OBJECTIVES:Gluten-free diets pose nutritional risks as they are diets of exclusion, raising concerns in settings where patients often require increased nutritional support for recovery. The objective of this study was to determine the association between expanding gluten-free menu options and improved nutritional intake among hospital inpatients. METHODS:This was a retrospective, observational study comparing nutritional intake and adequacy in patients across three menu groups in a large, urban hospital in Brisbane, Australia. Participants included 229 adult inpatients allocated a gluten-free diet code between September 2024 and February 2025 across the three menu groups. The standard room service menu had the fewest number of gluten-free options, the private menu featuring fresh herbs had additional gluten-free options (mostly animal-based proteins), and the private menu featuring alternative grains had additional meals featuring naturally gluten-free grains. Patient satisfaction and menu engagement were assessed in the cohort ordering from the private menu featuring alternative grains. Main outcome measures included nutritional intake and adequacy (percentage of requirements) for energy, protein, saturated fat, and fiber and macronutrient distribution. Secondary outcomes included patient satisfaction and menu engagement. Kruskal-Wallis tests were used to assess differences in nutritional intake across the menu groups. RESULTS:Gluten-free patients ordering from the private menu featuring fresh herbs met their energy requirements (99%) and exceeded their protein needs (120%) compared with the standard room service menu (83% and 84%, respectively; P ≤ 0.05 for both). By adding additional naturally gluten-free grain options to the enhanced private menu, patient energy and protein requirements were adequate (94% and 106%, respectively). Patient satisfaction and menu engagement were high for the private menu featuring alternative grains group, with more than 90% rating the food service as "good" and half ordering a meal featuring an alternative grain. CONCLUSIONS:Increasing options for gluten-free meals, through grain-free or alternative grains, may be effective strategies for improving the nutritional intake of patients in hospital.

INTRODUCTION:Texture modified foods are recommended for people with dysphagia but the visual appeal and nutritional quality of the foods may be reduced through modification. Moulding pureed foods back into their original shape rather than serving as a scoop in a ramekin may improve the visual appeal of texture modified foods, and their intake. The current study describes the cost, nutritional composition, intakes and satisfaction of two methods for preparing and serving texture modified meals in hospital, one cooked-fresh and scooped in ramekins and one commercially prepared and moulded. METHODS:Data on patient nutritional intakes and adequacy of energy and protein were collected retrospectively from two cohorts of patients receiving texture modified foods in hospital using data recorded in the electronic menu management system and compared to theoretical nutrition requirements calculated based on height and weight. The first cohort (n = 120) were served texture modified meals made on-site, served in ramekins. The second cohort (n = 152) were served externally sourced commercially prepared, moulded food items. RESULTS:Overall, we found the externally sourced commercially-prepared, moulded meals to be more nutrient dense and approximately 10% more expensive than cooked-fresh, scooped meals, but there were no differences in nutritional intakes between the two cohorts (with patients meeting 43%-47% of energy requirements and 55%-59% of protein requirements). Patient satisfaction reports appeared to favour the commercially-prepared meals. CONCLUSION:Our findings suggest that for a 10% increase in cost, an externally sourced commercially prepared, moulded texture modified meal can deliver a more energy dense product though significant improvements in intakes of energy and protein were not achieved.

In this perspective we describe our experience in developing a novel approach to delivering nutrition education through the hospital patient menu to a broad audience. Using an evolving, themed 'weekly specials' patient menu, unique nutrition education materials were developed across a range of topics, aligned with menu themes to be delivered to patients, staff and the broader community. The current strategy has successfully been implemented over a 3 year period. It has been driven by a series of patient menus showcasing nutritious, varied and sustainable nutrients and ingredients accompanied by a diverse range of education mediums including in-service education sessions for staff, printed nutrition education materials for patients and social-media messaging for the broader community. We are unaware of any other hospital (or institution) that consistently draws on their core patient menu to inspire and educate staff and the broader community. Opportunities for application in other institutions such as schools and worksites are evident.

