Liquid Nutritional Supplements for the Elderly

Liquid Multivitamin Supplements

Liquid nutritional supplements are useful for elderly individuals when they have trouble swallowing normal tablets.  This could happen if they are already on a lot of prescription drugs or if they have swallowing difficulties.  If a resident is not eating much but is willing to eat only comfort foods like porridge, smoothies, milkshakes, soups, desserts, custards, mousses, scrambled eggs and hot chocolate, I would supplement their comfort foods with the following liquid vitamins.

Liquid Multivitamin Supplements for the Elderly

Liquid Multivitamin Supplements for the Elderly

Below is a long list of common liquid multivitamin supplements available on the market:

  1. Hivita Liquivita 200ml Oral Liquid
  2. Bioceuticals Vitamin D3 drops
  3. Bioceuticals Vitamin B12 spray
  4. Country Life, Food Based Multivitamin & Mineral Complex, Natural Mango Flavor, 32 fl oz (944 ml)
  5. Nature’s Way, Alive.  Liquid Multi, vitamin and mineral, natural citrus flavour, 30 fl oz (900ml)
  6. Sunwarrior, Liquid Vitamin Mineral Rush, 8 fl oz (236.5 ml)
  7. Garden of Life, Vitamin Code Liquid, Multivitamin Formula, Orange-Mango Flavor, 30 fl oz (900 ml)
  8. Thorne Research, Vitamin D, 1fl oz (30ml)
  9. Epreset Multivitamin Tonic 250ml by Floradix, 250ml
  10. Dream Health, D•R•E•A•M Complete, Liquid Vitamin & Mineral Supplement, 32 oz
  11. Dynamic Health Laboratories, Liquid Vitamin C, Natural Lemon & Lime Flavors, 1000 mg, 16 fl oz (473 ml)
  12. InterPlexus Inc., NutriSorb A, Liquid Vitamin A, 0.6 fl oz (17 ml)
  13. Natural Vitality, Organic Life Vitamins, Organic Raspberry-Cranberry Flavor, 30 fl oz (887 ml)
  14. Natural Factors, BioSil, ch-OSA Advanced Collagen Generator, 1 fl oz (30 ml)
  15. Nature’s Answer, Liquid Vitamin B-Complex, Natural Tangerine Flavor, 8 fl oz (240 ml)
  16. Trace Minerals Research, Liquimins, ConcenTrace, Trace Mineral Drops, 4 fl oz (118 ml)
  17. Thorne Research – Vitamin D/K2 Liquid – 1 oz.
  18. Nature’s Answer, Liquid Multiple Vitamins, 16 fl oz (480 ml)
  19. Swisse Ultiboost Hair Skin Nails Liquid – 500mL
  20. Buried Treasure, Liquid Nutrients, VM100 Complete, 32 fl oz (946 ml)
  21. Vitamin B12 (With Folic Acid) Liquid Drops 1000mcg (2oz) 60ml
  22. Liquid3 Ultra Pure Liquid Vitamin D3 With Tcentials Trace Minerals (Tropical Cherry) 5000iu (16oz) 473ml
  23. Country Life, Liquid Calcium Magnesium, Wild Blueberry Flavor, 32 fl oz (944 ml)

Liquid Multivitamin Supplements for the Malnourished

The above listed liquid vitamins are also suitable for elderly individuals who are most likely also malnourished because they are over weight or under weight.  Malnutrition prevention is of paramount importance in the elderly because older adults often manifest compromised ability to digest and assimilate  food so it stands to reason that when their nutrient reserves diminish or are drawn down, it would be a lot harder for them to rebuild their reserves again.

Calculate the Amount of Liquid Multivitamin Supplements Required

Prevention is thus the best cure when it comes to treating residents or older adults who are trying to stay at home as long as possible.  To calculate the optimum amount of various nutrients required by an individual based on age, gender, physical activity and disease state, please consult an accredited practising dietitian (APD) today.

Sample Meal Satisfaction Survey in Residential Aged Care

Meal Satisfaction Survey

This is a sample Meal Satisfaction Survey for residential aged care faculties to use to ascertain the level of satisfaction in the existing menu on offer at an facility.
Meal Satisfaction Survey results and report will shape menu planning in flavour of the more popular food items. Solutions to problems identified will aid in improving quality of service, choice of food items on offer and consequently quality of life for aged care residents.
Your opinion on our food service is greatly appreciated.

