Fibre fortification of long term care diets
Dahl, Wendy Joanne
Constipation is a serious problem for long term care residents, who are routinely prescribed laxatives and enemas. Fibre fortification of food offers an alternative which may be preventative and less invasive. It was determined that the addition of 4 grams of pea hull fibre (PHF) to usual foods consumed by elderly long term care residents was acceptable and resulted in increased bowel movement frequency per month (18.7 ± 9.4 to 20.1 ± 9.6; p< 0.05) for the population as a whole, and for the constipated subgroup (8.8 ± 1.0 to 12.6 ± 3.8; p < 0.05). While PHF did not decrease pharmaceutical laxative and enema use, monthly fruitlax administration significantly decreased. PHF, incorporated into baked products, diminished sensory attributes, but all characteristics were ranked acceptable. Textural quality of these same products was improved with the addition of PHF. In a survey, dysphagic institutionalized elderly were offered only 1.4 servings per day of breads and cereals, indicating a need for fibre fortification of pureed foods. The textural characteristics of commercial and institutional pureed foods were evaluated. Viscosities of the institutional pureed foods deviated from the pudding-like standard with five samples too viscous for determination and none met the 1mm standard for particle size. The effect of the addition of PHF on the sensory and textural attributes of pureed foods was assessed. Texture of pureed foods fortified with PHF, as evaluated by sensory volunteers, differed from those fortified with soy cotyledon fibre (SCF) (p < 0.05), which is typically used in commercial pureed foods. Grittiness was apparent with PHF. Adhesion, perceived viscosity and mouth-coating were rated as high (> 3) and neither was significantly correlated with the objective measures. Viscosity characteristics of fibre fortified pureed beef, potato, carrot and beef stew were determined and found to be similar to the pudding standard, and were significantly and directly related to incremental increases in microcrystalline cellulose (MCC) and SCF. PHF had similar effects as MCC. Fibre fortification is a realistic and cost-effective means of increasing fibre intakes of elderly and dysphagic institutionalized individuals. Whereas fibre fortification of baked products required little product development, pureed foods did. Fibre can function to produce the recommended consistency for pureed foods.