AIM:To quantify, describe, and compare production waste and food packaging waste in two healthcare centres with different foodservice models. METHODS:In this observational study, all food wasted during production and all food packaging was measured by weight and cost over a 7-day period for two hospitals: Hospital A (800 beds, cook-on demand fresh, a la carte menu room service model) and Hospital B (60 beds, traditional cook chill retherm model with weekly cyclical menu and set meal times). Comparisons between sites were made per patient overnight bed day, as an indicator of hospital activity. The average daily waste was calculated, and costed by multiplying cost (AU$) food item/ kilogram by measured weight; to derive the cost of food waste per kilogram. Food waste by weight and cost per overnight bed day was used as a measure to compare the hospitals. RESULTS:Over 7 days, Hospital A wasted 916.4 kg (AU$6937.22) and Hospital B wasted 69.7 kg (AU$417.10) of food. Most food wasted at both hospitals was edible (78.6% Hospital A and 93.5% Hospital B) and trayline contributed more food waste than bulk production. At both hospitals, plant-based foods comprised the greatest proportion of edible food waste by weight, but not by cost. When accounting for hospital activity, food waste was lower at Hospital A than at Hospital B (0.15 kg of food per overnight bed day and 0.30 kg, respectively). Hospital A generated 199.5 kg (0.03 kg per overnight bed day) of packaging waste compared to 32.2 kg (0.14 kg per overnight bed day) at Hospital B. CONCLUSION:Findings suggest that food waste is costly, that food waste differs between hospitals with different foodservice models, and that overnight bed days is a useful metric for making comparisons. A cook-fresh, on-demand room service foodservice model resulted in less food and packaging waste.

OBJECTIVE:To explore dietary salt-related knowledge, attitudes, and behaviors of New Zealand (NZ) adults aged 18-65 years and assess differences by demographic subgroups. DESIGN:Cross-sectional online survey conducted between June 1, 2018 and August 31, 2018. SETTING:Participants were recruited in shopping malls, via social media, and a market research panel. PARTICIPANTS:English-speaking adults residing in NZ. VARIABLES MEASURED:An amended version of The Pan American and World Health Organization Knowledge, Attitudes, and Behaviors standardized survey tool was used. Demographic data (age, sex, ethnicity, and educational attainment) were also collected. ANALYSIS:Descriptive statistics reported. Chi-square test for independence to assess differences by demographics. RESULTS:The survey was completed by 1,131 adults (mean age 36 ± 15 years; n = 876 [78%] female; n = 661 [78%] NZ European/other; n = 210 [19%] Asian; n =164 [15%] Māori). In addition, 865 participants (83%) knew the primary dietary source of salt; 406 (40%) knew the recommended salt intake; 946 (95%) believed food manufacturers are responsible for sodium reduction; 563 (55%) supported government regulations; and 259 (26%) used food labels. Females and NZ European/other participants reported more favorable salt-reducing behaviors, such as avoiding fast-food and packaged, ready-to-eat foods (P < 0.001). CONCLUSIONS AND IMPLICATIONS:Improving salt-related knowledge, attitudes, and behaviors in NZ is particularly important for men, underserved populations, and adults aged 45-65 years. A multicomponent, national NZ salt reduction program based on research addressing engagement and effectiveness for at-risk groups is warranted.

Objective: The modern Australian diet is largely characterised by too few fruits and vegetables and too many discretionary foods. This is very different to how Indigenous Australians ate prior to colonisation. Native plants and seeds like bush tomatoes, warrigal greens, Kakadu plum and wattleseed are not common features of the contemporary Australian diet. We developed an initiative to incorporate native plants and seeds into a hospital inpatient menu to normalise their use and provide nutrition education to patients, staff and the community of the nutrition and sustainability benefits of native ingredients. Design: Between May and August 2022, the Chef’s Special menu (for privately funded patients) featured Australian native ingredients in all dishes. The nutritional benefits of native foods were communicated to patients through a printed brochure delivered with the menu, to foodservices staff through in-service training, and to the broader community through social media. Setting: Urban hospital in Brisbane, Australia. Method: Data were collected on acceptability, engagement and reach of the education initiative. Results: The initiative was successfully delivered, with more than 8,000 patient brochures distributed, 45 staff attending training, and social media reaching approximately 10,000 people. The most frequently ordered main meal on the menu was grilled snapper (fish) with macadamia Asian herb salad and finger lime. Conclusion: The work highlighted how the patient menu in hospital can serve as a useful tool to communicate nutrition education to patients, staff and the broader community. In addition, we reflect on the many opportunities to continue to celebrate the nutritional benefits of Australian native foods in healthcare settings.

