Dietary advice to help improve Nutrition & Dietetics nutritional intake Patient information How to make every bite count – information for patients at risk of malnutrition Introduction • Have at least 1 pudding per day. During your recent appointment with a • Choose 2 good protein sources each day, health care professional you were asked such as: meat, fish, chicken, eggs, cheese, about your appetite and if you had lost any nuts, yogurt or beans and pulses. weight recently. You may have had your • Have 1 pint of full cream milk each day. weight and height recorded. • Drink 6 – 8 glasses of fluid each day (tea, This information identified you as being ‘at coffee, fruit juice, milky drinks). Sip on risk’ of becoming malnourished. It is these throughout the day and take drinks important to maintain your weight and after your meals, to avoid filling up on prevent any further weight loss to reduce them. further health problems and to keep you as • Fortify your milk (add 4 tablespoons of well as possible. To do this it is important to dried milk powder to 1 pint of full cream eat nourishing foods; high in energy and milk). protein. This leaflet gives you ideas on how to make small changes to help you eat a more If you have a small appetite nourishing diet and prevent any further weight loss. The following suggestions may You should: help and should be followed until your • Try to eat ‘little and often’. healthcare professional is happy with your weight. • Try to choose foods you fancy. • Try convenience foods or ready meals if you are finding cooking difficult or tiring. How to eat a nourishing diet It may also be a good idea to freeze smaller portions of home cooked meals You should try to: for convenience. • Eat 3 small meals each day as well as • Do not try to eat large amounts and mid-morning, mid-afternoon and supper over-face yourself. time snacks or eat small amounts every 2 – 3 hours. • Choose high calorie items such as, full If you have diabetes cream milk, puddings, pastries, pies, If you have diabetes, sugary items should be sweets, chocolate, biscuits, nuts, tea cakes, avoided. You should choose higher fat foods crumpets, scones, crisps, cakes, cooked in order to maintain your weight. A high fat breakfast and meals with creamy and/or diet is suitable in the short term for those cheesy sauces. with high cholesterol, as it is more important • Avoid ‘low fat’ or ‘diet’ products. that you are not losing weight. Choose nourishing snacks Choose nourishing drinks • Scone, crumpet, muffin or toasted teacake These recipes provide a similar amount of with butter and jam calories as supplement drinks that are • Cheese or peanut butter on toast available to buy or get on prescription. • Crackers with butter and cheese or patè • Bacon sandwich Cup-a-soup • Thick and creamy yogurts or mousse Ingredients: • Cake bar or muffin 200ml of full cream milk • Sausage roll, , pakora, spring rolls 2 heaped teaspoons of milk powder or pork pie 1 packet of cup-a-soup • Crisps Method: Mix together milk, milk powder • Pot of custard or rice pudding and cup-a-soup. Heat until simmering in a saucepan or microwave. • Pot of trifle or individual cheesecake • Flapjack, biscuits, chocolate bar or cereal Nutritional value (approx): bar 250kcal per cup • Malt loaf with butter. Milkshake Quick meal ideas Ingredients: • Jacket with butter, beans and 200ml (1/3 pint) full cream milk cheese 2 heaped teaspoons of milk powder • Sausage, mash and beans (add butter and Add milkshake syrup or powder to taste cheese to ) Method: Whisk milk and milk powder • Cheese, scrambled egg, beans or spaghetti together, add milkshake syrup or powder. on well-buttered toast Nutritional value (approx): • Omelette with cheese and ham 230kcal per cup • Try tinned, oven ready or microwave Variations: meals for convenience (avoid diet brands) Add 1 scoop of ice cream (extra 115kcal) • Sausage roll, corned beef slice, pasty, pork Add 1 tablespoon of single or double cream pie, spring roll, or bhaji (extra 60/149kcal) • Oven chips or potato with beans and cheese. Milky coffee Dessert ideas Ingredients: • Instant desserts: instant whip or custard 150ml (1/4 pint) full cream milk made with fortified milk 1 heaped teaspoon of milk powder 4 tablespoons of single cream • Tinned: milk pudding, custard, fruit in 1 teaspoon of coffee powder syrup, sponge puddings • Frozen: cakes, gateaux, ice cream, ice- Method: Mix together milk, milk powder lollies, choc-ices, ready to bake puddings and cream. Heat until simmering in a saucepan or microwave. Remove from heat • From the fridge: thick and creamy yogurt, and add coffee powder. cheesecake, mousses, trifles • Homemade: crumbles, bread and butter Nutritional value (approx): pudding, fruit pies, milk puddings, scones, 240kcal per cup cakes, halva, kheer and kulfi. MICB3831 Smoothie Try adding extra calories to Ingredients: 100ml full cream milk food 100ml fruit juice (orange/ cranberry/ Fats and sugars are high in energy and can pineapple) be added to foods to increase calories. 1 heaped tablespoon of milk powder This is what you can do to your normal 1 scoop of ice cream menu to make it higher in energy: Fruit, for example, 1 banana, 3 tablespoons of berries or 3 pineapple rings Method: Blend all the ingredients in a Sample menu liquidiser for 10 - 15 seconds. Serve chilled. Breakfast: Nutritional value (approx): 390kcal (depending on fruit used) Cereal - use full cream milk or fortified milk and add 2 teaspoons of sugar Toast - spread butter thickly and add Hot chocolate/malted milk drinks jam, marmalade, honey or syrup Ingredients: Have a mid morning snack 150ml (1/4 pint) full cream milk (see suggestions page 2) 1 heaped teaspoon of milk powder 4 tablespoons of single cream Lunch: 3 heaped teaspoons of hot chocolate, Soup - choose ‘cream of soups’ and add Horlicks or Ovaltine powder butter, cheese, cream or crème fraiche Method: Whisk and heat all ingredients Bread bun or pitta bread together until simmering in a saucepan or Yogurt - choose thick and creamy microwave. yogurt Nutritional value (approx): Have a mid afternoon snack 290kcal per cup (see suggestions page 2) Variations: Top with squirty cream and a chocolate flake Evening meal: or marshmallows (extra 50kcal) Roast chicken, potatoes and vegetables - add butter, full cream milk, cream or cheese to mashed potato, have Yogurt drink vegetables with butter or in cheesy Ingredients: sauces 150ml (1/4 pint) full cream milk Curry, rice and naan bread - add 1 pot of thick and creamy fruit yogurt coconut milk to the curry 1 level tablespoon of milk powder Dessert - try stewed fruit with ice Method: Blend all ingredients in a liquidiser cream, cream, custard or milky for 10 -15 seconds. Serve chilled. puddings Nutritional value (approx): 270kcal per cup Supper: (see suggestions) Variations: Top with squirty cream (extra 30kcal) Hot chocolate – (see nourishing drink recipes pages 2-3) You can purchase ‘Complan’ or other similar high energy “milkshake” products and soups from the local supermarket or pharmacy (chemist) if you are unable to make the nourishing drinks. MICB3831 What if I cannot make my own meals? Some companies will deliver frozen foods to your door:

