Authors (including presenting author) :
Shum CK (1), Chan CH (1), Wong SYI (2), Koo HWJ (3), Yeung W (2), Yung IY (3), Tang PCR (4), Hai MK (1), Tse LS (1), Chiu SY (1), Lau CK (1), Tang LC (1), Tso WM (1), Leung Z (5), Wong A (5), Chan NH (6)
Affiliation :
(1) Department of Medicine and Geriatrics, Tuen Mun Hospital, (2) Department of Speech Therapy, (3) Dietetic Department, (4) Hospital Food Service Unit, (5) Quality and Safety Division, (6) Department of Medicine and Geriatrics, Pok Oi Hospital and Tin Shui Wai Hospital, New Territories West Cluster, Hospital Authority, Hong Kong SAR
Keyword 2: :
Nutrition Management
Keyword 3: :
Frail Hospitalized Patients
Keyword 4: :
Nutrient Condensed Pureed Diet
Keyword 5: :
Malnutrition
Introduction :
Malnutrition is prevalent among frail hospitalized patients and is associated with adverse clinical outcomes, particularly during acute illness when oral intake is often reduced. Traditional pureed diets, although necessary to ensure swallowing safety, are frequently unappealing and not nutrient dense, which contributes to nutritional inadequacy from suboptimal intake. To address these challenges, “Joyful Meal”, a nutrient condensed pureed diet, was developed by a multidisciplinary workgroup under the New Territories West Cluster Nutrition Management Committee in collaboration with the catering service. It aims to improve meal palatability, texture, and nutritional value through the application of culinary science (taste enhancement and low-temperature cooking) and homology of medicine and food in the cook-chill cum cold-plating mode patient meal service.
Objectives :
To evaluate the effects of “Joyful Meal” on nutritional intake and clinical outcomes in frail hospitalized patients, compared with a traditional pureed diet.
Methodology :
This pilot study compared frail hospitalized patients who received the “Joyful Meal” (study group) between 24 February and 23 March 2025 with a control group who received a traditional pureed diet between 14 April and 11 May 2025. Patients were recruited from acute medical and convalescent wards of Tuen Mun Hospital. Eligible patients had dysphagia requiring a D-pureed diet. Exclusion criteria included those who were kept nil by mouth, had severe dysphagia or required careful hand feeding. Nutritional intake, feeding-related parameters and clinical outcomes were assessed and compared between groups.
Result & Outcome :
A total of 105 frail hospitalized patients were recruited [mean±SD age 89.6±11.3 years, 69% female], with 61 in the study (Joyful Meal) group and 44 in the control (traditional puree) group. Baseline characteristics were comparable between groups. Following the intervention, the Joyful Meal group had significantly higher caloric intake per meal than the control group (466.7±261.7 vs. 288.6±175.4 kcal per meal, p< 0.01). The study group also demonstrated slightly higher oral intake and protein intake per meal and a lower proportion of behavioral feeding problems, although these differences did not reach statistical significance. No significant differences were observed in feeding time and body weight changes between groups. Regarding clinical outcomes, the Joyful Meal group had a significantly shorter hospital length of stay [median (inter-quartile ranges) 4.0 (1.0-8.0) vs. 7.0 (2.3-14.3) days, p=0.04] and a higher proportion of acute patients discharged directly home (82.2% vs. 37.0%, p< 0.01), with fewer requiring transfer to convalescent care (15.5% vs. 63.0%, p< 0.01). The “Joyful Meal” program demonstrates potential in improving nutritional intake and clinical outcomes in frail hospitalized patients. Further service development is warranted to support wider implementation in clinical practice and to optimize patient care.
