Supplementary file 1_The mushrooms on the menu (MOM) study: vitamin D mushrooms (UV-exposed) are a feasible and acceptable way to increase vitamin D intake in a residential aged care facility.docx

BackgroundVitamin D deficiency is highly prevalent in aged care due to reduced endogenous synthesis of vitamin D and less time outdoors, and is associated with poorer health outcomes. Supplementation implementation is variable and dosages are often suboptimal. Due to limited food sources, diet is frequently overlooked, yet mushrooms can raise vitamin D levels in deficient individuals similar to a supplement.
ObjectivesMushrooms on the Menu (MOM) was a 10-week prospective pre-post mixed method study that evaluated the feasibility of adding vitamin D mushrooms to the menu of a residential aged care facility.
MethodsDuring the 4-week baseline phase, residential care (RC) participants ordered meals from the standard food service menu, while independent living (IL) followed their usual diet. During the 4-week MOM phase, participants were instructed to consume at least one mushroom meal containing 75 g of UV-exposed mushrooms daily. In RC, 26 recipes were modified and two recipes newly created to include mushrooms. RC participants chose a minimum of one mushroom meal from the lunch or dinner menu, and IL residents were instructed to prepare at least one mushroom meal daily. Dietary intakes were estimated by plate wastage (RC) or 24-h recalls (IL), while qualitative data were collected during and post the MOM.
ResultsIn RC (n = 60), vitamin D provision via mushrooms from the MOM menu increased by 180% compared to the standard menu (7.0 vs. 2.5 μg, p < 0.0001), with no significant differences in total energy and other nutrients. During MOM, vitamin D intake increased by 212% for RC (6.0 vs. 18.7 μg; p < 0.0001) and 740% for IL participants (n = 12; 8.7 vs. 73.1 μg; p < 0.0001) compared to baseline, representing 125 and 1,387% of the adequate intake (AI) for over 70-year-old’s, respectively. Over 75% of participants rated the taste of vitamin D mushroom meals as good or excellent, while qualitative data reported participants enjoyed mushrooms as both hero and complimentary ingredients. Over 75% of staff understood the health benefits of vitamin D mushrooms and found the meals easy to prepare, but preferred low-burden ordering and preparation processes. Both participants and staff supported the continued inclusion of MOM.
ConclusionMOM is a well-accepted food-first approach that provides substantial vitamin D to aged care residents.