Background: In community and school settings, gardens and garden interventions have been shown to confer several psychosocial, physiological, and nutritional benefits. However, little is known about the implementation and impact of health care gardens on patients, visitors, and staff health and well-being. The primary aim of this review is to identify and describe the types of gardens and common design elements implemented in health care settings and the impact these gardens have on the health and well-being of patients, visitors, and staff. A secondary aim is to assess the quality of available evidence.Methods: PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched on October 28, 2022. Primary qualitative and quantitative studies (excluding case reports and studies) were eligible for inclusion if they described the types of gardens and common design elements implemented in health care settings (hospitals, aged care, rehabilitation facilities, and medical centers) and/or assessed the impact of garden interventions on the health and well-being of patients, visitors, and staff. Review, selection, and data extraction were conducted by two independent researchers, with findings synthesized and presented in narrative form. Articles were critically appraised using the mixed methods appraisal tool (MMAT).Results: Eighteen articles were included. Eight studies provided detailed descriptions of the types of gardens implemented in health care settings (healing [n = 3], therapeutic [n = 2], sensory [n = 2], children's fairy gardens [n = 1], and enriched [n = 1] gardens). Studies examining the psychosocial impacts of gardens were most frequently reported (n = 16), followed by physical (n = 4) and nutritional (n = 2). A wide range of positive outcomes, predominantly relating to patients (n = 12), were reported, including improvements in stress, quality of life (QOL), cognitive function, physical activity, and fruit and vegetable intake. The evidence was heterogeneous and low-medium quality.Conclusions: The findings suggest that implementing gardens and garden interventions in health care settings may positively impact the health and well-being of patients, visitors, and staff. Most studies related to the impact of gardens on patients' mental health and QOL, indicating the need for further research to explore physical and nutritional outcomes, as well as health outcomes of staff and visitors. Findings also suggest the need for high-quality study designs (e.g., cluster control trials) and standardized measurement tools.

AIMS:This systematic review aims to describe the dietary quality, dietary intake and related behaviours of adults diagnosed with cystic fibrosis. METHODS:A comprehensive literature search was conducted in four databases (Medline, CINAHL, EMBASE, CENTRAL); studies were included if they addressed dietary intake, diet quality or eating behaviours among adults (≥15 years) living with cystic fibrosis and were published from January 2000 to November 2022. The Mixed Methods Appraisal Tool was used to assess the risk of bias and quality of included studies. Findings were synthesised narratively. RESULTS:Nineteen observational studies (n = 2236) were included and considered high to moderate quality. Most (13/19) studies reported that individuals with cystic fibrosis were consuming high-energy diets; where studies reported energy intake as a proportion of requirements met, energy intake was high, even when using individualised or cystic fibrosis-specific referents. In addition, fat intakes as a proportion of energy appeared high (29%-39% of total energy), particularly as current guidelines recommend macronutrient profile similar to the general population (<30% of total energy). There was considerable variation in the reporting of fatty acid profiles and other nutrients. Five studies reported on concerns regarding diet and eating in this population. CONCLUSION:Findings from the current review suggest dietary intakes of adults with cystic fibrosis appear to be less than optimal and concerns about diet, weight and food may be emerging in this population. Future research utilising consistent measures of dietary assessment and reporting, reporting of medical therapies, and exploring potential concerns about diet and eating is warranted.