Please complete the meal satisfaction survey and help us to help you develop a new, delicious and nutritious meal plan.

How would you rate the courtesy of the food service staff?
 Poor
 Unsatisfied
 Satisfied
 Good
 Excellent

How would you rate the times at which meals are served?
 Poor
 Unsatisfied
 Satisfied
 Good
 Excellent

Do you have enough time to eat your meal?
 Poor
 Unsatisfied
 Satisfied
 Good
 Excellent

Please circle your appropriate responses to the questions in this Meal Satisfaction Survey

How do you rate the eating environment?
(choice of music, smell, temperature, etc.)
Is it a congenial environment?

1    2    3    4    5    6    7    8    9    10

On a scale from 1-10, how much do you like delicious small snacks and appetising beverages?

1    2    3    4    5    6    7    8    9    10

 

Fortified Raspberry Juncket in Meal Satisfaction Survey

Fortified Raspberry Junket

 

Fortified Finger Foods in Meal Satisfaction Survey

Fortified Fun Finger Foods

How do you rate the appearance of the meal?

1    2    3    4    5    6    7    8    9    10

How do you rate the overall quality of the food?

1    2    3    4    5    6    7    8    9    10

How do you rate the quantity of the food?

1    2    3    4    5    6    7    8    9    10

How do you rate the quality of the hot foods?

1    2    3    4    5    6    7    8    9    10

How do you rate the quality of the cold foods?

1    2    3    4    5    6    7    8    9    10

What other dishes would you like to request for on the menu?
____________________________________________________________
____________________________________________________________

What are your most disliked foods on the menu?
____________________________________________________________
____________________________________________________________

This Meal Satisfaction Survey is of paramount importance for our menu planning and menu review purpose.  Your feedback will provide us with benchmark statistics, important facts and help us identify areas for change and improvement.

We are committed to making your stay at our aged care facility as good as possible through continuous improvement.

Thank you so much for taking the time to complete this Meal Satisfaction Survey.

Nutritional Supplements for Individuals with Food Sensitivities

Supplements Suitable for Food Sensitivities

Exponential Growth in Food Sensitivities

Food sensitivities are growing at an alarming rate in first world countries. They are increasing in prevalence and complexity especially in the elderly.  It is not uncommon for elderly individuals to display multiple allergies or sensitivities at once.  There are many theories on what might be causing this.  They range from antibiotics abuse to poor dietary choices to the environment in which we are living.

Immune Over-activation and Food Sensitivities

To date, the body of scientific information emerging in the latest research seem to point to the fact that the causes are complex and appear to be closely associated with probiotics health and the immune system.  Food sensitivities include food allergies and food intolerances.  Allergies are characterised by over-active immune responses to offending foods.   This is caused by food proteins entering the body through digestive system or lungs causing antibodies to be produced leading to swelling, itching and even death.   Food intolerances or non-allergic food hypersensitivities are characterised by delayed reactions occurring hours or even days after eating certain offending foods.

Poor Immunity with Ageing leads to Greater Food Sensitivities

As we age, our immune systems deteriorate and individuals who have never had any food sensitivities before might suddenly develop these symptoms:

  1. Abdominal gas accompanied by belching and flatulence
  2. Abdominal cramps
  3. Diarrhoea
  4. Constipation
  5. Eczema / Hives
  6. Asthma / Wheezing
  7. Watery eyes / Runny nose
  8. Vomiting / Diarrhoea / Nausea
  9. Redness with itchy mouth / Itchy throat

Offending Food Avoidance – Treatment for Food Sensitivities

Treatment of these food intolerance symptoms often involves food avoidance.  This means suffers may no longer have balanced diets and may be required to take nutritional supplements to prevent malnutrition.  Care must be taken to prevent further deterioration of their immune status as poor immune systems can lead to further exacerbation of food sensitivities as tolerance for the offending food substances will diminish.

Nutritional Supplements for the Elderly with Food Sensitivities

Nutritional Supplements for the Elderly with Food Sensitivities

Nutritional Supplements Suitable for Individuals with Food Sensitivities

Now it must be emphasised that not all common nutritional supplements are suitable for elderly individuals with food sensitivities as some of these offending compounds can be found in the nutritional supplements as well!

