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:
- 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)
- 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.
- 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.
- 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).
- 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.
