Table 1.

Summary of individual studies related to the impact of hospital food service intervention strategies on inpatient’s food intake.

Author (s), (Year), Country	Study Design; Sample Size; Age Group; Study Duration	Types of Intervention Strategies	Outcome Parameters	Results	Summary of Findings
Beelen et al. (2018) [15], Netherlands	RCT; 147 patients (RCT: 67; control: 80); patients ≥65 years old; 7 months	Meal composition modification	Protein intake	Protein intake: RCT = 105.7 ± 34.2 g vs. Control = 88.2 ± 24.4 g (p < 0.01). More patients in RCT than control group reached a protein intake of 1.2 G/KG/D (79% vs. 47.5%).	High protein intake in the intervention group.
Munk et al. (2017) [16], Denmark	RCT; 91 patients (HIG = 41, and IG = 50); >18 years old; 8 months	Multidisciplinary approaches	Energy and protein intake Estimation of energy and protein requirement	>75% of energy requirement: IG = 92% vs. HIG = 76% (p = 0.04). >75% of protein requirement: IG = 90% vs. HIG = 66% (p = <0.01)	High mean energy and protein intake and the high number of patients reached >75% of energy and protein requirement in IG.
Navarro et al. (2019) [17], Israel	Intervention study randomized patients; 131 patients (white napkin: 65, orange napkin: 66); >18 years old; NA	Meal presentation	Food intake Patient satisfaction	IG consumed 17.6% more hospital-provided food than CG. IG significantly greater satisfaction with the hospital’s food service than CG.	Increase food intake and patient satisfaction in the intervention group.
Porter et al. (2017) [18], Australia	A prospective, stepped wedge cluster randomized controlled trial; 149 patients; ≥65 years old; 4 weeks	Protected mealtime	Energy and protein intake Nutritional status	Energy intake: IG (6479 ± 2486 kJ/day) vs. CG (6532 ± 2328 kJ/day), p = 0.88. Protein intake: IC (68.6 ± 26.0 g/day) vs. CG (67.0 ± 25.2 g/day), p = 0.86. Energy deficit: (coefficient [robust 95% CI], p value) of −1405 (−2354 to −457), p = 0.004	No significant difference in energy and protein intake for both groups. Significant finding in energy deficit.
Rüfenacht et al. (2010) [19], Switzerland	RCT; 36 patients (NT group = 18 vs. ONS group = 18); >18 years old; 10–15 days	Multidisciplinary approaches	Food intake QOL	Energy and protein intakes increased in both groups (p = 0.001). Energy intake that meets ER: NT (107%) vs. ONS (90%) Protein intake meets PR: NT (94%) vs. ONS (88%). QOL increased in NT (p = 0.016).	Increased QOL, energy and protein intake in both groups.
Ingadottir et al. (2015) [20], Iceland	Intervention study; 161 patients (2011 = 69, and 2013 = 92); ≥18 years old; 5 months	Menu modification	Energy and protein intake	Energy intake: IG (1293 ± 386 kcal/d) vs. CG (1096 ± 340 kcal/d), p = 0.001. Protein intake: IG (54.0 ± 17.8 g/d) vs. CG (49.1 ± 16.1 g/d), p = 0.085	Increased energy intake in the intervention group.
Holst et al. (2015) [21], Denmark	An observational multi-model intervention study; 545 patients (baseline = 287 patients, post intervention = 258 patients); >18 years old; 12 months from the baseline	Multidisciplinary approaches	Energy and protein intake Staff KAP regarding clinical nutrition GNP initiatives	Energy intake improved from 52% to 68% (p < 0.007). Protein intake from 33% to 52% (p < 0.001) (>75% of requirements). Intake of less than 50% of requirements decreased with 50%. Screening improved from 56% to 77% (p < 0.001). Nutrition plans from 21% to 56% (p < 0.0001). Monitoring food intake from 29% to 58% (p < 0.0001).	Improvement in energy and protein intake. Improvement of screening and monitoring the food intake process.