AimShocks to the food system (such as extreme weather events, wars, and pandemics) are felt by institutional food systems. For hospitals, these shocks affect the quantity, quality, and variety of foods that can be offered to patients. One strategy to buffer the hospital food supply from external threats is to prioritise ingredients produced locally. Thus, the aim of the current research is to describe the country of origin of all foods purchased by a large, metropolitan healthcare organisation and to identify opportunities for improving the locality of the food supply.MethodsThis study was of a cross-sectional, observational design. The country of origin for all foods procured over a 1-year period by a large, urban healthcare organisation was determined by proportion of food budget spend. State of origin was identified for fresh fruit, vegetables, and meat. The organisation was in Queensland, Australia and utilised a cook-fresh, room-service foodservice model. Descriptive analysis was used to to determine the number of items and the proportion of budget spend on all foods produced in Australia, and by food category. Similar descriptive statistics were generated to determine the proportion of the budget spend on fresh fruits, vegetables and meats produced in Queensland.ResultsOver the 1-year period, 659 individual food items were purchased by the hospital foodservice, and 502 food items were included in the anlaysis. In total, 53% of the food budget was spent on Australian foods (100% Australian ingredients) and almost all fruit (73%) and vegetables (91%) were Australian grown. Procuring fresh fruit (28%), vegetables (35%), and meat (46%) from within the state was less common, and this may reflect the primary states of production across Australia, and seasonal variability of the food supply.ConclusionsFindings offer priority areas for improving the locality of the food supply. Future research to determine if procuring more foods locally has benefits to consistency of the food supply is warranted.

Aim: To explore the chef’s experience with a newly implemented indoor hospital-based kitchen garden designed to supplement herbs ordered for patient meals and improve staff engagement. Background: Hospital-based therapeutic and kitchen gardens have emerged as effective health-promoting tools in hospital healthcare environments. They promote emotional, mental, and physical well-being for patients, visitors, and staff. However, formal evaluations are limited, and studies focusing on indoor hospital kitchen gardens are noticeably absent in the literature. Methods: Qualitative evaluation of a hospital-based kitchen garden. Open-ended interviews were conducted approximately 6 months after garden implementation and explored key informants ( n = 6) overall experience, engagement with the garden, perceived benefits, and opportunities for improvement. Interview data was analyzed using a thematic approach. Results: The implementation of the kitchen gardens was met with overall acceptance among staff. However, the project’s feasibility faced challenges related to local food service leadership, communication, and certain aspects of the garden setup. Despite these obstacles, the gardens contributed positively to the quality of meals by including fresh herbs and fostering greater staff engagement. Conclusions: The chefs viewed the concept of the hospital-based kitchen garden favorably, noting that it closely aligned with their mission of providing nutritious meals to patients. However, consideration of the broader issues facing hospital food services may be required to seamlessly integrate this task into the kitchen staff’s daily routine. Further research is warranted to investigate the effective implementation and feasibility of indoor kitchen gardens in hospitals and their impact on patient menus, food service staff, and the workforce.

Background: Nurses are the largest health professional body globally. Despite the significant role they play in healthcare, nurses exhibit poor dietary habits and have high rates of chronic diseases. Understanding the factors underlying healthy eating for nurses in the workplace is important to implement effective interventions. Objective: To identify enablers and barriers related to healthy eating among nurses employed in a hospital setting.Design: A systematic literature review of qualitative, quantitative, and mixed methods research (PROSPERO ID: CRD42021290913).Data sources: A comprehensive systematic search was conducted across PubMed, CINAHL, Embase, Web of Sci-ence and ProQuest databases for papers published after January 2015.Methods: Two authors independently screened titles and abstracts of 4139 deduplicated studies, performed crit-ical appraisals on eligible studies using the Mixed Methods Appraisal Tool and extracted data relevant to the re-search question. This review includes papers that examined nurses' eating behaviours specifically, were conducted in a hospital setting and distinguished healthy eating from other behaviours. Data synthesis was con-ducted through descriptive summarisation of studies and enablers and barriers were classified according to the socio-ecological model.Results: A total of 29 studies were identified with 8024 participants. 8 studies were qualitative, 18 quantitative, and 3 were mixed method design. At an environmental level, barriers were high accessibility and availability of unhealthy foods, high cost and low availability of healthy foods and lack of storage and preparation facilities, while an enabler was close proximity to healthy options. Novel organisational enablers were considered roster planning which allowed for established routines around meals, and structured workplace programs that encour-aged improvement in health behaviours, while barriers were shift work, inconsistent rosters and high work de-mands. An interpersonal enabler was supportive networks while barriers were work culture, social norms of celebrations and gifts of food from patients. Finally, intrapersonal barriers were stress and fatigue, personal values, beliefs, attitudes, and individual characteristics, with the latter two also acting as enablers. Conclusions: This review identifies the complexity and interconnectedness of enablers and barriers to healthy eating across four domains of the socio-ecological model. Multi-faceted strategies which address factors across several domains are recommended for healthcare organisations to facilitate healthy eating among nurses. Further research is needed to assess these strategies and understand the extent to which eating behaviours can be improved.(c) 2022 Elsevier Ltd. All rights reserved.

