fresh only), anchovies and swordfish. Poultry Chicken, turkey, duck, pheasant, quail, goose, pigeon and partridge. What s a Portion?? Cheque book size (125g/5oz) Pack of cards size (110g/4oz Meat Beef, pork, lamb, venison, gammon and ham. Dairy and other sources Milk, yoghurts, cheese, cottage cheese, soya, beans, pulses, nuts, seeds, tofu, quorn and eggs. Milk 200ml (1/3 pint) 1 Yoghurt (125g) Cheese-matchbox size Cottage cheese- 1 cupped handful 2 tablespoons of nuts 2 eggs 4

5 Carbohydrates Why are they important? Carbohydrates are the body s preferred source of energy. They provide fuel for all our organs and cells. It is vital that residents receive an adequate amount of carbohydrate foods to avoid their bodies breaking down fat and muscle. Carbohydrates are the preferred energy source particularly for the brain, low quantities can lead to poor concentration, tiredness and weight loss. This food group also commonly contains other nutrients such as B vitamins; to help metabolism, calcium; to maintain a solid bone structure, and sometimes iron; to help transport oxygen around the body. Residents should be having this food group at every meal, or around 10 servings per day (see below). Sources of Carbohydrate Bread/flour products Bread/toast, bread roll, pitta bread, naan bread, tortilla wrap, crisp breads, chapatti, crumpets, breakfast muffins and scone Potatoes, pasta and rice Potatoes (all varieties incl. sweet potato) chips, wedges, roasts, mashed, pasta (all varieties) i.e. spaghetti, noodles, cous cous and rice Cereals Cornflakes, branflakes, coco pops, frosties, weetabix, shredded wheat, porridge oats and muesli What s a portion?? 1 slice bread ½ breadroll/pitta bread/tortilla wrap/chapatti/ muffin 2 crisp breads 3 crackers 2 egg sized potato, ½ jacket potato 8 oven chips 2 tablespoons of mash/cooked pasta/cooked rice 3 tablespoons of cereals/oats 1 weetabix or shredded wheat 5

6 Fruit and Vegetables Why are they important? Fruit and vegetables are an excellent source of vitamins such as vitamin C and E; they are rich in antioxidants which can protect the body from damage and disease. Fruit and vegetables are also rich in fibre; this keeps our bowels healthy. In addition, fruit is a source of carbohydrate (vegetables do not contain much carbohydrate). Fruit and vegetables are a vital part of a healthy balanced diet, however they can be filling and contain little calories so limit the quantity for residents who require extra calories. Pure fruit juices can be a nourishing drink for those who require extra energy and can provide some nutrients for people who have a poor appetite. Choose from fresh, frozen or tinned vegetables Include a variety of different fruit and vegetables in the diet, especially if the resident is finding it hard to open their bowels Try enrichment techniques such as adding cream or evaporated milk to fruit, adding butter onto cooked vegetables and oils onto salads 6

7 Foods high in fat and/or sugar Why are they important? These foods tend to be high in calories so can be very useful for those who wish to gain weight. In addition, as these foods are densely packed with calories; only a small amount is required compared to other food types (i.e. half a tablespoon of double cream contained the same amount of calories as a whole apple!!). Foods high in fat and sugar are a really good energy source and can help us store extra energy and gain weight as a result. Examples of foods high in fat and sugar Butter Margarine Cooking oils Cream Jam Honey Cheese Biscuits These foods can be added to meals to fortify them or given in between meals to increase calorie intake. If residents enjoy snacks such as cakes and biscuits try giving these inbetween/after meals, avoid giving directly before a meal. Cakes Pastries Sweets IMPORTANT!! - Please take into consideration dental care if residents are having more sweet foods; ensure mouth/teeth are cleaned at least twice daily to minimize the risk of decay and infections. 7

8 Fluids Why are they important? Fluids are vital for survival. Adequate fluid is imperative in order to avoid dehydration and water infections; this is a common cause for hospital admissions. The human body can only survive around 3 days without fluids. How much is recommended? At least 8 glasses/ cups per day. This is around 2000ml High calorie fluids can be better for people who are malnourished. Try full fat milk, pure fruit juices and non-diet drinks. Try to ensure residents don t fill up on fluids. Tip: To determine each resident s individual daily fluid requirement use the following equation: years old 35ml per kg body weight Over 60 years old 30ml per kg body weight 8

