Individualised nutritional treatment increases the positive effects of a novel á la carte hospital food service concept: Results of a quasi-experimental study.

BACKGROUND & AIMS: One-third of hospitalised patients are at nutritional risk, and limited choice regarding meals and meal times, and inadequate nutritional support may contribute to inadequate nutritional intake during hospitalisation. The aim was to test the effect of a novel á la carte hospital food service concept as a stand-alone intervention and combined with individualised nutritional treatment. METHODS: Medical inpatients at nutritional risk were recruited for this three-arm quasi-experimental study. The control group received meals from the traditional bulk trolley food service system. Intervention group 1 (IG1) received meals from a novel á la carte food service concept with an electronic ordering system, whereas intervention group 2 (IG2) in addition to this received individualised nutritional treatment by a clinical dietitian. Nutritional intake and length of stay was measured, and patient satisfaction was assessed with purpose-designed questionnaires. RESULTS: 206 patients were included: 67 in the control group, 68 in IG1, and 71 in IG2. The proportion of participants reaching ≥75 % of both their energy and protein requirement was higher in IG1 compared to the control group (34 % vs. 12 %, p = 0.002) and higher in IG2 compared to IG1 (53 % vs. 34 %, p = 0.035). Length of stay was shorter in IG2 compared to the control group (6.0 vs. 8.7 days, p = 0.005). It was important to participants to be able to choose when and what to eat, and this preference was met to a larger extent in the intervention groups. CONCLUSION: The novel á la carte concept increases energy and protein intake in hospitalised patients, and the positive effects are increased, when the concept is used in combination with individualised nutritional treatment.

Nutritional Interpretation of Hospital Diets for Elderly Patients With Chronic Diseases and Analysis of Factors Influencing Actual Intakes.

Background: The provision of hospital meals is considered a therapeutic intervention, and a therapeutic diet consisting of a post-discharge meal sample is provided. For elderly patients who require long-term care, it is important to determine the significance of nutrition by taking into account hospital meals, including therapeutic meals for conditions such as diabetes. Therefore, it is important to identify the factors that influence this judgment. This study aimed to investigate the difference between the expected nutritional intake via nutritional interpretation and actual nutritional intake. Methods: The study included 51 geriatric patients (77.7 ± 9.5 years; 36 males and 15 females) who could eat meals independently. The participants completed a dietary survey to determine the perceived nutritional intake obtained from hospital meal contents. Additionally, we investigated the amount of hospital meal leftovers from the medical records and the amount of nutrients from the menus to calculate the actual nutritional intake. We calculated the amount of calories, protein concentration, and non-protein/nitrogen ratio from the perceived and actual nutritional intake values. We then calculated the cosine similarity and conducted a qualitative analysis of factorial units to examine similarities between perceived and actual intake. Results: Among factors that constituted the large cosine similarity group (gender, age, etc.), gender was found as a particularly significant factor, with a high number of female patients (P = 0.014). Conclusions: Gender was found to influence the appropriate interpretation of the significance of hospital meals. The perception of such meals as samples for post-discharge dietary practice was more significant among female patients. This demonstrated that in elderly patients, it is important to consider gender differences when providing diet and convalescence guidance.

A Logical Framework (MYGERYFS) for Hospital Foodservice to Prevent Malnutrition Among Geriatric Patients in Hospitals, Malaysia: Protocol for a Feasibility Study.

