Food First Information for patients, relatives and carers
Sometimes we need extra calories to help us maintain or increase our weight. There are many reasons why we might need help, for example if we experience: Loss of appetite Swallowing problems Treatment side effects Medication side effects. It is important to get the most from the food and drink we consume on a daily basis. Using the information provided in this booklet, you will be able to ensure your diet is as nourishing as possible. Doing this will improve your overall nutritional status and general health. This booklet will explain how to fortify your food and drinks (enrich with calories without changing the volume). It also gives you examples of high calorie snacks and drinks to have between and after meals. Avoid low fat/sugar, diet or light products. Please note, the high calorie snacks and drinks should not be a meal replacement. To get the most benefit; these should be in addition to your daily intake. If you have a diagnosis of diabetes some of the snack ideas and drink recipes in this booklet may increase blood glucose levels. Please seek advice from a healthcare professional (dietitian, GP or nurse) if you have any concerns or queries. This booklet has been provided to you by your nurse/healthcare professional as they feel you need some extra support to increase your overall daily calorie intake. My nurse/healthcare professional:... It is important that you monitor your weight or other visual signs of weight gain to ensure you are making progress with improving your nutritional status. Your nurse/ healthcare professional can help you work out your body mass index (BMI) which indicates if you are at a healthy weight for your height. Please note, if at any point your BMI exceeds 25kg/m2, please discontinue the advice in this booklet.
The information in this booklet has been developed by Registered Dietitians at Rotherham Doncaster and South Humber NHS Foundation Trust. Contact details for more information: Rotherham Doncaster and South Humber NHS Foundation Trust Dietitians Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust Dietitians Telephone: 01302 796410 Email: rdash.dietetics@nhs.net Telephone: (Doncaster): 01302 642742 (Bassetlaw): 01909 572773 Email: dbh-tr.dietetics@nhs.net www.rdash.nhs.uk 3
Food Fortification The following ingredients can be used to enrich your food and drink with calories, without changing the volume: Milk Condensed milk Evaporated milk Fortified milk (Mix 2-4 tablespoons of dried milk powder to 1 pint of whole milk). Add to: Hot drinks (coffee, malted drinks, hot chocolate) Mashed potato Sweet and savoury sauces Packet soup Desserts Fruit. Cereals Porridge Butter and oils Cook/fry all foods in butter or oil if possible. Add to: All potatoes Bread/toast Grated cheese or cream cheese Add to: Soup All potatoes Savoury and milk based sauces Teacake Scones Malt loaf Vegetables Pasta Egg dishes (scrambled egg, omelette). Baked beans Meat dishes (cottage pie, bolognaise). Egg dishes (scrambled egg, omelettes) Vegetable dishes (stews, bakes). 4 Food First
Food Fortification Double cream or créme fraiche Add to: Savoury and milk based sauces Hot drinks (coffee, malted drinks, hot chocolate) Soup Egg dishes (scrambled egg, omelette) All potatoes Vegetables Fruit. Hot and cold desserts Porridge Cereal Sauces Have high fat versions of: Savoury sauces: Parsley Cheese Hollandaise Gravy Salad dressing Mayonnaise Horseradish Tartare. Sweet sauces: Custard Ice cream sauce. www.rdash.nhs.uk 5
Meal Ideas If you are unable to eat a full meal, try to eat little portions and often, every 2-3 hours. The following ideas are examples of enriched meals: Breakfast Cereals with fortified milk and honey, sugar, double cream or dried fruit Toast with thickly spread butter and jam, marmalade, chocolate spread, peanut butter, paté or cheese spread Egg dishes with added butter, double cream or cheese. Light meals Toast with thickly spread butter and fortified scrambled egg, beans, cheese or paté Sandwiches with added mayonnaise or salad cream Jacket potatoes with butter and cheese, beans or tuna mayonnaise Soup with added fortified milk and double cream with bread thickly spread with pate, cream cheese or butter. 6 Food First
