Nutrient composition of planned adult patients’ normal diet menus in selected public hospitals in Gauteng Province, South Africa

Abstract

Nutritional quality has been a major food and beverage service consideration in planning and reviewing menus to meet patients’ nutritional needs. Failure to provide sufficient and nutritionally adequate hospital meals results in adverse consequences in a patients’ nutritional, health status and the national economy. The intent of this study was to provide useful information and direction for government agencies, hospital administrators and foodservice leaders whose mandate includes making improvements in the quality of hospital menus. A quantitative, descriptive and analytical approach was applied to assess the nutritional content of planned menus in selected public hospitals in Gauteng province. Samples of adult regular diet menus including breakfast, lunch, supper and all snacks were collected from eight hospitals and analysed using the South African based Food Finder 3 software. The recommended South African total energy RDI (Recommended Daily Intake) range is 6300-8400 kJ. Of the 8 hospitals, only two hospital menus met the requirements with a 6743 kJ and a 7978 kJ, respectively. Four hospital menus were below the RDI with the following data: 5751 kJ, 3239 kJ, 3239 kJ and 6105 kJ. Two hospital menus exceeded the RDI, i.e. 12892 kJ and 9073 kJ. While two hospitals met the RDI requirements for total energy, there are still concerns about hospitals with planned menus falling below and above the RDI as this could affect the patients’ nutritional and health status negatively. Therefore, the assessment of nutritional composition of menus could be helpful to provide information on the adequacy of hospital menus, and guide food providers to make informed decisions in improving in-patient menus.

Full text

African Journal for Physical Activity and Health Sciences (AJPHES) Volume
24(3), September 2018, pp. 245-261.
Nutrient composition of planned adult patients’ normal diet
menus in selected public hospitals in Gauteng Province, South
Africa
M.J. JIYANA1, L.J. NCUBE2 AND A.E. NESAMVUNI3
1Department of Mathematics, Science and Business Education, Tshwane University of
Technology, Pretoria, South Africa
2Department of Human Nutrition and Dietetics, Sefako Makgatho Health Sciences University,
Pretoria, South Africa.
E-mail: Lindie.Ncube@smu.ac.za
3Faculty of Management Sciences, Tshwane University of Technology, Pretoria, South Africa
(Received: 10 February 2018; Revision Accepted: 25 June 2018)
Abstract
Nutritional quality has been a major food and beverage service consideration in planning and
reviewing menus to meet patients’ nutritional needs. Failure to provide sufficient and
nutritionally adequate hospital meals results in adverse consequences in a patients’ nutritional,
health status and the national economy. The intent of this study was to provide useful information
and direction for government agencies, hospital administrators and foodservice leaders whose
mandate includes making improvements in the quality of hospital menus. A quantitative,
descriptive and analytical approach was applied to assess the nutritional content of planned
menus in selected public hospitals in Gauteng province. Samples of adult regular diet menus
including breakfast, lunch, supper and all snacks were collected from eight hospitals and
analysed using the South African based Food Finder 3 software. The recommended South
African total energy RDI (Recommended Daily Intake) range is 6300-8400 kJ. Of the 8 hospitals,
only two hospital menus met the requirements with a 6743 kJ and a 7978 kJ, respectively. Four
hospital menus were below the RDI with the following data: 5751 kJ, 3239 kJ, 3239 kJ and 6105
kJ. Two hospital menus exceeded the RDI, i.e. 12892 kJ and 9073 kJ. While two hospitals met
the RDI requirements for total energy, there are still concerns about hospitals with planned
menus falling below and above the RDI as this could affect the patients’ nutritional and health
status negatively. Therefore, the assessment of nutritional composition of menus could be helpful
to provide information on the adequacy of hospital menus, and guide food providers to make
informed decisions in improving in-patient menus.
Keywords: Nutrient content, normal diet menu, adult patients, public hospitals.
How to cite this article:
Jiyana, M.J., Ncube, L.J. & Nesamvuni, A.E. (2018). Nutrient composition of planned adult
patients’ normal diet menus in selected public hospitals in Gauteng Province, South Africa.
African Journal for Physical Activity and Health Sciences, 24(3), 245-261.
Introduction
The health and well-being of the South African population is a massive
responsibility for government officials, as clearly documented in the South

