How an NHS trust is improving in-hospital nutrition through fortified ice cream

Malnutrition affects more than three million people – or 1 in 20 – in the UK and 1 in 10 people of the age of 65. In addition, around 1 in 3 patients admitted to hospital or care homes are malnourished or at risk of becoming so, while from those living in the community, around 93% suffer from malnutrition.

The condition, which results from not consuming the right amount of nutrients as part of your diet, has adverse effects on health, disease and well-being and costs the National Health Service (NHS) an estimated £13bn/$20.7bn per year (Elia & Russell for BAPEN, 2009).

Speaking in the House of Commons in 2022, Scottish MP Martyn Day said this cost had risen to ‘a staggering £23.5bn’.

“The cost of treating a malnourished patient is two to three times more than treating a non-malnourished patient,” said Day. “It has been calculated that treating a non-malnourished patient amounts to £2,155/$2,692 whereas treating a malnourished patient comes to £7,408/$9,255. That is reported to be driven largely by poorer outcomes leading to increased healthcare needs.”

Oral nutritional supplements have been considered a cost-effective way of managing disease-related malnutrition – but one NHS trust has found a more appealing way to add essential nutrients to the diets of older patients; ice cream.

The Food Innovation Centre at the University of Nottingham worked alongside the Nottingham University Hospitals (NUH) to develop N-ICE Cream, a dairy vanilla-flavored ice cream enriched with vitamin D and leucine.

Professor Opinder Sahota, consultant in ortho-geriatric medicine at NUH, and leader of the N-ICE Cream project, said the researchers went for dairy ice cream because ‘this is what patients wanted’. “The nutritional value [the ice cream], in terms or energy and protein content, is very similar to the high-protein oral nutritional supplement drinks,” he told us.

Due to this similarity, it could be inferred that N-ICE Cream – which stands for Nottingham ice cream - provides similar nutritional benefits as those observed in clinical trials, such as improved energy and protein levels and improved weight, according to the professor.

Sahota said that almost half of all patients admitted with a hip fracture suffered from malnutrition. “The hormonal and physiological changes that occur during this acute period will lead to further weight loss and muscle wasting in this group who are already malnourished, which is a real concern,” he said, adding that while the research team found that older patients had poor dietary intake of additional nutritional supplement drinks, ice cream was ‘a popular choice’ among them.

And so, during the study carried out in Summer 2022, patients with broken bones who required additional nutritional supplements were asked to try N-ICE Cream for two days, and standard nutritional supplement drinks for two days, to see what they preferred. The professor said that the study could ‘lead towards a change in the way this group of patients are treated at NUH and possibly later in other NHS hospitals in the country’. “It could also help us reduce waste by finding the ideal way of helping patients get the nutrition they need,” he added.

N-ICE Cream, which is high in protein and has added vitamin D and leucine to support muscle health, was initially made with locally-sourced dairy milk from family-run farm Dreamy Cow Farmhouse Ice Cream in Leicestershire. The milk is now sourced from Matlock Meadows in Derbyshire, we were told.

“The protein is a combination of whey protein and leucine, which are commonly used in gym goers (protein shakes and protein supplements) to help build up muscle,” Sahota explained. “Vitamin D has a direct action on muscle and bone.”

The proverbial cherry on top was recognition from the food and beverage industry, as the NUH researchers recently scooped a health innovation award. N-ICE meanwhile was pitted against the likes of plant-based meat company Impossible Foods and microbiome solutions firm, Biohm Health and was the only NHS organisation to be shortlisted and win an accolade.

Commenting after the ceremony, professor Sahota said: “I’m delighted that our team at NUH has received this prestigious accolade for developing and launching our N-ICE Cream product.

“We were the only NHS trust to win in these very competitive international awards – which attract hundreds of entries each year – so this throws the spotlight on why our innovation is so important for older patients.”

“Our achievement highlights the pressing need to address malnutrition in older people to a wider audience, and we developed our N-ICE Cream to address this serious problem.”

Sources:

New guidance to raise awareness of the importance of good nutritional care
Published 8 October 2015
www.england.nhs.uk/2015/10/guidance-nutritional-care/
Combating malnutrition: Recommendations for action
M. Elia et al
www.bapen.org.uk/pdfs/reports/advisory_group_report.pdf

Malnutrition and the NHS
Volume 712: debated on Monday 25 April 2022
https://hansard.parliament.uk/Commons/2022-04-25/debates/9BA607B2-C2C7-4A70-B8C4-8BDC148B6BE9/MalnutritionAndTheNHS