Meal and Dessert Ideas Main meals Seal the meat off in oil Sauté vegetables in butter and serve with additional butter, cheese or savoury/milk based sauce Serve stews and casseroles with dumplings or Yorkshire puddings Shallow/deep fry fish and fish products Serve main courses with savoury or milk based sauces Add butter and cheese to potatoes Sprinkle a handful of cheese onto finished dishes e.g. spaghetti bolognaise, cottage pie Drizzle olive oil over pasta based meals and add a spoonful of pesto. Where possible encourage a dessert after a meal. Desserts Cake Trifle Sponge pudding Bakewell tart Rice pudding Cheese cake Cremé caramel Pie/crumble. Serve with sweet sauces, custard, double cream and/or ice cream. www.rdash.nhs.uk 7
High Calorie Snacks Aim for two high calorie snacks per day between meals if possible. For patients on a regular diet (IDDSI Level 7) only. Biscuits Digestives with butter Cream filled biscuits Chocolate biscuits Shortbread Cakes Chocolate cake with jam and cream Victoria sponge with jam and cream Lemon cake with lemon curd and cream filling Carrot cake with cream cheese Ginger cake and butter Fruit cake and butter or cheese. Savoury snacks Mini pork pie Sausage roll Scotch egg Crackers with butter and cheese Cheese biscuits Cheese scone with butter Quiche Half a sandwich with cheese, chicken, chopped meats, peanut butter, egg, or tuna mayonnaise. Other sweet snacks Malt loaf with butter Flapjack Scone with butter and jam Custard or bakewell tart Millionaire s shortbread Chocolate brownie Jam/lemon curd sandwiches Trifle Milk based snacks Thick and creamy yoghurt Fromage frais (2 small pots) Mousse Crème caramel Instant whip Milk pudding with jam. 8 Food First
Texture Modified High Calorie Snacks For patients who have swallowing problems and have been advised a textured modified diet. Aim for two high calorie snacks per day between meals if possible. IDDSI Level 6 Soft and Bite-Sized (previously known as texture E/fork mashable) Cake, cream buns or muffins with extra seedless jam, double cream or custard (no hard chunks) Carrot cake with cream cheese (no nuts) Ginger cake and butter Thick and creamy yoghurt Fromage frais (2 small pots) Mousse Crème caramel Trifle Instant whip Milk pudding with seedless jam Crustless quiche. Filling of a custard tart Chocolate brownie (warmed, no nuts or hard chunks) IDDSI Level 5 Minced and Moist (previously known as texture D/pre mashed) Pre-mashed cake, cream buns or muffins with extra seedless jam, double cream or custard (no hard chunks) Pre-mashed carrot cake with cream cheese (no nuts) Pre-mashed ginger cake and butter Pre-mashed chocolate brownie (warmed, no nuts or hard chunks) Thick and creamy yoghurt Fromage frais (2 small pots) Mousse Crème caramel Instant whip Milk pudding with seedless jam Pre-mashed crustless quiche. Pre-mashed filling of a custard tart www.rdash.nhs.uk 9
Texture Modified High Calorie Snacks For patients who have swallowing problems and have been advised a textured modified diet. Aim for two high calorie snacks per day between meals if possible. IDDSI Level 4 Pureed (previously known as texture C) Blended cake, cream buns or muffins with extra seedless jam, double cream or custard (no hard lumps/chunks) Blended carrot cake with cream cheese (no lumps/nuts) Blended ginger cake and butter Blended filling of a custard tart Thick and creamy yoghurt Fromage frais (2 small pots) Mousse Crème caramel Instant whip Smooth milk pudding with seedless jam Topping of a smooth cheesecake. Please note: Bread and biscuits should be assessed on an individual basis by a Speech and Language Therapist. Please contact your GP/Speech and Language Therapist for further instruction. 10 Food First
