Rich in fibre, vitamins and minerals, they help protect against many conditions, including cancer, cardiovascular disease, obesity and diabetes.
Fruit and vegetables can be eaten in any form: fresh, frozen, canned or jarred, cooked or raw. They can also be eaten as compote—homemade or preferably with “no added sugar”—or in soups. If possible, choose organic fruit and vegetables.
Whenever you can, choose a portion of fruit for dessert.
⇒ lentils—green, red or black—beans—white, kidney or black—chickpeas, split peas and broad beans.
They are rich in fibre and also provide plant protein.
They can be eaten on their own or with fish or meat, vegetables, or cereal foods such as pasta, rice or couscous.
⇒ cereal foods: wholemeal or multigrain bread, wholegrain pasta, couscous and rice, and wholemeal flour
These can be eaten every day. Whenever possible, choose wholegrain or semi-wholegrain versions, which contain more fibre.
Please note: white bread and standard pasta are made from refined flour. The germ and outer layers of the grain have been removed, so they contain less fibre, minerals and vitamins. Wholegrain starchy foods retain all parts of the grain and therefore more of its nutrients.
Starchy foods contain what are known as complex carbohydrates, sometimes called “slow-release carbohydrates”. They provide energy that is available to the body over a longer period than simple sugars.
Alternating between oily fish—such as sardines, mackerel, herring and salmon—and white fish helps limit overall fat intake while providing the omega-3 fatty acids found in oily fish.
Fish also provides protein and iron. Please note: some fish may contain environmental contaminants, so vary both the species you eat and where they come from.
Frozen fish has the same nutritional value as fresh fish. Avoid breaded fish and fish in rich sauces, which can contain large amounts of fat.
⇒ Walnuts, hazelnuts, almonds and pistachios.
They are rich in healthy fats; walnuts are particularly rich in omega-3.
Added fats—such as oil, butter and margarine—can be eaten every day in small amounts.
Over time, eating too much fat increases the risk of weight gain and cardiovascular disease. However, some fats are essential for the body. Choose vegetable oils, particularly rapeseed, walnut and olive oil, and limit butter.
One effective way to reduce your fat intake is to cook from scratch as often as possible and choose healthier cooking methods such as stewing, steaming or grilling.
Reduced-fat products can help, provided you do not eat more of them simply because they contain less fat. For example, 20 g of reduced-fat butter may contain as much fat as 10 g of standard butter.
Please note: “reduced fat” does not mean fat-free. It means that the product contains at least 30% less fat than the standard version.
One portion is equivalent to one plain yoghurt, a medium glass of milk (150 ml), a 30 g piece of cheese, or some grated cheese added to pasta, a bake or a quiche.
Dairy products fall into three categories:
Please note: cream, butter and spreadable cheeses are made from milk, but they are high in fat and low in calcium and do not count as dairy portions. Limit how much you consume.
Hard cheeses such as Emmental, Comté and Parmesan contain the most calcium, but are also often the highest in fat. Be mindful of very salty cheeses such as feta and Roquefort.
Please note: quantities are described in “portions”. An adult portion is approximately 80–100 grams.
Useful resources:
Eating seasonal produce
Create healthy menus tailored to your tastes
Understanding food labels
More information about nutrition
Dysphagia, or difficulty swallowing, may develop after a long period during which the swallowing muscles were not used, or as a result of neurological damage. Weakened muscles may not move food and drink safely into the oesophagus, allowing some to enter the airway. This is known as aspiration. It may cause coughing while eating or drinking and can lead to lung infections. Depending on the problem, aspiration may occur with solid food, liquids or both. Food and drink can be adapted during rehabilitation to reduce the risk until normal swallowing returns.
When swallowing is difficult, an adapted diet can make it easier to meet nutritional needs.
An adapted diet should provide enough fluid to prevent dehydration and, above all, enough energy and nutrients—particularly important after intensive care.
How can food be adapted?
Food can be prepared in advance by cutting it into small, soft pieces and serving it with a binding element, such as a sauce or purée, so that it is easy to eat and less likely to be aspirated.
It is very important to preserve flavour and the pleasure of eating while using suitable cooking techniques. The aim is to stimulate appetite and enjoyment while meeting the patient’s needs and safety requirements.
Making eating safer when swallowing is difficult
◊ Preparing the meal:
◊ Positioning:
◊ During the meal:
If you are tired or preparing food feels overwhelming:
Convenient products that can help adapt meals include:
Foods that may increase the risk of aspiration:
Foods that crumble or scatter: crispbread, dry biscuits, pastries and vermicelli
Foods containing small grains, seeds or stones: rice, couscous, wheat, mustard seeds and peppercorns; grapes, tomatoes, cherries and olives
Foods with skins or husks: peas, oranges and pulses
Fibrous foods: stewing meat, salsify, leeks, chard stalks and pineapple
Hard, round or crunchy foods: raw apple, radishes, nuts such as peanuts and almonds, gratinated or crisp-topped foods, and sweets
Please note: these foods are not necessarily forbidden. They need to be prepared in a way that is appropriate for the type and severity of dysphagia—often blended or finely minced.
