Hospital Diet Research Articles

Влияние дополнительной нутритивной поддержки на нутритивный статус и переносимость химиотерапии у детей в реальной практике противотуберкулезного диспансера

Aim: in conditions of the real clinical practise, to evaluate the effect of nutritional support (NS) with a hypercaloric polymer formula with dietary fibers on the nutritional status of children with pulmonary tuberculosis (TB) who started chemotherapy, as well as the possible NS impact on the chemotherapy efficacy and tolerability. Patients and Methods: a retrospective and prospective, partial cross-sectional cohort study was conducted. The main group (prospective) included 23 children with an established diagnosis of pulmonary TB and I–III degree underweight. In the comparison group (retrospective), 20 children were selected who corresponded to the main characteristics of the main group patients. Main group, in addition to a balanced individually selected hospital diet, received NS with a hypercaloric polymer formula with dietary fibers in the amount of 100 ml 2 times a day on a daily basis (300 kcal/day). The patient's body weight, height, subscapular skinfold thickness, body mass index (BMI) Z-score, hemoglobin level, total protein, urine specific gravity, chemotherapy tolerance and NS product tolerance (in the main group) were assessed initially and after 3 months. Results: the study demonstrated that the NS use has a significant positive effect on the nutritional status (body weight, height, BMI) of children with malnutrition who received chemotherapy in pulmonary TB. NS use with a specialized product contributed to a significant improvement in blood parameters (an increase in hemoglobin and total protein count) and normalization of urine specific density versus the comparison group, which achieved no significant improvement in these indicators. The good tolerability of the specialized product helped to reduce the risk of adverse events during daily chemotherapy administration by 65.2%, which improved treatment adherence. Conclusion: the obtained results confirmed the NS administration efficacy for children with diagnosed pulmonary TB during chemotherapy indicated to normalize the nutritional status. KEYWORDS: tuberculosis, children, adverse events, nutritional support, adherence, efficacy. FOR CITATION: Barbolina S.F., Naumov A.G., Ovchinnikova O.A., Bikbaev R.R. Nutritional support effect on the nutritional status and tolerability of chemotherapy in children in the real clinical practice of the tuberculosis dispensary. Russian Journal of Woman and Child Health. 2023;6(4):405–410 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-13.

Pressure injury prevention measures: overview of systematic reviews.

Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries. Overview of systematic reviews conducted in accordance with Cochrane guidelines. A search was performed in databases, repositories and systematic review registration sites. 15 reviews were included in this overview. The sensitivity analysis showed a reduction in the incidence of pressure injuries with nutritional supplementation compared to the standard hospital diet (Relative Risk (RR) = 0.83; 95% Confidence Interval (CI): 0.72-0.95). There was evidence of the superiority of constant low-pressure surfaces (RR = 0.38; 95% CI;0.24-0.61), alternating pressure devices (RR = 0.31; 95% CI:0.17-0.58) and alternative foams (RR = 0.40; 95% CI:0.21-0.74) when compared to the standard hospital mattress or standard foam. The use of a silicone cover reduced the incidence of pressure injuries by 75% (RR = 0.25; 95%CI:0.16-0.41) when compared to no cover. Although some interventions have been shown to be effective in reducing the incidence of pressure injury, the evidence is limited or very limited and subject to change. Registration CRD42017064586.

How processed is the hospital menu? An analysis based on NOVA food scoring system

Having healthier, less processed hospital menus is an emerging issue. Diets high in ultra-processed foods (UPF) have lower nutrient density, but the incidence of UPF in hospital menus has not been previously addressed. The present study determined the presence of UPF, minimally processed foods (MPF) and processed culinary ingredients (PCI) and their correlations with provided energy and nutrients. We recorded the hospital diet for 14 consecutive days and analyzed it with the USDA database, and published NOVA values. The NOVA score of the menu was 1.90, 1.80-1.93, while the energy from UPF was 25.2%, 23.2%-29.9% (medians, interquartile ranges). Energy from UPF was positively related to beta-cryptoxanthin and negatively associated with dietary cholesterol and manganese. In contrast, the energy from MPF and PCI was positively associated with energy, protein, zinc, selenium, iron and B12. In conclusion, MPF and PCI in hospital diets relate to higher energy, protein and several micronutrients, which is essential to combat hospital malnutrition.

Trans Fatty Acids Content in Whole-Day Diets Intended for Pregnant and Breastfeeding Women in Gynaecological and Obstetric Wards: Findings from the Study under the "Mum's Diet" Pilot Program in Poland.

