Adherence and barriers to the vitamin D and calcium supplement recommendation at Danish nursing homes: a cross-sectional study.

BACKGROUND: Nursing home residents are in high risk of vitamin D deficiency, which negatively affects bone health. Vitamin D and calcium supplements haves shown to increase bone density and reduce fracture risk. Therefore, The Danish Health Authority recommends all nursing home residents a daily supplement of 20 µg vitamin D and 800-1000 mg calcium. However, adherence to the recommendation and knowledge of it is unknown. The aims of this study were to investigate adherence, knowledge, and potential barriers to this recommendation in Denmark. METHODS: A cross-sectional electronic survey was conducted in May-June 2020 among 50 randomly selected nursing homes widely distributed in Denmark. Questions included degree of adherence to the recommendation at each nursing home as well as respondent's knowledge and attitudes towards it, and experienced barriers in relation to adherence. RESULTS: Respondents from 41 nursing homes answered the questionnaire, and these were mainly nurses (63%) or nursing home leaders (20%). Low adherence (≤ 40% of residents receiving both supplements) was reported at 35% of nursing homes, and only 8% of the nursing homes had a high adherence (> 80% of residents receiving both supplements). Most respondents (88%) had knowledge of the recommendation and 62% rated importance of increased implementation as high. Common explanations of low implementation were a lack of prescription by the general practitioner in the central electronic database (60%), resident-refusal to eat tablets (43%), chewing-swallowing difficulties (40%), and a high number of tablets given to the residents daily (34%). CONCLUSIONS: The recommendation of daily vitamin D and calcium supplements to Danish nursing home residents is poorly implemented even though knowledge of the recommendation is relatively high. Barriers relate to an ambiguity of responsibility between the general practitioners and the nursing home staff, as well as the high number of tablets to be consumed in total by the residents. These barriers must be targeted to improve adherence in this vulnerable group of institutionalized older adults.

Eat what you want and when you want. Effect of a free choice menu on the energy and protein intake of geriatric medical patients.

BACKGROUND: Geriatric medical patients are often at nutritional risk when admitted to hospital. More flexible meal service concepts may prove successful in improving nutritional intake. AIM: To evaluate whether the Free Choice Menu (FCM), a new room service resembling meal service concept, improves energy and protein intake in a population of geriatric medical patients compared with the traditional concept of serving meals from a trolley with a fixed menu (trolley). METHODS: Data were collected consecutive in a geriatric ward at Slagelse Hospital (Denmark) before (autumn 2018; n = 98) and after (autumn 2020; n = 52) implementing the Free Choice Menu. Weighed dietary intake was recorded for three full days for each patient. RESULTS: Energy and protein intake did not differ significantly when comparing the two meal service concepts (trolley: 6124 kJ; 52.6 g and FCM: 5923 kJ; 47.1 g) over three days. The FCM concept showed however a significantly higher energy and protein intake for the dinner (relative to the other meals), whereas a higher percentage of protein and energy intake was covered by oral nutritional supplements in the trolley concept. The majority of the participants met the recommendations for energy intake, while only a minority met the recommendations for protein intake. Plate waste was significantly lower (p = 0.0005) at the lunch meal for the FCM concept (15.6%) compared with the trolley concept (26.1%). CONCLUSION: When implementing a FCM, energy and protein intake was maintained and patients received more energy and protein from the dinner and less from oral nutritional supplements. However, the introduction of a free choice of meals concept did not in itself ensure nutritional intake in geriatric medical patients.

Fate of ethanol during cooking of liquid foods prepared with alcoholic beverages: Theory and experimental studies.

To obtain an understanding of the ethanol loss during cooking of liquid foods containing alcoholic beverages, ethanol concentration was measured as a function of time and remaining volume in meat stocks prepared with wine and beer. A mathematical model describing the decline in volatile compounds during heating of simple liquid foods was derived. The experimental results and the model show that concentration of ethanol at any given time is determined by the initial concentration and a power law function of the remaining volume fraction. The power law function is found to be independent of factors like pot dimensions and temperature. When using a lid to cover the pot during cooking, the model was still valid but the ethanol concentrations decreased more steeply, corresponding to a higher exponent. The results provide a theoretical and empirical guideline for predicting the ethanol concentration in cooked liquid foods.