Beermann et al. (2016) [22], Denmark	Intervention study; 60 patients (baseline:32; follow-up:30); >18-year-old; 6 weeks	Menu modification	Energy intake Protein intake	Energy intake at breakfast: CG (14%) vs. IG (22%), p < 0.001. Protein intake breakfast: CG (14 g) vs. IG (20 g), p < 0.002. Total protein intake: CG (64%) vs. IG (77%), p = 0.05. Total energy intake: CG (76%) vs. IG (99%), p < 0.01.	Energy and protein intake were improved.
van der Zanden et al. (2015) [23], Netherlands	Intervention study; 208 patients (control = 63 vs. intervention = 145); ≥18 years old; 14 days of 4 consecutive weeks	Foodservice system	Protein intake Caloric content Ordering of the target product	Meal ordering: CG (6.5%) vs. IG (45.2%). Protein content: larger in IG > CG (p < 0.025)	High significant protein intake and content in the intervention group.
Campbell et al. (2013) [24], Australia	Intervention study; 98 patients (group 1 traditional: 33; group 2 MedPass: 32; group 3 mid-meal trolley: 33); ≥60 years old; 24 months	Menu and meal composition modification	Food intake Energy intake Protein intake Clinical measurements QOL Cost assessment Patient satisfaction	Weight changes (mean ± SD): traditional = 0.4 ± 3.8%, MedPass = 1.5 ± 5.8%, mid-meal = 1.0 ± 3.1% (p = 0.53) Energy intake and protein intake (% of requirement): traditional (107 ± 26, 128 ± 35%), MedPass (109 ± 28, 126 ± 38%), mid-meal = (85 ± 25, 88 ± 26%) (p = 0.003 and p < 0.001, respectively) QoL ratings (scale 0–100): MedPass (mean change, 12.4 ± 20.9), mid-meal (21.1 ± 19.7), traditional (1.5 ± 18.1) (p = 0.05). Patient satisfaction: sensory qualities (taste, look, temperature, size) and perceived benefit (improved health and recovery) was rated highest for mid-meal trolley (all p < 0.05).	Significantly increased food intake and patient satisfaction improved QoL and cost-effectiveness in the intervention groups. Energy and protein intake was achieved in both groups.
Barrington et al. (2018) [25], Australia	An observational point prevalence study; Oncology patients (BMOS: 105; PMs: 96); >18 years old; 18 months	Foodservice system	Dietary intake Plate waste Meal ordering Patient meal experience survey	Meal ordering: Energy = BMOS (8683 kJ day−1) vs. PM (6773 kJ day−1), p = 0.004); Protein = BMOS (97 g day−1) vs. PM (82 g day−1), p = 0.023. Food intake: Energy = BMOS (6457 kJ day−1) vs. PM (4805 kJ day−1), p < 0.001; Protein = BMOS (73 g day−1) vs. PM (58 g day−1), p < 0.001. Plate waste: BMOS (34.3 ± 4.9) vs. PM (35.3 ± 4.5), p = 0.75 Patient meal experience survey = significant increase in BMOS receiving ordered food (p < 0.001), able to choose their preferred food (p = 0.006) and able to assess nutritional information of the menu (p = 0.002) compared to the PM.	A significant increase in food intakes and meal experience improved upon access to nutritional information in the intervention group.
Doorduijn et al. (2016) [26], Netherlands	An observational prospective study; 337 patients (traditional meal system = 168, At Your Request® = 169); ≥18 years old; 12 months	Foodservice system	Patient satisfaction Nutritional status Food choice and food intake	Patient satisfaction: increased after intervention from 7.5 to 8.1 (scale 1–10) and 124.5 to 135.9 point on a nutrition-related quality of life questionnaire (p < 0.05). Body weight: Traditional meal service (83.7 to 83.5 (0.2 ± 2.7) kg, p = 0.824), At Your Request® (77.6 kg to 77.4 (0.2 ± 2.6) kg, p = 0.851) Handgrip strength: Traditional meal service (Day 1: 30.2 kg, End: 30.5 kg) vs. At Your Request® (Day 1: 30.2 kg, End: 30.6 kg) MUST score: Improved in 18 patients in both groups. Protein intake (based on food records from patients on energy and protein enriched diet): Traditional meal service (n = 34, 0.91 g/kg) vs. At Your Request® (n = 38, 0.84 g/kg).	Significantly higher intake of energy and protein, and patient satisfaction in the intervention group. MUST score improved in both groups.