The table below features a list of common nutritional supplements suitable for individuals with food sensitivities:

Amcal One-a-Day
Cenovis Multivitamin and Minerals
Natures Own Multivitamin and Minerals
Amcal Multi Vitamins and Minerals
Vitaminorum
Herron Multi Vitamin
Myadec Capsules
Blackmores Multivitamin
Caltrate (http://pfizerconsumer.com.au/)
Herron Calcium plus with Magnesium
Fabcal
Golden Glow Calcium and Magnesium Chelate
OsteVit-D & Calcium (http://keypharm.com.au/home/home.php)
Kirkman’s hypoallergenic Calcium Powder with Vitamin D (http://kirkmanlabs.com/products/product_index.html)
Osteo Vit-D
Alphapharm Megafol
Golden Glow Folic Acid
FAB Iron & Vitamin B Compex

These nutritional supplements are suitable for use by elderly individuals with food sensitivities because they free of PABA (para-aminobenzoic acid), colours, flavours, lactose, gluten, herbs, bioflavonoids, rutin, kelp, hesperidin and common food chemicals that irritate the gut.  In summary, care must be taken when choosing nutritional supplements for elderly individuals with food sensitivities.

Food Safety in the Vulnerable Population

Factors that affect Food Safety

There are a few important things to note when preparing food for the elderly. Food safety for older individuals is often something that is often overlooked but is particularly important as old people are very susceptible to food poisoning because of their compromised immunity and reduced stomach acid production. That is why what makes us very unwell with food poisoning symptoms like diarrhoea and vomiting, may kill older people.
It is worthwhile to remember that food containing dangerous levels of bacteria may not look, smell or taste off. The frail old also display blunted food tasting abilities which make them even more susceptible to the slight off taste of unsafe foods or foods past expiry dates. When we say a food is unsafe we are really referring to foods that contain bacteria at such high levels that they produce toxins or poisons in high enough concentration to cause sickness or disease.

Food Safety Depends on Nutrition

Bacteria need nourishment to multiply therefore the more nutritious a food the faster the rate of bacteria growth. Examples of common nutritious foods are milk, eggs, meat and seafood. Whatever is nutritious for you is nutritious for bacteria so you can expect the bacteria population to explode quickly under the right environmental conditions.
Temperature dramatically affects the rate of bacterial growth. Bacteria generally grow best between 5 to 60 degree Celsius. This is known as the temperature danger zone in food safety. Therefore, it is safer to store foods at below 5 degree Celsius in the refrigerator or above 60 degree Celsius in the oven. Warm conditions or room temperatures are ideal for bacterial growth.

Food Safety Depends on Moisture

Moisture or water is important for bacterial growth, that is why wet milky dishes, coconut milk desserts, soups and stews are considered high risk foods with short shelf-life. It is recommended that you do not keep these foods beyond 72 hours at less than 5 degrees Celsius if you are planning to serve them to the elderly. And it is also recommended that you reheat these foods to 75 degrees Celsius or beyond before serving to kill any bacteria present during storage. To be on the safe side, just boil the food again before serving.

Food Safety Depends on Time

Time is the other component that we have to remember when storing food. Bacteria need time to grow and multiply. Never leave high-risk foods at ambient temperature for more than two hours. Discard any foods left at ambient temperature for more than 4 hours immediately. And if storing wet food items in the refrigerator, do not store for more than 3 days. Always reheat before serving.

Food Safety Depends on use of Bactericides

When handling foods, always remember to wash your hands thoroughly with a good anti-bacterial soap before and after each task, particularly when going from preparing raw foods to cooked foods.

Food Safety Depends on Cross Contamination

Cross contamination is a common issue. Prevent cross contamination by using different coloured chopping boards and knives for raw and cooked or ready-to-eat foods like fruits and vegetables. Always sanitise the equipment with enough contact time to kill all bacteria before washing, drying and storing equipment to prevent cross contamination.

Food Safety Depends on Exposure in Temperature Danger Zone

If buying ready-to-eat barbecue chicken or grilled seafood always remove the food item from the bag before putting in the fridge. These bags insulate the food, keep them in the temperature danger zone between 5-60 degrees Celsius, preventing them from being cooled down to less than 5 degree Celsius quickly. Always store cooked food at the top of the shelf in the refrigerator and raw food at the bottom of the fridge so that the raw juices will not drip onto read-to-eat foods and cross-contaminate them.

Food Safety Depends on Cooling Time

To freeze cooked stews, casseroles and soups in the refrigerator quickly, place them in flat small containers for faster cooling and place right away in freezer. Smaller portions of foods are also faster to thaw or reheat.