ObjectiveEvaluate the acceptability and feasibility and explore the potential health impacts of a hospital-based herb and vegetable garden.MethodsMixed-method program evaluation assessed dietetic and food service staff health, well-being, and garden engagement. Surveys were administered at baseline and follow-up (6 months). Key informant interviews (n = 6) were conducted at 6 months to evaluate program feasibility.ResultsThere was good acceptance and engagement with the garden, with 18 participants volunteering to maintain the garden. Key informant interviews identified workforce, leadership, and garden design engagement factors. Participants also noted several psychosocial benefits.Conclusion and ImplicationsA hospital-based garden for staff is feasible if programmatic improvements are addressed. More robust evaluations considering challenges with measuring key outcomes with survey methodology and extended periods are warranted.

ISSUE ADDRESSED:Dietary intake of Australian adolescents is suboptimal. Schools are an ideal setting for health promotion initiatives to develop healthy lifestyle behaviours among adolescents. However, we do not know which nutrition-focused, school-based interventions are effective at improving health outcomes in adolescents in Australia. Therefore, the aim was to evaluate the effect of nutrition interventions on health outcomes in Australian secondary school students. METHODS:MEDLINE, EMBASE, CINAHL, ERIC and Informit were systematically searched on 4th November 2022. Studies in any language evaluating nutrition interventions implemented in Australian secondary schools were included. Studies evaluating interventions conducted in primary schools or outside the school setting were excluded, as were any grey literature, systematic reviews and meta-analyses. Screening and data extraction were performed in duplicate. Quality was assessed using the Mixed Methods Appraisal Tool. RESULTS:Thirteen studies (n = 27 224) reporting on nutrition interventions implemented in Australian secondary schools were included. Studies were conducted in five different states and a capital territory within Australia and were mostly randomised controlled trials. Most studies reported a significant improvement on nutrition-related health outcome measures (dietary behaviour n = 6, nutritional knowledge and attitudes n = 4 and anthropometric n = 1). CONCLUSIONS:This review found limited studies reporting on nutrition interventions in Australian secondary schools. However, most were shown to be effective in improving nutrition-related health outcomes. SO WHAT?: Since there were limited studies in peer-reviewed journals, more research in this area is needed to confirm the effectiveness of nutrition interventions in Australian secondary schools and to assess long-term effects on student's health outcomes.

The aim of this study was to determine the effectiveness of hospital-based interventions in improving eating patterns and food purchasing behaviours of hospital staff. Four electronic databases were searched from inception to November 2021 for intervention studies conducted within hospital retail food environments. Studies assessing outcomes pertaining to changes in eating patterns and/or food purchasing behaviour were included. Intervention effectiveness was defined as a statistically significant change in primary outcomes. Study quality was assessed independently by two researchers using the Mixed-Methods Appraisal Tool. In total, 20 studies were included in the review. 10 studies were moderate to low quality and almost half of the included studies (n = 9) utilised a quantitative descriptive design. Intervention modes included signage and health labels (n = 17), price modifications (n = 9), recipe modifications (n = 7), choice architecture (n = 5), altering healthy food availability (n = 5) and cooking processes (n = 1). Most studies (n = 15) contained more than one intervention type within their intervention design. Significant improvements in all primary outcomes were identified within eight studies, in which all had included a point-of-purchase prompt. Multicomponent interventions that incorporate point-of-purchase prompts may be useful in improving eating patterns and/or food purchasing behaviour of hospital staff. Further rigorous research identifying the long-term effectiveness of these interventions on improving health outcomes is warranted.