Hickson et al. (2011) [27], United Kingdom	Direct observational study; 99 patients (baseline = 39, PM = 60); NA; baseline: June/July 2008, PM: Oct/Nov 2009	Protected mealtime	Mealtime experience Nutrient intake	Mealtime experience: Monitor using food/fluid charts (before PM (32%) vs. after PM (43%), p = 0.14); wash hands offer (before PM (30%) vs. after PM (40%), p = 0.03); served meals at uncluttered tables (before PM (54%) vs. after PM (64%), p = 0.04; experiencing mealtime interruptions (before PM (32%) vs. after PM (25%), p = 0.14). Energy intake: 1088 kJ vs. 837 kJ, p = 0.25 Protein intake: 14.0 g vs. 7.5 g, p = 0.25	Improvement in mealtime experience. There was a decrease in protein intake observed after the implementation of PM.
Holst et al. (2017) [28], Denmark	Interventional study: 67 patients (baseline = 30, follow up = 37); >18 years old; 3 months	Multidisciplinary approaches	Demographic information Energy and protein intake Patient-perceived quality Staff-perceived quality	Food intake: Energy intake: the overall group (67.6% vs. 40%; p = 0.036) vs. the Heart–Lung Surgery group (85.7 vs. 38.5; p = 0.036); Protein intake: the overall group (37.8% vs. 33.3%, p = 0.7037). Patient and staff-perceived quality: IG reported satisfaction regarding individualized food serving, nurse communication, and improved meal environments.	The food and energy intake, patient satisfaction on individualize meal serving and nurse communication, and meal environment were improved in the intervention group.
Chan et al. (2017) [29], Hong Kong	Pre-post design; 100 older patients (male: 49; female: 51); >65 years old; 3 months	Menu modification	Food intake	Food intake: IG (68%) vs. CG (57%). Increased intake of food, energy, protein, and sodium in IG by 8% (p < 0.05), 10% (p < 0.01), 9% (p < 0.01), and 53% (p < 0.01), in all patients, and by 13% (p < 0.01), 19% (p < 0.01), 17% (p < 0.01), and 67% (p < 0.01).	Increased intake of food, energy, protein, and sodium intake in lunch with condiments.
McCray et al. (2018) [30], Australia	Pre-post study design; 187 patients (TM = 84 and RS = 103 patients respectively); >18 years old; 1 month for each cohort	Foodservice system	Nutritional intake Plate waste Patient satisfaction Patient meal cost	Energy intake: TM (5513 kJ day−1) vs. RS (6379 kJ day−1), p = 0.020 Protein intake: TM (53 g day−1) vs. RS (74 g day−1), p < 0.001 Plate waste: TM (30%) vs. RS (17%), p < 0.001 Patient satisfaction: TM (75%) vs. RS (98%), p < 0.04 Food cost: decreased by 28% per annum with RS.	Significant increases in energy and protein intake, improved patient satisfaction, reduced plate waste and food cost in the intervention group.
Palmer and Huxtable (2015) [10], Australia	Pre-post study; 798 patients (Pre-PMP = 348 vs. Post-PMP = 450); >18 years old; 24 months	Protected mealtime and mealtime assistant	Food intake Aspects of protected mealtimes	Food intake: mean intake energy (1419 ± 614 kJ) and protein (15 ± 7 g); intakes associated with gender, age, season, stopping or refusing a meal, time until discharge and eating at dinner (B = − 829–222 kJ, B = − 8.8 to 2.2 g protein, p = 0.000–0.032); Intake in intervention group (p = 0.094–0.157); association of aspects of protected mealtimes with intake such as the need for mealtime assistance, introduction of mealtime volunteers, time to eat and appropriate positioning during mealtimes (B = 177–296 kJ, B = 0.07–3.9 g protein, p = 0.000–0.014, R2 = 0.148–0.154). Protein intake in those requiring mealtime assistance was associated with mealtime volunteers and appropriate positioning (B = 4.1–4.4 g protein, p = 0.013–0.026, R2 = 0.197).	The intake was associated with aspects of protected mealtimes, mealtime volunteers and appropriate positioning.
Roberts et al. (2019) [31], Australia	Observational, pre-post study; 207 patients (pre = 116 vs. post = 91); ≥18 years old; 2 months	Multidisciplinary approaches	Demographic data Food intakes Mealtime environment	Energy intake: Pre (4818 ± 2179 kJ) vs. Post (5384 ± 1865), p = 0.119 Protein intake: Pre (48 ± 24 g) vs. post (57 ± 22 g), p = 0.042 Mealtime interruption: Pre (111/423 meals) vs. Post (150/400 meals), p < 0.001. No. patients to receive their meal tray: Pre (76%) vs. Post (84%), p < 0.05	The number of patients with sufficient food consumption was doubled, and mean energy and protein intakes were significantly higher.