BACKGROUND: Geriatric malnutrition in hospitals is common and can be affected by many things, including poor satisfaction toward hospital foodservice. Hospital foodservice plays an important role in a patient's recovery process by providing adequate nutrients. On top of that, patients' foodservice satisfaction can easily be afflicted by the quality of food served and the overall foodservice experience. Furthermore, malnutrition can occur from poor foodservice quality, especially among geriatric patients. OBJECTIVE: This study aims to assess the effectiveness of the Malaysian Geriatric Patients' Hospital Foodservice Protocol (MYGERYFS). METHODS: The protocol comprises 3 phases. Phase One is a cross-sectional study that took place at public hospitals with geriatric wards in the Klang Valley. Univariate data from Phase One were analyzed descriptively. Pearson correlation and chi-square were conducted to find factors associated with foodservice satisfaction. Phase Two involves the collaboration of health care professionals in the geriatric field. In Phase Three, a feasibility study will be conducted to determine the feasibility of the MYGERYFS protocol in a hospital among 60 geriatric patients. These patients will be randomized into control and intervention groups, respectively. Intervention care will be done to ensure the safety of the protocol. RESULTS: Data collection for Phase One of the study has been completed. A total of 233 geriatric respondents with the mean age of 71.39 (SD 7.99) years were gathered. Approximately 51.5% (n=120) of the respondents were female, while 48.5% (n=113) were male, with a mean BMI of 24.84 (SD 6.05) kg/m2. Their mean energy and protein intakes were 1006.20 kcal (SD 462.03 kcal) and 42.60 (SD 22.20) grams, respectively. Based on the Mini Nutritional Assessment, older patients who scored 12-14 (normal) were 27.9% (n=65), those who scored 8-11 (at risk) were 54.9% (n=128), and those who scored 0-7, which is the lowest (malnutrition), were 17.2% (n=40) of the study population. Hence, most patients were at risk of malnutrition. Although a majority of the patients claimed to have good foodservice satisfaction 26.2% (n=61), they also experienced at least 3 barriers during mealtimes. It was found that dietary intake and mealtime barriers were significantly associated with the respondent's foodservice satisfaction. Data for Phase Two and Phase Three are yet to be collected and analyzed. CONCLUSIONS: This study protocol could potentially benefit the hospital foodservice system and aid in improving geriatric nutritional status. TRIAL REGISTRATION: ClinicalTrials.gov NCT04858165; https://clinicaltrials.gov/ct2/show/NCT04858165. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/42496.

Purine content of hospital meals and its effect on serum uric acid, urine pH, and urinary uric acid excretion.

Hospital meals are prepared with the nutrients required by the patient's medical condition in consideration. However, no research on the purine content of hospital meals has been conducted, and it is not shown on the purine content. The recommended purine consumption for patients with gout and hyperuricemia is 400 mg/day based on the Japanese guidelines for the management of hyperuricemia and gout. In this study, the purine content in hospital meals was evaluated using the purine content of foods previously determined by our laboratory as a reference. The serum uric acid levels and uric acid excretion in admitted patients who consumed these diets were examined.

Putting quality food on the tray: Factors associated with patients' perceptions of the hospital food experience.

INTRODUCTION: Perceptions of hospital meal quality can influence patient food intake. Understanding what patients prioritise and what they think of current meals can support menu development. The present study assessed patients' food and food-related priorities for hospital meals and their sensory experience using the Hospital Food Experience Questionnaire (HFEQ). Factors independently associated with the HFEQ were determined. METHODS: Cross-sectional study (n = 1087 patients; 16 Ontario hospitals). Patients completed the HFEQ at a single meal. Descriptive statistics determined the importance of food traits and ratings of a served meal using 22 HFEQ questions (five-point Likert scales, total score 110). Bivariate and multivariable linear regression tested the association between patient and hospital characteristics and HFEQ score. RESULTS: Most food traits were rated as 'important' (4) or 'very important' (5) by two-thirds or more of patients. Patients typically rated served meal items as 'good' (4). Mean HFEQ score was 90.60 (SD 10.83) and was associated with patient and hospital traits in multivariable analyses (F42,556  = 2.34, p < 0.001). Older and woman-identifying patients were more likely to have a higher score. Foodservice models were associated with HFEQ. Cold-plated rethermed food resulted in the lowest HFEQ. Local food use > 10% was associated with lower HFEQ score, whereas larger hospitals had a higher score. CONCLUSIONS: Patients prioritised taste, freshness and food that met their dietary needs. Meal sensory ratings were average. A gap exists between what patients want in hospital meals and what they receive. Attention to patient demographics and food delivery that retains sensory properties and supports choice may increase HFEQ score.

The Science of Salt: A global review on changes in sodium levels in foods.

This review aims to summarize and synthesize studies reporting on changes in sodium levels in packaged food products, restaurant foods, and hospital or school meals, as a result of salt reduction interventions. Studies were extracted from those published in the Science of Salt Weekly between June 2013 and February 2018. Twenty-four studies were identified: 17 assessed the changes in packaged foods, four in restaurant foods, two in hospital or school meals, and one in both packaged and restaurant foods. Three types of interventions were evaluated as part of the studies: voluntary reductions (including targets), labeling, and interventions in institutional settings. Decreases in sodium were observed in all studies (n = 8) that included the same packaged foods matched at two time points, and in the studies carried out in hospitals and schools. However, there was little to no change in mean sodium levels in restaurant foods. The pooled analysis of change in sodium levels in packaged foods showed a decrease in sodium in unmatched food products (-36 mg/100 g, 95% CI -51 to -20 mg/100 g) and in five food categories-breakfast cereals, breads, processed meats, crisps and snacks, and soups. Twenty-two of the 24 studies were from high-income countries, limiting the applicability of the findings to lower resource settings.