Wiltshire Farm Foods Oakhouse Foods Royal Voluntary Service 147 Stockton Street Unit 21/22 Riverside Park 18 Brentnall Street Middlesbrough Middlesbrough Middlesbrough TS2 1BU TS2 1RP TS1 5AP Telephone: 01642 643999 Telephone: 01642 221112 Telephone: 01642 222643 Monday – Friday Monday – Friday Monday – Friday 9am – 5pm 9am – 5pm 9am – 2.30pm

Comments, compliments, Patient Advice and concerns or complaints Liaison Service (PALS) South Tees Hospitals NHS Foundation Trust is This service aims to advise and support concerned about the quality of care you receive and patients, families and carers and help sort strives to maintain high standards of health care. out problems quickly on your behalf. However we do appreciate that there may be an This service is available, and based, at occasion where you, or your family, feel dissatisfied The James Cook University Hospital with the standard of service you receive. Please but also covers the Friarage Hospital in do not hesitate to tell us about your concerns as Northallerton, our community hospitals this helps us to learn from your experience and to and community health services. Please ask improve services for future patients. a member of staff for further information.

If you require this information in a different format please contact Freephone 0800 0282451

Author: Dietitians – Community Nutrition & Dietetic Service

1st Floor, Langbaurgh House, Bow Street, Guisborough, Cleveland, TS14 7AA. Telephone: 01287 284074

Version 3, Issue Date: September 2018, Revision Date: September 2020 MICB3831