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• W2034240912 abstract "To the Editors: As dietetics professionals who have long been involved in planning and evaluating hospital diets, we are concerned about the commentary that appeared in the June 1998 issue (Singer AJ, Werther K, Nestle M. Improvements are needed in hospital diets to meet dietary guidelines for health promotion and disease prevention. J Am Diet Assoc. 1998;98:639-641). Singer and colleagues contend that hospital diets place too much emphasis on treatment of illness and not enough on prevention. It is our understanding that hospitals exist to treat illness. Although we support the need for disease-prevention strategies, we believe such strategies should target people who are likely to benefit, in an appropriate community setting ((1)Franko J.M. Smith J.S. Lengyel C. Investigation of effective client-centered nutrition counseling..Can J Diet Pract Res. 1998; 59 ([abstract]): 154Google Scholar). Acute illness, with its associated stress and fatigue, is recognized as one of several learning barriers associated with hospitalization ((2)Picus S.S. Evaluation of the nutrition counseling environment of hospitalized patients.J Am Diet Assoc. 1989; 89: 403-405Google Scholar). What are the demographic and health characteristics of the persons who are most likely to benefit from dietary prevention interventions? Dietary prevention trials for cancer and cardiovascular disease have focused on younger persons without preexisting chronic disease ((3)Greenwald P. Experience from clinical trials in cancer prevention.Ann Med. 1994; 26: 73-80Google Scholar, (4)Kjelsberg M.O. Cutler J.A. Dolecek T.A. Brief description of the Multiple Risk Factor Intervention trial.Am J Clin Nutr. 1997; 65: 191S-195SGoogle Scholar). From this we surmise that young, healthy persons are most likely to benefit from dietary prevention. In large university teaching hospitals, the average age and medical acuity of patients has risen over time, with costly hospital admissions reserved for those with the greatest need. The average acute-care patient is beyond middle age, has chronic illness, has or is at risk for malnutrition, and is hospitalized for less than 7 days. For most of these patients, a “heart-healthy” diet is contraindicated. Furthermore, the majority of these persons are in no condition to be instructed on preventive dietary measures or to recognize that they are being subliminally educated via their meal tray offerings. The mental image of undertaking health promotion activities with persons who are seriously ill with cancer, organ failure, postoperative pain and nausea, gunshot wounds, or drug overdoses is enough for us to see that the concept has little merit. Teaching survival basics for discharge is a sufficient challenge! We do agree with Singer et al on one point: the need for interdisciplinary groups to evaluate and plan changes to hospital diets. Hospital diets should be planned like any other patient service, that is, using a multifaceted needs assessment.The US Dietary Guidelines are not designed for treatment of seriously ill persons, but rather for the prevention of chronic disease Following are some of the guiding principles that we have developed for needs assessment: ■ Carefully define patient populations served and avoid promoting a single dietary message to all patients. ■ Seek patient input into menu changes. ■ Provide entrees with moderate (not low) fat, sodium, and energy content. Adjustments to beverages and other accompaniments can help individual patients achieve a range of dietary modifications. ■ Always offer the option of plain foods for patients requiring very restricted diets, and for those recovering from illness or surgery who may prefer them ((5)Traviss K.A. Barr S.I. Rethinking postoperative diets for short stay orthopedic surgery patients.J Am Diet Assoc. 1997; 97: 971-974Google Scholar). ■ Address both nutritional and sensory aspects of meals. ■ Use an evidence-based approach to determine which hospital diets are necessary. We would like to see dietetics professionals retain their leadership role in planning hospital diets while working with multirepresentational teams to ensure that patient needs are met. We look forward to seeing more commentaries, research studies, and review articles that support dietitians in these efforts." @default.
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• W2034240912 title "Should Hospital Diets Meet the Dietary Guidelines for Healthy Persons?" @default.
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• W2034240912 doi "https://doi.org/10.1016/s0002-8223(98)00308-3" @default.
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