Protein and energy intake improved by in-between meals: An intervention study in hospitalized patients.

BACKGROUND/AIM: Disease related malnutrition is a major problem in hospitals. Malnutrition in hospitalized patients is caused by many factors. Among these factors are decreased appetite and early satiety, and reaching nutritional requirements in nutritional risk patients is a challenge when using ordinary energy and protein dense food. The aim of this study was to examine if total protein and energy intake in medical and surgical patients at nutritional risk could be improved by protein fortified and energy rich in-between meals. METHODS: An assortment of fortified in-between meals including 10 g of protein was developed based on patient preferences and served in the Departments of Lung Medicine and Abdominal Surgery for a period of three months. Nutrition intake was recorded before and after intervention. RESULTS: Food intake records were collected from a total of 92 patients, (46 before and 46 after intervention). The total amount of protein intake per in-between meal was increased from 2,6 g to 10,3 g. Total daily protein intake increased from 49% to 88% (p < 0.00) and total energy intake from 74% to 109% (p < 0.00) of requirements. CONCLUSION: Protein and energy intake for surgical and medical patients at in-between meals as well as total daily intake increased significantly. Recommended average level for individually measured requirements was reached.

Protein Intake Falls below 0.6 g•kg-1•d-1 in Healthy, Older Patients Admitted for Elective Hip or Knee Arthroplasty.

OBJECTIVE: Hospitalization is generally accompanied by changes in food intake. Patients typically receive hospital meals upon personal preference within the framework of the food administration services of the hospital. In the present study, we assessed food provision and actual food and snack consumption in older patients admitted for elective hip or knee arthroplasty. DESIGN: A prospective observational study. SETTING: Orthopedic nursing ward of the Maastricht University Medical Centre+. PARTICIPANTS: In the present study, n=101 patients (age: 67±10 y; hospital stay: 6.1±1.8 d) were monitored during hospitalization following elective hip or knee arthroplasty. MEASUREMENTS: Energy and protein provided by self-selected hospital meals and snacks, and actual energy and protein (amount, distribution, and source) consumed by patients was weighed and recorded throughout 1-6 days. RESULTS: Self-selected meals provided 6.5±1.5 MJ•d-1, with 16, 48, and 34 En% provided as protein, carbohydrate, and fat, respectively. Self-selected hospital meals provided 0.75±0.16 and 0.79±0.21 g•kg-1•d-1 protein in males and females, respectively. Actual protein consumption averaged merely 0.59±0.18 and 0.50±0.21 g•kg-1•d-1, respectively. Protein consumption at breakfast, lunch, and dinner averaged 16±8, 18±9, and 20±6 g per meal, respectively. CONCLUSIONS: Though self-selected hospital meals provide patients with ~0.8 g•kg-1•d-1 protein during short-term hospitalization, actual protein consumption falls well below 0.6 g•kg-1•d-1 with a large proportion (~32%) of the provided food being discarded. Alternative strategies are required to ensure maintenance of habitual protein intake in older patients admitted for elective orthopedic surgery.

Ward culture and staff relationships at hospital mealtimes in Australia: An ethnographic account.

Nutrition care is a fundamental component of quality health care provided to patients in hospital, yet little is known about the staff who deliver this care and their interrelationships, and how this impacts nutrition care. In this ethnographic study on two subacute wards, 67 h of fieldwork was conducted over 3 months to explore the relationships, roles, and responsibilities of those involved at mealtimes, and the influence on meal provision. Data were analyzed inductively and thematically. Three themes describing ward culture and staff relationships emerged: (i) defining mealtime roles and maintaining boundaries; (ii) balancing the need for teamwork and having time and space; and (iii) effective communication supports role completion and problem solving. Lack of appreciation of workflow enablers and barriers degraded working relationships between staff with and without central roles at mealtimes. The present study informs health-care organizations on building a culture that supports interprofessional collaboration in nutrition care in the subacute setting. All staff need to be aware of their and others' mealtime roles and responsibilities to support a coordinated approach.

