July 2009 Issue

Fortify to Enhance Nutritional Value
By Becky Dorner, RD, LD
Today’s Dietitian
Vol. 11 No. 7 P. 20

In long-term care, we are often focused on helping our residents consume adequate nutrients to maintain weight and nutritional status. This article reviews nutrition interventions to boost calorie and protein intake for those who cannot get enough nutrition from their diet. These suggestions may be beneficial for people who are unable to consume a large volume of food, have poor appetites, or experience weight loss or pressure ulcers.

It is important to individualize approaches and ensure that each person receives foods that he or she is willing to eat. Provide residents with their favorite foods and cater to their preferences whenever possible. Consider offering small, frequent meals and snacks. Most importantly, ensure that each individual has the assistance he or she needs at mealtime (eg, assistive feeding devices, encouragement, help with eating).

Focus on Food First
Our kitchen staff go out of their way to prepare three balanced meals and snacks daily. Rather than add to the volume and cost of food by providing additional supplements, why not fortify the foods your facility already serves? Add nutritional value to residents’ favorite and most accepted foods by using the suggestions presented here. The goal is to power pack each mouthful of food and drink for those who cannot consume large volumes.

Note that the following recommendations are not intended for people on low-fat or carbohydrate-controlled diets. All liquids for those on thickened liquids must be served at the thickness that the physician orders. As always, it is important to monitor individuals’ acceptance, tolerance, and weight status. It may be necessary to alter interventions if residents demonstrate poor tolerance.

Calorie Boosters
Add calorie-dense foods to dishes increase their caloric impact. Use the following suggestions to fortify foods and boost calories:

• Margarine or butter: Add to casseroles, hot cereals, vegetables, potatoes, noodles, soups, and puréed foods. Spread on bread, sandwiches, and muffins.

• Mayonnaise: Spread on bread and sandwiches and use as a garnish for appropriate puréed foods. Use in egg, chicken, tuna, and meat salads or their alternate ground or puréed foods.

• Peanut butter: Use as a snack on bread, pretzels, apples, and celery. Blend into cookies, brownies, and milk shakes. (Do not use peanut butter for mechanical soft diets or dysphagia diets. For puréed diets, use creamy peanut butter only if puréed into another recipe, such as puréed sandwiches, muffins, and cookies.)

• Sour cream: Use on mashed potatoes and noodles and as a dip.

• Half-and-half or cream: Add to milk shakes, hot chocolate, and other beverages; pour over cereals; and use in cream soups and puddings.

• Other calorie-dense foods: Casseroles with added calorie boosters, cheese, corn syrup*, cream cheese, evaporated milk, gravy, honey*, ice cream floats and sundaes*, jelly*, maple syrup*, oils, pudding*, salad dressings, soups (made with whole milk or half-and-half), syrup*, and whipped cream. (Foods marked with an asterisk are high in simple sugars and must be counted into the day’s total carbohydrate if on a carbohydrate-controlled diet.)

Protein Boosters
Add high-protein items such as powdered milk, cheese, eggs, and peanut butter to foods to boost their protein value. The following suggestions are intended to help boost protein intake for people who have difficulty eating high-protein foods:

• Skim milk powder: Mix 1 cup of skim milk powder into 1 qt of whole milk and use in recipes for creamed soups, hot cocoa, cooked cereals, cooked custard or pudding, casseroles, and mashed potatoes. Skim milk powder can also be added to scrambled eggs, soups, casseroles, meatloaf or meatballs, cookies and muffins, and puréed foods. If using dry milk powder, start by adding 1 T of skim milk powder per serving.

• Milk or half-and-half: Use instead of water for soups, cereals, and instant cocoa. Add to milk shakes, hot chocolate, and other beverages; pour over cereals; and use in cream soups and puddings.

• Cheese sauce: Add to casseroles and soups and pour over vegetables.

• Eggs (cooked only): Plain, in egg dishes, and added to mixed dishes.

