Correspondence

Hospital Food

N Engl J Med 1997; 336:1261-1262April 24, 1997

Article

To the Editor:

Heaven help us! Diets in university hospitals may be lacking in nutritional value, according to Singer et al. (Nov. 7 issue).1 Perhaps we should question whether a “healthy diet” given to a helpless patient during a 2- to 10-day hospital stay benefits anyone or anything other than the dietitian's sense of “doing good.” I am always bothered when a healthy 75-year-old recovering from a joint-replacement procedure is deprived of a desired morning egg because a “healthy” low-cholesterol diet has been ordered. Perhaps a case can be made for informing hospitalized patients about the possible benefits of changing dietary habits, but let us not delude ourselves into thinking that a few days of less saturated fat is of benefit to anyone.

Lonnie Hanauer, M.D.
116 Millburn Ave., Millburn, NJ 07041-1919

1 References

1. 1

   Singer AJ, Werther K, Nestle M. The nutritional value of university-hospital diets. N Engl J Med 1996;335:1466-1467
   Full Text | Web of Science | Medline

To the Editor:

Singer et al. have shown that menus vary among U.S. hospitals. But are hospital meals actually eaten? I examined the number of meals missed by patients in five clinical units at a Scottish university teaching hospital over a two-week period. Randomly selected patients were asked whether they had missed any meals during the previous 24-hour period and, if so, why. In the case of patients who were unable to respond, their assigned nurses answered the questions.

The percentage of meals missed ranged from 11 to 27 percent (Table 1Table 1Missed Meals during a Two-Week Period in a Scottish University Hospital.); breakfast was missed most frequently, and the evening meal least frequently. In the general medical unit, 25 percent of meals were missed, 7.6 percent because of clinical investigations and more than 92 percent because of illness or the quality or taste of the food or lack of variety in the meals available. In the surgical unit, more than one quarter of all meals were missed; postoperative fasting accounted for three quarters of these missed meals. Patients admitted for short stays for the purpose of clinical investigations seldom missed meals. After major surgery, patients can be maintained on infusions of glucose, salt, and water for more than a week.

Martin Eastwood, M.B., Ch.B.
Western General Hospital, Edinburgh EH4 2XU, United Kingdom

To the Editor:

The conclusions of Singer et al. were featured in our local newspaper with the headline “Warning: Hospital Food Bad for Health.”1 I think the authors' conclusions are not based on their evidence. They describe their results as “discouraging,” but over half the hospitals met or exceeded more than half the guidelines, and the statistical means and ranges indicated that the others were not far off. It would not take more than choosing eggs for breakfast and 2 percent milk with meals to exceed the recommended intake of cholesterol and fat. Often, the items on the default menu, such as 2 percent milk rather than nonfat milk or eggs rather than cereal, are offered because many patients in acute-care hospitals need extra protein and calories or because of studies of plate waste. In most hospitals, the default meal is sent to a patient only once and is followed by a visit from a dietetic technician or registered dietitian, who encourages patients to make choices that are individually appropriate in terms of therapy, rehabilitation, and disease prevention. The provocative conclusions of Singer et al. only lead the media and the public to conclude that we are a bunch of dunces who have no understanding of the relation between nutrition and disease prevention.

Carol Porter, Ph.D., R.D.
Medical Center at the University of California, San Francisco, San Francisco, CA 94143-0212

1 References

1. 1

   Warning: hospital food bad for health. San Francisco Examiner. November 9, 1996:A7.
   

Citing Articles (3)

Citing Articles

1. 1

   Angela VIVANTI, Merrilyn BANKS, Judith ALIAKBARI, Michelle SUTER, Mary HANNAN-JONES, Elizabeth MCBRIDE. (2008) Meal and food preferences of nutritionally at-risk inpatients admitted to two Australian tertiary teaching hospitals. Nutrition & Dietetics 65:1, 36-40
   CrossRef

2. 2

   Simon Allison. (2002) Institutional feeding of the elderly. Current Opinion in Clinical Nutrition and Metabolic Care 5:1, 31-34
   CrossRef

3. 3

   MARY ANGELAMILLER, M.ROSITA SCHILLER. (1998) To the Editors. Journal of the American Dietetic Association 98:12, 1401
   CrossRef