High-protein high-energy cookies: satisfaction survey with 30 hospital patients from the gerontology department of the Nice University Hospital.

High protein high energy cookies, with their specific texture specifically designed for people with chewing difficulties.

These cookies, currently in advanced experimentation, have been distributed to 30 elderly people staying at the gerontology department of the Nice University Hospital in 2009.

The goals of this study were:

• To find out if malnourished people, or people with a risk of malnutrition, would appreciate this new product.
• To find out what the preferred intake times would be.
• To evaluate the impact of oral parameters on the cookie intake.

The inclusion criteria for this study were: age > 70, and ability to eat without assistance solid, chopped, or mashed food, without deglutition problems.

The small butter cookies were made by the hospital Pastry Chef. Each cookie weighted 5 g and contained 1g of milk proteins, 29 Kcal with 21% of the total energy from proteins. During the one week experiment, each participant was given a 7 cookie box (35 g) every morning.

The experiment took place from February 1st to April 30th 2009. The average age of the 30 patients was 83 years old, with 11 men and 19 women.

Amongst the 30 patients who took part in the experiment, 77% had protein rich milk drinks, milk creams or protein fruit juices in the morning at 10am. The intake of these nutritional complements has not impacted the cookie intake.

The satisfaction questionnaire that was given to the patients about the cookies focused on the acceptability and the sensory properties of this new product.(evaluation - -, -, 0, +, + +), with the possibility for free comments.

Acceptability :

• 52% of the patients ate the cookies with a drink, mostly water.
• 75% of the patients considered the cookies were "good" or "very good".
• Women liked the cookies more than men (p<0,05).

Sensory properties of the cookies :

- Look : the patients gave the cookies an average mark of 3,9/5. Comments like "cute, small" were mentioned several times.

- Taste: the patients gave an average mark of 3,9/5. Women liked the taste of the cookies much more than men (p<0,01). Comments: " They have a nice taste of butter", "It is just like the good old-style cookies", "We do not feel the taste of the proteins", "They do not have the strong taste of milk".

- No aftertaste: this specific aspect of the protein cookies was particularly appreciated, with an average mark of 4,5/5.

- Ease to swallow the cookies : this aspect was also very much appreciated, with an average mark of 4,3/5. Comments : "It goes down well", "I do not struggle to swallow them", "These cookies are not big so it goes down quickly, which is good for me".

- "In the stomach" : the cookies are easy to digest, with an average mark of 4,5/5. Comments : "It goes well", "I digest them well despite my stomach problems. It is very light and it does not swell up like bread".

This study showed that preferred intake times vary significantly with the people :

• 40% prefer to have them regularly along the day,
• 40% prefer to have them for the afternoon snack (16h),
• 20 % prefer to have them for the morning snack (10h).

The oral parameters did not have an impact on the cookie intake: the cookies were eaten and appreciated by patients without oral problems as much as by patients suffering from oral pain (3%), drymouth (21%), lack of teeth (50%), with removable dentures (30%) or needing new dentures (50%).

Conclusions :

1.  In this group of 30 elderly people staying at the hospital, 75 % of the patients liked the high protein high energy cookies, despite the fact that these people represent a group of patients with a high risk of anorexia.

2.  This study has highlighted the notion of pleasure to have the cookies whenever one wishes, without imposed set times. The fact that the boxes contained a number of portions allowed the patient to deal with the snack himself when it best suits him.

3.  Approximately half of the patients (52%) take the opportunity of "the cookie break" to drink water, which encourages them to take fluids.

4.  Women more than men like the cookies.

5.  The cookie intake is not related to the intake of liquid nutritional complements.

6.  Whatever the drymouth and teeth or denture problems, the appetence for the cookies remains the same: the intake is based on the notion of pleasure.

References :

Helou C, Madinier I, Brocker P, Schneider S, Fontas E, Hamm G, Barthélémi C, Karcher B, Grégoire J. Biscuits protéinés pour les personnes ayant des difficultés à mastiquer : enquête de satisfaction sur 30 sujets hospitalisés en gériatrie. Etude pilote monocentrique UF 0493, promoteur Centre Hospitalier Universitaire de Nice, 2009.

Examiners, University Hospital, Nice:

• Dr. Caroline HELOU, odontology department UF 7647
• Pr. Isabelle MADINIER, odontology department UF 7647
• Pr. Patrice BROCKER, gerontology department  UF 3310
• Pr. Stéphane SCHNEIDER, nutrition department UF 7817
• Dr. Eric FONTAS, clinical research and development department UF 0942
• Mrs Gisel HAMM, engineer, central food production unit UF 0400
• Mrs Christine BARTHELEMI, dietician health executive, nutrition department
• Mrs Brigitte KARCHER, dietician, digestion department  UF 7817
• Mrs Justine GREGOIRE, dietician, gerontology department UF 0453