246 Jiyana, Ncube and Nesamvuni
African Constitution (1996), Clause 27.1 (Act 108 of 1996). Therefore, it is
unconstitutional and undignified amid a violation of human rights, access to
sufficient and nutritious food, which obliges hospital managers to commit to
providing in-patients with quality healthcare services. A major consideration
when providing a food and beverage service is to ensure nutritional adequacy for
the diversity in patients’ nutritional needs. Failure to provide nutritionally
adequate meals results in adverse consequences to patients’ nutritional, health
status, and the national economy.
Adequately planned menus aim to deliver a range of balanced diets, with the
required nutrients and energy. These are blueprints to ensure successful meal
provision as the key to meeting nutritional goals in hospitals (Gandy, 2014).
Efficient menu planning and the provision of high nutritional diet are crucial in
the prevention of in-patients’ malnutrition (Trang, Fraser, Wilkinson, Steckham,
Oliphant, Fletcher, Tzianetas & Arcand, 2015). In the midst of conflicting
priorities and limited resources, foodservice leaders are challenged to regularly
gather data in order to make sound decisions about nutritional adequacy and
patient preferences when planning menus. Food service leaders are responsible
to the selection of menu food items that after production will be nutritionally
adequate, are culturally and religiously acceptable, and enjoyed by in-patients
(Brown, 2015; Shepherd, 2011; Department of Health, 2010; Puckett, 2004),
while increasing their consumption levels and improving their nutritional status.
A hospital meal is an essential part of in-patients’ institutional care and
nutritional support. The length and cost of a hospital stay are related to a
patient’s nutritional status. Under-nutrition in sick patients is associated with
body system impairment; muscle weakness, particularly in respiratory muscles;
reduced immune system functioning ability; gut structure and function
alterations, delayed wound healing; apathy and depression; reduced appetite an
inability to eat; and higher rates of mortality. These factors increase the length
and cost of a hospital stay. Inevitably, patients’ quality of life is immensely
affected while hospitalised and after discharge. Hospital food provision
contributes significantly to in-patients’ wellbeing and recovery, supporting them
physically and emotionally during their stay (Johns, Hartwell & Morgan, 2010).
Therefore, improving hospital menus and mealtime atmosphere may improve
food intake and help to meet patients’ nutritional requirements (O'Regan, 2009;
Kondrup, Hansen, Ipsen & Ronneby, 1998).
While hospital malnutrition is common, patients could become further
malnourished during a hospital stay. A study conducted by Allard, Keller,
Jeejeebhoy, Laporte, Duerksen, Gramlich, Payette, Bernier, Davidson, Teterina
and Lou (2016) in 18 Canadian hospitals, showed a decline in 15% well-
nourished patients on admission, and deterioration of nutritional status in 20%
patients discharged from the hospital. The decline in nutritional status was

Nutrient composition of planned adult patients’ normal diet menus 247
associated with a prolonged stay in hospital with patients been admitted for 7
days or more. Hospital malnutrition is a pandemic in South Africa (de Lange,
2010). When combined with poor patients’ nutritional status for patients, results
could include prolonged hospitalisation. However, it was observed that
complication rates, mortality and hospital stay time are decreased through
increased food intake (Mentziou, Delezos, Nestoridou & Boskou, 2014).
Adequate meal consumption that meets patients’ dietary requirements is
therefore necessary to speed recovery from illness (Edwards & Hartwell, 2006;
Stanga, Zurflüh, Roselli, Sterchi, Tanner & Knecht, 2003), while an inadequate
foodservice system may lead to sub-standard quality in planned menus and meals
served to hospitalised patients, resulting in hospital malnutrition.
Proper nutritional intervention through the provision of nutritionally adequate
meals could improve the quality of life, build strength, decrease infectious
complication risks, relieve pressure ulcers and eventually lower patients’ death
risk (Correia, Hegazi, Graf, Gomez-Morales, Gutiérrez, Goldin, Navas, Espitia
& Tavares, 2016). Hospital foodservices may be used as educational tool for
sustainable good practice or sustainable healthy eating habits. Patients’ healthy
eating habits may be positively influenced, and sustained to prevent malnutrition
even after being discharged (Kim, Kim & Lee, 2010). During hospitalisation, a
good quality meal is the most important factor in facilitating the healing process
(World Health Organization, 2014), as nutrients are viewed as medicine and the
basis on which modern medicine rests (Sekumade, 2013). For patients
hospitalised over longer periods, it is important that good quality meals resemble
a familiar home-cooked meal.
The World Health Organization (WHO, 2014) views nutrition as the intake of
good, adequate, well-balanced food, meeting the dietary needs of the body and
able to prevent malnutrition in all its forms. Mahakalkar, Modi, Yeola, Kaple,
Patwardhan and Laddha (2014) found that 25% of loss in body weight was
associated with apathy, depression, fatigue, and a loss of will to recover among
normal volunteers that were subjected to intentional starvation. This therefore,
proves that nutritional status has significant effects on health and recovery from
illness. Some of the cited negative outcomes for hospitalised patients include
high rates of infection, increased muscle loss, slower wound healing, increasing
susceptibility to chest infections, reduced cardiac function, longer hospital stays,
increased morbidity and mortality (Mahakalkar et al., 2014). Generally, induced
malnutrition commonly occurring in public hospitals is associated to incorrect
meal servings, poor food intake, as well as pitiable planning and meal
preparation. Therefore, patients’ health and recovery through the provision and
consumption of healthy and nourishing meals, remain the most pivotal objectives
for the hospital foodservice unit, because they are used as a yardstick to measure
the success of the hospital healthcare system (Dall’Oglio, Nicolò, Di Ciommo,
Bianchi, Ciliento, Gawronski, Pomponi, Roberti, Tiozzo & Raponi, 2015).