Trans fatty acids (TFAs) have been proven to have an adverse effect on human health by interfering with n-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) synthesis. LC-PUFA n-3 are necessary for the development and maturation of the nervous system and retina during the prenatal period and infancy. TFAs are not synthesized de novo in the human body. Their presence in body fluids arises from the diet. The aim of our study was to determine the content of TFAs in individual meals and in a whole-day hospital diet intended for pregnant and breastfeeding women. Samples were collected from six different hospitals in Poland which voluntarily applied to the “Mum’s Diet” Pilot Program. The content of fatty acids, including TFAs, was determined by gas chromatography coupled with mass spectrometry (GC-MS). The TFAs content in the whole-day hospital diets ranged from 3.86 to 8.37% of all fatty acids (% wt/wt). Food products served for elevenses and afternoon snacks contributed the highest amounts of TFAs. These mainly included dairy products containing TFAs of natural origins. The estimated average intake of TFAs with the hospital diet was 0.72 g/person/day (range: 0.34–1.16 g/person/day) and did not exceed the maximum level of 1% of dietary energy recommended by the World Health Organization.

The effect of postprandial exercise on mean blood glucose concentrations following high and maintenance carbohydrate content meals in healthy dogs

ObjectivesTo compare the effect of 15 min of exercise 30 min post-meal on mean blood glucose concentrations in 5 well-conditioned versus 5 over-conditioned dogs. To compare the effect of exercise on glycemic control in dogs eating their maintenance diet as compared to a high carbohydrate meal. AnimalsTen healthy staff or student owned dogs, five well- and five over-conditioned. ProceduresThis was a crossover study over 5 days. Continuous glucose monitors (CGM) were placed on day 1. On days 2 and 3, dogs received their maintenance diet and a high carbohydrate meal, respectively and were walked on the treadmill for 15 min following each meal. On day 4, dogs were given their maintenance diet in hospital without treadmill activity. On day 5, the CGM were removed. The mean blood glucose 30 min post-meal, during exercise, 15 min after completing exercise, and the 1–3 h period after completing the exercise were compared to detect any effect of exercise, diet composition, or body condition. ResultsDogs consuming a high carbohydrate meal had a significantly higher mean blood glucose 15 min post-exercise. Mean glucose values at all time points following a high carbohydrate meal were significantly higher than mean glucose values on the non-exercise day. Conclusions and clinical relevanceNo impact of post-prandial exercise on glucose concentrations were identified in this study, however, the carbohydrate content of the meal impacted post-prandial glycemic responses in healthy dogs regardless of body condition. Evaluating the impact of post-prandial exercise in insulin-dependent or glucose-intolerant dogs is warranted to determine if these findings persist.

Acceptance of Low-Sodium Hospital Diet by Cardiac Patients: A Randomized Controlled Crossover Trial

Background Cardiovascular diseases are the major cause of hospitalization. Dietary salt restriction is indicated as part of clinical treatment, however, it is not always well accepted by the patients, resulting in low food intake and malnutrition. Objective To compare acceptance of a low-sodium diet cooked with salt with a standard low-sodium diet in cardiac inpatients. Methods A randomized controlled crossover trial in patients with low-sodium diet prescriptions (Clinical Trials NCT03481322). Patients were given a control standard low sodium diet [...]

Evaluating the impact of using a wound-specific oral nutritional supplement to support wound healing in a rehabilitation setting.

Chronic wounds adversely affect patient quality of life, increase the risk of mortality, and impose high costs on healthcare systems. Since protein-energy malnutrition or specific nutrient deficiencies can delay wound healing, nutritionally focused care is a key strategy to help prevent or treat the occurrence of non-healing wounds. The objective of our study of inpatients in a rehabilitation hospital was to quantify the effect of daily wound-specific oral nutritional supplementation (WS-ONS) on healing chronic wounds. Using electronic medical records, we conducted a retrospective analysis of patients with chronic wounds. We identified records for (a) a treatment group who received standard wound care + usual hospital diet + daily WS-ONS for ≥14 days, and (b) a control group who received standard wound care + a usual hospital diet. We collected data for demographics, nutritional status, and wound-relevant health characteristics. We examined weekly measurements of wound number and sizes (surface area for superficial wounds or volume for non-superficial wounds). There were 341 patients identified, 114 with 322 wounds in the treatment group and 227 patients with 420 wounds in the control group. We found that rehabilitation inpatients who were given nutritional support had larger wounds and lower functional independence on admission. At discharge, wound area reduction (percent) was nearly two-fold better in patients who were given daily WS-ONS + usual hospital diet compared to those who consumed usual diet only (61.1% vs 34.5%). Overall, weekly wound improvement (lowered wound area or wound volume) was more likely in the WS-ONS group than in the Control group, particularly from the start of care to week 2. Inpatients with largest wounds and lowest functional independence on admission were most likely to be given WS-ONS, an indication that caregivers recognised the need for supplementation. Week-to-week improvement in wound size was more likely in patients who received WS-ONS than in those who did not. Specifically, wound areas and wound volumes were significantly lower at discharge among patients who were given specialised nutritional support. More research in this field is needed to improve care and reduce healthcare costs.