Summary for Food Safety in the Vulnerable

All factors collectively affect food safety

All factors collectively affect food safety

The above summarises some of the common food safety practices that are mandatory to observe when preparing food for the vulnerable or elderly.  Nutrition, moisture, time, anti-microbial use, cross contamination, temperature danger zone and cooking curve all impact directly upon food safety on the vulnerable.

Sample Menu Planning Checklist for Residential Aged Care

Menu Planning Checklist for Residential Aged Care Facilities

Fortified Smoothie

Fortified Smoothie in Aged Care Setting

Menu Planning Checklist for Residential Aged Care Facilities

This is a list that serves as a reminder of important items to be included while planning aged care menu.

Menu Planning Checklist for Main Meals

Residents have two hot options each main meal

(  ) Check

Each hot option has at least 1 serve of high protein food like meat, chicken, eggs or fish.

(  ) Check

Red meat is on the menu 1x/day

(  ) Check

Vegetarian meals contain eggs, cheese, nuts, legumes or tofu

(  ) Check

Main meals comprised of salad have meats, eggs, chicken, fish or eggs

(  ) Check

Desserts are served with meals

(  ) Check

Menu Planning Checklist for Light meals

Residents have a choice of soup/salad/sandwich or hot meal

(  ) Check

Hot light meals contain meal/soup/salad/sandwich

(  ) Check

A dessert comes with the light meal

(  ) Check

Menu Planning Checklist for Mid – Meals

Mid meals are energy-dense

(  ) Check

Fruits and Vegetables

Menu provides 5 serves of vegetables

(  ) Check

Menu provides 2 serves of fruit

(  ) Check

Option of 3 serves of fruit and 4 serves of vegetable available

Check

Menu Planning Checklist for Dairy Foods

4 serves of calcium-rich foods are on the menu.

(  ) Check

Desserts are made with full cream milk and fortified either with supplements or milk powder.

(  ) Check

Milk drinks are available every main meal and mid meal.

(  ) Check

Menu Planning Checklist for Bread, Pasta, Rice and Cereal

4 serves of bread or equivalent are offered each day.

(  ) Check

High fibre options are available.

(  ) Check

 

To ensure nutritional adequacy, according to the Nutrition Standards set out for Older Australians, check every item on the Menu Planning Checklist.

How to improve aged care menu

Get rave reviews and keep residents asking for more

  • Focus on what residents want

Get focus groups together after breakfast (when residents are well-rested and well-fed, they are more alert) and conduct resident interviews and discussions to identify the most popular and most disliked meals.  Create food surveys and get residents to rate on how much they liked what they were eating after each meal on a scale of 1-10.  Record plate waste after each meal or simply observe residents eating at meal times and identify items that are repeatedly thrown away and ascertain why for example, grilled beef could be thrown away because it is overcooked and hard to chew or toasts in the morning are thrown away because they are too dry and hard.  Collate all results from food satisfaction surveys and eliminate 20-30% of the most disliked meals and create variations of the top 20-30% of the most popular meals.  For example, if chicken schnitzel is very popular, create a veal schnitzel as well.  Make relevant changes to the menu, implement changes and start collecting statistics of food surveys again to confirm acceptance of new menu.

  • Whet their appetite with delicious food smells

Fry onions, bake bread on site to produce pleasant cooking aromas in the dining hall, this starts residents thinking about food during meal times.  Thoughts about food increase stomach acid and saliva production and help prepare residents for digestion of food at meal time.

  • Improve nutritional quality of food

Fortify favourite foods like desserts, smoothies and drinks with high protein powders like Beneprotein, Sustagen Hospital Formula (neutral), Two Cal, Resource 2.0 fibre, just to name a few supplements, to increase the nutritional adequacy of popularly foods so that they are more nutritionally complete.  Fortified “finger” foods are especially good for residents with dementia and who desire to “eat on the run” or while walking everywhere.

  • Aim for exciting presentations

Arrange the dining hall in such a way that tables and chairs are organized into “café-style” look for a more pleasurable dining experience.  Play background music, let the smells of delicious cooked food drift into the dining hall (alternatively, use aroma therapy to create smells of delicious licorice or rose water to simulate food smells) , all of these with the café ambiance can significantly improve the dining experience.  Use simple white table cloth with bold coloured plates help the visually impaired.  Hydration is particularly important for elderly individuals and is often a neglected part of their nutrition and hydration.  To encourage more drinking, make drinks really colorful and tasty with flavor-enhancers and serve them in cocktail glasses from brightly coloured beverage carts.  Some examples of visually exciting presentations are shown below:

Mocktails in aged care setting.