Calleja-fernández et al. (2017) [32], Spain	A cross-sectional, two-centre study; 201 patients (TK), 41 patients (CK); >18 years old; 18 months	Foodservice system	Energy intake Protein intake	Food intake: TK (median: 76.83%, IQR 45.76%) vs. CK (median: 83.43%, IQR 40.49%), p < 0.001 Energy intake: CK (1741.6 (SD 584.0) kcal) vs. TK (1481.7 kcal (SD 584.0) kcal) vs. TK (1481.7 kcal (SD 576.0) kcal); p = 0.014, after the statistical adjustment (1608.1 (SD 134.9) vs. 1466.8 kcal (SD 80.5) kcal; p = 0.243) Protein intake: CK (90.5 (SD 4.4) g) vs. TK (70.4 (SD 2.0) g); p < 0.001). after statistical adjustment (CK = 80.0 (SD 6.4) g vs. TK = 67.6 (SD 3.8) g; p = 0.032)	Higher energy and protein intake in the intervention group before the statistical adjustment.
Sathiaraj et al. (2019) [33], India	Cross-sectional analytical study; 160 patients (traditional foodservice = 60 vs. patient-centered foodservice = 100); >18 years old; 4 months	Menu modification	Nutritional intake Patient satisfaction	Energy intake: Patient-centered model: mean (SD) 1633.33 (158.11) kcal; Traditional foodservice model: mean (SD) 1501.67(171.22) kcal; p <0.001 Protein intake: Patient-centered model: mean (SD) 59.89 (10.897) kcal; Traditional foodservice model: mean (SD) 48.42 (10.794) g; p <0.001 In-hospital weight change: Patient-centered foodservice: mean (SD) 0.18 (0.99) kg; Traditional foodservice: mean (SD) −0.58 (1.25); p <0.001 Patient satisfaction: Quality of food (28.6 vs. 35.2%), timeliness of delivery (36.2 vs. 37.1%), flavour of food (21.9 vs. 37.1%), special/restricted diet explained (41 vs. 41.9%), and overall satisfaction (36.2 vs. 42.9%); p = 0.000	The mean of energy and protein intake, weight, and overall patient satisfaction in the intervention group was significantly increased.
Young et al. (2018) [34], Australia	Cross-sectional study; 30 patients (pre-plated n = 16; bistro style n =14); ≥65 years old; 4 weeks	Foodservice system	Dietary intake Patient satisfaction Meal quality	Energy intake: Bistro (2524 ± 927 kJ) vs. Pre-plate (2692 ± 857 kJ), p = 0.612 Protein intake: Bistro (29 ± 12 g) vs. Pre-plate (27 ± 11 g), p = 0.699 Patient satisfaction: appearance (preplated: 50%, Bistro: 46%), quality (preplated: 57%, bistro: 54%), staff demeanor (preplated: 100%, bistro: 92%) Meal quality: sensory properties (preplated: 4.2 ± 0.4, Bistro: 4.4 ± 0.7) and temperature accuracy (preplated: 3.1 ± 0.9, Bistro: 3.6 ± 1.3).	There is no difference in energy and protein intakes, patient satisfaction, or meal quality in both groups.
Ofei et al. (2015) [35], Denmark	Prospective observational cohort study; 71 patients (256 meals; lunch n = 142; supper n = 114); ≥18 years old; five weekdays	Menu and meal composition modification	Food intake Plate waste	Positive relationship between meal portion size and plate waste (p = 0.002) and increased food waste in patients at nutritional risk during supper (p = 0.001).	Increased the proportion of energy and protein consumption in both groups. There was a relationship between meal portion size and plate waste and increased food waste in patients at risk during supper.
