Can foodservices in aged care homes deliver sustainable food fortification strategies? A review

Exploring consumer beliefs about novel fortified foods: A focus group study with UK-based older and younger adult consumers

Consuming 'nutritionally-enhanced' food products (including those that are fortified or enriched to deliver nutritional and functional properties) may help to improve overall diet quality and combat risks associated with malnutrition. However, fortification can negatively impact consumer acceptance, particularly where expected sensory properties of 'delivery' foods are affected by target ingredients. Here, we explored factors influencing consumer acceptability for six novel food products that had been fortified, including both savoury and sweet meal components (e.g., high protein dumplings, probiotic yoghurt drink). In person focus groups (25 consumers aged between 22 and 76 years old) were conducted with two stages; firstly, participants completed a blind taste test of products without awareness of fortification. Secondly, participants discussed products with awareness of additional ingredients and food properties. Reflexive thematic analysis showed that liking of sensory properties differed between foods, but informing participants about the fortification of products highlighted potential trade-offs between taste, health, price, and familiarity. Though taste and texture were generally prioritised by participants, positive perceptions of health benefits increased consumer willingness to buy, whilst both cost and uncertainty about product use were potential barriers. Trust of information was a key concern for labelling and product claims. These results highlight product features that may be optimised to support the success of fortified foods. Greater transparency when building product brands and improving consumer knowledge of fortification may also be important for longer-term consumer acceptance.

Investigation of some quality properties of yogurt made from cow and sheep milk fortified with folic acid (B9 ), biotin (B7 ), and vitamin D3

BACKGROUND

The aim of this study was to investigate the effects on some physicochemical properties and starter cultures of yogurts enriched with vitamins at different concentrations during storage. For this purpose, yogurt was produced by adding the vitamins folic acid (B9 ), biotin (B7 ), and vitamin D3 in different concentrations to sheep and cow milk and stored at 4 °C. Physicochemical analyses and microbiological analyses were performed for each group of yogurt on days 0, 7, 14, and 21.

RESULTS

There was no significant difference (P > 0.05) between the groups in pH and titration acidity (%) during storage. It was determined that in the yogurts produced from sheep milk, the groups enriched with vitamins had a higher number of L. bulgaricus than the control group on the 7th day of storage. Moreover, the groups containing vitamin D3 exhibited a higher Lactobacillus bulgaricus count on the 21st day of storage. The highest L. bulgaricus counts on the 7th day in yogurts produced from cow's milk were observed in groups containing 0.5 mL of vitamin B9 and B7 . No mold or yeast growth was observed during storage in any of the yogurt groups made from cow and sheep milk.

CONCLUSION

In conclusion, it was determined that the enrichment of yogurt with vitamins B7 , B9 , and D3 did not adversely affect the quality of the yogurt; rather, it improved. We recommend that yogurt enriched with micronutrients be studied economically, and mass production should be initiated by yogurt companies as soon as possible. © 2023 Society of Chemical Industry.

The challenges facing residential aged care homes to participate in quality food and nutrition research

BACKGROUND

There is a clear need for food and nutrition research to lead to pragmatic and sustainable solutions to the ongoing problems in residential aged care, particularly within foodservices. The present study aimed to identify systemic challenges for residential aged care homes in Australia to participate in quality food and nutrition research, using a complexity science lens.

METHODS

Qualitative data from three studies in residential aged care were gathered, which included 28 participants across 21 aged care homes. Qualitative data consisted of in-depth interviews, field notes and email communications with aged care staff. Thematic analysis was undertaken using both inductive and deductive approaches.

RESULTS

Four themes were identified: (1) complex staffing issues deter or impede participation in research; (2) external pressure on the aged care system leads to research not being a priority; (3) funding issues are variable and pose a barrier for some aged care homes; and (4) research processes and requirements can lead to biased samples.

CONCLUSIONS

Several challenges to undertaking quality empirical research in residential aged care in Australia were identified. Research needs to be part of usual business, similar to hospitals, and operate independently of staffing and funding issues. Issues within foodservices are system issues and there is a need for quality empirical research to determine solutions.

OUP accepted manuscript

AIMS

To identify and provide clarity on factors that influence coping and the type of coping strategies used by patients with heart failure (HF) to improve health-related quality of life (HRQoL).

METHODS AND RESULTS

The Arksey and O'Malley template framed this scoping review guided by the stress and coping model. Five databases were explored: PubMed, Web of Science, Cochrane, CINAHL, and PsycINFO. Keywords included HF, quality of life, coping, and influencing factors. Eligibility criteria involved patients with HF, reported on coping strategies and HRQoL, and published in English. Thirty-five studies were included (4 randomized controlled trials, 27 cross-sectional, and 4 qualitative/mixed methods). Active emotional coping (e.g. acceptance) and problem-focused (e.g. seeking social support) coping strategies were linked to better HRQoL, while avoidant emotional coping (e.g. denial) was linked to worse HRQoL. In the presence of the stressor of HF severity, key factors that influenced the types of the coping strategy included sex, age, social support, income, education, spiritual beliefs, and illness duration. However, the evidence on the effectiveness of the type of coping on HRQoL remains inadequate due to the majority of studies being cross-sectional.

CONCLUSION

Problem-focused and active emotional coping strategies are associated with improved HRQoL. However, their effect is inconclusive due to the lack of experimental studies. Additional predictive studies will enhance the understanding of coping among HF patients.

Food and Nutrition Champions in Residential Aged Care Homes Are Key for Sustainable Systems Change within Foodservices; Results from a Qualitative Study of Stakeholders

The role of foodservices in aged care is difficult to understand, and strategies to improve the nutritional care of residents are often unsustainable. In particular, food-first strategies such as food fortification are poorly executed in everyday practice and its execution relies upon the foodservice system in aged care homes. The aim of this study was to explore the perspective of staff on the role of foodservices in aged care and gauge the level of skills, education, access, time, and ability to deliver food fortification. Semi-structured interviews were conducted with foodservice managers, foodservice workers, dietitians, carers, and other managers who work in aged care homes across Australia. Participants were recruited purposively through email and through snowballing. Interviews (n = 21) were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Three themes and six sub-themes were identified. The three themes include the role of foodservices being more than just serving food, teamwork between all staff to champion nutrition, and workplace culture that values continuous improvement. These themes identify how staff perceive the role of foodservices in aged care and provide an important perspective on the long-term sustainability of food fortification strategies and how to improve current practice.