Correspondence

The Nutritional Value of University-Hospital Diets

N Engl J Med 1996; 335:1466-1467November 7, 1996

Article

To the Editor:

In 1989, the National Research Council1 published a comprehensive and authoritative examination of the role of diet in disease, which on the basis of the evidence, proposed dietary guidelines for promoting health and reducing the risk of chronic disease. The council recommended reducing the percentage of dietary fat to an average of 30 percent of calories or less, the amount of saturated fat to 10 percent of calories or less, and the level of cholesterol to 300 mg per day or less; eating five or more servings of fruits and vegetables daily and six or more servings of grains; limiting the total daily intake of salt to 6 g; and maintaining a calcium intake of at least 800 mg per day. Such recommendations were incorporated by the Public Health Service as national nutrition objectives for health promotion and disease prevention to be attained by the year 2000.2

We performed a computerized analysis (N-Squared Nutritionist IV, N-Squared Computing, Silverton, Oreg.) of the nutritional value of the house diets offered in 65 university teaching hospitals, which were members of the University Hospital Consortium, to determine their compliance with the above recommendations. Each institution was asked to provide three daily menus that they offered to patients who were not under any specific dietary restrictions and to indicate the menu items that would be served to patients who did not make their own selections. The dietary departments of 57 of 65 hospitals (88 percent) responded to the survey. Only four (7 percent) of the hospital menus met all seven recommendations. The content of fat, saturated fat, cholesterol, and sodium exceeded the recommended levels in 22 (39 percent), 27 (47 percent), 46 (81 percent), and 31 (54 percent) of the hospitals, respectively (Table 1Table 1Nutritional Analysis of the House Diets of 57 University Hospitals.). The menus provided for an adequate number of servings of fruits and vegetables and grains in 50 (88 percent) and 53 (93 percent) of the hospitals, respectively. The menus of 25 hospitals (44 percent) provided information concerning the nutritional value of dietary items to patients.

On the basis of this study, we conclude that many teaching hospitals do not design house diets to meet nationally recognized dietary recommendations and do not supply patients with enough information to help them make healthful dietary choices. These discouraging results are consistent with those of a recent report by Israeli investigators, who found that none of that country's university hospitals served diets that met the dietary goals of the American Heart Association.3

Hospitals should assume a greater role in promoting more healthful diets. We cannot think of a more appropriate place to encourage the nutritional health of Americans.

Adam J. Singer, M.D.
Kathleen Werther, M.A., R.D.
State University of New York at Stony Brook, Stony Brook, NY 11794

Marion Nestle, Ph.D., M.P.H.
New York University, New York, NY 10012

3 References

1. 1

   National Research Council, Committee on Diet and Health. Diet and health: implications for reducing chronic disease risk. Washington, D.C.: National Academy Press, 1989.
   

2. 2

   Department of Health and Human Services. Healthy People 2000: national health promotion and disease prevention objectives. Washington, D.C.: Public Health Service, 1991.
   

3. 3

   Singer A, Berner Y, Winkler E. Hospital diets: how nutritious are they? Arch Intern Med 1991;151:1240-1240
   CrossRef | Web of Science | Medline

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   J H Frisbie. (2007) Salt wasting, hypotension, polydipsia, and hyponatremia and the level of spinal cord injury. Spinal Cord 45:8, 563-568
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   MARY ANGELAMILLER, M.ROSITA SCHILLER. (1998) To the Editors. Journal of the American Dietetic Association 98:12, 1401
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3. 3

   ADAM J SINGER, KATHLEEN WERTHER, MARION NESTLE. (1998) Authors' Response:. Journal of the American Dietetic Association 98:12, 1402
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4. 4

   ROBIN B FELLERS. (1998) To the Editors. Journal of the American Dietetic Association 98:12, 1401-1402
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5. 5

   ADAM J SINGER, KATHLEEN WERTHER, MARION NESTLE. (1998) Improvements are Needed in Hospital Diets to Meet Dietary Guidelines for Health Promotion and Disease Prevention. Journal of the American Dietetic Association 98:6, 639-841
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6. 6

   (1997) Hospital Food. New England Journal of Medicine 336:17, 1261-1262
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