Hospital Services to Improve Nutritional Intake and Reduce Food Waste: A Systematic Review

Abstract

Background and Aims: Patients’ nutritional intake is a crucial issue in modern hospitals, where the high prevalence of disease-related malnutrition may worsen clinical outcomes. On the other hand, food waste raises concerns in terms of sustainability and environmental burden. We conducted a systematic review to ascertain which hospital services could overcome both issues. Methods: A systematic literature search following PRISMA guidelines was conducted across MEDLINE, Web of Science, and Scopus for randomised controlled trials (RCTs) and observational studies comparing the effect of hospital strategies on energy intake, protein intake, and plate/food waste. The quality of included studies was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Risk of Bias tool from the Cochrane Handbook for Systematic Reviews of Interventions for RCTs. Results: Nineteen studies were included, assessing as many hospital strategies such as food service systems—including catering and room service—(n = 9), protected mealtimes and volunteer feeding assistance (n = 4), food presentation strategies (n = 3), nutritional counseling and education (n = 2), plant-based proteins meal (n = 1). Given the heterogeneity of the included studies, the results were narratively analysed. Conclusions: Although the results should be confirmed by prospective and large sample-size studies, the personalisation of the meal and efficient room service may improve nutritional intake while decreasing food waste. Clinical nutritionist staff—especially dietitians—may increase food intake reducing food waste through active monitoring of the patients’ nutritional needs.

Hospital Food Waste: Contributing Factors of Waste Generation and Strategy for Waste Minimization

“…The crosssectional study conducted in Canada found that the room service implementation resulted in a notable rise in customer satisfaction, decreased food costs during breakfast and lunch, and reduced waste across all meals. Notably, there was a rise in the consumption of energy, protein, carbohydrates, and fats during the lunch period (Rinninella et al, 2023). Additionally, Dynesen et al (2021) found that participants consumed more of the food provided than the trolley model, particularly during the afternoon meal.…”

“…However, in general, it has been observed that the technique tends to either underestimate or overestimate the proportion of leftover food on a plate compared to the weighing method (Antasouras et al, 2023;Heighington-Wansbrough & Gemming, 2022;Ofei et al, 2019). This measurement frequently relies on subjective monitoring of patient food intake, such as estimating food intake through plate diagrams and employing diverse job roles as evaluators (Heighington-Wansbrough & Gemming, 2022;Papathanail et al, 2021;Rinninella et al, 2023). It is also affected by missing data, such as conflicting obligations of nursing personnel that result in hurried recordkeeping, unintentional mistakes, and administrative oversights, such as skipped meals and evaluators' failure to grasp the significance of monitoring (Heighington-Wansbrough & Gemming, 2022;Rinninella et al, 2023).…”

“…Another measure that appears to be effective in reducing plate waste is enhancing patients' autonomy in selecting their meals by providing selective menus. Implementing a program to enhance patients' meal options by providing tailored menus appears to hold significant potential, particularly in mitigating food wastage (Antasouras et al, 2023;Paiva et al, 2022;Rinninella et al, 2023). The food selection allows patients to exert a certain degree of influence over their healthcare experience, albeit limited, such as having the option to choose their dessert.…”

“…The electronic system may pose difficulty in terms of management for elderly patients, but it is comparable to a conventional paper menu in terms of facilitating food selection (Rinninella et al, 2023). Collins and Porter (2023) contested that using paper menus in all three hospitals delays the process, as manual activities such as printing, disseminating, and retrieving menus and manually verifying and summing up orders necessitate scheduling.…”

“…Furthermore, this system enables patients to place their orders more conveniently at their designated mealtimes, enhancing their ability to choose a meal that aligns with their preferences (Dynesen et al, 2021;Lewandowski et al, 2023;MacKenzie-Shalders et al, 2020). Adopting digital technology is crucial for healthcare facilities because it can eliminate laborious manual tasks (Collins & Porter, 2023;Rinninella et al, 2023;Yona et al, 2020).…”