The journal of nutrition, health & aging

, Volume 17, Issue 6, pp 509–513 | Cite as

Consuming two additional serves of dairy food a day significantly improves energy and nutrient intakes in ambulatory aged care residents: A feasibility study

  • Sandra IulianoEmail author
  • J. Woods
  • J. Robbins



Low-level aged-care residents are at risk of malnutrition. Oral supplements and fortified foods used to treat malnutrition in the elderly require special preparation and administration by staff. Therefore we aimed to determine if increasing dairy food intake in residents by two serves per day would improve energy and nutrient intakes and prevent malnutrition in residents.


Prospective intervention study.


2 intervention and 2 control low-level aged-care facilities in Melbourne, Australia.


130 residents (n = 68 intervention, 78% female, mean age 86.5 years).


This feasibility study was a 4-week intervention where menus were modified to include at least two additional serves of dairy food/day. Control facilities consumed from their regular menus.


Mean macro- and micro-nutrient intakes before and after intervention and over the same time period in controls were recorded using observed intake (food served minus waste) and changes over time determined using paired t-tests. Comparison in proportion of residents meeting nutritional requirements was determined using Chi-square distribution test.


Following intervention, daily increases in mean energy intake (900kJ, P<0.001), protein intake (+25g, P<0.0001), proportion of energy from protein (+4%, P<0.0001) and proportion of estimated energy requirements (EER) (+18%, P<0.0001) were observed, while proportion of energy from fat decreased (−3%, P<0.0001). In controls mean energy intake remained below the EER, and protein intake remained unchanged. Increases in mean daily micronutrient intakes were observed for numerous nutrients including calcium (+679mg, P<0.0001), vitamin D (+1.4μg, P<0.0001), phosphorus (+550mg, P<0.0001), and zinc (+2.8mg, P<0.0001), which remained unchanged in control residents. Calcium and zinc intakes achieved recommended intake levels on the higher dairy diet, but were below recommended levels in controls. Mean sodium intakes remained unchanged. During intervention a greater proportion of residents achieved the EER for energy and the RDI for protein and calcium compared to controls.


Two additional serves of dairy food can significantly improve nutrient intake in aged-care residents and its ease of provision makes it a viable option to potentially prevent malnutrition..