248 Jiyana, Ncube and Nesamvuni
Studies assessing the nutrient content of menus revealed varied findings. A study
conducted by Trang et al. (2015) in three Canadian hospitals, indicated a lower
calorie content of standard menus due to lower protein levels in these planned
menus. Wright, Connelly and Capra (2006) in a study conducted in two US
hospitals, found quantity of nutrients supplied by different daily diets having
adequate energy, protein and vitamin A content, but being deficient in vitamins
and minerals. The findings of a study conducted by Iff, Leuenberger, Rösch,
Knecht, Tanner and Stanga (2008) at Bern University hospital indicated lower
energy and carbohydrate content of the meals that did not meet German
recommendations.
The South African policy for foodservice management in public hospitals
recommends an 8 to 21-day cycle menu plan subject to regular review to
accommodate long-term patients, the inclusion of varied menu items provision
and the use of different food preparation methods to avoid monotony. Regular
monitoring and evaluation, safe food procurement, availability and use of menu
planning policies and adequate resources should guarantee the provision of
nutritionally adequate (DoH, 2010). Planned menus did not exist in most public
hospitals. Factors such as limited financial and human resources, a lack of core
standards and acknowledgment of diversified changing food preferences, as well
as food being managed in silos were the sole responsibility of the assigned
dietitian therefore good nutritional practices did not exist. A combined effort
with better communication and co-operation among dieticians, foodservice
managers, nurses, doctors and pharmacists is needed to review and ensure an
effective menu planning process (Tappenden, Quatrara, Parkhurst, Malone,
Fanjiang & Ziegler, 2013).
Malnourished hospitalised patients expect their nutritional needs to be met
during their hospital stay. However, meals provided are often not acceptable and
the food is wasted (Hartley & Hamid, 2002). In most instances, food wastage
occurs due to the foodservice weaknesses (Edwards, Edwards & Salmon, 2000).
Compliance with municipal, provincial and national legislation is another issue
for consideration when evaluating menus. Despite the availability of legislation
governing South African hospital foodservice, none directly addresses nutrient
composition or in-patients’ level of satisfaction with meals. Four studies that
assess the nutrient content of menus exist, to overcome hospital malnutrition,
politicians and administrators need to afford hospital foodservice and nutritional
care priority. Only reliable menu assessment for nutritional composition will
make foodservice leaders recognize that current hospital menus provide
inadequate, adequate or excessive amounts of specific nutrients. Against this
background, this study aimed to assess the nutrient composition of menu plans in
public hospitals in Gauteng province. The following research questions on
specific nutrients in public hospital diet menus were formulated:

