Food First/Food Enrichment

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

CrispsFlavoured rice cakesCheese biscuits
Bread sticksCrackers / crisp breadsCheese twists
Handful of nutsMini sausage rollsMini pork pies
Scotch eggCheese and crackersBuild up/ Complan packet soups
Sweet (may not be suitable for patients with diabetes)
Jelly sweetsSnack / full size chocolate barsJaffa cakes
Dried fruitPopcornIce cream
Full fat yoghurts or moussesCustard potsTinned fruit in syrup
Rice puddingChocolate spread
Angel DelightFruit and custard / creamCrème caramel
Crème brulée potsTrifle potsPanna cotta
Mini apple piesCream cakesFruit Fool
Milk jellySemolinaSponge Pudding

Recipe for homemade milkshakes

IngredientsPer portion
Double Cream40ml
Whole milk80ml
Sugar4g (1 tsp)
Vanilla Ice Cream80ml
Skimmed milk powder24g
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 ideasEnergy before (kcal)Energy After (kcal) and % added
Whole Milk (1 Pint)Add 4 tablespoons of dried skimmed milk powder.375583 (55% extra)
Custard (125ml)Add 1 tablespoon of dried skimmed milk powder and 2 tablespoons of double cream.148349 (135% extra)
Milk based Soup (125ml)Add 1 tablespoon of dried skimmed milk powder and 2 tablespoons of double cream.80280 (250% extra)
Porridge made with whole milk (200g)Add 1 tablespoon dried skimmed milk powder and 2 tablespoons of double cream.226426 (88% extra)
Mash potato (1 scoop)Add 1 tablespoon of butter and 1 tablespoon double cream.70183 (160% extra)
Vegetables (2 tablespoons)Add 1 teaspoon of butter.1552 (246% extra)
Rice Pudding (125g)Add 1 tablespoon of dried skimmed milk powder and 2 tablespoons double cream and 2 teaspoons of jam.106332 (213% Extra)

Energy and Protein in common food enrichers

Food EnricherEnergyProtein
Full Fat Milk
Skim Milk Powder
Crème fraiche
Cream cheese✔ Low


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.