EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To assess the size of food portions of select meals by comparing them with standard portion recommendations
To assess the nutrient content of selected meals by comparing them with standard nutrient intake recommendations
To determine the effect of delivery time on the temperature of the meals to be served.

Inclusion Criteria:

Meals on Wheels meals from seven providers in 1991 and six providers in 1995.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

The sample was not recruited for this study. Meal trays from various sites were randomly selected for analysis.

Design

Trend study
To assess portion size, food was collected and weighed from a randomly selected lunch tray prepared by each of seven providers in 1991 and six providers in 1995. Portion sizes provided were compared with a set of standard portion sizes. Nutrient content for nutrients known to be limited in older adults diet (energy, iron, vitamin A and calcium) as well as sodium were analyzed using Nutrition IIII, version 5.0 and compared to one third of the RDA.
To assess the effect of delivery time on temperature, temperature of randomly selected food was taken within two minutes of pick up time and during 15-minute intervals until delivery for a total of four temperatures.

Statistical Analysis

Two-tailed T-tests were conducted to determine nutrient consumption and temperature changes between 1991 and 1995. A paired T-test was done to determine temperature differences between various intervals within each year.

Data Collection Summary:

Timing of Measurements

Analysis were completed during a two-week period in February 1991 and again in June 1995
For temperature assessment, temperatures were taken within two minutes of pick-up time and during 15-minute intervals during delivery. The final temperature was taken 45 minutes after initial pickup.

Dependent Variables

Portion sizes as compared to standard portions
Nutrient content as compared to 33% of the RDA for specific nutrients
Temperature of food 45 minutes after pickup.

Independent Variables:

Meals on Wheels 1991 program
Meals on Wheels 1995 program.

Description of Actual Data Sample:

Initial N:
- N = seven meal trays in 1991 (one from each local Meals on Wheels provider)
- N = six meal trays in 1995 (one from each local Meals on Wheels provider).
Attrition (final N): As above
Location: Honolulu, Hawaii.

Summary of Results:

Comparison to the RDA of Select Nutrients per Meal*

Variable	Energy	Iron	Vitamin A	Folate	Sodium	Calcium
1991	32.3±4.5	51.4±12.8	131.7±4.3	41.0±15.3	51.6±17.0	50.9±6.6
1995	42.5±10.9	54.5±19.2	96.7±74.9	53.7±23.9	71.7±35.3	55.7±12.1

*Mean ±standard deviation.

Other Findings

In 1991 the average servings of milk and bread were above the recommended serving standards, while the servings of the vegetable, fruit, and meat groups were below the recommended standards. In 1995 all of the five good groups were equal to or above the recommended servings. The differences between tray servings sizes from 1991 to 1995 was not statistically significant.
Energy and nutrient analysis of trays vs. the RDA met or exceeded 33% of the RDA for men. There were differences in select nutrients between 1991 and 1995 but they weren't statistically significant.
Initial mean food temperature at pick up was 112.6 degrees in 1991 and 135.7 degrees in 1995. After 45 minutes, temperatures had dropped significantly to 93.6 (1991) and 110.0 (1995).

Author Conclusion:

Results show that food portions and nutrient content of foods delivered by the providers that were studied met recommendations in both 1991 and 1995
In 1991, most all temperatures of the hot items were out of the safe range during pickup and delivery. Temperatures of meat, egg and milk products were in the danger zone. Temperatures were improved in 1995, possibly due to changes in delivery containers and education provided based on 1991 results.

Funding Source:

University/Hospital:

University of Honolulu, Hawaii

Not-for-profit

Hawaii Meals on Wheels

Reviewer Comments:

The method of holding foods during delivery were not discussed. It is unclear if they were placed in insulated containers during delivery or left open in air-conditioned vehicles. It was not specified whether or not the temperatures were taken on the same plate. If so, the opening and closing of the containers to take temperatures could have resulted in a lowering of the temperatures.
The N is this study was very small, and a very small percentage of the total number of meals served. A larger sample size might have produced different results. The reviewer questions whether the statistical results can be considered valid because of the small sample size.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	No
	2.2.	Were criteria applied equally to all study groups?	N/A
	2.3.	Were health, demographics, and other characteristics of subjects described?	N/A
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		N/A
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	N/A
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		???
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	N/A
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	N/A
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	No
	7.7.	Were the measurements conducted consistently across groups?	???
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	???
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes