Energy, protein, calcium, vitamin D and fibre intakes from meals in residential care establishments in Australia

Residents from high level (nursing homes) and low-level care facilities (hostel) being served the three common diet texture modifications (full diet, soft-minced diet and pureed diet) were assessed. Individual plate waste was estimated at three meals on one day. Fifty-six males and 156 females, mean age 82.9+/-9.5 (SD) years, of which 139 lived in nursing homes (NH) and 76 in hostels (H) were included. Mean total energy served from meals was 5.3 MJ/day, 5.1 to 5.6 MJ/day, 95% confidence intervals (CI), in NH which was less than in H, 5.9 MJ/day (CI 5.6 to 6.2 MJ/day) (P=0.007). Protein and calcium intakes were lower in NH, 44.5g (CI 41.5 to 47.5g), 359.0mg (CI 333.2 to 384.8mg), versus 50.5g (CI 46.6 to 54.3g), 480.5mg (CI 444.3 to 516.7mg) in H (P=0.017, P<0.001 respectively). There was no difference in nutrient/energy ratios, except for protein/energy, which was higher in NH 11.7 (CI 11.3 to 12.2) than in H 9.8 (CI 9.4 to 10.3) (P<0.001). Ability to self-feed had no significant effect on nutrient intakes in NH. The self fed group (N=63) had the following nutrient intakes: energy 4.0 MJ (CI 3.6 to 4.3 MJ), protein 44.6g (CI 40.3 to 48.9g), calcium 356.9mg (CI 316.3 to 397.4mg), fibre 14.9g (CI 13.2 to 16.5g). The assisted group (N=64) had the following nutrient intakes: energy 3.9MJ (CI 3.6 to 4.2MJ), protein 46.0g (CI 40.7 to 49.6), calcium 361.9mg (CI 327.8 to 396.1mg), fibre 14.9g (CI 13.2 to 16.1g). Of NH classified as eating impaired, 36% received no assistance with feeding and had lower intakes of protein 37.8g (CI 33.0 to 42.1g) compared to those receiving some assistance 46.1g (CI 41.3 to 50.9g) (P=0.026). Reduced energy intake accounted for the differences in nutrient intakes between nursing homes and hostels, except for protein. Strategies to effectively monitor nutrient intakes and to identify those with eating impairment are required in order to ensure adequate nutrition of residents in nursing homes and hostels.

The occupiers' burden: tackling food shortage and related health problems in post-war Germany 1945-47

The end of the Second World War brought much relief to its combatants, but a range of problems remained that would plague post-war Europe for years to come. Chief among them was food shortage. The breakdown of agricultural systems, essential services, and the state itself laid fertile ground for food shortage to develop in parts of post-war Germany occupied by the victorious powers. There is much to be gained from comparing the occupiers’ responses to this Horseman of the Apocalypse. The most fruitful comparison lies between the Soviets and British. Unlike the Americans whose economic might in the post-war period allowed them to better feed and supply Germans living in their occupation zone, domestic economic weaknesses hamstrung both Soviet and British responses to the more severe advent of food shortage which confronted them. Their responses were very different—some successful, others not—but all instructive for understanding the impacts of natural and policy factors on the development of food shortage and the consequences to the health of the population. The variety of these impacts have been obscured by the absence of this comparison in the literature, which is now made more feasible by the greater availability of the extensive resources that each occupier devoted to recording food and health data, particularly in the Soviet case. The data is not only relevant to the occupation period from 1945 to 1949, as it suggests long-term health impacts on those most exposed to the risk of food shortage then, and most at risk to the consequences of malnutrition decades later. In fact, as the available data defines regional differences in food rations and, accordingly, comparative food shortages in Soviet and British occupation zones, the situation in post-war Germany provides an excellent platform for future research linking differences in early nutrition to adult health outcomes.