Dijxhoorn et al. (2019) [36], Netherlands	A prospective cohort study; 637 subjects (TMS: 326, FfC: 311); ≥18 years old; TMS: 12 months, FfC: 12 months	Meal presentation	Protein intake per mealtime	Protein intake (g) at all mealtimes (p < 0.05) except for dinner (median (IQR) at breakfast: 17 (6.5–25.7) vs. 10 (3.8–17); 10:00 a.m.: 3.3 (0.3−5.3) vs. 1 (0−2.2); lunch: 17.6 (8.4−25.8) vs. 13 (7−19.4); 2:30 p.m.: 5.4 (0.8–7.5) vs. 0 (0–1.8); 7:00 p.m.: 1 (0–3.5) vs. 0 (0–1.7); 9:00 p.m.: 0 (0–0.1) vs. 0 (0–0)). Protein intake highest for both food services during dinner (20.9 g (8.4–24.1) vs. 20.5 g (10.5–27.8))	Protein intake higher in the intervention group except for dinner.
Goeminne et al. (2012) [37], Belgium	Prospective cohort trial; 189 patients (control = 83, MOW = 106); ≥18 years old; 2 months	Foodservice system	Food intake Food waste Food access and appreciation	Food intake: 236 g more in patients in the MOW group compared to controls (95% confidence interval: 163–308 g) Food waste: significantly less waste in the MOW group (p < 0.0001) Food access and appreciation: patients appreciated Meals on Wheels more than the old system in terms of choice (p = 0.048; OR 6.8; 95% CI (0.8–58)), hunger (p = 0.0012), food quality (p < 0.0001) and organization.	Food intake significantly increased for each meal, with reduced food waste, and greater ONS use in the MOW group. Patient noted increases in terms of choice, hunger, food quality and organization in MOW group.
Young et al. (2018) [38], Australia	Prospective cohort study; 320 patients (cohort 1 n = 129; cohort 2 n = 139; cohort 3 n = 52); ≥65 years old; 5 months for each cohort	Protected mealtime and mealtime assistant	Energy and protein intake Nutrition care process	Energy intake: cohort 1: 5073 kJ/d; cohort 2: 5403 kJ/d; cohort 3: 5989 kJ/d, p = 0.04 Protein intake: cohort 1: 48 g/d, cohort 2: 50 g/d, cohort 3: 57 g/d, p = 0.02	Energy and protein intakes were significantly improved between cohorts.
Munk et al. (2012) [39], Denmark	Historically controlled intervention pilot study; 40 patients; ≥ 18 years old; 10 weeks	Menu modification	Food intake	Energy intake: time gradient in energy intake (p = 0.0005, r = 0.53) Protein intake: 17.5% of the patients in the IG reached minimum p requirements (p = 0.17)	No significant difference in energy and protein intake in both groups. A significant time gradient was recorded in the energy intake.
Markovski et al. (2017) [40], Australia	A prospective observational pilot study; 34 patients; >65 years old; 3 months	Protected mealtime	Food intake MST	Food intake: patients consumed 20% more energy and protein when dining in a communal environment (p = 0.006 and 0.01, respectively) Patients with a BMI >22 (p = 0.01 and 0.01, respectively) and those with significant cognitive impairment (p = 0.001 and 0.007, respectively) ate 30% more protein and energy in the dining room, and those identified as at risk of malnutrition (MST ≥ 2) ate 42% more energy and 27% more protein in the dining room.	Higher energy and protein intakes and mealtime preferences among patients in the dining room.
Collins et al. (2017) [35], Australia	Parallel controlled pilot study; 122 geriatric patients; >65 years old; 4 months	Menu modification	Weight changes HGS Energy intake Protein intake Patient satisfaction	Weight changes: IG vs. CG (−0.55 (3.43) vs. 0.26 (3.33) %, p = 0.338) HGS change: IG vs. CG (mean (SD): 1.7 (5.1) versus 1.4 (5.8) kg, p = 0.798) Energy intake: IG vs. CG (mean (SD) 132 (38) vs. 105 (34) kJ/kg/day, p = 0.003). Protein intake: IG vs. C (mean (SD) 1.4 (0.6) vs. 1.1 (0.4) g protein/kg/day, p = 0.035) Patient satisfaction: food quality (p = 0.743), meal service (p = 0.559) or staffing and service (p = 0.816) scores, physical environment significantly higher among IG (p = 0.013).	Significant higher mean intake of energy and protein in the intervention group.
Farrer at al. (2015) [41], Australia	Pilot study; 66 patients (control group = 38, treatment group = 27); ≥18 years old; 2 weeks	Menu modification	Food intake Plate waste Patient satisfaction	Food intake: increased oral intake in the IG (p = 0.03) Plate waste: CG (median: 286 g) vs. IG (median: 160 g), p = 0.09 Patient satisfaction: no significant in both groups (p = 0.31)	Significantly increased food intake in the proportion of intervention group, but there was no significant change in all groups.
