Researchers use AI to determine key diet improvements in Canadian long-term care

29 Mar 2023 --- Artificial intelligence (AI) technology has determined that diets in long-term care homes must contain more whole grains, plant-based proteins and plain fruits and vegetables. The AI found that this would help residents reduce their risk of inflammation and meet government guidelines. 

According to the authors, consumption patterns indicated not a single protein or vegetable source was among the top five most commonly consumed foods. 

The healthfulness of Canadian long-term care menus should be enhanced, which would also lower inflammatory potential to support chronic disease management, note the authors. 

Researchers developed a new AI tool that could automate the process that previously was a time-consuming manual task, prone to bias and error. 

Long-term care diets need to contain more whole grains, plant-based proteins and plain fruits and vegetables.“These food analytics can support long-term care menu planning and provide data-driven insights to support nutritional interventions geared at improving clinical outcomes and quality of life,” says Dr. Kaylen Pfisterer, an adjunct assistant engineering professor at Waterloo and a scientific associate at the Centre for Digital Therapeutics within the University Health Network.

Automating categorization with AI 
With the AI tool, the research team analyzed data on food and fluids consumed by over 600 residents in 32 long-term care homes over three days. 

“The ability to do such massive categorization using AI in an automated fashion allowed us to get much deeper, much more comprehensive insights into the inflammatory potential of what is currently eaten in long-term care,” explains Dr. Alexander Wong, professor of systems design engineering at the University of Waterloo, Canada. 

The researchers compared the AI’s outcomes to Canada’s 2019 Food Guide on healthy eating and expert information on foods that could cause inflammation, contributing to chronic diseases including diabetes, cardiovascular disease, arthritis and dementia.

Researchers categorized food items from food records into 68 expert-informed categories and food groups from Canada’s Food Guide. They assessed the dietary inflammatory potential of these food sources with the Dietary Inflammatory Index. 

Opportunities to improve menus 
In the study published in BMC Public Health, the researchers highlighted several opportunities to enhance the quality of the menus by reducing the inflammatory index. 

If menus would switch from refined to whole grains, it could reduce their inflammatory index. Changing from fruit-based pies to a fruit cobbler or crumble can increase nutritional density in desserts. 

Plant-based protein sources could further reduce inflammation and add protein in mixed dishes, stews, soups and baked goods. However, these need to consider the replacements’ product acceptability and comparative protein content to mitigate protein malnutrition and sarcopenia concerns. 

Education for residents on healthy food choices may help to facilitate behavior change. 

Recent research suggests that decreasing food insecurity in older adults may reduce the rate of cognitive decline. 

Improving diets could help reduce residents’ risk of inflammation and meet government guidelines.Outcomes 
The top five food categories that accounted for the highest daily calorie intake were juice, bread, milk and soymilk, oral nutritional supplements and cereal. Protein food sources represented the highest proportion of daily calorie intake at 33.4%, followed by other foods (31.3%), grains (25%) and vegetables and fruits (10.4%). 

Most protein-rich foods were animal-based, mainly milk, soups and stews. Though this meets the daily recommended allowance, it does not meet recommendations focused on preventing sarcopenia. Consumption of other nutritional supplements was relatively high and necessary to meet the potential shortfall in protein intake. 

Vegetable and fruit consumption was much lower than the 50% recommended by the Canadian Food guide. During total grain consumption aligned with these guidelines, residents consumed more refined grains than suggested, resulting in lower fiber intake than recommended. 

Foods consumed tend toward a pro-inflammatory response. Females consumed higher inflammatory foods than men. Residents consuming pureed foods had lower inflammatory potential compared to minced foods. 

Challenges of creating long-term care diets   
Food service in long-term care should be nutrient-dense and support health. Moreover, older adult residents must also enjoy the food and drinks they consume, as it affects their quality of life. 

The researchers explained that long-term care residents are at risk of malnutrition. Ensuring they receive sufficient calories can be difficult, especially with budgetary constraints and the seasonable availability of certain foods. 

DSM has called for a food-first approach to addressing malnutrition in seniors. Around 60% of residents in care homes are at risk for malnutrition.

US research indicated that rising inflation affected the nutrition insecurity of almost three-quarters of people over 50. 

Future research will consider specific contributions of protein intake by food source and include an assessment of protein adequacy, according to the researchers.

By Jolanda van Hal 

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