Ghanaian cocoa bean fermentation characterized by spectroscopic and chromatographic methods and chemometrics.

Export of cocoa beans is of great economic importance in Ghana and several other tropical countries. Raw cocoa has an astringent, unpleasant taste, and flavor, and has to be fermented, dried, and roasted to obtain the characteristic cocoa flavor and taste. In an attempt to obtain a deeper understanding of the changes in the cocoa beans during fermentation and investigate the possibility of future development of objective methods for assessing the degree of fermentation, a novel combination of methods including cut test, colorimetry, fluorescence spectroscopy, NIR spectroscopy, and GC-MS evaluated by chemometric methods was used to examine cocoa beans sampled at different durations of fermentation and samples representing fully fermented and dried beans from all cocoa growing regions of Ghana. Using colorimetry it was found that samples moved towards higher a* and b* values as fermentation progressed. Furthermore, the degree of fermentation could, in general, be well described by the spectroscopic methods used. In addition, it was possible to link analysis of volatile compounds with predictions of fermentation time. Fermented and dried cocoa beans from the Volta and the Western regions clustered separately in the score plots based on colorimetric, fluorescence, NIR, and GC-MS indicating regional differences in the composition of Ghanaian cocoa beans. The study demonstrates the potential of colorimetry and spectroscopic methods as valuable tools for determining the fermentation degree of cocoa beans. Using GC-MS it was possible to demonstrate the formation of several important aroma compounds such 2-phenylethyl acetate, propionic acid, and acetoin and the breakdown of others like diacetyl during fermentation. Practical Application: The present study demonstrates the potential of using colorimetry and spectroscopic methods as objective methods for determining cocoa bean quality along the processing chain. Development of objective methods for determining cocoa bean quality will be of great importance for quality insurance within the fields of cocoa processing and raw material control in chocolate producing companies.

Investigating the fermentation of cocoa by correlating denaturing gradient gel electrophoresis profiles and near infrared spectra.

Raw cocoa has an astringent, unpleasant taste and flavour, and has to be fermented, dried and roasted in order to obtain the characteristic cocoa flavour and taste. During the fermentation microbial activity outside the cocoa beans induces biochemical and physical changes inside the beans. The process is complex involving activity of several different groups of microorganisms which bring about numerous biochemical and physical changes inside the beans. Due to the complexity of these processes no thorough investigations of the interactions between the microbial activities on the outside of the beans and the chemical processes inside the beans have been carried out previously. Recently it has been shown that Denaturing Gradient Gel Electrophoresis (DGGE) offers an efficient tool for monitoring the microbiological changes taking place during the fermentation of cocoa. Near Infrared (NIR) spectroscopy has previously been used to determine various components in cocoa beans, offering a rapid alternative compared to traditional analytical methods for obtaining knowledge about changes in the chemical composition of the cocoa beans during fermentation. During a number of cocoa fermentations bean samples were taken with 24 h intervals to be dried and analysed by NIR. Cocoa pulp samples taken simultaneously during the same fermentations have previously been characterised using DGGE [Nielsen, D.S., Teniola, O.D., Ban-Koffi, L., Owusu, M., Andersson, T., Holzapfel, W.H. (2007). The microbiology of Ghanaian cocoa fermentations analysed using culture dependent and culture-independent methods. International Journal of Food Microbiology 114, 168-186.]. Here we report the first study where microbiological changes during the fermentation determined using DGGE are correlated to changes inside the beans determined by NIR using multivariate data analysis. Following data pre-processing (baseline correction followed by Co-shift correction or Correlation Optimised Warping) the DGGE spectra were analysed using Principal Component Analysis (PCA). A clear grouping according to fermentation time was seen demonstrating the microbial succession taking place during the fermentation. Subsequently the DGGE spectra were correlated to the NIR spectra using Partial Least Squares regression models (PLS2). Correlations of 0.87 (bacterial derived DGGE spectra) and 0.81 (yeast derived DGGE spectra) were obtained indicating the relationship between the microbial activities in the pulp and the (bio)chemical changes inside the beans. By comparing the X-block loadings of the PLS2 models and the DGGE spectra it was possible to directly link several microbial species with changes in the NIR spectra and consequently also with changes inside the beans.