IMPACTO DO CUIDADO NUTRICIONAL NA INGESTÃO ALIMENTAR DE PACIENTES INTERNADOS NA UNIDADE DE EMERGÊNCIA

This study aimed to investigate the impact of nutritional care on improving food intake (AI) of patients admitted to an emergency unit. 49 patients admitted to the Emergency Department were evaluated, where nutritional assessment (body mass index and subjective assessment according to age) and AI assessment were performed. Patients with decreased AI were submitted to individualized nutritional intervention. There was a predominance of risk of hospital malnutrition by subjective assessment. It was observed that the reduced AI was caused mainly by the difficulty of chewing and the decrease in appetite. After the nutritional intervention, there was an increase in acceptance of the hospital diet, as well as an increase in the caloric intake. It is concluded that there is a predominance of risk of malnutrition in patients admitted to the Emergency Unit and that low food acceptance is imminent, and nutritional care in these patients can be a simple and effective strategy to overcome this situation.

Formulation of the Menu of a General Hospital After Its Conversion to a "COVID Hospital": A Nutrient Analysis of 28-Day Menus.

AimThe aim of the present study was to modify the hospital menu to increase energy and protein provision in COVID-19 patients.MethodsAfter the conversion of our hospital to a COVID-19 hospital, eggs, and comfort foods such as vanilla pudding were added to the menu to boost energy and protein intake of patients. All meals of the standard menu of the hospital, i.e., breakfast, lunch, and dinner were recorded for 14 consecutive days during two periods: pre-COVID-19 and after being converted to a “COVID hospital.” The menus were analyzed with the use of the USDA database.ResultsThe total content of energy (1,873 ± 87 vs. 2,489 ± 137 Kcal), protein (97 ± 11 vs. 126.4 ± 18.7 g), fat (55 ± 9 vs. 74.1 ± 12.8 g), and carbohydrate (241.0 ± 16.0 vs. 323.0 ± 16.0 g) of the provided menus was increased in the COVID-19 period compared to the pre-COVID period. The leucine provision was also increased (4.8 ± 1.08 vs. 7.2 ± 1.3 g). Changes in protein and leucine were greater for breakfast (10 vs. 21 g protein and 0.8 vs. 1.7 g of leucine). The menu during COVID-29 provided more vitamin C (69.5 vs. 109.4 mg), thiamine (1.5 vs. 1.6 mg), riboflavin (2.1 vs. 2.6 mg), niacin (20.6 vs. 27.2 mg), pantothenic Acid (5.7 vs. 7.9 mg), vitamin B6 (2 vs. 2.6 mg), folate (274 vs. 334 μg), B12 (4.8 vs. 6.2 μg), choline (296 vs. 458 mg) as well as vitamins A (8,564 vs. 21,258 IU), D (3.9 vs. 4.7 μg), and K (59.3-111.5 μg). As far as micronutrients are concerned, the provisions of calcium (972 vs. 1375 mg), iron (10.2-12.8 mg), magnesium (236 vs. 294 mg), phosphorus (1,325 vs. 1,807 mg), copper (1.0 vs. 1.3 mg), manganese (2.1 vs. 2.4 mg) and selenium (148 vs. 183 μg) were increased during the COVID-19 period.ConclusionSimple menu changes and addition of comfort foods can substantially boost the nutrient content of a hospital diet, which in concert with provision of oral nutritional supplements could have an impact on patients’ nutritional status.

