Abstract
Background/Objectives
Plate diagrams (PDs) are commonly used to monitor dietary intake in nursing homes
(NHs). PD intake estimation of texture-modified diet (TMD) is reliable, but only if
the offered portion is determined by weighing records (WRs). Offered portion size
is usually individualized in NHs and WRs are impractical for NH routine. Thus, an
estimation of offered portion size by PDs seems to be appropriate but its validity
is unknown. Further, validity of PDs for intake estimation based on estimated offer
(instead of WRs) is unknown.
Design
Main meal dietary offer and intake were assessed via PDs and WRs.
Setting and Participants
Seventeen NH residents receiving TMD regularly.
Methods
Offered portion size and intake of breakfast, lunch, and dinner at 42 days were estimated
by nursing personnel via PDs (answer options offered portion size: >standard, standard,
¾, ½, ¼, nothing, I do not know; answer options intake: all plus second helping, all,
¾, ½, ¼, nothing, I do not know). In parallel, scientific personnel weighed all offered
food items and leftovers. PD estimation of offered portion size was multiplied by
energy and protein content of predefined standard portions. Afterward, PD estimation
of intake was multiplied by PD determined energy and protein offer to determine the
estimated energy and protein intake. PD determined offer and intake were compared
with weighed offer and intake.
Results
Seventeen residents (14 female) with a mean [±standard deviation (SD)] age of 87.1
(±7.5) years participated in the study. Nursing personnel overestimated offer and
intake. Mean daily differences (±SD) between WR and PD determined offer were −349.0
(±315.7) kcal, P < .001, (−36.3% of mean weighed energy offer) and −15.0 (±12.8) g protein, P < .001, (−42.2% of mean weighed protein offer). Mean daily differences (±SD) between
WR and PD determined intake were −283.0 (±299.8) kcal, P < .001, (−35.1% of mean weighed energy intake) and −12.6 (±12.7)g protein, P < .001, (−43.1% of mean weighed protein intake).
Conclusions and Implications
PD estimation of individualized offered portion size of TMD by nursing staff is not
valid and can, thus, not be recommended. The mistake in estimation of offered portion
size is continued on intake estimation but does not become larger, which supports
the use of PDs for intake estimation but just in case of a WR determined offer.
Keywords
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References
- Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet.J Hum Nutr Diet Off J Br Diet Assoc. 2005; 18: 213-219
- Energy, protein, calcium, vitamin D and fibre intakes from meals in residential care establishments in Australia.Asia Pac J Clin Nutr. 2003; 12: 172-177
- Dietary and fluid intakes of older adults in care homes requiring a texture modified diet: The role of snacks.J Am Med Dir Assoc. 2011; 12: 234-239
- Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: A review and summary of an international expert meeting.Clin Interv Aging. 2016; 11: 189-208
- Dietary assessment methods for older persons: What is the best approach?.Curr Opin Clin Nutr Metab Care. 2013; 16: 534-540
- Validity of plate diagrams for estimation of energy and protein intake of nursing home residents receiving texture-modified diet: An enable Study.J Am Med Dir Assoc. 2021; 22: 634-639
- Size matters! Differences in nutritional care between small, medium and large nursing homes in Germany.J Nutr Health Aging. 2017; 21: 464-472
- Factors influencing accuracy in estimating plate waste.J Am Diet Assoc. 1987; 87: 1219-1220
- The plate diagram: An instrument to record insufficient dietary intake in hospitalized patients.Aktuel Ernährungsmed. 2006; 31: 66-72
- Enable office. enable - healthy food choices in all stages of life.(Available at:)http://www.enable-cluster.de/index.php?id=29&L=1Date accessed: July 1, 2019
- ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- A global clinical measure of fitness and frailty in elderly people.Can Med Assoc J. 2005; 173: 489-495
- Frailty consensus: A call to action.J Am Med Dir Assoc. 2013; 14: 392-397
- Statistical methods for assessing agreement between two methods of clinical measurement.The Lancet. 1986; 327: 307-310
- Why Bland–Altman plots should useX, not (Y+X)/2 whenX is a reference method.Stat Med. 2008; 27: 778-780
- DGE-Qualitätsstandard für die Verpflegung in stationären Senioreneinrichtungen. 2015.(Available at:)https://www.fitimalter-dge.de/fileadmin/user_upload/medien/DGE-Qualitaetsstandard_Stationaere_Senioreneinrichtungen.pdfDate accessed: December 5, 2017
- Estimation of calorie and protein intake in aged patients validation of a method based on meal portions consumed.J Gerontol A Biol Sci Med Sci. 2002; 57: M52-M56
- Comparison of visual estimation methods for regular and modified textures: Real-time vs digital imaging.J Acad Nutr Diet. 2012; 112: 1636-1641
- Development of a method for estimation of food and fluid intakes by nursing assistants in long-term care facilities: A pilot study.J Am Diet Assoc. 2003; 103: 873-877
- Criterion validity of the visual estimation method for determining patients’ meal intake in a community hospital.Clin Nutr. 2016; 35: 1543-1549
- Nutrient intake at meals in residential care facilities for the aged: Validated visual estimation of plate waste.Aust J Nutr Diet. 1998; 55: 188-193
- Validation of a plate diagram sheet for estimation of energy and protein intake in hospitalized patients.Clin Nutr. 2013; 32: 746-751
- How to measure energy and protein intake in a geriatric department – A comparison of three visual methods.Clin Nutr ESPEN. 2017; 17: 110-113
- Inherent flaws in a method of estimating meal intake commonly used in long-term-care facilities.J Am Diet Assoc. 2002; 102: 826-830
- Using digital photography in a clinical setting: A valid, accurate, and applicable method to assess food intake.Eur J Clin Nutr. 2018; 72: 879-887
Article info
Publication history
Published online: December 10, 2020
Footnotes
This work is submitted in partial fulfilment of the requirements for obtaining the degree Dr. rer. biol. hum. (PhD in Human Biology) for the primary author Angela Ott at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany.
This work was supported by the German Ministry for Education and Research (Grant 01EA1409C), Germany.
The preparation of this report is part of the enable cluster and is cataloged by the enable Steering Committee as enable31 (http://enable-cluster.de).
Dorothee Volkert received a research grant from Nestec Ltd, Vevey, Switzerland (agreement from Dec 2016), honorary for lecture from Nutricia and Fresenius outside the submitted work and is member of the Scientific Board of apetito AG. The other authors declare no conflict of interest.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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