Nutrient composition of planned adult patients’ normal diet menus 249
What are the contents of the following nutrients in normal diet menus in public
hospitals in Gauteng province: total energy, protein, carbohydrate, fat, folate,
iron, vitamin A and vitamin B6?
Methodology
Design
A cross sectional quantitative, descriptive and analytical approach was applied in
this study, whereby the 8 days cycle menus consisting of breakfast, lunch, supper
and all the snacks provided were collected from different hospitals and analysed
for nutrient content.
Population and sampling
Gauteng province has a population of 8 district, 10 regional and 4 provincial
tertiary hospitals. Based on the categories or levels (strata) of the different
hospitals, one district and 9 regional hospitals were selected using stratified
random sampling. Consequently, the menus of one district and 9 regional
hospitals were selected, while one district and 7 regional public hospitals gave
permission to conduct the study.
Data collection
Eight (8) days’ planned normal diet menus including breakfast, lunch, supper
and snacks were requested from each hospital, copied and kept for subsequent
analysis. Menus were collected for 8 days i.e. 1 day from each hospital. Only
menus planned for adult males and females between 19 and 50 years were
considered for this study.
Validity and reliability
A South African-based Food Finder 3 software programme developed by the
Medical Research Council, which has been validated and widely used in
previous studies (MRC, 2015; Wolmarans & Danster, 2008; Labadarios et al.,
2008) for nutrient analysis, was applied to assess the nutrient content of the
hospitals’ menus. Menus were copied, the meal plan and the portion sizes
planned were analysed using the correct software programme, thereby ensuring
that analysed data were valid and reliable.
Data analysis
Data were analysed by the researcher using the Food Finder 3 that was the latest
version of the South African Food Composition Database (SAFOODS) software.

250 Jiyana, Ncube and Nesamvuni
The nutrient content was assessed in respect of the current DRIs for
macronutrients and micronutrients. Mean values and standard deviations of
energy, protein, carbohydrate, fat, iron, vitamin A, folate and vitamin B6 intake
for the food samples were determined.
Ethical Considerations
Ethical clearance was obtained from Tshwane University of Technology Ethics
Committee with ethical clearance no: [Ref#2009=08=003=NcubeL.J]. Approval
of and permission for the study were granted by the National Department of
Health, the Gauteng Provincial Health Department, as well as the chief executive
officers (CEOs) of the participating public hospitals.
Results
The nutrient composition of normal diet menus in use at eight Gauteng province
public hospitals were analysed for total energy, protein, fat, carbohydrate, iron,
folate, vitamin B6 and B12 content according to the DRI standard.
Total energy composition of planned normal diet menus in public hospitals in
Gauteng province
The RDI range for total energy in South Africa is 6300-8400 kJ. Of the 8
planned adult normal diet menus in the selected public hospitals in Gauteng
province, 2 hospital menus were within the RDI range, 4 hospital menus were
below, and 2 menus were above the total energy RDI range (Figure 1).
Figure 1: Total energy composition of normal diet menus planned in public hospitals in Gauteng
province
Protein composition of normal diet menus planned in public hospitals in
Gauteng province

Nutrient composition of planned adult patients’ normal diet menus 251
Six hospitals’ menus were within the RDI range and 2 were below the RDI range
of 56-99 g for protein (Figure 2).
Figure 2: Protein composition of normal diet menus planned in public hospitals in Gauteng
province
Carbohydrate composition of normal diet menus planned in public hospitals in
Gauteng province
Two hospitals’ menus were within the recommended range of 206-276g, 5 were
below, and 1 exceeded the carbohydrate RDI range (Figure 3).
Figure 3: Carbohydrate composition of normal diet menus planned in public Hospitals in
Gauteng province
Fat composition of normal diet menus planned in public hospitals in Gauteng
province
Two hospitals’ menus were within the RDI range of 41-55g, 2 were below and 4
were above the fat RDI range (Figure 4).

252 Jiyana, Ncube and Nesamvuni
Figure 4: Fat composition of normal diet menus planned in public hospitals in Gauteng province
Iron composition of normal diet menus planned in public hospitals in Gauteng
province
None of the hospitals menus met the RDI of 8 mg for iron (Figure 5).
Figure 5: Iron composition of normal diet menus planned in public hospitals in Gauteng province
Folate composition of normal diet menus planned in Gauteng province public
hospitals
None of the hospital’s menus met the RDI of 400 μg for folate (Figure 6).

Nutrient composition of planned adult patients’ normal diet menus 253
Figure 6: Folate composition of normal diet menus planned in public hospitals in Gauteng
province
Vitamin A composition of normal diet menus planned in public Hospitals in
Gauteng Province
Six hospitals’ menus were below, and 2 were above the RDI of 400 μg for
Vitamin A (Figure 7).
Figure 7: Vitamin A composition of normal diet menus planned in public hospitals in Gauteng
province.
Vitamin B6 composition of normal diet menus planned in public hospitals in
Gauteng province
Five hospitals’ menus were below the RDI, and three were above the RDI of 1.3
μg for Vitamin B6 (Figure 8).