Effect of Oral Nutritional Supplementation on National Institute of Health Stroke Scale in Acute Ischemic Stroke

BACKGROUND: Approximately, 6-31% of nutritional deficits are present before the stroke and worsen during hospitalization. Besides affecting the patient’s physical and mental abilities, stroke can also cause a decrease in nutritional status, which has a major influence on the rate of death and disability. One intervention to overcome stroke patients’ nutritional problems is giving oral nutritional supplementation. The role of oral nutritional supplementation in stroke severity in patients with acute ischemic stroke has not yet been extensively studied. AIM: This study aimed to evaluate the effect of oral nutritional supplementation on the National Institute of Health Stroke Scale (NIHSS) in patients with acute ischemic stroke. METHODS: This was an experimental study with a pre- and post-study group method. Twenty-eight patients with acute ischemic stroke were referred to Adam Malik General Hospital, Medan, Indonesia, and were allocated randomly into two groups. Fourteen patients as control group received the normal hospital diet and 14 patients as intervention group received normal hospital diet plus oral nutritional supplementation for 7 days. The NIHSS scores were assessed on the first day and the eighth day after intervention in each group. RESULTS: There were significant reductions in NIHSS scores between day 1 and day 8 in both groups (p < 0.001). The mean delta NIHSS scores were −2.28 ± 1.63 and −2.57 ± 1.98 in the intervention and control groups, respectively. There was no significant difference in NIHSS scores between the intervention and control groups (p = 0.682). CONCLUSION: The effect of oral nutritional supplementation significantly reduced the NIHSS scores in acute ischemic stroke, but there was no significant difference compared to the normal hospital diet.

Nutritional overview of non-critical COVID-19 patients during quarantine in a premier hospital of India

Corona virus disease (COVID-19) is a recent global disease. During hospital quarantine of non-critical COVID-19 patients, specific attention is given on their general management and little is known regarding the nutritional approach. The present study was therefore conducted to assess their dietary predilections during hospital quarantine.A prospective observational study was conducted in non-critical COVID -19 patients admitted in isolation wards of All India Institute of Medical Sciences (AIIMS), New Delhi from 1 November 2020 to mid of January 2021. A dietician administered a pre validated questionnaire telephonically to obtain data regarding demographic, anthropometric and dietary characteristics. The results were expressed as mean, standard deviation and median. Chi square tests were used to compare category variables. Statistical analysis was performed using SPSS 9 version 20.0.SPSS, Inc., Chicago IL). 132 patients volunteered to enrol in the study. The mean age of patients was 34.6 +13.5years. Portion size of foods served and number of food groups in breakfast, lunch and dinner as per standard diet scale for balanced hospital diet, did not differentiate by BMI categories (Pearson’s x>0.05). The mean body mass Index (BMI) was 23.75+4.15. Being overweight and obese correlated with taste issues (Pearson’s x< 0.05). Additional centre of attention on fruits, vegetables, fluids and proteins Owing to the recent growing COVID-19 situation, the findings of the present study may be utilized in developing the most favourable nutritional strategies within the inpatient hospital menu for providing enhanced nutritional care.

Evidence-based Discharge Nutrition to Optimize Preterm Infant Outcomes.

Despite abundant research comparing postdischarge hospital diets for preterm infants, the ideal clinical approach has not been determined. Dilemmas persist because randomized controlled trials of preterm versus term infant formula have yielded equivocal results and because the predominant postdischarge diet for preterm infants has shifted from formula-based to a combination that includes maternal milk and increasingly includes a plan for breastfeeding. As the investigation of the influence of the post-hospital discharge diet on preterm infant outcomes evolves, factors to consider include the infant's oral feeding ability and the maternal lactation goal. The maturation of the preterm infant's oral feeding skills may at least partially explain why increased nutrient density appears to most benefit growth outcomes when given during the first 3 to 4 months after hospital discharge. At some point in maturation, the preterm infant may develop the ability to vary intake as needed to obtain sufficient nutrition no matter the density of the diet. In addition, attention to the maternal lactation goal is critical as intake of maternal milk likely influences neurodevelopmental outcomes as much or even to a greater extent than growth trajectory.

Effect of a Nutritional Support System to Increase Survival and Reduce Mortality in Patients with COVID-19 in Stage III and Comorbidities: A Blinded Randomized Controlled Clinical Trial.