Mocktails in aged care setting.

Pureed food molds should be used to improve the presentation of pureed foods. Example of a molded foods presentation can be seen below:

Jelly and strawberries.

Jelly and strawberries

Dysphagia sandwishes

Dysphagia sandwiches

Cheesecake

Cheesecake

Pudding

Pudding

Finger Foods

Fun finger foods

Fortified Smoothie

Fortified Smoothie

  • Sensory experience – aim for the bliss point

Elderly individuals have fewer taste buds and so their taste experience at meal time is blunted.  For food to taste good them, all flavors need to be amplified with more salt, sugar, fat, gravy to deliver a more acute or sharper “bliss point” to optimize palatability of each food item.  For example, in making strawberry smoothies, it would help to add strawberry flavor on top of fresh or frozen strawberries in the recipe for an altogether stronger sharper taste experience.  Use insulated mugs and bowls to regulate food temperatures for the slow feeders.  Insulation keeps cold foods cold and hot foods hot for greater food enjoyment.

  • Supplement comfort foods

Create a list of comfort foods for residents at high risk of malnutrition and seek to supplement those foods to increase caloric intake.  For example, if a resident would eat only cakes and coffee, fortify their cakes and cappuccino so that they are more nutritionally complete for nutritional adequacy.  Run random taste-testing sessions from food carts and deliver cheese platters, popsicles, fortified ice-creams during recreation activity time.

  • Identify individuals at risk of malnutrition

Use the malnutrition universal screening tool (MUST) to identify individuals at risk of malnutrition and plan and monitor effects of appropriate nutritional supplementation program.  Aim for high-energy fortified desserts (like cakes, junkets, custards, milk-shakes) and if all else fails, cheese, chocolates, fried foods can also deliver delicious high energy foods for muscle-sparing effects i.e. to prevent muscles wasting away when food intake is poor.

Vitamin D Supplementation in the Elderly

Vitamin D Supplementation

Vitamin D is 1,25 dihyroxycholecalciferol or 25(OH)D.  This nutrient is used to measure vitamin D status.  It is estimated that almost 80% of elderly women and 70% of men are deficient in vitamin D.  Long term vitamin D deficiency (severe deficiency < 12.5nmol/L, vitamin D levels are lowest late winter and early summer) leads to bone and muscle pain and poor done mineralization leading to rickets in children and osteomalacia in adults, osteopaenia and osteoporosis.  Lately more and more diseases have been linked to vitamin D deficiency and some examples of these diseases are multiple sclerosis (MS), diabetes (types 1 and 2), cancers (colon), heart disease, cardiac arrest, stroke, autoimmune disease and even mental health problems like schizophrenia.  Since deficiency has far reaching consequences for sufferers, all the more we should make it mandatory to supplement elderly individuals.

  • Vitamin D from sunlight

Sunlight is the best source of vitamin D.  The darker the skin colour of an individual, the longer they have to stay in the sun to get the same level of sun-derived vitamin D.  This is because melanin (dark colour) in the skin acts to filter UVB radiation out.  The following individuals are most at risk of vitamin D deficiency – elderly individuals residing in aged care facilities, individuals at risk of skin cancer, individuals wearing burka or long religious clothing, individuals who have been institutionalized long term, individuals with disability or chronic disease, office workers, shift workers.  Fair skin individuals require 6-7 minutes sun exposure to the face, arms and hands during mid-morning or mid-afternoon.  Darker skin individuals require 3-6 times of sun exposure to acquire the same vitamin D level.  These individuals may need to be supplemented orally to get enough vitamin D.

Relaxing sun bed for vitamin D

Sitting in a greenhouse drenched in sunlight does not help your body to generate vitamin D as the glass filters out light in the low 300nm wavelengths (UV rays) required for the manufacture of vitamin D by the skin.  On that note, slapping your skin with sun block also blocks out the UV rays required for vitamin D production.

Relaxing sun bed for weekly vitamin D boost!

  • How much vitamin D supplement?