Nutritional Quality of Lunches Served in South East England Hospital Staff Canteens.

Worksite canteens generally are characterized by obesogenic environments, which offer access to energy-dense foods and sugar-sweetened beverages rather than nutrient-rich food. This study assessed the nutritional quality of hot lunches offered in National Health Service (NHS) hospital staff canteens: 35 side dishes and 112 meals were purchased from 8 NHS hospital staff canteens. The meals were analyzed for portion size, energy, protein, total fat, saturated fatty acids (SFAs), salt, and the sodium to potassium ratio. The vegetarian and meat-based lunch meals served in the hospital staff canteens tended to be high in energy, total fat, saturated fatty acids, and salt: 40%, 59% and 67% of meat meals and 34%, 43%, and 80% of vegetarian meals were assigned the red traffic light label for total fat, salt, and SFAs per portion, respectively. Similar types of meals, but served in different hospitals, varied considerably in their nutritional quality. The consumption of some lunch meals could provide more than 50% of recommended total fat, SFAs, and salt for both men and women and daily energy for women. The majority of analyzed lunch meals were characterized by an unfavorable nutrient profile, and regular consumption of such meals may increase the risk of noncommunicable diseases.

Antimicrobial Susceptibility and Enterotoxin-Encoding Genes in Staphylococcus spp. Recovered from Kitchen Equipment from a University Hospital in Rio de Janeiro, Brazil.

This study was conducted to determine the occurrence of antimicrobial resistance and enterotoxin-encoding genes (EEGs) in Staphylococcus spp. recovered from equipment used to prepare hospital meals, in a university hospital in Rio de Janeiro, Brazil. Sixty samples were collected from semi-industrial equipment (one blender and one mixer) in the hospital's kitchen. Resistance genes and SCCmec types were detected by PCR. From the 40 isolates of Staphylococcus spp. identified, 8 were Staphylococcus aureus. Thirty-two (80%) Staphylococcus spp. isolates were resistant to at least one antimicrobial agent. Resistance genetic determinants were detected: erm gene (Staphylococcus epidermidis [n = 2]; Staphylococcus hominis [n = 1]), mecA gene (S. epidermidis [n = 2]), and aa(6')-aph(2'') gene (Staphylococcus caprae [n = 1], S. epidermidis [n = 2], S. hominis [n = 1], Staphylococcus pausteri [n = 1], Staphylococcus simulans [n = 1], and Staphylococcus warneri [n = 1]). The presence of at least one EEG in 83% (n = 33) of the isolates was identified. Two strains of S. epidermidis were methicillin-resistant S. epidermidis (MRSE) and harboring SCCmec type IV. Staphylococcus spp. contaminated some hospital kitchen's equipment, indicating that hygiene procedures should be improved. Results also indicate that meals can be a vehicle to disseminate multiresistant Staphylococcus spp., including MRSE, and Staphylococcus with EEGs.

An investigation into between-meal food desires among hospitalised haematological cancer patients.

BACKGROUND & AIMS: Hospitalised haematological cancer patients often suffer from reduced appetite and food intake, which negatively influences the patients' well-being and nutritional status. The aim of this study was to identify specific between-meal food desires in a patient group, in order to increase food intake. The study was conducted using a picture-aided questionnaire, and relating the preferences to factors that could easily be implemented in the hospital menu, such as time of the day and texture. Moreover, the results of the questionnaire were verified by acceptance tests on six selected food items. METHODS: A structured 42 items food questionnaire was developed and used to quantify appetitive food desires in patients during morning (11 am) and afternoon (3 pm) sessions. Food items were scored according to patients' preferences and immediate desire to eat. A total of 112 hospitalised haematological cancer patients, screened for nutrition-related symptoms, participated. Univariate statistical models were used to investigate the influence of time-of-day and food texture on between-meal desires. RESULTS: Fresh fruit, ice cream, cheese and mashed potatoes with bacon were the most desired food items. Patients showed significant higher desire to eat in the morning as opposed to the afternoon. Moreover, texture had an influence on food desire, where liquid food was more desired than food with soft or coarse texture. CONCLUSION: Ranking of food desires among hospitalised cancer patients showed inclination for fresh fruit, ice cream, mashed potatoes with bacon, and cheese. Time of the day (morning) and texture (liquid) had the greatest and most positive impact on food desires. The findings may be easily implemented in hospital food service routines for cancer patients, and might positively contribute to patients' well-being and nutrition.