9 First Line Dietary Advice If you find a resident has a reduced appetite, starts to lose weight or is underweight then immediate action needs to be taken to help prevent this from developing further. The following pages outline steps you can take within you care home before making a referral to the dietitian. If you identify an at risk resident it is good practice to increase the monitoring of the person s nutritional status. Ensure the following is put into place: Commence a food record chart Commence a fluid record chart Monthly weights at the very least, you may want to increase this to weekly if there are concerns Nutritional screening such as MUST (Malnutrition Universal Screening Tool) monthly Use the calorie booster checklist If you find a resident to be at risk of malnutrition, the first line recommendation is to use enrichment techniques in order to increase the calorie and protein content of the diet. Try the following. Savoury Foods Try offering high calorie savoury foods. Pastries tend to have high calorie content. Snacks such as nuts (dependent on residents chewing and swallowing ability) and crisps are also calorific. Try adding butter or margarine to potatoes, vegetables and thick coatings on bread, toast, crumpets and other bread products. 9

10 Add mayonnaise or oils to salads or use them as a dip for finger foods. Double cream can be added to soups and sauces Add cheese to sauces, potatoes, vegetables, toast and in sandwiches. Use plenty of sandwich filler, particularly ones with cheese and mayonnaise and good sources of protein like meats and chicken Sweet Foods Sweet foods are usually rather high in calories and can play a crucial role in preventing weight loss. Some residents may find they prefer sweeter foods to savoury; in this case it is a good idea to offer extra helpings of desserts and regular snacks. However ensure a savoury option is offered first and that snacks do not interfere with meals; avoid giving snacks directly before a meal Add sugar, jam or honey to cereals, puddings and drinks. Double cream can be added to custard, milk puddings such as rice pudding, and used as a topping on fruit. Butter can be added onto malt loaf, scones etc. Skimmed milk powder can be added to puddings. Important!! For food enrichment techniques to be beneficial; a certain amount of the high kcal foods need to be added to meals and snacks, see next page for examples and a sample menu 10

11 Meal Type Enrichment source Additional Kcal Breakfast Porridge/cereal Lunch/Tea Soup Desserts/Snacks Fruit/custard/rice pudding Breakfast Toast/muffins/crumpets Lunch/Tea Vegetables i.e. sweetcorn, carrots swede etc Potatoes(all varieties) Desserts/snacks Cheese and biscuits/fruit loaf/malt slice Breakfast Cereals/porridge Desserts/snacks Milk based puddings Drinks Milkshakes/plain milk/coffee Breakfast Toast/muffins/crumpets Lunch/Tea Pasta dishes/cauliflower/potato (mash/jacket) Soups Lunch/Tea Double Cream 30ml (2 tablespoons) Traditional full fat Butter 10g (2 teaspoons) Dried milk powder 15g (1tablespoon) Hard Cheese i.e. cheddar 30g (matchbox size) Olive oil Casserole/salads/soups 15ml (1 tablespoon)

12 Example Breakfast 1 bowl of porridge made with whole milk Normal kcal 230 Enriched kcal (with 2 tablespoons of double cream) 365 Lunch Beef, mash and carrots 350 (1 match box size of cheese- 30g) (2 teaspoons of butter on carrots) Tea Veg soup 2x Slices toast (One tablespoon of olive oil in soup) (4 teaspoons of butter on toast) 533 Drinks 2 x glasses of whole milk (2/3 pint) Snacks Banana 257 (2 x tablespoons milk powder) (with 2 tablespoons of double cream) 210 Total (856kcal extra!!!) 12

13 Snacks The following foods contain approximately 100kcals; they can be added to meals or be eaten alone. Savoury Medium spread of peanut butter (16g) 1 tablespoon mayonnaise (15g) 2 tablespoon salad cream (30g) 2 tablespoon hummus (50g) 1 tablespoon pesto (20g) Sweet 1 tablespoon sugar (25g) 2 teaspoon honey (35g) 2 teaspoon syrup (35g) 2 teaspoon lemon curd (35g) Fruit/nuts Small handful of peanuts (30g) 5 Brazil nuts (15g) Small handful of cashew nuts (20g) 2 dried apricots (50g) 6 prunes (60g) 3 dates (40g) 1 tablespoon sultanas (35g) Dairy 2 tablespoon skimmed milk powder (30g) 150ml whole milk (1/4 pint) 1 scoop ice-cream 75ml evaporated milk 30ml condensed milk 1 small full fat yogurt 30ml coconut milk 13

