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To examine whether the nutritional status of aged undernourished residents in care could be improved through dietary modification to increase energy intake but not portion size.

A 12‐week cluster randomised controlled trial was carried out in 21 residential care homes. Participants comprised undernourished residents with a body mass index (BMI) <18.5 kg m^–2. All menus were analysed to evaluate nutrient provision. Energy and macronutrient intakes of undernourished residents were estimated using 3‐day weighed food intake diaries. Those resident in homes randomised to intervention had their usual meals enriched with energy‐dense foods to a maximum of +1673 kJ day⁻¹.

Of 445 residents screened, 41 (9%) had a BMI <18.5 kg m^–2 and entered the study. Despite adequate food provision, energy and macronutrient intakes were below UK dietary reference values. Mean …