Since this vitamin D is a fat soluble vitamin, it may be supplemented daily (1000 units per day) or monthly (50,000 units per day).  In elderly              individuals in aged care facilities, mega dosing in 50,000 units once a month is commonly practiced to reduce the labour of daily dosing.  It is possible to get 50,000 units of vitamin D drops into delicious vanilla milkshakes or smoothies without the residents being aware that they are being supplemented/medicated at all.  Serve vitamin D beautifully presented as shown below:

milkshake sun - drink vitamin D

Vitamin D – fortified strawberry milkshake

      Supplementation like this is most critical during late winter or early spring when most individuals’ vitamin D levels are at their lowest due to    seasonal variations.

  • Food sources of vitamin D

Most vitamin D come from fatty fishes like makeral, salmon, sardine and trevally.  Other common sources of vitamin D include oils, butters, irradiated mushrooms, eggs and margarine.  Most Australians get 5-10% of their daily vitamin D from dietary sources of food like milk and margarine.  It is also noteworthy to know that regular daily exercise also assist in vitamin D production.  The biologically active form of vitamin D – 1,25 dihydroxycholecalciferol is derived from the double hydroxylation of the much condemned blood cholesterol.  This is testimony that cholesterol is a good thing as it is used in the production of vitamin D – a nutrient that is vital to life.

In summary, for residents to get minimal vitamin D levels, they must get approximately 2 hours’ sun exposure at least once a week before 11 am or after 3pm.  They should also be supplemented with 1,000 units or 25,000 µg of vitamin D daily.  Alternatively they could be mega dosed at 50,000 units once a month.

References on Vitamin D

  1. Working Group of the A, New Zealand B, Mineral S, Endocrine Society of A, Osteoporosis A. Vitamin D and adult bone health in Australia and New Zealand: a position statement. Medical Journal of Australia 2005 Mar 21: 182(6): 281-5.
  2. Shrapnel W, Truswell S. Vitamin D deficiency in Australia and New Zealand:  What are the dietary options?  Nutrition and Dietetics 2006; 63(4):7
  3. Vic Health. Low vitamin D in Victoria.  Key messages for doctors, nurses and all allied health 2010.
  4. Vitamin D and health in adults in Australia and New Zealand: a position statement. Nowson CA, McGrath J. Ebeling PR. MJA 196(11) 18 June 2012.
  5. Cancer Council Australia. The Australian and New Zealand Bone and Mineral Society.  Osteoporosis Australia and the Australasian College of Dermatologists (2012) How much sun is enough?  Getting the balance right.

Nutrition in Aged Care – Finger Foods

1. Hot chips – potato / sweet potato / yam
2. Chicken nuggets
3. Fish fingers
4. Hash browns
5. Cheese cube / cheese sticks
6. Meatballs – chicken / beef / lamb
7. Shelled prawns
8. Scallops
9. Soft fruits like kiwi, strawberries, grapes, orange, cherries, pear, plum, lychee, watermelon, rockmelon, peaches, apricots, mandarin
10. Gherkin
11. Fresh cut vegetables – cucumber, mushroom, celery (stings removed), baby carrot, tomato
12. Cut steamed vegetables – carrot, broccoli, baby zucchini, cauliflower, baby squash, sweet potato, asparagus, mushrooms, baby corn,
13. Gnocchi
14. Watermelon
15. Sweet potato pieces
16. Cooked pumpkin pieces
17. Grilled potato / sweet potato / yam wedges
18. Biscuits
19. Cakes
20. Rice cakes
21. Corn Thins
22. Vanilla wafers
23. Water crackers – cheese, tomato, jam, honey, avocado
24. Dried fruits – apricots, apple, prunes, sultanas, raisins, peaches, figs, mango, pineapple, dates
25. Sandwiches – lean ham, chicken, egg, fish, jam, vegemite, peanut butter, avocado, cheese, butter, jam, honey
26. Scone
27. Toast / Raisin toast / Fruit loaf / Pretzels
28. Hard-boiled egg
29. Pastries – Minced pie, Custard tart, Chicken pie, Beef pie,  Raspberry tartlets, Small cup cakes, Small muffins,
30. Cold cuts – processed meats like chicken breast / corned beef / meatloaf / chicken loaf /corned silverside, smoked fish, cold roast meats, sausage
31. Ice cream on cone
32. Rocky road / marshmallow / bite-size chocolate / toffees / brownies
33. Mini quiche – vegetables / pumpkin / leek / spinach and basil / cheese and mushroom
34. Crumpets
35. Tea / Coffee / Milo /High protein favoured milk drinks in spill-proof cups for drinking on the go
36. Sliced ham / salami / prosciutto / Devon
37. Chicken schnitzel (fish-finger size)
38. Pikelets – raspberry and cream, honeycomb, coconut and banana, mascarpone
39. Seafood basket (fried) – calamari / fish / scallop / prawns / seafood stick
40. Mini Pies – cheese and spinach / chicken / beef / seafood / vegetable / cheese
41. Filo triangles
42. Gozleme
43. Quesadillas
44. Mini Muffins – salmon and chive / cheese and raspberry / banana and walnut/ chocolate / cappuccino / blueberry / strawberry and ricotta / peach / sticky date / apple and oat / fig jam / spinach and cheese / peach and buttermilk / strawberry and cheesecake
45. Ravioli – meat / vegetable / ham and cheese
46. Pillows – ricotta and spinach / walnut / pear / fig and walnut
47. Dumplings – meat / vegetables / meat and vegetables
48. Spring rolls – vegetable / meat / seafood / meat and vegetable
49. Fish cakes – salmon / tuna / cod
50. Rissoles – Moroccan / chicken and almond / beef / Thai chicken / tuna / salmon / Turkey / French / Italian / Greek / Mexican / beef and lentil
51. Lemon coconut slice
52. Donuts – raspberry / blueberry / chocolate / cheese
53. Mini Bagels – blueberry / strawberry + cream cheese + honey
54. Profiteroles – raspberry / cream / chocolate / vanilla mascarpone / caramel / custard
55. Mini Pavlova – mango / passion fruit/ coconut mixed berry mascarpone
56. Mini friands – lemon / blueberries / raspberries / apple / cherry
57. Samousa
58. Macaroons – berries, chocolate, French almond
59. Sausage rolls / Savoury mince
60. Croquettes – crabs / tuna / potato and herb / ham or bacon and cheese / lentil
61. Finger buns
62. Baked miniature frittatas
63. Meringue dessert slice / milk pudding
64. Twists – herb, cheese, pesto and parmesan, sugar, cheddar and cumin

