Although there is limited research into this area, studies have shown that increasing the energy density of meals through food enrichment can increase an individual’s overall caloric intakes up to 30% (Odlunds et al 2003). Other studies have indicated that dietary counselling gave comparable increases in weight to oral nutritional supplement use (Baldwin and Weekes, 2012). 

If a patient has a poor appetite, problems with eating, or has lost weight recently, it is important that the food and drinks taken contain as much energy and protein as possible.

Dietary advice could include:

  1. Little & often: aim to have three small meals plus two to three nourishing snacks in between (eating every 2-3 hours) as trying larger meals may over-face the patient (see table 1 for snack ideas)

  2. Choosing full fat and sugar products rather than ‘low fat/sugar’ as they contain more calories. e.g. Choose full cream milk instead of skimmed/semi skimmed milk and normal butter/spread rather than low fat spread.

  3. Nourishing drinks can be a simple way of increasing calories intake. Options include malt drinks, milk based coffee, hot chocolate, fresh fruit juices, milkshakes, smoothies or enriched soups. 

  4. Food Enrichment: Involves using every day food items to enrich the diet with energy and protein such as using adding butter, cream, cheese, full fat milk, skimmed milk powder, oils, crème fraiche to foods to boost their energy and protein content (see Table 3). Please note that some foods only add energy to food while others also provide protein which is required for tissue growth and repair (see Table 4).

  5. Consider a multivitamin & mineral supplement as those eating small amounts or a limited variety of foods may not have adequate micronutrient intake.

Savoury and sweet snacks ideas

Savoury
Crisps Flavoured rice cakes Cheese biscuits
Bread sticks Crackers / crisp breads Cheese twists
Handful of nuts Mini sausage rolls Mini pork pies
Scotch egg Cheese and crackers Build up/ Complan packet soups
Sweet (may not be suitable for patients with diabetes)
Jelly sweets Snack / full size chocolate bars Jaffa cakes
Biscuits Flapjacks Pastries
Cakes Teacake Scones
Dried fruit Popcorn Ice cream
Full fat yoghurts or mousses Custard pots Tinned fruit in syrup
Rice pudding Chocolate spread
Puddings
Angel Delight Fruit and custard / cream Crème caramel
Crème brulée pots Trifle pots Panna cotta
Mini apple pies Cream cakes Fruit Fool
Milk jelly Semolina Sponge Pudding

Recipe for homemade milkshakes

Ingredients Per portion
Double Cream 40ml
Whole milk 80ml
Sugar 4g (1 tsp)
Vanilla Ice Cream 80ml
Skimmed milk powder 24g
Total (approx. -more if whisked and frothy) 180ml
Calorie content (estimated) 400kcal
Protein content (estimated) 13g
Combine all ingredients with a whisk or in a blender.
Milkshake powder/chocolate spread/fruit can be added to vary flavour if desired.

Examples of the increases in energy possible through food enrichment

Food enrichment ideas Energy before (kcal) Energy After (kcal) and % added
Whole Milk (1 Pint) Add 4 tablespoons of dried skimmed milk powder. 375 583 (55% extra)
Custard (125ml) Add 1 tablespoon of dried skimmed milk powder and 2 tablespoons of double cream. 148 349 (135% extra)
Milk based Soup (125ml) Add 1 tablespoon of dried skimmed milk powder and 2 tablespoons of double cream. 80
280 (250% extra)
Porridge made with whole milk (200g) Add 1 tablespoon dried skimmed milk powder and 2 tablespoons of double cream. 226
426 (88% extra)
Mash potato (1 scoop) Add 1 tablespoon of butter and 1 tablespoon double cream. 70 183 (160% extra)
Vegetables (2 tablespoons)
Add 1 teaspoon of butter. 15
52 (246% extra)
Rice Pudding (125g) Add 1 tablespoon of dried skimmed milk powder and 2 tablespoons double cream and 2 teaspoons of jam. 106
332 (213% Extra)

Energy and Protein in common food enrichers

Food Enricher Energy Protein
Butter
Cream
Full Fat Milk
Skim Milk Powder
Oil
Crème fraiche
Cheese
Cream cheese ✔ Low
Sugar

References

Baldwin, C. and Weekes, C. E. (2012), Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials. Journal of Human Nutrition and Dietetics, 25: 411–426.

Odlunds Olin A., Armyr I., Soop M., et al. (2003) Energy dense meals improve energy intake in elderly residents in a nursing home. Clin Nutr, 22:125-131

Further reading

Silver, H.J. (2009) Food modification versus Oral Liquid Nutrition Supplementation. Nestle Nutrition institute workshop service clinical performance program, 12:79-93

Stratton, R. (2005) Should food or supplements be used in the community for the treatment of disease-related malnutrition?. Proceedings of the Nutrition Society, 64: 325–333.

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