Menu planning for hospitals and rest homes and different ethnic groups

Roslyn Norrie, NZRDINNOVATE, INTEGRATE & INSPIRE

Dietitians NZ 2017 NATIONAL MEETINGSeptember 1st, Te Papa, Te Whanganui-a-Tara

Taste preferences of UK's major regions

The UK's favourite regional foods stem from the West Country, particularly Cheddar Cheese and Devonshire Cream Teas.

• Scots are the slowest eaters and contrary to folklore, prefer Yorkshire Pudding and Italian Ice Cream because of their mouth-melting properties.

• People from the North East seek tastes that offer immediate satisfaction, borne from a history of hungry heavy industry workers demanding foods that offer immediate sustenance.

• The Midlands, known to be the Balti centre of the UK, but people from the area were predisposed to enjoy Asian food long before it arrived in the UK. The region's taste dialect is for soft, suckable foods that have a slightly sweet dimension and can be eaten with their hands like naan.

• The South: A melting pot of people and cultures from all round the UK and abroad, the South/South East of England has the least defined taste dialect of all the regions.

Ref: https://phys.org/news/2009-06-uk-dialects.html

https://phys.org/news/2009-06-uk-dialects.html

Better Hospital Food programmeHospital food is an essential part of patient care. Good food can encourage patients to eat well, giving them the nutrients they need to recover from surgery or illness

The Better Hospital Food (BHF) programme was introduced to ensure the consistent delivery of high quality food and food services to patients.

The BHF programme, which ran until the summer 2006, was an excellent example of a national approach supporting local improvement. BHF programme reflected one of the aims of the NHS Plan –that dietitians would advise and check on nutritional values of food.

The BHF programme’s outputs are now on the Hospital Caterers Association website. The website includes information on a wide variety of initiatives including• the national dish selector• protected mealtimes• nutrition• sustainability.

Ref: http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Managingyourorganisation/Workforce/Leadership/Healthcareenvironment/DH_4116450

http://webarchive.nationalarchives.gov.uk/+/http:/www.dh.gov.uk/en/Managingyourorganisation/Workforce/Leadership/Healthcareenvironment/DH_4116450

Ethnic breakdown - South London borough of Lewisham, 2011 census

• 57% White, British• 4% Mixed• 7% Asian or British Asian• 19% Black or Black British• 2% Chinese

Ref: http://www.pat.nhs.uk/patients-and-visitors/catering-and-food-for-patients.htm

Bringing Food Into HospitalWe would hope that our services will cater for all your needs, although it is recognised that visitors may wish to bring food and drinks for patients to enjoy whilst they are in hospital. The Trust does, however, have a responsibility to ensure that the products are safe for patients to eat, and we would be grateful if visitors complied with the following guidance. The following foods are low risk and therefore suitable for relatives or visitors to bring in:• Washed fresh fruit (but not prepared)• Fruit juice, cordials and glucose drinks• Savoury snacks such as nuts or crisps• All kinds of biscuits• Plain cakes (but not those containing cream or custard e.g. trifles or vanilla slices)• Sweets, chocolates or other confectionary

The following foods are considered a higher risk and should be avoided:• Sandwiches containing cooked meats, fish, eggs or other protein filling and made up meat products

such as pies, pastries and scotch eggs are considered high risk, and as such should not be brought in from outside.

if such foods are brought in, they must, where possible, be eaten during the visit, eaten only by the patient and not shared with other visitors or patients on the ward. Any foods consumed by the patient brought in from outside must be recorded in their notes. These foods should not be stored or reheated, to reduce the risk of contamination. If meals are brought in at mealtimes, they can only be reheated if a probe is used and the core temperature is over 75OC. Any food stored for later consumption must be put straight into the fridge and clearly labelled with the patient's name and date, and must be discarded if not used within 24 hours.

http://www.pat.nhs.uk/patients-and-visitors/catering-and-food-for-patients.htm

Understand differences between migrant groups

Migrants have different needs depending on whether they are first generation, 1.5 generation or second generation.

For example, after undertaking market research, Foodstuffs identified three core customer types that it needed to target:• Westerners who wanted to learn about Asian food• “Western Asians” those born in New Zealand or well settled here• “Asian Asians” new migrants bring their consumer habits with them

from their individual home countries.

Ref:http://www.chenpalmer.com/wp-content/uploads/Superdiversity_Stocktake.pdf

http://www.chenpalmer.com/wp-content/uploads/Superdiversity_Stocktake.pdf

WHO is my menu for?

http://ethniccommunities.govt.nz/story/our-operating-context

http://ethniccommunities.govt.nz/story/our-operating-context

Climate change mitigationThe NZ Public Health and Disability Act 2000 Section 22, Objective (j) requires that DHBs ‘exhibit a sense of environmental responsibility by having regard to the environmental implications of its operations'.