Try our new high calorie snack recipe! This high calorie snack is suitable for regular and all texture modified diets and those who require thickened fluids. New recipe Lemon Fool 100ml double cream 1 tablespoon caster sugar Juice of ½ lemon 2 heaped teaspoons of dried milk powder 1. Put cream and dried milk powder in saucepan and heat until dissolved 2. Add sugar 3. Bring to the boil for 3 minutes 4. Mix the lemon juice to taste 5. Pour into a dessert bowl and chill 620 calories, 5g protein High Calorie Drinks Aim for two high calorie drinks per day, between or after meals if possible. Try to replace low calorie drinks, such as tea, water and diluted juice with high calorie drinks such as whole milk, high sugar drinks and coffee, malted drinks and hot chocolate made with fortified milk. The following high calorie drinks provide a variety of vitamins and minerals and can be made up and stored in a refrigerator for up to 24 hours. The high calorie drinks can be thickened using a thickening agent. Please discuss with your Speech and Language Therapist for instructions on how to do this, to ensure the correct thickness. (High Calorie Drinks continue on the next page). www.rdash.nhs.uk 11
Milk-Based Options Booster Smoothie Handful of soft fruit 2 scoops vanilla ice cream 30ml flavoured sauce 1 tablespoon of dried milk powder 1. Mix in a blender 2 tablespoons double cream 100ml whole milk 430 calories, 12g protein Booster Breakfast Drink 200ml fruit juice 1. Mix ingredients in a blender or with a fork 125g Greek yoghurt 1 tablespoon honey or sugar 1 tablespoon dried milk powder 230 calories, 16g protein Booster Milkshake 40g chocolate spread, lemon curd or smooth jam 150ml whole milk 1. Mix ingredients in a blender or with a fork 40ml condensed milk 1 scoop of ice cream 380 calories, 10g protein 12 Food First
Milk-Based Options Supershake 200ml whole milk 2 tablespoons dried milk powder 3 heaped teaspoons vitamin fortified milkshake powder (e.g. Nesquik or supermarket own brand) 1. Mix dried milk powder and milkshake powder together in a glass 2. Gradually add in the milk and stir well 300 calories, 17g protein Supershake Compact This is suitable for those who struggle to manage large volumes of fluid, please also see High Calorie Shots overleaf. 125ml whole milk 3 tablespoons dried milk powder 3 heaped teaspoons vitamin fortified milkshake powder (e.g. Nesquik or supermarket own brand) 1. Mix dried milk powder and milkshake powder together in a glass 2. Gradually add in the milk and stir well 300 calories, 21g protein Superfloat 100ml lemonade (avoid no added sugar) 1 tablespoon caster sugar 1. Mix ingredients together and stir well 100ml fresh fruit juice 1 scoop ice cream 300 calories, 3g protein www.rdash.nhs.uk 13
Juice-Based Options The juice-based drinks are not suitable for people with diabetes unless agreed with your nurse/healthcare professional Superjuice 100ml lemonade (avoid no added sugar) 75ml cordial (avoid no added sugar) 2 tablespoons icing sugar 1 tablespoon golden syrup 1. Mix ingredients together and stir well 450 calories, 2g protein Superfruit Punch 180ml fresh fruit juice 40ml cordial (avoid no added sugar) 10g (2x5g sachets) egg white powder 1. Mix cordial into egg white powder with a fork until there are no lumps 2. Gradually mix in fresh fruit juice and stir well 160 calories, 9g protein Fruit Smoothie 150ml fresh fruit juice 1 mashed banana 4 segments of tinned peaches (in syrup) 2 teaspoons of honey 1. Mix in a blender 260 calories, 3g protein 14 Food First
Savoury Options Supersoup 1 sachet of cup a soup 1 tablespoon dried milk powder 200ml whole milk A little boiling water 1. Mix the cup a soup sachet contents and dried milk powder with a little boiling water to dissolve 2. Heat the milk and stir in gradually until dissolved 250 calories, 15g protein High Calorie Shots These are ideal for patients who struggle to manage large volumes of fluid. Booster Milk Shot 40ml condensed milk 1 teaspoon chocolate spread 1. Mix ingredients together and stir well 150 calories, 3g protein Super Creamshot 40ml double cream Flavouring to taste such as vanilla, strawberry, chocolate, blackcurrant or peppermint 1. Mix ingredients together and stir well 180 calories, 2g protein www.rdash.nhs.uk 15
This information is correct at the time of publishing Last Reviewed: May 2018 get approved We are a smokefree organisation. Please provide a smoke free environment for your healthcare provider DP8201/08.18