Objective: To assess whether adolescents who appeared in an after-school cooking nutrition programme (Teen Battle Chef) sustained healthful food behaviours in the ensuing years into young adulthood.Design: Interviews involving a short verbal survey assessing six health behaviours coded dichotomously and open-ended questions coded for themes describing how participants did or did not sustain behaviour change.Setting: Adults who had previously participated in TBC culinary nutrition programme while in high school discussed whether any lifestyle changes prompted by the programme continued into their adult lives.Method: The 30 young people were interviewed (in-person or by telephone) and the interviews were audio-recorded. Transcripts were made verbatim to allow for NVivo analysis of responses.Results: Thirty 17- to 24-year-olds, 6 months to 7 years after TBC programme, reported current favourable health behaviours. Results were similar for participants <3 and 3+ years post TBC. In interviews, 27 of 30 provided in-depth description of how TBC had changed their behaviours. They described cooking skills learned in TBC that they still practised. Participants discussed specific ways in which peers and family supported them to sustain behaviour change.Conclusion: Even modest findings of short-term evaluations of cooking programmes may be significant if impacts are sustained. More longer-term evaluations are needed to confirm these results.

The current research describes the indicators of good nutrition among staff working in a hospital setting and determines if dietary indicators are associated with work-related burnout. In total, 501 staff of a large healthcare organization in SouthEast Queensland, Australia completed a health and wellbeing survey. Multiple regression models were constructed to describe the associations between dietary indicators and burnout, while controlling for age, gender, work role and level of employment. Among the total sample of healthcare workers, indicators of healthy eating were poor. Fewer than 40% reported their overall diet as very good and fewer than 15% of healthcare workers reported eating the recommended 5 or more servings of vegetables per day. There was an inverse relationship between good nutrition and burnout, across a range of indicators (including rating of overall diet, fruit and vegetable consumption and sharing meals with family), such that healthier eating indicators were associate with less burnout. Given that rates of both poor nutrition and burnout among healthcare professionals are high, findings from the current study suggest that efforts to promote better nutrition among healthcare workers are warranted. Future research may evaluate if improving the nutrition of healthcare workers has a positive impact on work-related burnout.

INTRODUCTION:Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality. METHOD:PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively. RESULTS:Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed. DISCUSSION:Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality. IMPLICATIONS FOR RESEARCH AND PRACTICE:Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.

AIM:The current study describes food-purchasing behaviours of healthcare staff, determines whether purchasing food at work is associated with overall indicators of healthy eating, and explores opportunities for improving the hospital food environment.METHODS:A secondary analysis of a health and wellbeing survey of healthcare workers (n = 501) in Queensland, Australia. Multiple regression models describe the associations between food purchases and indicators of healthy eating, while controlling for age, gender and work role.RESULTS:More than 60% of staff purchased food/drinks at work in the past week, and this was inversely associated with indicators of healthy eating. For example, among those purchasing food/drinks at work on most days, only 18% reported their overall diet as excellent or very good, compared to 50% of those who do not purchase food/drink at work (odds ratio [OR] = 0.24; 95% confidence interval [CI] = [0.12,0.48] in adjusted models). Staff feedback prioritised strategies to make healthy meals more accessible and affordable.CONCLUSION:Improvements to the retail food environment in hospitals could have a positive impact on the overall nutritional wellbeing of staff.

The current report explores how well vending machines are meeting the needs of health care organizations and their staff and visitors in Australia. Hospital vending machines often provide the only source of food through the night to staff and visitors and traditionally offer less-healthy options. Findings presented in this report suggest that vending machines are not meeting current statewide policies and guidelines for healthier food environments in health care. This is despite widespread support for healthier refreshments in hospitals by staff, visitors, and patients. Alternatives to traditional vending and opportunities for nutrition educators and researchers are discussed.