• Peanut butter: Use as a snack on bread, pretzels, apples, and celery. Blend into cookies, brownies, and milk shakes. (Do not use peanut butter for mechanical soft or dysphagia diets. For puréed diets, use creamy peanut butter only if puréed into another recipe.)

• Other high-protein foods: Cottage cheese, yogurt, meat, fish, poultry, commercially prepared high-calorie/high-protein supplements such as beverages*, fortified or enhanced foods, juices, milk shakes*, and puddings*.

— Becky Dorner, RD, LD, is a speaker and an author who provides publications, presentations, and consulting services to enhance the quality of care for the nation’s older adults. Visit www.beckydorner.com for free articles, newsletters, and information.

 

Enhanced/Fortified Food Recipes

Fortified Oatmeal

Serves 10

Ingredients:
3 1⁄3 cups oatmeal
5 cups half-and-half
2 1⁄2 cups water
1 1⁄4 tsp salt
3 1⁄3 T margarine
10 T brown sugar

Directions:
Measure half-and-half, water, salt, and margarine into saucepan and bring to a boil. Add oatmeal and cook until thick. Serve with brown sugar on top. Hold at 135˚F or higher until service.

Cool any leftovers to less than 41˚F within 4 hours for storage.  Reheat leftovers to 165˚F for a minimum of 15 seconds prior to serving (hold at 135˚F or higher for service).

Nutrient Analysis: 1/2 cup portion = 331 calories, 6.6 g protein, 38 g carbohydrate, 18 g total fat, 44 mg cholesterol, 397 mg sodium, 3 g dietary fiber

Note: Oatmeal must be puréed for level 1 puréed diets.

 

Super Soup

Serves 10

Ingredients:
Three 10 3/4-oz cans condensed cream soup (cream of celery, chicken, mushroom, potato, or onion)
Three 10 3/4-oz cans half-and-half

Directions:
Measure ingredients into an appropriate-sized pan and whisk together (use soup can to measure the half-and-half). Heat to boiling, stirring constantly. Maintain temperature at 135˚F or higher for holding and service.

Cool any leftovers to less than 41˚F within four hours for storage. Reheat leftovers to 165˚F for a minimum of 15 seconds prior to serving (hold at 135˚F or higher for service).

Nutrient Analysis: 3/4 cup (6 oz) portion = 217 calories, 5.3 g protein, 11.4 g carbohydrate, 17 g total fat, 44 mg cholesterol, 703 mg sodium, (dietary fiber depends on the type of soup but is negligible)

 

Power Potatoes

Serves 10

Ingredients:
3 1/3 cups mashed potato flakes
1 1/4 cups water
3 1/3 cups half-and-half cream
5 T margarine
1 1/2 tsp salt

Directions:
Heat water, half-and-half cream, margarine, and salt in a saucepan just to boiling. Do not overheat or cream will curdle. Remove from heat. Stir in mashed potato flakes until moistened. Let stand 30 seconds or until liquid is absorbed. Whip with spoon until fluffy. Add additional hot liquid if potatoes are too stiff. Serve with margarine or gravy to moisten. Hold at 135˚F or higher for service.

Cool any leftovers to less than 41˚F within 4 hours for storage.  Reheat leftovers to 165˚F for a minimum of 15 seconds prior to serving (hold at 135˚F or higher for service).

Nutrient Analysis: 1/2 cup portion = 226 calories, 4 g protein, 19.7 g carbohydrate, 15 g total fat, 29 mg cholesterol, 475 mg sodium, 13 g dietary fiber

Variations:
• Sour Cream: Serve with 1 to 2 T sour cream per serving.
• Cheesy: Mix in 1 T grated cheddar cheese per serving.
• Garlic: Substitute garlic salt for salt in the recipe.

For additional recipes, visit www.beckydorner.com/membersonly. (Free membership required to access full document.)