Key words

Aged-care calcium dairy foods energy intake malnutrition 


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  1. 1.
    Gaskill D, Black LJ, Isenring EA, Hassall S, Sanders F, Bauer JD. (2008) Malnutrition prevalence and nutrition issues in residential aged care facilities. Australas J Ageing. Dec;27(4):189–194.PubMedCrossRefGoogle Scholar
  2. 2.
    Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. (2010) Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Amer Geri Soc. 2010 Sep;58(9):1734–1738.CrossRefGoogle Scholar
  3. 3.
    Correia MI, Waitzberg DL. (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. Jun;22(3):235–239.PubMedCrossRefGoogle Scholar
  4. 4.
    Isenring EA, Bauer JD, Banks M, Gaskill D. (2009) The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care. J Human Nutr Diet. Dec;22(6):545–550.CrossRefGoogle Scholar
  5. 5.
    Woods J, Walker K, Iuliano-Burns S, Straus B. (2009) Malnutrition on the menu: nutritional status of institutionalised elderly Australians in low-level care. J Nutr Health Aging. 13(8):693–698.PubMedCrossRefGoogle Scholar
  6. 6.
    Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP. (1998) Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, doubleblind, placebo-controlled trial. Ann Intern Med. 15;128(10):801–809.Google Scholar
  7. 7.
    Leslie WS. (2011) Improving the dietary intake of frail older people. Proc Nutr Soc. 70(2):263–267.PubMedCrossRefGoogle Scholar
  8. 8.
    Simmons SF, Patel AV. (2006) Nursing home staff delivery of oral liquid nutritional supplements to residents at risk for unintentional weight loss. J Amer Geri Soc. Sep;54(9):1372–1376.CrossRefGoogle Scholar
  9. 9.
    Gosney M. (2003) Are we wasting our money on food supplements in elder care wards? J Adv Nurs. 43(3):275–280.PubMedCrossRefGoogle Scholar
  10. 10.
    Manders M, de Groot CP, Blauw YH, Dhonukshe-Rutten RA, van Hoeckel-Prust L, Bindels JG, et al. (2009) Effect of a nutrient-enriched drink on dietary intake and nutritional status in institutionalised elderly. Euro J Clin Nutr. 63(10):1241–1250.CrossRefGoogle Scholar
  11. 11.
    Bonjour JP, Benoit V, Pourchaire O, Ferry M, Rousseau B, Souberbielle JC. (2009) Inhibition of markers of bone resorption by consumption of vitamin D and calciumfortified soft plain cheese by institutionalised elderly women. Br J Nutr. 102(7):962–966.PubMedCrossRefGoogle Scholar
  12. 12.
    Smoliner C, Norman K, Scheufele R, Hartig W, Pirlich M, Lochs H. (2008) Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition. Nutrition. 24(11–12):1139–1144.PubMedCrossRefGoogle Scholar
  13. 13.
    Iuliano-Burns S, Woods J, King K, Ghasem Zadeh A, Wang X-F, Wang Q, et al. (2012) A dairy-based protein, calcium and vitamin D supplement reduces falls and femoral neck bone loss in aged care residents: a cluster randomised trial. J Aging Res Clin Prac. 2(2):141–146.Google Scholar
  14. 14.
    Australian Institute of Health & Welfare. (2006) Residential aged care in Australia 2005–06: a statistical overview.:; [cited 2007 October].Google Scholar
  15. 15.
    Sherwin A, Nowson CA, McPhee J, Alexander JL, Wark JD, Flicker L. (1988) Nutrient intake as meals in residential care facilities at the aged: validated visual estimation of plate waste. Aust J Nutr Diet. 55:188–193.Google Scholar
  16. 16.
    Nutrient Reference Values for Australia and New Zeland. (1991) [cited March 2012].
  17. 17.
    Amarantos E, Martinez A, Dwyer J. (2001) Nutrition and quality of life in older adults. J Gerontol Series A, Biol Sci Med Sci. 56Spec No 2:54–64.CrossRefGoogle Scholar
  18. 18.
    Woods JL, Iuliano-Burns S, Walker KZ. (2011) Weight loss in elderly women in low-level care and its association with transfer to high-level care and mortality. Clin Interv Aging. 6:311–317.PubMedGoogle Scholar
  19. 19.
    Paddon-Jones D, Rasmussen BB. (2009) Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care. 12(1):86–90.PubMedCrossRefGoogle Scholar
  20. 20.
    Dillon EL, Sheffield-Moore M, Paddon-Jones D, Gilkison C, Sanford AP, Casperson SL, et al. (2009) Amino acid supplementation increases lean body mass, basal muscle protein synthesis, and insulin-like growth factor-I expression in older women. J Clin Endocrinol Metab. 94(5):1630–1637.PubMedCrossRefGoogle Scholar
  21. 21.
    Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. (2006) A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly. Amer J Physiol. Aug;291(2):E381–E387.Google Scholar
  22. 22.
    Sugarman JR, Connell FA, Hansen A, Helgerson SD, Jessup MC, Lee H. (2002) Hip fracture incidence in nursing home residents and community-dwelling older people, Washington State, 1993–1995. J Am Geriatr Soc. 50(10):1638–1643.PubMedCrossRefGoogle Scholar
  23. 23.
    Chen JS, Sambrook PN, Simpson JM, Cameron ID, Cumming RG, Seibel MJ, et al. (2009) Risk factors for hip fracture among institutionalised older people. Age Ageing. 38(4):429–434.PubMedCrossRefGoogle Scholar
  24. 24.
    Flicker L, Mead K, MacInnis RJ, Nowson C, Scherer S, Stein MS, et al. (2003) Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc. 51(11):1533–1538.PubMedCrossRefGoogle Scholar
  25. 25.
    Huang Z, Himes JH, McGovern PG. (1996) Nutrition and subsequent hip fracture risk among a national cohort of white women. Am J Epidemiol. 144(2):124–134.PubMedCrossRefGoogle Scholar
  26. 26.
    Ribot C, Tremollieres F, Pouilles JM, Albarede JL, Mansat M, Utheza G, et al. (1993) Risk factors for hip fracture. MEDOS study: results of the Toulouse Centre. Bone. 14 Suppl 1:S77–S80.Google Scholar
  27. 27.
    Gibson RA. (2011) Milk fat and health consequences. Nestle Nutr Workshop Ser Pediatr Program. 67:197–207.PubMedCrossRefGoogle Scholar
  28. 28.
    Simmons SF, Zhuo X, Keeler E. (2010) Cost-effectiveness of nutrition interventions in nursing home residents: a pilot intervention. J Nutr Health Aging. 14(5):367–372.PubMedCrossRefGoogle Scholar
  29. 29.
    Beck AM, Damkjaer K, Beyer N. (2008) Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function. Nutrition. 24(11–12):1073–1080.PubMedCrossRefGoogle Scholar
  30. 30.
    Cruz-Jentoft AJ, Calvo JJ, Duran JC, Ordonez J, De Castellar R. (2008) Compliance with an oral hyperproteic supplement with fibre in nursing home residents. J Nutr Health Aging. 12(9):669–673.PubMedGoogle Scholar
  31. 31.
    Simmons SF, Reuben D. (2000) Nutritional intake monitoring for nursing home residents: a comparison of staff documentation, direct observation, and photography methods. J Amer Geriatr Soc. 48(2):209–213.Google Scholar
  32. 32.
    Simmons SF, Alessi C, Schnelle JF. (2001) An intervention to increase fluid intake in nursing home residents: prompting and preference compliance. J Amer Geriatr Soc. 49(7):926–933.CrossRefGoogle Scholar
  33. 33.
    Woo J, Chi I, Hui E, Chan F, Sham A. (2005) Low staffing level is associated with malnutrition in long-term residential care homes. Euro J Clin Nutr. 59(4):474–479.CrossRefGoogle Scholar
  34. 34.
    Gaskill D, Isenring EA, Black LJ, Hassall S, Bauer JD. (2009) Maintaining nutrition in aged care residents with a train-the-trainer intervention and Nutrition Coordinator. J Nutr Health Aging. 13(10):913–917.PubMedCrossRefGoogle Scholar
  35. 35.
    Meijers JM, Halfens RJ, Wilson L, Schols JM. (2012) Estimating the costs associated with malnutrition in Dutch nursing homes. Clin Nutr. 31(1):65–68.PubMedCrossRefGoogle Scholar
  36. 36.
    Blundell JE, Stubbs RJ. (1999) High and low carbohydrate and fat intakes: limits imposed by appetite and palatability and their implications for energy balance. European Journal of Clin Nutr. 53 Suppl 1:S148–S165.CrossRefGoogle Scholar
  37. 37.
    Aged Care in Australia. (2006) [cited July 2007].

Copyright information

© Serdi and Springer-Verlag France 2013

Authors and Affiliations

  1. 1.University of Melbourne / Austin HealthWest HeidelbergAustralia
  2. 2.Department of Nutrition and DieteticsMonash UniversityClaytonAustralia
  3. 3.Judy L. Robbins Consultant DietitianHawthorn EastAustralia
  4. 4.Department of EndocrinologyHeidelberg Repatriation HospitalWest HeidelbergAustralia

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