One in four people is at risk of malnutrition at the beginning of a hospital admission. Nutrition in hospitals influences the general evolution of health during the length of stay.
Menus cannot be customized, but greater patient involvement is advisable. The variety of foods and the size of the portions must be individualized, adapted or enriched. In different cases, a deficient consumption of meat is observed in the recommended amounts.
They are the owners of the EFEsalud interview with SEMERGEN doctors José Manuel Fernández and Félix Suárez on nutrition and feeding of patients in hospitals.
How do you rate the food and menus that are dispensed in Spanish hospitals?
According to the latest publications reviewed on the nutritional status of patients admitted to hospitals in Spain, it can be concluded that one in four people is at risk of malnutrition at the beginning of admission. In other words, the precarious nutritional situation with which they enter should be a primary aspect to take into account during their stay.
This prevalence is higher in people with chronic diseases, who are more likely to have complications during the hospital stay, and that it lasts longer.
Malnutrition implies a worse evolution of the wounds, a greater number of diseases or complications related to the reason for admission, longer stays and greater health costs.
But the data is not unique to Spain, European statistics are similar. Although we must bear in mind that there is a lot of variability in the approach to malnutrition in each hospital, an aspect in which it depends on the number of personnel and its location, an assessment of malnutrition is not always carried out on admission.
Several studies have investigated the benefits and cost-effectiveness of the early therapeutic approach to this assessment in malnourished patients, showing that they significantly reduce associated morbidity and mortality, as well as length of hospital stay.
Are the menus nutritious, balanced, healthy, tasty?
The menus are supervised by specialists in Nutrition, and we understand that in addition to being nutritious, they are balanced and take into account the most up-to-date eating guides.
The only issue is that in most generalized diets are established: a normal menu, a low-salt or no-salt menu, a menu for diabetics, a menu for people with protein restriction, or for allergy sufferers…. These are aspects that are taken into account and are established in a generic way but not personalized to the tastes and beliefs of each one.
It would not be approachable to make an à la carte menu in all centers, but greater involvement of the patient is needed to prepare their daily menu based on the proposal made by the hospital.
As for whether it is tasty or not, each menu is elaborated in chain with the maximum possible care, but having to avoid seasonings or even salt limits the palatability that is offered in the kitchen of your home.
The type of population treated in hospitals is very heterogeneous according to age, cultural and religious aspects, pathologies treated, etc. The human and material resources of the hospitality area of the hospital can determine the type of food that is prepared and distributed in each center.
Dietary guidelines in hospitals are sometimes very strict and, although scientific societies encourage the possibility of liberalizing the diet, it is common to receive complaints about food in hospitals.
Diet planning in a hospital is a laborious and difficult task because it tries to integrate the dietary recommendations established for health and illness situations in the field of collective catering.
Are there menus based on the patients and their needs, ages, diseases?
Indeed, there are menus for age groups, especially children and adults, and adapted to the needs of each one in a general way.
There are normal diets, of soft texture or easy chewing, shredded diets for people with dysphagia or swallowing problems.
Allergies and intolerances are also taken into account, but always in a generic way by groups, not personalized, which in centers with a large volume of patients would be unfeasible or at least extremely complex.
The classification in diets for hypertensive and diabetic, low in fat or with protein restriction are the most common. Within the availability of the menu of each center, the request of each patient is chosen.
What should they improve, in quantity, quality, variety, proportion, types of food?
The supervision of the menus is a guarantee of adequacy to the recommendations that the Food Guides offer.
It should be borne in mind that admitted people have energy requirements adapted to their functional and illness situation: they receive a wide variety of treatments during admission, they have daily fluid therapy supplements, they are in an unfamiliar environment, with physical and mental discomfort due to their income,… That is, although the context is not ideal for an optimal diet, this should not be an excuse to stop offering a variety of healthy foods in quantity and quality.
Another fundamental aspect to consider is the size of the servings; They should be tailored to each person, although five meals are offered per day in line with the recommendations.
In cases of insufficient intakes, the duly qualified staff of the center must assess the causes and record it systematically to make the appropriate decisions. In these cases, meals should be individualized, adapted and enriched or supplemented with nutritional supplements if necessary, so that they meet the patient’s requirements.
What role should meat play on hospital menus?
In some studies carried out in a hospitalized population over 20 years of age, prevalences of malnutrition of 53% have been detected and these patients did not consume meat in the recommended amounts or did so occasionally.
Meat is a food that provides vitamins, minerals, proteins and fats. The most important thing is the contribution of proteins of high biological value, since they are made up of amino acids that the body cannot make and must be provided through food or supplements.
It is a food that can be cooked in many different ways: grilled, cooked, baked or stewed. Its preparation in fried or breaded should be avoided due to its high fat content and caloric intake.
Processed meats contain salts and preservatives that should be limited in the hospital diet. The preparation of these products must be manual in the kitchen itself, if possible, with pieces of meat that are minced later. Meat dishes should be accompanied by legumes, greens, vegetables so that they are healthy and rich in all nutrients.
As a guide, the recently published guide on healthy eating for citizen groups and Primary Care recommends portions of meat of about 125-150 grams that should be consumed alternating with fish, eggs or legumes in an amount of one to three daily servings.
Meats should preferably be lean. We must know that classic white meats such as chicken or rabbit, present amounts of fats similar to those of certain parts of the pig such as sirloin or loin. Even beef, depending on the cut piece, can provide more or less fat.