The COVID-19 evolution depends on immunological capacity. The global hospital mortality rate is 15–20%, but in México it is 46%. There are several therapeutic protocols, however, integral nutrition is not considered. In this study, a Nutritional Support System (NSS) was employed to increase survival and reduce mortality in patients with stage III COVID-19. A randomized, blinded, controlled clinical trial was performed. Eighty patients (aged 30 to 75 years, both sexes) were assigned to (1) “Control Group” (CG) hospital diet and medical treatment or (2) “Intervention Group” (IG) hospital diet, medical treatment, and the NSS (vitamins, minerals, fiber, omega-3, amino acids, B-complex, and probiotics). IG significantly increased survival and reduced mortality compared to CG (p = 0.027). IG decreased progression to Mechanical Ventilation Assistance (MVA) by 10%, reduced the intubation period by 15 days, and increased survival in intubated patients by 38% compared to CG. IG showed improvement compared to CG in decrease in supplemental oxygen (p = 0.014), the qSOFA test (p = 0.040), constipation (p = 0.014), the PHQ-9 test (p = 0.003), and in the follow-up, saturation with oxygen (p = 0.030). The NSS increases survival and decreases mortality in patients with stage III COVID-19.

Texture-Modified Diets Need to be Improved in Vietnamese Hospitals.

Purpose : The aim of this study is to compare the nutritional status of older adult inpatients consuming Texture-Modified Diets (TMD) to older adult inpatients consuming a regular diet. Methods : The study was designed as cross-sectional and was conducted in three large hospitals in northern Vietnam. The data for 344 older adult inpatients were collected in 2021 by dietitians. Results : The result showed 104 subjects were prescribed TMD. The textures of hospital diets have still not been adequately developed. In particular, the hospitals had not yet developed pureed meals. All older adult inpatients (74.7 ± 6.8 years old, 52.9% female) had 28.8% malnutrition by the GLIM criteria. The TMD group had a malnutrition prevalence two times higher than the regular diet group. Total energy intake from hospital meal and outside snacks in the regular diet group was higher than in the TMD group, about 150 kcal. Although energy provided from the hospital diet in both groups was similar, hospital meal wastage in the TMD group was higher than in the regular diet group. Conclusion : The older adult inpatients on TMD may have a nutritional status worse than those consuming a regular diet. Hospital diets need to be improved in texture and quality. J. Med. Invest. 69 : 230-236, August, 2022.

Role of calcium in health and reducing the risk of non-communicable diseases

Calcium as an essential mineral is involved in many processes in the body, being the main one in the mineral matrix of bones and teeth. It is necessary for conducting nerve impulses, blood coagulation, muscle contraction, regulation of the transport of various ions through the cell membrane, glycogenolysis and gluconeogenesis, and the activity of many enzymes. In Russia, insufficient calcium intake is noted. The purpose of the work was to assess the role of calcium of various origins in meeting the needs and health of the population. Material and methods. Literature search was carried out using the PubMed, Google Scholar, ResearchGate, RSCI, CyberLeninka systems, mainly for the last 10 years, with the exception of research of fundamental importance, using the keywords "calcium", "milk", "bioavailability". Results. Dairy consumption is associated with an overall reduction in the risk of noncommunicable diseases, including cardiovascular disease, type 2 diabetes mellitus, and some types of cancer. Calcium in natural milk and dairy products, as well as calcium of milk origin, has a higher bioavailability and absorption than from other sources of synthetic or natural mineral origin. The recommendation to reduce dairy consumption may be counterproductive to health and therefore may increase health care costs. Conclusion. Milk and dairy products are the optimal source of calcium. The high bioavailability of calcium of milk origin justifies the expediency of its preferred use in dietary nutrition, both as part of therapeutic diets in hospitals and nutrition in social service institutions, and in outpatient practice. Additional studies, including randomized controlled trials, may be needed to explore in more detail the optimal consumption of milk and dairy products, as well as the use of calcium-containing pharmaceutical products and dietary supplements.

Standard and therapeutic diets in hospital: assessment of caregivers' knowledge and application in comprehensive cancer centres (CCC) in France

Rationale: Due to the high rate of sarcopenia in oncology [1, 2] and based on the guidelines on standard and therapeutic diets in hospital published in 2019 [3], the nutritionist experts in oncology working in CCC (InterCLAN) decided to assess the knowledge of caregivers about diet in hospital.