NZ has committed under the Paris Climate Agreement to reduce greenhouse gas emissions by 30% below 2005 levels by 2030. The health sector will need to contribute to this target

Ref: Bennett H, Jones R, Keating G et al. Health and equity impacts of climate change in Aotearoa-New Zealand, and health gains from climate action. NZMJ, 2014. http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2014/vol-127-no-1406/6366

http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2014/vol-127-no-1406/6366

Menus with CO2 & Nitrous Oxide

• less red meat• more vegetable derived proteins

Menus with less embedded water

• Potato• Sweet potato• Taro, cassava, • Breads, pasta• Rice, barley, • Polenta, tortilla, • Pseudo-grains: amaranth, buckwheat, millet,

quinoa, & etc.

Menus that fight dysbiosis• Alterations in intestinal microbiota composition are associated

with several chronic conditions• Faecal microbiota composition significantly correlated with

measures of frailty, co-morbidity, nutritional status, markers of inflammation and with metabolites in faecal water

• Individual microbiota of people in long-stay care was significantly less diverse than that of community dwellers

• Loss of community-associated microbiota correlated with increased frailty.

• A relationship between diet, microbiota and health status, indicates a role for diet-driven microbiota alterations in varying rates of health decline upon ageing.

Ref: Gut microbiota composition correlates with diet and health in the elderly Claesson, et al, Nature, suppl. NATURE OUTLOOK: AGEING; London (Dec 6, 2012)

Descriptive menus may increase food consumption

Vegetarian egg noodles with fresh vegetables, chilli, mushrooms and vegetarian sauce

Ref:Ella Ottrey, Judi Porter, (2016) Hospital menu interventions: a systematic review of research, International Journal of Health Care Quality Assurance, Vol. 29 Issue: 1, pp.62-74, https://doi.org/10.1108/IJHCQA-04-2015-0051

http://www.emeraldinsight.com/author/Ottrey,+Ellahttp://www.emeraldinsight.com/author/Porter,+Judihttps://doi.org/10.1108/IJHCQA-04-2015-0051

DinnerSample menu for a NZ rest homes written by local development chef.

Both midday and evening meals include daily blackboard options of main meal salads, and sandwiches made with a choice of white or wholemeal bread

Ref: Terrence Austin, personal communication, July 2017

Main Pan fried fishStandard and SoftAccompaniment Cream sauce2nd Choice Grilled chickenStandard and SoftAccompaniment mushroom sauceAsian Choice Beef stir fryStandard and Soft with noodlesAccompaniment Soy jusVegetarian Vege chop suey

or Chick pea fingersSauce Mushroom sauceCarbohydrate Saute potatoVegetables 1 Grilled herb yamsVegetables 2 Parsley cabbageMince n Moist Steamed fish, sautePuree Potato, VegeSauce Cream sauceDessert Chocolate friandStandard and Soft garnishedMince n Moist Chocolate friandPuree or below garnishedIce cream in a bowl ice creamYoghurt YoghurtPudding/Mousse Fruit mousse

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4 DAY MENU SAMPLE

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

BREAKFASTBreakfast

FruitPearsPeachesApricotsFruit Salad

Cereal hot/coldPorridge, Weetbix, Cornflakes, Rice bubblesGluten free available on request

AdditionalMilk, Cream, Yoghurt, Prunes, Fresh fruit, Orange juice, kiwifruit juice, also make available items for specific dietary requirements

Toast/BreadWholemeal and White toast/ bread with margarine, butter, marmite, vegemite, marmalade, jams, honey, peanut butter Gluten free available

MORNING TEA

Morning teaMille fuilleGrilled pepperRaspberry chantillyAsparagus feta

HousemademuffinsSconePuffs

SoftWhere possible the same as above, but also a sandwhich - no nuts,dried fruits or seeds

PureeChocolate parfaitMuffin ,with sauceDiced yoghurtAsparagus feta

DiabeticsAlso have the option of sandwich or cracker and cheese

BeverageTea, coffee, hot chocolate, juice, diabetic juice available

LUNCH

LunchMenu choice includes option of main meal, salad, sandwich - choice of white or wholemeal bread

Fresh FruitAssortment of seasonal fruit available

SoupKumara n chiveBeef MinestroniCurried vegetableRoasted pumpkin

Pureed soupAs above but pureed and fortified where required

BreadWhite or wholemeal available with butter or margarine

MainLamb ragoutFettuciniBeef stoutChicken n veg

CabonnaraVol au ventsCobbler

AccompanimentBraised vegItalian saladSlaw saladGreek salad

SauceJusCream sauceJusGravy

2nd ChoiceBeef stroganoffSmoked fishChicken stir fryPastrami n veg

PieQuiche

AccompanimentSteamed riceItalian saladSaute vegetablesGreek salad

SauceMushroom wineSoy jusTomato sauce

OmletteTomatoGrilled peppersSaute mushroomsCheese

Asian AlternativeGreen thai curry tofu n veg on riceSatay chickenon riceChickpea KormaBlack bean saucewith Pork

