Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review

This review aims to identify hospital food service strategies to improve food consumption among hospitalized patients. A systematic search that met the inclusion and exclusion criteria was manually conducted through Web of Science and Scopus by an author, and the ambiguities were clarified by two senior authors. The quality assessment was separately conducted by two authors, and the ambiguities were clarified with all the involved authors. Qualitative synthesis was used to analyze and summarized the findings. A total of 2432 articles were identified by searching the databases, and 36 studies were included. The majority of the studies applied menu modifications and meal composition interventions (n = 12, 33.3%), or included the implementation of the new food service system (n = 8, 22.2%), protected mealtimes, mealtime assistance and environmental intervention (n = 7, 19.4%), and attractive meal presentation (n = 3, 8.3%). Previous studies that used multidisciplinary approaches reported a significant improvement in food intake, nutritional status, patient satisfaction and quality of life (n = 6, 16.7%). In conclusion, it is suggested that healthcare institutions consider applying one or more of the listed intervention strategies to enhance their foodservice operation in the future.

Effect of meal composition and alcohol consumption on postprandial glucose concentration in subjects with type 1 diabetes: a randomized crossover trial

IntroductionMeal composition is known to affect glycemic variability and glucose control in type 1 diabetes. The objective of this work was to evaluate the effect of high carbohydrate meals of different nutritional composition and alcohol on the postprandial glucose response in patients with type 1 diabetes.Research design and methodsTwelve participants were recruited to this randomized crossover trial. Following a 4-week run-in period, participants received a mixed meal on three occasions with the same carbohydrate content but different macronutrient composition: high protein-high fat with alcohol (0.7g/kg body weight, beer), high protein-high fat without alcohol, and low protein-low fat without alcohol at 2-week intervals. Plasma and interstitial glucose, insulin, glucagon, growth hormone, cortisol, alcohol, free fatty acids, lactate, and pH concentrations were measured during 6 hours. A statistical analysis was then carried out to determine significant differences between studies.ResultsSignificantly higher late postprandial glucose was observed in studies with higher content of fats and proteins (p=0.0088). This was associated with lower time in hypoglycemia as compared with the low protein and fat study (p=0.0179), at least partially due to greater glucagon concentration in the same period (p=0.04). Alcohol significantly increased lactate, decreased pH and growth hormone, and maintained free fatty acids suppressed during the late postprandial phase (p<0.001), without significant changes in plasma glucose.ConclusionsOur data suggest that the addition of proteins and fats to carbohydrates increases late postprandial blood glucose. Moreover, alcohol consumption together with a mixed meal has relevant metabolic effects without any increase in the risk of hypoglycemia, at least 6 hours postprandially.Trial registration numberNCT03320993.

MyPlate, Half-Plate, and No Plate: How Visual Plate-related Dietary Benchmarks Influence Meal Composition

Can visual plate-related dietary guidance systems -- such as the MyPlate guideline or the Half-Plate Rule -- help people eat better when dining at home or in restaurants? To help explore this, 104 young adults completed a food diary study after having been randomly assigned to follow either 1) USDA MyPlate guidelines, 2) the Half-Plate Rule, or 3) no guidelines (control condition). Both of the visual dietary guidance systems were considered easy to understand, to follow, and left people with fewer questions about what to eat (all p<.01). Moreover, people who rated a system "easy to follow" indicated they had consumed less (meat (r = .268), but this was uncorrelated with fruit and vegetable intake (r =.092) and carbohydrate intake (r = .069). There are three key conclusions to these and other findings: First, the simplest guidance system may be more effective than no system. Second, even the most perfect dietary guidance system will not change behavior if the foods are not available or it is not followed. Third, guidance systems could over-increase the consumption of any food they specifically mention.

Chrononutrition and Breast Milk: A Review of the Circadian Variation of Hormones Present in Human Milk

IntroductionBreast milk contains a wide range of hormones, nutrients, and bioactive compounds. Chrononutrition looks at the interaction between food, both meal timing and meal composition, and circadian rhythms.MethodThis review is a continuation on series on chrononutrition and breast milk. All human studies published in English were included regardless of location or year of publication.ResultsThis review identifies the hormonal circadian variation researched in breast milk to date for melatonin, cortisol, cortisone, leptin, and insulin.ConclusionThe circadian variation observed in some hormones reinforces the superiority of breast milk over formula milk. Melatonin has been the most studied, but more research for all the hormones is needed due to various gaps in the literature and varying levels of study quality. There is insufficient evidence to make recommendations specifically targeting the lactating mother, but we identify and recommend several ideas for future research.

Breakfast Frequency and Composition in a Group of Polish Children Aged 7–10 Years

Breakfast is considered one of the crucial elements of a healthy diet. Most studies evaluate breakfast consumption with the risk of obesity and other health effects. Less attention is paid to the evaluation of breakfast composition and patterns. Thus, this study aimed to describe the most frequently observed breakfast patterns and to assess breakfast composition and quality in a group of Polish early school-age children. The cross-sectional survey study was conducted in school years 2017/2018 and 2018/2019. Information regarding breakfast was obtained with the use of an original paper-based weekly observation diary, and breakfast quality was assessed with a special scoring designed to be used together with the diary. In total, 223 schoolchildren of the second and third grades participated in the study, and 200 diaries were analyzed. More than ¾ of the participants consumed breakfast every day. Nearly 68% of meals were classified as well balanced, but only 16.5% of children eat a well-balanced breakfast every day. The number of children who usually (≥5 times per week) eat a sandwich for breakfast was 94 (47%), and that of those who habitually eat cereal and milk or porridge was 29 (14.5%). Only 7% of children consumed fruit or vegetables for breakfast daily, and 26.5% never eat fruit or vegetables for breakfast. Concluding, most children eat breakfast regularly, but the meal composition and quality might be improved.