254 Jiyana, Ncube and Nesamvuni
Figure 8: Vitamin B6 composition of normal diet menus planned in public hospitals in Gauteng
Discussion
This study analysed the most important nutrients in the planned hospital menu
food items using a descriptive and analytical approach. Of the eight hospitals,
four hospital menus were below, two hospital menus were above while only two
hospital menus met the RDI for energy. Five hospital menus exceeded the RDI
for protein; and three hospital menus were below the RDI for protein. In Gauteng
province, the RDI for carbohydrate RDI in planned menu was met by only one
hospital, while 1 hospital was above, and six hospitals were lower than the RDI
required for carbohydrates. Three planned menus were below the RDI, while
four were higher, and only one menu met the RDI for fat. All the planned menus
were below the RDI for iron; all the planned menus were below the folate RDI;
two planned menus were higher than the RDI, and lower Vitamin A RDI was
observed in 5 menus; and 2 menus exceeded the Vitamin B6 RDI, while lower
RDI was found in six menus.
Total energy composition of hospital menus
The results showed that most 4-hospital menus were below the RDI for energy.
The results of this study are similar to the results of the study conducted by
Trang et al. (2015), in three hospitals in Canada where 84 standard menus
evaluated. Mean levels of calories, macronutrients and vitamins as well as
minerals provided were calculated and comparisons made with the RDI and the
country’s Food Guide recommendations. Calorie levels ranged from 1281 to
3007 calories, with 45% of menus below 1600 calories. Total energy is the sum
of three energy-yielding nutrients. Meals with insufficient total energy have
shown to increase significantly the onset of malnutrition. Excessive total energy
in provided meals may expose patients to emerging obesity risk, diabetes

Nutrient composition of planned adult patients’ normal diet menus 255
mellitus, hypertension and other chronic diseases, with excessive energy intake
listed as a possible cause (Whitney, DeBruyne, Pinna & Rolfes, 2012). Over-
nutrition stemming from consumption of energy-dense food, coupled with a lack
of physical activity results in obesity (Rolfes, Pinna & Whitney, 2015). Over
time, repeated energy shortages could lead to malnutrition that could have been
avoided by providing nutritionally adequate meals (Viganó, Silva, Cremonezi,
Vannucchi & Campanelli, 2011).
Protein composition of hospital menus
A study conducted by Pietersen, Charlton, Du Toit and Sibeko (2002) in 22
crèches in Cape Town showed similar findings. In 86.4% of the meals sampled,
one-third of the RDA for protein for 1 - 3-year-olds and 68.2% for 4 - 6-year-
olds met the standard. Low protein levels in patients’ meals have proved to be
inadequate to meet the raised energy and protein needs of hospitalised in-patients
(Nelms, 2011). Since the preparation of hospital meals has the sole purpose of
meeting patients’ nutritional requirements, their composition is crucial when
satisfying patients’ nutritional needs (Ahoya & Situma, 2015). Unfortunately, the
body’s vulnerability to infectious diseases intensifies in the presence of protein
malnutrition, causing diseases such as coronary heart disease, diabetes,
hypertension and anaemia (Nsele, 2014). The increased protein needs of
hospitalised patients due to illness, fever and stress could aggravate nutrient a
deficiency, if a poor diet is followed (Trang et al., 2015). This nutrient deficiency
links to negative clinical outcomes such as delayed wound healing that may
prolong hospital stays and repeated admissions (Tappenden et al., 2013).
Carbohydrate composition of hospital menus
The findings of this study are similar to the findings of the study conducted by
Nhlapo, Lues, Kativu and Groenewald (2015) who sought to identify possible
nutritional benefits/deficiencies of food item served in the South African
National School Nutrition Programme in the Free State province (South Africa).
Representative meal samples were collected from randomly selected schools and
the nutrient content of each meal was determined. The results were measured
against nutrient-based standards for an average school lunch for persons aged 7–
10 and 11–18 years. The meals did not meet the nutrient standards for
carbohydrate and energy content for either age group. The low-carbohydrate
content could suffocate body cells and deprive them of glucose needed to
provide energy. On the other hand, excessive consumption could be serious,
initiating obesity and cardiovascular diseases, especially in a sedentary lifestyle
as in-patients are almost bed-ridden (Rolfes et al., 2015). The inconsistences in
carbohydrate content result from poorly planned menus. Among other factors,
deviation of served meals from the properly planned menu, and poor portion