14 Try providing 2 snacks per day in between meals. See below for some high calorie snacks ideas. Snack Scone with jam and butter Calories 300 kcals Average scotch egg (120g) 300 Kcals Average sausage roll 290 kcals Handful dry roasted peanuts (50g) 280 kcals 2 thick slice malt loaf + thick spread butter 270 kcals 1 wheat biscuit, 150ml fortified full cream milk (1/4 pint) and 2 teaspoons sugar 1 medium slice bread toasted with a thick spread of butter and 1 boiled egg 200ml glass full cream milk + 3 tablespoons dried milk powder Ready-made toffee popcorn (50g) Average bar of milk chocolate Greek yoghurt pot (150g) 270 kcals 270 kcals 225 kcals 220 kcals 200 kcals 200 kcals 2 crackers + 2 thick slices cheese 200 kcals 200ml glass semi skimmed milk (1/3 pint of milk) + 3 tablespoons dried milk powder Average packet crisps 185 kcals 180 kcals 1 medium banana + 1 scoop ice cream 180 kcals 2 chocolate digestives 170 kcals 14

15 Second Line Dietary Advice If you find that, despite carrying out first line dietary advice, the patient continues to lose weight in the next 2-4 weeks then it is recommended that you implement second line advice. Try introducing high calorie enriched drinks into the person s diet (you should have already introduced high kcal drinks such as whole milk, pure fruit juices etc.). However if these alone have been ineffective try over the counter build up or complan (these tend to contain around 400kcal when made up with full cream milk). Alternatively, you can make some home-made high kcal drinks for the resident; these are sometimes better tolerated than build up drinks. See below for some recipes to follow: Strawberry Milkshake Ingredients Method 1 level tablespoon milkshake powder Mix the milkshake powder 200ml whole milk with a small amount of milk 1 scoop of ice-cream to make a paste 1 tablespoon/15g of double cream Add the remaining milk, Kcal 346 Protein - 8g double cream and ice-creammix well or alternatively use a blender 15

16 Banana Milkshake Ingredients Method 1 banana Add all ingredients to a bender 200ml whole milk and blend for 30 seconds 1 scoop of ice-cream 1 tablespoon of double cream Kcal 384 Protein 9.1g Frozen Berry Smoothie Ingredients Method 50g frozen berries Put berries, double 1 scoop of ice-cream cream and milk into 1 tablespoon of double cream a blender and blend 150ml whole milk for 30 seconds. Add a scoop of icecream on top and serve with a spoon Kcal 285 Protein 7.5g 16

17 High Calorie Malt Drink Ingredients Method 2 teaspoon malt powder (i.e. Horlicks or Mix malt powder supermarket equivalent) and milk powder 150ml whole milk with a little milk to 1 heaped teaspoon milk powder make a smooth paste 1tablespoon double cream add the cream and the remaining milk. Microwave until desired Kcal 231 Protein 10.5g temperature reached. Tip Use hot chocolate powder instead of malt powder if preferred Peach, Mango and Banana Smoothie Ingredients Method 1 small banana Using a blender, mix ½ small tin of peaches all ingredients 200ml orange and mango juice together for 30 seconds Kcal 200 Protein 2g 17

18 Chocolate Smoothie Ingredients Method 1 scoop of chocolate ice-cream Using a blender, mix all 1 teaspoon chocolate sauce ingredients together for 150ml whole milk 30 seconds 1tablespoon double cream Kcal 248 Protein 6.5g 18

19 References Fish consumption in the UK (2003) [Online image] Available from:< > [Accessed 13 th May 2004]. Bedford Hospital NHS Trust, (Date not known) Nutrition care plan, Nutrition and Dietetic Department Bedford Hospital NHS Trust, Bedford. Glass of water (n.d) [Online image] Available from:< [Accessed 11 th January 2015]. 19

20 Contact Us Other resources: Dietetics Department (Hull Team) Highlands Health Centre Lothian Way Hull HU7 5DD Tel Dietetics Department (East Riding Team) Beverley Health Centre Manor Road Beverley HU17 7BZ Tel