Food as Treatment: Care Homes

Food as treatment involves a 3-pronged approach: 1) Food toppers 2) Nourishing snacks 3) Homemade supplements . . (also known as nourishing drinks)

Food Toppers: Medium risk: 1 food topper per meal High risk: 1 food topper per dish (i.e. main meal and )

Food Toppers (per person portion)

Examples: Add to (approx. 100kcals each) Peanut/ almond/Nut butter Toast / porridge/ spread on plain biscuits / add to baking ( 1 tbsp - 25g) e.g. brownies Enriched milk Add 5 heaped tbsp (63g) of powder to 1 pint of whole milk. (100mls) (use in cereal/ / sauces/ soups/ /) Double cream Mash / porridge /angel delight/ rice pudding/ custard/ ( 2 tbsps; 30mls) yoghurt/ soups/ sauces / Cheddar / other cheese Grated on Casseroles/ pasta/ potatoes or cooked into 30g (matchbox sized piece) sauce/ added to Avocado 80g (½ avocado) Mashed on toast, added to or salads Olive oil/ Vegetable oil/Butter/ Ghee For frying instead of grilling, added to mash/ veg/ soups (1 tsp per serving -5mls) /main courses Mascarpone or cream cheese Add to pasta / sandwiches/ potato salad/ soups / try cream (1 tbsp- 25g) cheese icing for cakes Mayonnaise/ / Pesto With salads/ vegetables, in sandwiches/ pasta (1 tbsp – 25g) Milkshake/ Hot choc powder (not free or ‘light’) Add to Enriched Milk as a drink or (2 tbsp – 25g) use to flavour custard Custard (5 tbsp) / ice cream (1-2 scoops) / Add a serving to puddings/ / fruit whipped cream (2 tbsp)

Establish resident’s preferences and document in care plan. Document actual intake of fortified food (clear documentation will help identify how to modify diet if first steps not effective)

Developed by CPCCG Dietitian for Primary Care & CPFT Dept. Nutrition and Dietetics Version V 1.0 Issue Date 2020, July Review Date 2022, July

2) Nourishing snacks

Medium risk: 1 Nourishing snack per day High risk: 2 Nourishing snacks per day

Nourishing Snacks examples (include at least once per day)

• roll (x 2 if picnic size) /scotch egg /Mini • Muffin (American style e.g. chocolate/ blueberry) • Slice of or • Chocolate bar (e.g. Dairy milk / crunchie/ mars bar) • Cup of tea and 2-3 biscuits or Cheese and crackers (x3) • Chocolate mousse/ crème caramel / - (try a supermarket readymade version for convenience) • Angel delight style pudding / fruit fool/ rice pudding • Danish pastry / doughnut /Pain au chocolat • Toast with pate /cheese/ avocado • Croissant (you could add a spoonful of jam or try with cheese and ham!) • Milkshake/ smoothie/ malted milk drink (try using Enriched Milk) • cheese twists or biscuits/ bhaji / pakora/ Samosa • Crumpet and butter with marmite/ jam (x1-2) • English muffin with butter/ cheese/ avocado / peanut butter • Piece of brownie/ swiss roll / traybake / flapjack • Handful of nuts/ Bombay mix

3) Homemade supplements: (click here for large volume recipes) Medium risk: 1 Nourishing drink per day High risk: 2 Nourishing drinks per day

Milkshake Plus • 140 ml (5 oz) Enriched milk • 4 teaspoons milkshake powder (e.g. Nesquik or supermarket vitamin enriched powder)

Calories: 302Kcal Protein: 18.6g

If the Resident is unable to consume 2 nourishing drinks per day, consider a portion of the following puddings instead: Mousse plus (makes 1 portions)

-75ml whole milk -10ml double cream -2 ½ rounded tsp instant dessert powder -2 Tbsp. skimmed milk powder

Method: 1. Mix the whole milk and double cream in a bowl. 2. Slowly add the skimmed milk powder and instant dessert powder. Blend well with a fork, whisk or hand-held blender. 3)The mousse can either be eaten straight away or left to stand in the fridge for 1 hour.

Per serving: 243Kcals +13g protein

Lemon Posset (makes 3 portions) Chocolate caramel cream (makes 3 portions) -300mls double cream -70 g caster sugar -30 skimmed milk powder - juice of 2 lemons -150 ml double cream - 30ml full fat milk -30 skimmed milk powder -2 x nougat caramel bar 1. Gently heat the cream with the milk powder until dissolved. 2. Add the sugar and bring to the simmer. 1. Heat cream, milk, and milk powder in saucepan 3. Boil for 3 minutes and turn off the heat. until powder has dissolved. 4. Mix in the lemon juice. Pour into 3 small 2. Add finely chopped chocolate bars dessert bowls and chill. Can be enjoyed frozen. 3. Heat gently, continually stirring, until the chocolate bars have completely melted try serving with some shortbread or ginger 4. Pour into 3 small bowls and chill biscuits Per serving: 488 kcals + 6.4 g protein Per serving: 565 kcals + 5 g protein

Food as treatment should be implemented for all patients at risk of malnutrition, including individuals with diabetes, who should have their medicines adjusted as necessary rather than limiting their food intake.