Assessment of Menus in a Selected Social Welfare Home with Regard to Nutritional Recommendations

Abstract

The aim of the study was to assess diets of residents of nursing homes. Provided by social welfare home, 10 day menus were introduced into the computer program Diet 5 and analyzed in respect of protein, fats, carbohydrates, energy, vitamin D and calcium. The resulting mean values of 10-day menus were compared with the existing Nutrition Standards for Polish population. The analysis menus showed that the average amount of energy supplied from food is not sufficient. Carbohydrates in food supply are too high and represent 257% of normal. The average value of fats and proteins supplied with food is adequate 85.2 g/day and 75.2 g/day. The calcium content of the diet is 513.9 mg/day. The amount of vitamin D supplied in the age group 51-65 years is 2.3 µg/day. Dietary errors that have been shown are due to the lack of detailed nutritional guidelines for nursing homes, as well as state-owned care facilities in general.

Full text

 Abstract—The aim of the study was to assess diets of residents of
nursing homes. Provided by social welfare home, 10 day menus were
introduced into the computer program Diet 5 and analyzed in respect
of protein, fats, carbohydrates, energy, vitamin D and calcium. The
resulting mean values of 10-day menus were compared with the
existing Nutrition Standards for Polish population. The analysis
menus showed that the average amount of energy supplied from food
is not sufficient. Carbohydrates in food supply are too high and
represent 257% of normal. The average value of fats and proteins
supplied with food is adequate 85.2 g/day and 75.2 g/day. The
calcium content of the diet is 513.9 mg/day. The amount of vitamin D
supplied in the age group 51-65 years is 2.3 µg/day. Dietary errors
that have been shown are due to the lack of detailed nutritional
guidelines for nursing homes, as well as state-owned care facilities in
general.
Keywords—Assessment of diet, essential nutrients, social
welfare home, nutrition.
I. INTRODUCTION
DEQUATE nutrient supply, covering protein, fats,
carbohydrates, vitamins, as well as micro- and macro-
nutrients, is a prerequisite for good health and physical fitness.
Importantly, either excessive or inadequate nutrient supply
may cause various diet-related diseases, such as
cardiovascular diseases, diabetes or obesity, and lead to
malnutrition [1]-[4]. A healthy diet is one that warrants regular
intake of necessary nutrients according to individual needs.
Currently, as world population is rapidly aging and there is
a wide prevalence of disabilities of various types, institutions
like nursing or care-and-board homes play an important role,
providing day-to-day care, assistance, nursing, and education
[5], [6]. Apart from the provision of relevant medical care, the
ability to offer a sustaining, healthy diet should be considered
one of their primary roles [6].
In Poland, dietary recommendations which should be
included in the daily meal plan have been developed by the
National Food and Nutrition Institute [7]. They list referential
values for energy and nutrient requirements [7].
All physiological functions, body growth and physical
activity require adequate energy supply. Individual calorie
needs vary depending on a combination of factors, such as a
person’s sex, age, health status, weight, height and their
physical activity level [7].
Unless daily food intake is adequate in terms of calorie
supply, the body is unable to function properly. When the
E. Grochowska-Niedworok is with the Medical University of Silesia in
Katowice, School of Public Health in Bytom, (corresponding author e-mail:
elzbieta.niedworok@onet.eu).
calorie supply is too high, the body stores it in the form of
excessive fat tissue, becoming overweight or obese [7], [8].
As the basic structural component of every cell, protein is
crucial for proper body functioning. It supports the functions
of the immune system, and is involved in multiple metabolic
processes [7], [11]. Just like with calorie intake, the required
protein intake depends on a number of factors, such as a
person’s age, health status, metabolism, level of physical
activity and the nutritional value of the dietary protein
consumed. The metabolic rate for protein is closely associated
with the body’s energy expenditure [7]. Protein sources may
be classified as animal- and plant-based. The main sources of
dietary protein in daily diet include meat, fish, eggs, milk and
other dairy products [10], [11].
Protein and calorie shortage initially induces weight loss,
but subsequently leads to adipose tissue atrophy, muscle
wasting, immune deficiency, poor digestion and inhibited
nutrient absorption. Protein deficiency is typically
accompanied by shortage of other nutrients [7], [9]. Intake of
excessive amounts of protein-rich foods, rich in fat and
calories, causes weight gain and adipose tissue buildup. To
ensure wellbeing and optimal health, it is vital to consume a
well-balanced diet containing adequate protein supply [12].
According to dietary guidelines, the recommended daily
protein intake falls in the range of 45-81 g [8].
Fats are a source of essential nutrients and dietary
unsaturated fatty acids. They also facilitate the absorption of
vitamin A, D, E and K. Excessive fat intake combined with a
low level of physical activity results with overweight and
cardiovascular diseases [7], [10], [13], [14]. The actual source
of fat is also important, as animal-based fats contain large
amounts of saturated fatty acids [13], [15]. They are found in
meat, processed meat products such as ham and sausage, eggs,
fish and dairy foods or lard [10].
Carbohydrates are commonly referred to as the body’s basic
fuel, with their primary function being the provision of energy.
They control blood glucose and insulin levels, as well as
hunger and satiation mechanisms. Carbohydrates, especially
glucose, are crucial for normal brain functioning. The type of
supplied carbohydrates influences the body’s glycemic
response. Excessive carbohydrate intake, however, has a
negative impact on an individual’s health, leading to
conditions such as diabetes, overweight ad obesity [7], [16].
Carbohydrates are provided with refined sugar, honey, potato
flour, dried fruit, as well as cereal and sweets. The bulk of
daily carbohydrate intake comes from cereal [10], [16], [17].
The recommended carbohydrate intake is 130 g/day [8].
In Polish population, vitamin D and calcium deficiency are
E. Grochowska-Niedworok, K. Brukalo, B. Całyniuk, J. Piekorz, M. Kardas
Assessment of Menus in a Selected Social Welfare
Home with Regard to Nutritional Recommendations
A
World Academy of Science, Engineering and Technology
International Journal of Medical and Health Sciences
Vol:13, No:1, 2019
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common across different age groups [18]-[21].
Calcium stimulates nervous impulses and muscle
contractility. It is also vital for healthy cardiac function, with
its deficiency leading to hypertension, hyperexcitation and
tetany. Outdoor physical activity on sunny days is vital to
facilitate vitamin D production by the body itself [7], [22],
[23]. Individual vitamin D requirements depend on sunlight
exposure, the mutual proportion of calcium and phosphorus in
the daily diet and their uptake from food [24]. Sea fish are the
most important source of vitamin D, followed by meat and
dairy products, yet to a much lesser degree. 90% of vitamin D
within the human body, however, is generated by sunlight [7],
[21].
The main calcium sources are milk and dairy products [7].
II. AIM OF THE STUDY
The study has been aimed at evaluating the meal plans
offered by a selected state-run nursing home, identifying
calorie, protein, fat, carbohydrate, calcium and vitamin D
intake of the residents.
III. MATERIAL AND METHOD
The study was carried out in a selected state-run nursing
home in the Silesian voivodeship, with 60 permanent
residents. The facility provides 24/7 care for residents with
intellectual disabilities. Its residents are male, aged 21-65
years old, accounting for large discrepancies in their dietary
needs.
The 10-day meal plans provided by the facility were entered
into Dieta 5 software developed by the National Food and
Nutrition Institute, and their protein (g), fat (g), carbohydrate
(g), energy (kcal), vitamin D (µg), and calcium (mg) contents
were analyzed, with mean values calculated. The results were
compared with the recommended daily intake values
(reference values) for Polish population, an updated version
[9].
To facilitate relevant calculations and compare the results
with the reference values, 70 kg was assumed as the residents’
mean body weight, and their physical activity level was
identified as 1.6.
The meal plan designed for the residents at this nursing
facility is based on a normal diet meal plan.
The calculations were performed with Statistica software
(parametric data) and in R software environment for statistical
computing and graphics (nonparametric data). The diagrams
were generated with Excel software.
Shapiro-Wilk test was applied to test data for normal
distribution. Parametric data were tested with the single
sample t-test, comparing the mean to a specified value.
Nonparametric values were analyzed with Wilcoxon signed
rank test. The statistical significance level was set up at α =
0.05.
IV. RESULTS
The mean daily energy intake was 2296.117 kcal, with the
minimum and maximum value being 1980.528 kcal and
2590.566 kcal, respectively (Table I). The single sample t-test,
comparing the mean to the specified value, showed the
differences between the data and the reference value to be
statistically significant, at p= 0.00.
TABLE I
CALORIE CONTENT OF DAILY MEAL PLANS ACCORDING TO SEASON
Winter Calorie content of daily
meal [kcal] Spring Calorie content of daily
meal [kcal]
1 2291,362 1 2338,057
2 2257,338 2 2230,152
3 2368,668 3 2231,722
4 2363,846 4 2413,873
5 2291,891 5 2440,984
6 2334,445 6 2590,566
7 2138,608 7 2334,902
8 2046,094 8 2399,411
9 2124,914 9 2355,083
Summer Calorie content of daily
meal [kcal] Autumn Calorie content of daily
meal [kcal]
1 2136,989 1 2229,11
2 2201,765 2 2362,255
3 2307,786 3 2315,615
4 2233,106 4 2312,13
5 2203,348 5 2283,092
6 1980,528 6 2273,172
7 2294,119 7 2309,485
8 2303,739 8 2278,052
9 2513,101 9 2435,078
The mean daily carbohydrate intake was 334.5788 g, with
the minimum and maximum value being 274.7107 g and
417.4075 g, respectively (Table II). The differences between
the data and the reference value were statistically significant,
at p=0.00.
TABLE II
DAILY CARBOHYDRATE INTAKE (10-DAY MEAL PLANS, ACCORDING TO
SEASON)
Winter Daily carbohydrate
intake [g] Spring Daily carbohydrate
intake [g]
1 338,4852 1 337,2797
2 329,76507 2 323,7548
3 326,8373 3 363,6841
4 358,1678 4 333,18
5 367,4727 5 344,8711
6 417,4075 6 356,5218
7 317,0771 7 284,2021
8 341,4734 8 274,7101
9 345,9164 9 285,9193
Summer Daily carbohydrate
intake [g] Autumn Daily carbohydrate
intake [g]
1 309,1552 1 314,4176
2 293,5729 2 347,1796
3 318,2843 3 346,273
4 325,5245 4 346,4761
5 322,0649 5 336,5706
6 280,0777 6 345,0738
7 335,0549 7 333,8083
8 335,6463 8 355,4286
9 387,2903 9 363,7039
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The mean daily fat intake was 85.17845 g, with the
minimum and maximum value being 76.24910 g and
104.6031 g, respectively (Table III). The differences between
the data and the reference value were statistically significant,
at p=0.00.
TABLE III
DAILY FAT INTAKE (10-DAY MEAL PLANS, ACCORDING TO SEASON)
Winter Daily fat intake [g] Spring Daily fat intake [g]
1 85,34976 1 83,2211
2 77,9018 2 81,57992
3 79,62897 3 81,00533
4 87,99186 4 87,8897
5 83,11887 5 78,76257
6 80,55928 6 78,35633
7 104,6031 7 89,71253
8 88,46483 8 85,68529
9 90,23794 9 86,15569
Summer Daily fat intake [g] Autumn Daily fat intake [g]
1 81,12249 1 86,98768
2 92,86431 2 89,77875
3 94,23639 3 81,31024
4 82,59933 4 84,93865
5 81,51501 5 86,19743
6 77,18277 6 79,80018
7 84,60308 7 87,5087
8 87,56807 8 76,2491
9 89,85361 9 87,37566
The mean daily protein intake was 75.10864 g, with the
minimum and maximum value being 65.99079 g and
84.12192 g, respectively (Table IV). The differences between
the data and the reference value were statistically significant,
at p=0.00
TABLE IV
DAILY PROTEIN INTAKE (10-DAY MEAL PLANS, ACCORDING TO SEASON)
Winter Daily protein intake [g] Spring Daily protein intake [g]
1 78,03525 1 73,45432
2 74,69839 2 80,06784
3 76,49764 3 71,85848
4 72,47082 4 83,25403
5 82,69354 5 75,99057
6 77,15968 6 76,14645
7 84,12192 7 73,31558
8 73,47631 8 69,94437
9 81,77648 9 74,32036
Summer Daily protein intake [g] Autumn Daily protein intake [g]
1 69,37256 1 79,90434
2 71,14986 2 72,61237
3 76,96504 3 80,34953
4 73,02839 4 69,30605
5 74,16763 5 71,15059
6 65,99079 6 70,98381
7 75,5152 7 73,23945
8 74,21252 8 72,93704
9 73,03756 9 78,88425
It was determined that daily calcium intake ranged from
421.4636 mg- 694.8719 mg, with the mean value of 513,9247
mg (Table V), and thus was not consistent with the
recommended daily intake. The difference was statistically
significant, at p= 0.00.
