Cater with Care
Tasty and effective nutrition for elderly

Determine (nutritional) needs

Prior to the development of the products and the studies within the target group, literature analyses and interviews with stakeholders on perspectives towards innovative products were performed. Consumer studies show that elderly are not aware of undernutrition and its health consequences. The provision of personal nutrition advice by dieticians, doctors and pharmacists and the presentation of information in a simple and clear format may contribute to the awareness of elderly about the importance of healthy food.
The recommended daily protein intake for healthy adults is 0.8 gram per kilogram of body weight. For hospital patients and people with increased risk of developing undernutrition, the recommended daily intake is 1.2 to 1.5 gram per kilogram of body weight. A protein intake of 25 to 30 grams per main meal seems optimal for the maintenance of muscle mass. Many elderly, however, fail to meet this recommendation. >>>> Read more

PhD thesis Janne Beelen

Develop great tasting products

The products developed by food companies and NIZO Food Research meet the needs of the target group with undernutrition or at risk of undernutrition. The products substitute regular products instead of serving as a supplementation. Proteins from soy, egg and dairy sources were used for the enrichment. Each product contains an additional 5 or 10 protein compared with the regular product. Protein-enriched products ranging from bread and fresh fruit juices to conserved products like instant mashed potatoes were developed. These products, together with veal meat processed into meat balls and stew meat, form the basis of the daily menu of the intervention study.

Provide valuable consumer feedback

During a first 10-day intervention study (the EET study), the dietary protein intake of participating institutionalised older adults - location Opella - was increased by 12 grams per day with just a few protein-enriched products. After the intervention all elderly reached a protein intake of 0.8 gram per kilogram of body weight and more elderly met the protein recommendation of 1.2 gram per kilogram of body weight than before.

During this pilot study, the participants gave their feedback on the developed products. Based on the many individual preferences, a larger variety of flavours and types of products was developed. Cater with Care® results about protein enrichment of familiar foods were presented at the ESPEN congress 2015 and in the Journal of Nutrition:

Run unique study in hospital and at home

A randomized controlled trial involving 147 patients of Hospital Gelderse Vallei of ≥ 65 years was performed to study the effects of the various products developed in Cater with Care ® and food service At Your Request ® (Sodexo). Both in the hospital phase and at home (prolonged period of time), it was investigated whether the daily consumption of high-protein and protein-enriched products would improve protein intake and recovery after hospitalization. Various measurements, including intake, gait speed, balance and strength of the participants, were conducted at various moments. The participants had free choice from an extensive menu and had to order the products actively.

This study shows that providing protein-enriched familiar products, as replacement of regular products or as additions to the hospital menu, enables hospitalized older patients to better reach protein intake recommendations.

First results were presented at the Food for Thought meeting (December 2015), the Gerontology congress (February 2016) and the National meeting ‘Focus op Ondervoeding’ (May 2016) in The Netherlands. Read more:

At Your Request ® meal service

Most hospitals offer a standard 3-meal service to their patients. Hospital Gelderse Vallei offers their patients a restaurant style menu, with kitchen times between 7 am and 7 pm. This At Your Request ® meal concept was evaluated for its effect on food intake, nutritional status, and patient satisfaction. The new meal concept was highly appreciated by patients, their food intake remained adequate and their nutritional status did not change when compared to the traditional meal service. Moreover, patients with a risk of undernutrition who received additional menu options rich in energy and protein, had a better intake than patients with the standard menu options, suggesting that intake can be influenced and nudged toward better choices.

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Explore introduction in the care market

Roundtable meetings were organized with a multidisciplinary team of medical doctors, dieticians and facility managers to discuss current issues and possible solutions in improving protein intake. National organizations were invited to visit the study site and to discuss first results. This meeting was attended by the Ministry of Health, Well-being and Sports, the National Institute for Public Health and the Environment, VU Amsterdam, UMCG, NVD, Mezzo, Dutch Nutrition Centre, Menzis (health care insurance) and the national platform for client boards (Landelijk Overleg Cliëntenraden).

The new insights of the Cater with Care® project have been shared with many hospitals, researchers, policy makers, food industry to increase the attention to tackle undernutrition.

In 2016, Stichting Alliantie Voeding (partner of national Prevention Programme 'Alles is Gezondheid…' of the Ministry of Health, Well-being and Sports) participated in Make the Move. In this initiative the Cater with Care® approach was presented as an innovative and successful solution to increase protein intake of elderly patients.

Scientific publications