Lindman et al. (2013) [42], Denmark	Quasi-experimental; 87 patients (before = 42, after = 45); >18 years old; 1 year	Mealtime assistant	Food intake Nutritional requirement	Energy requirement: before-group (76.2% (CI 95% 64.6–87.9) vs. after-group (93.3% (CI 95% 82.3–104.3), p = 0.03. Energy intake: before-group 21 (51%) vs. after-group (30 (67%)), p = 0.145 Protein intake: before-group (16 (39%)) vs. after-group (16 (36%)), p = 0.74.	Higher energy intake in the intervention group. The patients were informed about their nutritional needs after the intervention.
Maunder et al. (2015) [43], Australia	The quasi-experimental pre-test post-test cohort study; 119 patients (PM = 54 patients, BMOS = 65 patients); ≥18 years old; 1 months for each phase	Foodservice system	Dietary intake Patient satisfaction NA role	Energy intake: PM vs. BMOS (6273 kJ vs. 8273 kJ), p < 0.05 Protein intake: PM vs. BMOS (66 g vs. 83 g), p < 0.05 Patient satisfaction: PM (84%) vs. BMOS (82%), p > 0.05. NA role: mean NA time with patients increased significantly from 0.33 to 0.35 min/patient/day (p < 0.05)	Most of the patients preferred the BMOS and mean daily energy and protein intakes were significantly increased in the intervention group.
Mortensen et al. (2019) [44], Denmark	A quasi-experimental design with a non-equivalent control group; 92 patients (46 before and 46 after the intervention; >18 years old; 11 months	Menu and meal composition modification	Energy and protein intake	Energy intake: increased from 74% to 109% (p < 0.00) of requirements. Protein intake: increased from 49% to 88% (p < 0.00) of requirements.	Increased total energy and protein intake from the requirements, including between meals.
Navarro et al. (2016) [45], Israel	The prospective open labeled, non-randomized controlled study; 206 patients (control = 101, experimental = 105); >18 years old; 3 weeks	Meal presentation	Food intake Food waste Readmission rate	Food intake: 9% significantly higher in the experimental group vs. control group (0.77 ± 0.25 vs. 0.58 ± 0.31) Food waste: starch Participants from the experimental group left on their plate less starch (experimental (0.19 ± 0.30) vs. control (0.52 ± 0.41), p < 0.05; main course (experimental (0.18 ± 0.31) vs. control (0.46 ±0.41), p < 0.05; vegetable (experimental (0.37 ± 0.36) vs. control (0.29 ± 0.35), p > 0.05. Readmission rate: control (31.2%) vs. experimental (13.5%), p < 0.02	There was significantly higher food intake, less food waste, improved food taste and decreased readmission rate in the intervention group.
Manning et al. (2012) [46], Australia	Mixed methods design; 23 patients; >65 years old; 3 months	Mealtime assistant	Food intake Grip strength MNA	Food intake: Energy and protein intakes increased significantly (396 kJ and 4.3 g, respectively) when volunteers were present. MNA: 52% at risk (MNA score between 17 and 23.5) and 35% malnourished (MNA score <17).	Energy and protein intake increased significantly during lunchtimes when volunteers were present.
Keller et al. (2012) [47], Canada	Prospective interrupted time-series study; 67 patients; ≥60 years old; 9 months	Menu and meal composition modification	Nutritional status Food intake Co-morbidity Oral supplements	Nutritional status: 74% patients achieved their goal weight at the end of the intervention period. Food intake: nonsignificant decrease in total grams of main-plate food consumed during the six-month intervention period when compared with the control period (p = 0.11).	Most of the patients in the intervention group achieved their weight goals. No significant difference in main-plate food intake. Higher fat intake in the intervention group.
Laur et al. (2019) [48], Canada	Case study approach; 4000 patients (Site A: 1127, Site B: 860, Site D: 988, Site E: 968); ≥18 years old; 18 months	Multidisciplinary approaches	Food intake Body weight	Food intake monitoring: Site A (Increased from 0% to 97%). Site E (increased from 0% to 61%). Site B (improved from 3% to 95%). Body weight monitoring: Site A (improved from 14% to 63%), Site D (improved from 11% to 49%).	Food intake and body weight improved through interdisciplinary team approaches and documentation.