Musculoskeletal, Surgery, Inflammation and Recovery case studies

This impact story tackles malnutrition in hospitalised older adults with fragility fractures, a common and costly issue.

The primary problem is malnutrition in older people, particularly those admitted to hospital with fragility fractures (e.g., hip fractures).

• How common is it?: Approximately 25% of UK patients presenting with hip fractures are malnourished. Malnutrition is common among older adults and worsens during hospital stays.
• Clinical Impact: Malnutrition is associated with poor clinical outcomes, increased risk of complications, and a higher likelihood of recurrent falls and subsequent fractures.
• Operational Improvement Area: dietary intake remains inadequate for "nutritionally vulnerable" patients who consume on average <650 kcal/day and <25 g/day of protein, far below nutritional needs, compared to >1500 kcal/day and >65 g/day for "nutritionally well" patients. Compliance with oral nutritional supplements (ONS) is poor (28.3% consumption), meaning 70% of ONS drinks offered in hospitals are discarded unconsumed.
• Cost to NHS/Society: Malnutrition increases healthcare costs due to prolonged recovery, complications, and readmissions

The research demonstrates collaboration across multiple entities:

• Nottingham University Hospitals NHS Trust (NUH): The lead institution, where the study was conducted and funded, and where the N-ICE Cream® initiative was developed under Professor Opinder Sahota.
• University of Nottingham: Collaborated on the development and taste preference studies of N-ICE Cream®, contributing academic expertise in nutrition and dietetics
• Local Dairy Farms: DreamyCow and Matlock Meadows partnered to produce N-ICE Cream®, including new flavours, integrating industry into the health solution.
• Healthcare Teams: The study involved a multi-disciplinary team, including dietitians,   catering staff, nurses, doctors and a specialist dietetics service
• The BRC’s patient and public involvement group contributed to planning and monitoring food services, ensuring care was user-centred.
• NIHR Infrastructure: support in terms of PPI and liaisons with media  

What the impact of the research has been?

• Development of N-ICE Cream®: A high-protein, leucine- and vitamin D-fortified ice cream was created as an alternative to traditional ONS drinks, addressing poor acceptability and compliance.
• Improved Nutritional Intake/ 80% of older patients preferred N-ICE Cream®, increasing average calorie intake from 650 kcal/day to 1500 kcal/day in malnourished patients.
• Media and Awards Recognition: The work has gained extensive attention on BBC East Midlands News, ITV Central News, and BBC Radio 4, and won multiple awards: Medipex Innovation Award 2022, Food Bev Global Innovation Award (Jan 2023), Food Bev Global Dairy Innovation Award (March 2023), and UK Business Awards for Innovation and Best Product (March 2024).
• Published Research: Findings were disseminated in peer-reviewed journals enhancing the evidence base for nutritional interventions

Who has benefitted and how?

• Patients: Older adults with fragility fractures, particularly those malnourished, benefit from improved dietary intake via a more palatable option (N-ICE Cream®), potentially aiding recovery and reducing complications.
• Healthcare System (NHS): NUH benefits from an innovative, award-winning solution that aligns with NHS nutritional standards, reducing waste and improving patient outcomes,
• Researchers and Collaborators: The team, including Sahota, Marsh, Avery, and others, gained recognition through awards and media, enhancing their professional standing and influence.
• Industry Partners: Dairy farms (DreamyCow, Matlock Meadows) benefit from product development and market opportunities tied to a health-focused innovation.