Competition Nutrition Practices of Elite Male Professional Rugby Union Players

Thirty-four elite male professional rugby union players from the New Zealand Super Rugby championship completed dietary intakes via the Snap-N-Send method during a seven-day competition week. Mean seven-day absolute energy intake was significantly higher for forwards (4606 ± 719 kcal·day−1) compared to backs (3761 ± 618 kcal·day−1; p < 0.01; d = 1.26). Forwards demonstrated significantly higher mean seven-day absolute macronutrient intakes compared to backs (p < 0.03; d = 0.86–1.58), but no significant differences were observed for mean seven-day relative carbohydrate (3.5 ± 0.8 vs. 3.7 ± 0.7 g·kg·day−1), protein (2.5 ± 0.4 vs. 2.4 ± 0.5 g·kg·day−1), and fat (1.8 ± 0.4 vs. 1.8 ± 0.5 g·kg·day−1) intakes. Both forwards and backs reported their highest energy (5223 ± 864 vs. 4694 ± 784 kcal·day−1) and carbohydrate (4.4 ± 1.2 vs. 5.1 ± 1.0 g·kg·day−1) intakes on game day, with ≈62% of total calories being consumed prior to kick-off. Mean pre-game meal composition for all players was 1.4 ± 0.5 g·kg−1 carbohydrate, 0.8 ± 0.2 g·kg−1 protein, and 0.5 ± 0.2 g·kg−1 fat. Players fell short of daily sports nutrition guidelines for carbohydrate and appeared to “eat to intensity” by increasing or decreasing energy and carbohydrate intake based on the training load. Despite recommendations and continued education, many rugby players select what would be considered a “lower” carbohydrate intake. Although these intakes appear adequate to be a professional RU player, further research is required to determine optimal dietary intakes.

Family Meals, Conviviality and the Mediterranean Diet among Families with Adolescents

Two aspects that characterize the Mediterranean diet (MD) are “what” and “how” we eat. Conviviality relates to “how” we eat and to the pleasure of sharing meals with significant people. The most studied concept is “family meals”, which includes conviviality, which involves “enjoying” family meals. Given the lack of research on convivial family meals in Mediterranean countries, the purpose of this qualitative study was to analyze the family meal representations and practices of families with 12- to 16-year-old adolescents to assess whether they responded to a pattern of conviviality, and to examine their association with MD adherence. Twelve semi-structured interviews were conducted and food frequency and family meal questionnaires were administered. A food pattern analysis was carried out and digital photos of meals were analyzed to examine eating habits and meal composition, respectively. The findings showed that parents believed family meals are a space for socialization and communication. Items relating to the conviviality of family meals identified in the study were meal frequency, meals at the table, lack of digital distractions, pleasant conversations, and time spent on family meals. Attention should be paid to conviviality in Mediterranean families when designing multi-approach strategies to promote healthy eating among adolescents.

Postprandial effects of macronutrient composition meals on the metabolic responses and arterial stiffness indices of lean and obese male adults: a protocol of a pilot study

Background Prior studies have shown that meal composition may affect the metabolic responses and arterial stiffness indices, and these responses may be different in lean and obese adults. The primary objective of this study is to determine the feasibility of conducting a trial to compare the effect of three test meals in lean and obese men. Due to the lack of a comprehensive study that concurrently compares metabolic responses and vascular stiffness indices after receiving three different meals in lean and obese men, this pilot study will be conducted with a three-phase parallel design, aiming to investigate the effects of meal composition on the metabolic parameters and arterial stiffness indices of lean and obese adults. Methods This pilot, a parallel clinical trial will be performed on 24 male adults aged 18–35 years since January 2021 and will continue until March 2021 who are disease-free and selected based on the inclusion and exclusion criteria at Mashhad University of Medical Sciences, Iran. The subjects will complete three interventions at a 1-week interval, including high carbohydrate (70% carbohydrates, 10% protein, 20% fat), high protein (30% protein, 50% carbohydrates, 20% fat), and high-fat meal (50% fat, 40% carbohydrates, 10% protein). Postprandial effects will be assessed within 360 min after each meal, including the energy expenditure component (resting energy expenditure, thermic effects of feeding, respiratory quotient, and substrate oxidation) and arterial stiffness indices (augmentation index and pulse wave velocity). In addition, blood sampling will be performed to measure glucose, insulin, free fatty acids, and lipid profile. Discussion The differences in the postprandial responses can affect the metabolic and vascular parameters due to different meal compositions, thereby providing beneficial data for the establishment of new strategies in terms of nutritional education and metabolic/vascular improvement. Also, the results from this pilot study will inform intervention refinement and efficacy testing of the intervention in a larger randomized controlled trial. Trial registration Iranian Registry of Clinical Trials; code: IRCT20190818044552N1; registered on August 26, 2019