The HPE Diet

High energy high protein foods

If you’re a clinical dietitian working within the hospital setting, you probably know the high protein/energy (HPE) diet inside and out. For those of you with little exposure to the HPE, read on.

What is Malnutrition

Before we try to understand the HPE diet, we need to look at the condition a HPE diet is designed to prevent, malnutrition.

Malnutrition is a silent killer that goes largely unrecognised, undiagnosed, untreated in our hospitals. Often, it is not taken seriously enough. It occurs when an individual does not consume enough protein and/or energy to meet their requirements. Some common causes of malnutrition:
– Increased energy and protein requirements (for example, cancer patients, post-surgery).
– Decreased appetite (due to medication, age, being unwell etc.).
– Early satiety: feeling full quickly.
– Changes to taste and smell senses (for example, in chemotherapy).
– Fatigue.
– Depression.
– Nausea and vomiting.
– Diarrhoea and constipation.
– Gastric reflux.

There is strong evidence to suggest that malnutrition leads to poor outcomes for patients. Some of these include:
– Increased length of stay in hospital.
– Poor wound healing.
– Increased risk of pressure injury.
– Delirium.
– Increased risk of a harmful fall.
– Increased risk of mortality.
– Susceptibility to infection.
It, therefore, makes sense to avoid malnutrition at all costs. Cue HPE diet.

What is HPE

HPE is the term used to describe a high protein and high energy diet. It is designed to gain weight and/or maintenance of muscle mass. By providing extra nutrients, we offer patients the best chance at evading malnutrition, promoting healthier outcomes.

HPE diets are designed to deliver maximum nutrients in minimum volumes. Hence, those suffering early satiety, fatigue and decreased appetite do not have to consume large meals. This is done by fortifying foods with fat (energy-dense) and protein. Some examples might include a mashed potato with added milk powder to boost the protein. Or, adding oil to soups to improve the calorie content. HPE dieters should avoid foods with higher water and fibre content (for example, vegetables) which fill the stomach but provide little protein or energy. The HPE diet is, therefore, devoid of usually ‘healthy’ foods- vegetables, fibre, whole grains, lean meat. Instead, it is rife with typically unhealthy foods – high fat ice-creams and custards, fatty meats, cakes, creamy pasta etc. On the surface, HPE is unhealthy. Hence, for a healthy individual, it is not recommended. However, when the threat of malnutrition looms, HPE is the best option.

HPE is designed to be used in the short term (mostly) and therefore will not give rise to chronic conditions. When used long term (or example, elderly) malnutrition is more important to prevent than a chronic disease, which is likely to have already developed.

Who Should be on HPE?

Anyone who is at risk of malnutrition should be on a HPE diet. Such populations include:
– Elderly (who show evidence of malnutrition or at risk of malnutrition)
– Cancer patients
– Post-surgery patients
– Burns patients
– Patients with stage III pressure injury
– Patients with decreased appetite
– Patients who have recently lost weight unintentionally
– Patients with visible signs of muscle and fat store loss.

HPE at Home

For elderly individual living at home, cooking, shopping and eating are daily tasks often brushed to the side. This may lead to the burden of malnutrition, and if you or your loved ones are showing signs of muscle and fat wastage, the HPE diet may be considered. The following are some tips for HPE eating at home:
– Fortify mashed potato with milk powder, butter and cream.
– Add lentils and beans to soups.
– Use sauces and gravies.
– Add cream and milk powder to sauces and gravies.
– Choose meat dishes with added cream (for example, chicken carbonara or beef stroganoff). Add milk powder to these where possible.
– Eat nuts and dried fruit as a snack. Dip dried fruit in melted chocolate.
– Add milk powder to porridge in the morning.
– Use full-fat dairy products.
– Add yoghurt to cereal and salad dressings.
– Add milk powder to milk and smoothies.
– Sprinkle Sustagen powder on cereal.
– Consume your favourite foods, and fortify them where you can. For example, cakes and muffins.

If you require extra help, consider HPE meal delivery services such as meals on wheels, or ask a family member or friend for help with meal preparation. Consult a dietitian and bring along the family member or friend that will be helping you.

Oral Nutrition Supplements

When food fails to deliver all the energy and protein we require, we use oral nutrition supplements to aid in preventing malnutrition. These are flavoured (often milk-based) drinks that are high in both energy and protein. There are various on the market and a few include:
– Sustagen
– Ensure
– Resource
– Fortisip
These are really good to consume as a mid-meal snack, instead of regular tea and coffee (which doesn’t contain much protein or energy at all). They are also good to use as an alternative to milk on cereal, or in porridge.

Other Tips for Preventing Malnutrition

HPE diets are largely effective in preventing malnutrition. Some extra tips to increase consumption when you aren’t feeling so great are as follows:
– Consume your favourite foods. You are likely to eat more of something you love eating.
– Eat the protein portion of your meal first. Protein is the most important nutrient in recovery. Don’t fill up on vegetable and bread before you get to the meat.
– Eat small meals frequently to combat early satiety.
– Make your food extra tasty with salt, herbs, spices and sauces. If you like the taste of your food, you are likely to eat more. This is especially relevant to the elderly population who start to lose their sense of taste with age.
– If you are experiencing nausea, dry, salty foods are best tolerated.

Malnutrition is a diet disease we need to take seriously. It is important to recognise friends, family members, clients and patients who are at risk of malnutrition and offer them the required nutrition support. We must remember that energy and protein are the two most important nutrients for recovery and we need to get them in whatever way we can, even if this goes against what we might typically classify as a ‘healthy’ diet.

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