 

How to calculate the BMI of an Amputee

I was stunned and thought I was going crazy!

How was it possible I could not understand a simple calculation of BMI for an amputee?

You see, at a recent seminar in Ballina, I was asked how to calculate the BMI of an amputee.

I decided to share the answer with you via our newsletter. So one evening I sat down at my laptop, went to the official MNA (Mini Nutritional Assessment) website to look up the latest body part percentages and write the newsletter article.

So how do you calculate the BMI of an amputee?

The answer is actually quite simple – first you need to look up the estimated percentage of the missing body part as compared to a whole body. Now you can calculate what the "whole" body of the amputee would weigh based on the amputee’s current weight and the missing limb’s percentage. Once you have the "whole" body weight, you can determine the BMI as normal.

The following table has the appropriate percentages:

Body Part Percentage
Trunk without limbs 50.0
Hand 0.7
Forearm with hand 2.3
Forearm without hand 1.6
Upper arm 2.7
Entire arm 5.0
Foot 1.5
Lower leg with foot 5.9
Lower leg without foot 4.4
Thigh 10.1
Entire leg 16.0

What completely threw me was the example in Appendix 3 of the MNA guide for how to calculate the BMI of an amputee, which simply multiplied the missing body part’s percentage with the body weight to add to the total body weight.

Have a look:
example on how to calculate the BMI of an amputee

You see, the percentage of WHOLE body weight for the missing leg is 5.9%. But in the example, the percentage is taken from the CURRENT (i.e. amputated) body weight.

I struggled, I kept re-reading the definition of terms, questioned my husband for his opinion (in Star Trek he would be Mr Spock, because he is so logical).

In the end I sent a message to the MNA team. It turns out the example was wrong and I was correct.

So with my sanity saved (and Mr Spock on my side), let me give you a correct example.

Correct Example of How to Calculate the BMI of an Amputee

An amputee has lost an entire leg and weighs 70kg without his prosthesis.

His estimated total body weight would be 70kg/(100-16) x 100 = 83.3 kg.

And if his height is 1.7m, the BMI would be:
weight (kg) / height (m2) = 83.3 kg / (1.7 x 1.7) m2 = 28.8.
 

Hope you find this helpful in calculating your amputee’s BMI.

I’m told the MNA example will be rectified shortly, so hopefully nobody else will tear their hair out anymore. And we can all confidently calculate the BMI of an amputee!