Novel Meal Service Improves Nutritional Intake

Study Overview
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Brief Summary
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This study aims to investigate whether a novel meal service FoodforCare (FfC), comprising 6-protein-rich meals a day following proactive advice from a nutritional assistant, improves dietary intake and patient satisfaction, compared to the traditional 3-meals a day service (TMS).

Detailed Description
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The investigators performed a quasi experimental study at medical (Gastroenterology) and surgical (Gynecology, Urology, Orthopedics) wards. Patients were offered TMS (July 2015 - May 2016; n=326) or FfC meal service (after stepwise introduction per ward from January 2016 - December 2016; n=311). Primary outcome was the mean percentage of protein and energy intake relative to requirements, between patients receiving TMS and those receiving FfC, on the first and fourth day of full oral intake. Patient satisfaction comprised rating of the experienced quality of the food and the meal service and by means of a validated questionnaire.

Official Title
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A Novel In-hospital Meal Service Improves Protein and Energy Intake

Conditions
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Malnutrition

Intervention / Treatment
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* Other: Meal service


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Dutch speaking Aged 18 years or older Exclusively oral intake Expected hospital stay of at least 1 day Exclusion Criteria: Patients with tube- or parenteral feeding A language barrier Considered to be too weak to adequately answer our questions

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Traditional meal service<br>TMS consists of three meals served by nutritional assistants throughout the day. Preference for dinner can be indicated in the morning by the individual patient from a menu list with predefined choices for meat, potatoes/rice/pasta and vegetables with various portion sizes. | Other: Meal service<br>* The type of meal service in the hospital (usual care)<br>|
| FoodforCare<br>FfC consists of a 6-meals per day service. At bedside, patients are offered one or more small protein-rich dishes from a choice of 3. Nutritional assistants play a key role in recommending and delivering these protein-rich meals and assist patient in choosing the most optimal dish, based on the patient's nutrition order in the electronic patient record. | Other: Meal service<br>* The type of meal service in the hospital (usual care)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Protein intake day 1 (gram) | The percentage of protein intake (gram) relative to requirements (1.2 gram/kilogram bodyweight) on the first day of full oral intake. | 1 day | 
| Protein intake day 4 (gram) | The percentage of protein intake (gram) relative to requirements (1.2 gram/kilogram bodyweight) on the fourth day of full oral intake. | 4 days | 
| Energy intake day 1 (kcal) | The percentage of energy intake (kcal) relative to requirements (Harris & Benedict formula * 1.3) on the first day of full oral intake. | 1 day | 
| Energy intake day 4 (kcal) | The percentage of energy intake (kcal) relative to requirements (Harris & Benedict formula * 1.3) on the fourth day of full oral intake. | 4 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients' satisfaction (food appreciation and access to food) | Patients completed a questionnaire on food appreciation and experiences regarding food access on the third day of full oral intake in the hospital. | 3 day | 
| Patients' satisfaction (food quality and meal service) | Patients completed a questionnaire in which they rated the quality of the food and the meal service (scale 0-10) on the third day of full oral intake in the hospital. | 3 day | 
| Change in nutritional status (body weight) | Body weight (in kg) was measured prior to meals in the morning of the first and fourth day of oral intake. | 4 days | 
| Change in nutritional status (handgrip strength) | Handgrip strength (in kg) was measured prior to meals in the morning of the first and fourth day of oral intake. | 4 days | 
| Nutritional status (height) | Height (in cm) was measured prior to meals in the morning of the first day of oral intake. | 1 day | 
| Nutritional status (malnutrition universal screening tool) | Malnutrition universal screening tool (MUST)) was measured prior to meals in the morning of the first day of oral intake. Weight (kg) and height (cm) will be combined to report BMI in kg/m^2. | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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protein intake, satisfaction, meal service, hospitalized patients