Thickening powder is generally the most suitable way to thicken fluids. It can be used with any drink.
Please note: Nestlé’s Clinutren ThickenUp Clear is currently the only thickening powder reimbursed for community use in France.
To reduce risk when drinking, vary temperature, flavour and texture. Drinks may be easier to swallow when they are:
– Chilled
– Hot
– Flavoured
– Carbonated
– Thickened with a suitable powder when required.
– Avoid drinks at room temperature.
Choose soups that are completely smooth and thoroughly blended, with no pieces, pasta or croutons.
Additional resources:
IDDSI framework for food textures and drink thickness: Levels 0 to 7
This framework helps adapt the texture of food and drinks so that people can eat and drink safely while meeting their needs.
A dietitian or speech and language therapist can help you establish an appropriate diet. You can ask to see one during the hospital stay or arrange an appointment after discharge.
The International Dysphagia Diet Standardisation Initiative (IDDSI) develops resources with input from patients, carers, healthcare professionals, industry, professional associations and scientific societies in many countries.
IDDSI food and drink texture brochures
Hunger is regulated by several hormones, including ghrelin and leptin.
Ghrelin is produced when the stomach is empty or when the body needs energy because blood glucose has fallen.
Once the body judges that enough food has been eaten, leptin acts in the opposite way to ghrelin and helps bring eating to an end.
During a prolonged hospital and ICU stay, the body needs more energy while also losing muscle mass—see the page on physical effects.
Paradoxically, when we are ill and exhausted, we often have little appetite or desire to eat despite needing more energy.
To avoid a vicious cycle and help counter muscle loss, it is important to give your body the fuel it needs even when you do not feel hungry.
How can you stimulate appetite and increase your desire to eat?
Stimulating hunger begins with making food appealing:
Your nutritional needs after intensive care
Critical illness places the body under severe stress and can cause substantial muscle loss, particularly after a prolonged ICU stay.
During waking, early mobilisation and recovery after intensive care, calorie and protein requirements may therefore be higher to support recovery, particularly muscle recovery. Indicative requirements may be 30–35 kcal/kg/day and 1.3–2 g of protein/kg/day. For an adult weighing 60 kg, this could mean 30 × 60 = 1,800 kcal and up to 2 × 60 = 120 g of protein a day.
Protein plays a crucial role in rehabilitation after intensive care:
Animal protein generally provides the most complete source in terms of both quality and quantity. Sources include:
Animal protein can be replaced with plant protein. The main sources include:
Plant proteins may be absorbed less efficiently. However, combining different sources—one cereal food with one pulse—can provide a complementary and digestible protein intake comparable to animal protein.
For example:
Energy-dense foods:
These foods provide a large number of calories in a small volume, making it easier to meet increased energy needs. Examples include:
Personalised support is important, especially if you also have diabetes, cardiovascular risk or another condition. Some forms of enrichment marked ** may need to be limited, while others should be prioritised.
Ideas for enriching meals:
Ham and vegetable soup
Blend one slice of ham, one cooked egg yolk, two tablespoons of whole-milk powder, one to two tablespoons of cream, and two pinches of grated Gruyère or Gruyère cream into a bowl of vegetable soup.
Vegetable flan
Prepare a béchamel sauce. Add cauliflower, cooked spinach or carrot purée, one to two tablespoons of cream, two pinches of grated Gruyère, one to two tablespoons of whole-milk powder and one whole egg. Bake in a bain-marie.
Blended meat, ham or eggs
Prepare a béchamel sauce and add cooked minced meat—the equivalent of one beef patty—one slice of ham or two mashed hard-boiled eggs, two pinches of grated Gruyère and one to two tablespoons of cream. Blend until smooth.
Banana petit-suisse
Blend two petit-suisse soft cheeses with one banana, one to two tablespoons of whole-milk powder, one to two tablespoons of cream and some caster sugar.
Enriched milk pudding
Cook 50 g of rice, semolina, tapioca or cornflour in ½ litre of whole milk with five tablespoons of skimmed-milk powder, sugar and flavouring to taste. Blend if required.
Milkshake
Blend one bowl of milk with one to two tablespoons of whole-milk powder, one to two tablespoons of cream, two scoops of vanilla ice cream and a flavouring—coffee, chocolate, caramel, fruit syrup or cinnamon—or one very ripe fruit such as banana, strawberry or raspberry. Drink immediately.
Oral nutritional supplements
When prescribed by a doctor, these supplements can increase protein and energy intake and make it easier to meet nutritional needs. A wide range is available. Your dietitian can advise you on the most suitable type, format and flavour.
Please note: some supplements can be used in cooking and incorporated into recipes—for example, in place of milk in a cake. Recipe booklets may be available on the manufacturer’s website for the supplement you have been prescribed.
The consistency of supplements must be adapted to the appropriate IDDSI level and the speech and language therapist’s recommendations.