TABLE V
DAILY CALCIUM INTAKE (10-DAY MEAL PLANS, ACCORDING TO SEASON)
Winter Daily calcium intake [mg] Spring Daily calcium intake [mg]
1 493,6963 1 505,7887
2 592,9727 2 471,2771
3 439,6272 3 486,352
4 481,8043 4 518,221
5 514,5024 5 451,4672
6 572,9122 6 421,4636
7 551,4552 7 484,1046
8 589,3422 8 474,364
9 694,8719 9 497,6635
Summer Daily calcium intake [mg] Autumn Daily calcium intake [mg]
1 486,0781 1 541,8821
2 551,4694 2 515,8711
3 555,0862 3 456,3796
4 511,5841 4 501,1107
5 506,9821 5 561,7343
6 429,8378 6 443,1497
7 486,8314 7 432,9521
8 471,7578 8 602,0603
9 504,7117 9 600,7303
The analysis showed an insufficient daily vitamin D intake,
with the minimum and maximum value being 1.483430 µg
and 4.324780 µg, respectively, and the mean value of
2.368716 µg (Table VI). The difference between the data and
the reference value was statistically significant, at p=0.00.
TABLE VI
DAILY VITAMIN D INTAKE (10-DAY MEAL PLANS, ACCORDING TO SEASON)
Winter Daily vitamin D intake
[µg] Spring Daily vitamin D intake
[µg]
1 1,878 1 2,57386
2 1,93384 2 2,60524
3 2,47194 3 2,53405
4 1,92213 4 3,25138
5 1,94859 5 2,40228
6 1,63102 6 3,01902
7 2,35068 7 2,22661
8 2,41985 8 2,80778
9 2,17742 9 2,30971
Summer Daily vitamin D intake
[µg] Autumn Daily vitamin D intake
[µg]
1 2,16148 1 2,42685
2 2,06127 2 2,83687
3 2,6093 3 1,86791
4 1,8203 4 2,25564
5 1,48343 5 1,78439
6 4,32478 6 3,69947
7 1,91831 7 2,097
8 2,13527 8 2,13079
9 1,85162 9 3,4014
V. DISCUSSION
The evaluation of 10-day meal plans offered in the studied
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state-run nursing home showed the residents’ mean daily
calorie intake to be 2296.1 kcal, which was inadequate for all
age groups, younger residents in particular. The daily
energetic requirement in the 31-50 years old age group is 2700
kcal, whilst in this case the mean daily calorie intake made up
for 85% of this reference value. A similar result was obtained
in the PONS study, where inadequate calorie intake was also
shown [25]. A similar problem is also apparent in studies by
authors from other countries. For example, Crogan and
Pasvogel found that approximately 38.6% of residents living
in three nursing homes based in eastern Washington (USA)
were malnourished.
The residents of the nursing home in our study ate diet that
was carbohydrate-rich, with a daily carbohydrate intake of
334.5 g, accounting for 257% of the reference value.
Carbohydrate intake exceeded the reference value in all meal
plans offered throughout the year, with the mean daily
carbohydrate intake at 347.9 g in the winter and 322.9 g in
summer season. Fat intake of residents aged 51-65 years old
was consistent with the recommendations, whilst in the other
age groups it accounted for 90% of the reference value.
The mean daily protein intake was 75.2 g, falling within the
recommended range of 45-81 g/day. Our results are similar to
those from studies performed in other countries, which also
showed a widely varying daily calorie intake, yet the
proportion was reversed, with an insufficient percentage of
carbohydrate-derived energy and excessive percentage of fat-
derived energy [26]-[29].
The residents’ daily calcium intake was 513.9 mg,
accounting for 64% of the reference value. According to the
literature, in other countries the mineral intake of the elderly
also tends not to be consistent with the recommendations, with
calcium deficits, just as demonstrated in our study [30]-[33].
Daily vitamin D intake in 51-65 year old age group was 2.3
µg, accounting for 23% of the reference value. In the winter
season, the mean daily vitamin D intake was 2.1 µg, and in the
summer season it was 2.2 µg. This is a dramatically low result.
In other age groups, vitamin D intake accounted for 47% of
the recommended daily amount. Dietary vitamin intakes of the
elderly in other countries also range widely, frequently also
not being consistent with the recommended values. However,
in those countries the daily vitamin D intake of the elderly is
supplemented [30], [34]-[37]. It is estimated that vitamin D
deficiency is found in approximately 50% of the population,
contributing to the wide prevalence of diabetes and increasing
the risk for cardiovascular diseases and cancer [8].
The nursing home residents’ daily diet low in calcium and
vitamin D may lead to osteoporosis and the resulting frequent
bone fractures [17], [19].
VI. CONCLUSIONS
 Nutrient intakes in the analyzed meals plans varied
according to the season (summer vs. winter).
 A number of dietary shortcomings were found in the
analyzed meal plans, i.e. insufficient calorie, calcium and
vitamin D intakes and excessive carbohydrate intake.
 The dietary errors indicated above are caused by a lack of
mandatory dietary guidelines for state-run care facilities
such as nursing homes.
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