Are energy and protein requirements met in hospital?

Abstract

Background Malnutrition is a problem within hospitals, which impacts upon clinical outcomes. The present audit assesses whether a hospital menu meets the energy and protein standards recommended by the British Dietetic Association's (BDA) Nutrition and Hydration Digest and determines the contribution of oral nutrition supplements (ONS) and additional snacks. Methods Patients in a UK South West hospital were categorised as ‘nutritionally well’ or ‘nutritionally vulnerable’ in accordance with their Malnutrition Universal Screening Tool score. Energy and protein content of food selected from the menu (‘menu choice’), menu food consumed (‘hospital intake’) and total food consumed including snacks (‘overall intake’) were calculated and compared with the standards. Results In total, 93 patients were included. For ‘nutritionally well’ patients (n = 81), energy and protein standards were met by 11.1% and 33.3% (‘menu choice’); 7.4% and 22.2% (‘hospital intake’); and 14.8% and 28.4% (‘overall intake’). For ‘nutritionally vulnerable’ patients (n = 12), energy and protein standards were met by 0% and 8.3% (‘menu choice’); 0% and 8.3% (‘hospital intake’); and 8.3% and 16.7% (‘overall intake’). Ten percent of patients consumed ONS. Patients who consumed hospital snacks (34%) were more likely to meet the nutrient standards (P ≤ 0.001). Conclusions The present audit demonstrated that most patients are not meeting the nutrient standards recommended by the BDA Nutrition and Hydration Digest. Recommendations include the provision of energy/protein‐dense snacks, as well as menu, offering ONS where clinically indicated, in addition to training for staff. A food services dietitian is ideally placed to lead this, forming a vital link between patients, caterers and clinical teams.

Accurate determination of energy requirements in hospitalised patients with parenteral nutrition

“…Much remains to be learned about the correct interpretation or use of new REE equations in the noncritical hospitalised patient. This is consistent with the results obtained in the other study showing that the recommended energy of most patients failed to meet recommended nutrient standards (23) . It is likely that this problem is not unique to this hospital.…”

Room service in a public hospital improves nutritional intake and increases patient satisfaction while decreasing food waste and cost

“…This finding is important as hospitals continue to investigate strategies to assist patients to maximise their intake, with poor food intake being recognised as a risk factor for negative and costly clinical and hospital outcomes . These strategies usually focus on individual points in the foodservice process such as menu quality and supplementation , menu choice , meal environment , and ordering and delivery processes . RS delivers on all of these strategies, providing a wide range of high nutritional quality menu items at flexible times throughout the day via an engaging patient‐centric ordering process.…”

“…Having the ability to order food at times that suit their appetite and clinical schedule may improve both intake and satisfaction with the meal service . The provision of regular hospital snacks also comprises a strategy used for patients who prefer to eat little and often and a lack of hospital snack provision has been identified as an inhibitory factor of optimal nutrition . The order on‐demand nature of RS allows for this, with no limit on number of times that patients can order throughout the day.…”

Improving the nutritional intake of hospital patients: how far have we come? A re‐audit

“…Comparing nutritional intake against individual requirements in addition to the Digest standards increases the strength of the present audit by providing a more thorough assessment of nutritional adequacy in hospitals . Building on previous evidence , the Digest energy standard for nutritionally well patients appears to be appropriate for this population, given that there was no significant difference between the standard and individual requirements.…”

“…Percentage of participants meeting the Digest standards for energy and protein: a comparison with the baseline audit .…”