Patients in public hospitals received insufficient food to meet daily protein and energy requirements: Cape Town Metropole, South Africa

Objectives: This study aimed to determine the energy and protein content of meals served and consumed by hospitalised patients compared with their needs, to assess patients’ food satisfaction and investigate associations with energy and protein intake. Design: This was an exploratory quantitative cross-sectional study. Setting: Three public hospitals within the Cape Town metropole were recruited; a central hospital (945 beds), large district hospital (372 beds) and a medium district hospital (172 beds). Subjects: Adult inpatients 18+ years admitted to medical or surgical wards, on a non-therapeutic/normal hospital diet were recruited by purposive sampling method between 2018 and 2019. Outcomes measures: Each participant’s weight and height were measured to calculate body mass index (BMI) and to determine energy/protein requirements. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire was administered. Meals were weighed before and after consumption to calculate energy and protein intake per patient/day. Results: A total of 128 patients (males = 71) participated. Total protein served did not meet patient requirements in any of the hospitals. Consumed energy and protein were significantly below requirements in all hospitals (p < 0.002). Perceived food quality (r = 0.38, p = 0.039) and staff/service issues (r = 0.39; p = 0.035) were significantly positively correlated with protein intake, while appetite correlated positively (r = 0.42, p = 0.006; r = 0.41, p = 0.008) and length of stay (LOS) correlated negatively (r = −0.46, p = 0.002; r = −0.42, p = 0.008) with energy and protein intake, respectively. Conclusion: Energy and protein served was significantly lower than participants’ requirements in all three hospitals and none achieved the official ration scale amounts. Nearly 40% reported having a normal appetite and did not receive additional food from family or friends, which may lead to hospital-acquired malnutrition and increased hospital length of stay (LOS). Improved hospital food quality, quantity, mealtimes and staff training should be a focus to improve patient energy and protein intake.

Acrylamide Content in Breast Milk: The Evaluation of the Impact of Breastfeeding Women's Diet and the Estimation of the Exposure of Breastfed Infants to Acrylamide in Breast Milk.

Acrylamide in food is formed by the Maillard reaction. Numerous studies have shown that acrylamide is a neurotoxic and carcinogenic compound. The aim of this study was to determine the level of acrylamide in breast milk at different lactation stages and to evaluate the impact of breastfeeding women’s diet on the content of this compound in breast milk. The acrylamide level in breast milk samples was determined by LC–MS/MS. Breastfeeding women’s diet was evaluated based on the 24 h dietary recall. The median acrylamide level in colostrum (n = 47) was significantly (p < 0.0005) lower than in the mature milk (n = 26)—0.05 µg/L and 0.14 µg/L, respectively. The estimated breastfeeding women’s acrylamide intake from the hospital diet was significantly (p < 0.0001) lower than that from the home diet. We found positive—although modest and borderline significant—correlation between acrylamide intake by breastfeeding women from the hospital diet µg/day) and acrylamide level in the colostrum (µg/L). Acrylamide has been detected in human milk samples, and a positive correlation between dietary acrylamide intake by breastfeeding women and its content in breast milk was observed, which suggests that the concentration can be reduced. Breastfeeding women should avoid foods that may be a source of acrylamide in their diet.

ORGANIZATION AND HOLDING OF HOSPITAL THERAPEUTIC NUTRITION IN HOSPITALS FOR ACTIVE TREATMENT IN RUSE’S TERRITORY

Introduction: Daily food consumption is a basic factor for improving both the quality of life and the well-being of people. Hospital medical nutrition needs to suit certain standards and requirements, so as to provide all the necessary micro- and macronutrients for patients. It has to be high-quality food and also has to mind the technological requirements for its preparation in the hospital, in addition to looking aesthetically pleasing and tasting good.&#x0D; Objective: This report’s goal is to study the hospital dietary nutrition in the hospitals for active care in Ruse, Bulgaria – University hospital Kanev; University hospital Medika; Mental health center Ruse; Complex-oncological center Ruse and the Specialized Hospital for active treatment of pneumo-phthisiatric diseases - Dr Dimitar Gramatikov.&#x0D; Methods: The survey was conducted between the months of April and September 2020. The criteria for inclusion of those hospitals are: to perform an organized hospital nutrition, and the medical institution to be a hospital itself.&#x0D; Results: In the medical establishments that are included in the study, medical dietary nutrition is carried out in accordance with the normative documents and standards which are in force for the country. The numerological system of nutrition Pevzner is applied, as the basic diets are from №1 to 15, as well as their varieties according to the disease’s acuteness.&#x0D; Conclusions: We find that, just because contemporary requirements for nutrition in the Republic of Bulgaria have been presented in developed national recommendations for healthy eating, this is not enough. What is needed is to develop and apply a fully adequate hospital diet, based on an individual assessment of nutrition status, and degree of risk from malnutrition.

ESPEN guideline on hospital nutrition

In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.