Enhancement of select foods at breakfast and lunch increases energy intakes of nursing home residents with low meal intakes.

OBJECTIVE Nursing facilities often provide enhanced or fortified foods as part of a "food-first" approach to increasing nutrient intakes in residents with inadequate intakes or who are experiencing weight loss. The study objective was to determine whether energy and protein enhancement of a small number of menu items would result in increased three-meal (breakfast, lunch, and supper) calorie and protein intakes in long-term care residents. DESIGN A randomized cross-over design was used to compare investigator-weighed food intakes under three menu conditions: control (no meals enhanced); lunch only enhanced; and both breakfast and lunch enhanced. Two breakfast foods (juice and hot cereal) and two lunch foods (soup and potato side dish) were chosen for enhancement. SUBJECTS/SETTING Participants were 33 nursing home residents from a facility in South Florida (average age=87.3 years). STATISTICAL ANALYSIS Repeated-measures analysis of variance was used to test the effects of the within-subjects factor (control, lunch enhanced, breakfast and lunch enhanced conditions), the between-subjects factor (smaller vs bigger eater), and the interaction on intakes (gram, kilocalories, and protein). RESULTS Results revealed that bigger eaters consumed considerably more calories when breakfast foods, but not lunch foods, were enhanced. Smaller eaters achieved an increase in energy intake when either breakfast or lunch was enhanced. Overall daily protein intakes were not substantially increased by food enhancement. These data suggest that for an enhanced food program to be most effective for smaller eaters, who are at greatest risk for undernutrition and weight loss, it should include several enhanced foods at more than one meal.