VegetarianAs above orPumpkin and kumaraChickpea KormaVegetable stack

Mushroom crepetartor courgette roulardeon grilled polenta

AccompanimentRice, green saladItalian saladRice or saute vegGreek salad

SauceSour creamTomato salsaJusLemon dill sauce

SandwichOne of the following choices: Ham, Roast Beef, Corned beef and relish, Egg, Asparagus, Tuna, Tomato, Cheese

SaladOne of the following choices: Ham, Roast Beef and relish, Corned beef and chow chow, Egg and Tomato, Tuna, Cottage cheese

Mince n MoistLamb ragout, mashFettucini cabonnaraBeef stoutChicken cobbler

Puree1 veg1 veg, mashSaute mash, 1 vegPotato bake, 1 veg

SauceGravyJusGravyJus

BeverageTea, coffee, hot chocolate, juice, diabetic juice available

Afternoon Sample

AFTERNOON TEA

Afternoon teaSalami pastriesCarrot cakeMini pizzaRum n date

Housemadeloaf

SoftWhere possible the same as above, but also a sandwhich - no nuts,dried fruits or seeds

Puree, M&MLemon mousseCarrot cake, creamCustard squareRum n date loaf

DiabeticsAlso have the option of sandwich or cracker and cheese

BeverageTea, coffee, hot chocolate, juice, diabetic juice available

DINNERDinnerMenu choice includes option of main meal, salad, sandwich - choice of white or wholemeal bread

MainPan fried fishCountry GrilledHerb crusted beefItalian Chicken

Standard and SoftChickenServed with scone

AccompanimentCream sauceWine sauceJusGravy

2nd ChoiceGrilled chickenPork and basilFish mornayWine Braised

Standard and SoftloafSteak

Accompanimentmushroom sauceGravyCheese sauceOnion sauce

Asian ChoiceBeef stir fryPork chow meinBattered fishOriental crispy

Standard and Softwith noodleswith stir fry vegChicken and vege

AccompanimentSoy jusSoy jusSweet n sour sauceLemon sauce

VegetarianVege chop sueyVege chow mein orSweet n sour ballsCurried cannelili balls

or Chick pea fingersWalnut n lentil loafEggplant crumbleor Vege filo

SauceMushroom sauceWine sauceCheese sauceItalian sauce

CarbohydrateSaute potatoMashParsley potatoHerb potatoes

Vegetables 1Grilled herb yamsBaked kumaraGinger PumpkinJulienne carrots

Vegetables 2Parsley cabbageMixed greenSaute Green beansButtered Silverbeet

Mince n MoistSteamed fish, sautePork n basil loafRoast beef, parsleyItalian chicken, herb

PureePotato, VegeMash, 2 vegMash, 2 vegMash, 2 veg

SauceCream sauceGravyJusTomato, garlic sauce

DessertChocolate friandRice puddingAppleApricot upside

Standard and Softgarnishedwith peachesStrudel, creamCake with custard

Mince n MoistChocolate friandRice puddingAppleApricot upside

Puree or belowgarnishedwith peachesShortcake, creamCake with custard

Ice cream in a bowlice creamice creamice creamice cream

YoghurtYoghurtYoghurtYoghurtYoghurt

Pudding/MousseFruit mousseChoc mousseMocha puddingVanilla pudding

Jellied fruitJellied fruitJellied fruitJellied fruitJellied fruit

BeverageTea, coffee, hot chocolate, juice, diabetic juice available

SUPPERSupperBiscuit or Sandwich (preference to use wholemeal bread unless requested) available along with Puree Fruit and Yoghurt

BeverageTea, coffee, hot chocolate, juice, diabetic juice available

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short C.V. for introRoslyn Norrie currently works in Auckland as a part-time DHB foodservicescontract manager, which she combines with a private practise in food andnutrition. During the earlier part of her dietetic career she worked in HawkesBay, Otago and Canterbury before moving to the UK. There she worked firstlyin food manufacturing a post that involved much travel around Britain; thenlatterly in London, for a US-based food and facilities managementmultinational. Roslyn helped develop the Dysphagia Diet Food TextureDescriptors 2011, The Nutrition and Hydration Digest: Improving Outcomesthrough Food and Beverage Services 2012, and the Allergen Toolkit forHealthcare Catering 2014.

Now back in New Zealand, Roslyn represents Dietitians New Zealand on theInternational Dysphagia Diet Standards Initiative [IDDSI] working groupimplementing IDDSI in New Zealand. Roslyn has a particular interest innutrition for mental and neurological healthcare, and food for those ofadvanced age.

Menu planning for hospitals and rest homes and different ethnic groups Slide Number 2Taste preferences of UK's major regions Better Hospital Food programmeSlide Number 5Ethnic breakdown - South London borough of Lewisham, 2011 census Slide Number 7�Ref: http://www.pat.nhs.uk/patients-and-visitors/catering-and-food-for-patients.htm�Slide Number 9Understand differences between migrant groups�WHO is my menu for?�Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Climate change mitigationMenus with CO2 & Nitrous OxideMenus with less embedded waterMenus that fight dysbiosis�Descriptive menus may increase food consumption��Dinner�short C.V. for intro