256 Jiyana, Ncube and Nesamvuni
control contributed to the inadequate nutrient intake in the study conducted by
Viganó et al. (2011).
Consumption of non-starchy dietary carbohydrate from high fruit and vegetable
intake has been shown to be related to decreased weight gain in adults, therefore
promoting their high consumption should be an integral part of broader policies
and strategies for improved health- and disease prevention campaigns undertaken
nationally (Naude, 2013). High carbohydrate foods, especially in a non-starch
high-fibre diet, is ideal because fibre offers bulk to the diet and provides a
feeling of fullness to people with poor appetite while preventing frequent food
intake for patients requiring a healthy calorie-restricted diet (Jewell & White,
2011).
Fat composition of hospital menus
Provision of excessive amounts of fat in served meals contributes to over-
nutrition and increased risks of health complications. These include diabetes,
high blood cholesterol levels and a negative impact on cardiovascular diseases
thereby aggravating cancer progression, as well as obesity, kidney failure,
osteoarthritis, back pain and hypertension (Vorster, Badham & Venter, 2013).
Cancer which is frequently a result of ingesting saturated fat from animal
products has become the fourth highest cause of death and accounts for about
8.00% of reported deaths in South Africa (Naude, 2013). In this study, high fat
content arose from a restricted budget that led to the procurement of poor quality
meat with a high percentage of fat as opposed to meat tissue. In some cases, low-
grade meat or a limited portion of such dishes could be used to replace a portion
of good quality meat and fish once or twice in a week. These substitutions could
result in energy-dense meals that are not ideal for patients in general wards
requiring normal diet meals.
Iron composition of hospital menus
Similarly, a study conducted by Pietersen et al. (2002) in 22 crèches in Cape
Town on nutrient content assessment of meals revealed that none of the meals
provided met one-third of the age-related Recommended Dietary Allowance
(RDA) for iron. In a study conducted by Nhlapo et al. (2015) it was revealed that
10% of served meals met the standards for calcium and zinc, while children of
7–10 years met 80% of iron standards and 30% being by those 11–18 years old.
With inadequate iron content in planned menus, the iron stored in the body
decreases and the cells fail to carry sufficient oxygen from the lungs to the body
tissues. This could lead to anaemia, impaired immunity and unregulated body
temperature (Rolfes et al., 2015). Where there is sufficient iron concentration
intake, with inadequate consumption of carbohydrate sugar, legumes and meat,
absorption of iron into the body becomes ineffective (Whitney et al., 2012).

Nutrient composition of planned adult patients’ normal diet menus 257
Furthermore, inflammation because of being obese also hinders iron absorption
in the body resulting in further micronutrient malnutrition (Troesch, Biesalski,
Bos, Buskens, Calder, Saris, Spieldenner, Verkade, Weber & Eggersdorfer,
2015).
Folate composition of hospital menus
A lack of adequate folate composition in planned hospital menus increases the
risk of pancreatic cancer, and can lead to anaemia and heart disease as the
deficiencies cause an accumulation of amino acid, homocysteine that promotes
blood clotting and lacerations in the hardened arteries (Rolfes et al., 2015). Low
provision of folate in served meals could be an effect of non-existence of
standardised recipes for meals compatible with correctly planned menus.
Vitamin A composition of hospital menus
A lack of Vitamin A in planned menus increases the incidence of cancer of the
trachea, bronchi, lung, oesophagus and prostate in males, while in females, a
significant increase in the cancer of the cervix, breast and lung has been noted
(Naude, 2013). The insufficient intake of Vitamin A in hospitalised patients is a
serious health threat as their immunity becomes compromised and susceptibility
to infections rises, increasing the risk of diarrhoea as the Vitamin A deficiency
fails to uphold the stability of the respiratory and gastrointestinal tracts (Correia
et al., 2016).
Limitations of the study
Hospital menus were not planned according to age and gender. It was observed
that a generic menu that had been initially designed for adults was served to
children. This analysis was based on the generic menus that were used in
different hospitals. Nutrient analyses of standardised recipes could not be
performed, because there were no standardised recipes in use in some hospitals
Therefore, only planned menu food items could be analysed for nutrient
composition, and only the normal diet menus were analysed that excluded those
used in disease-specific wards.
Conclusion
Hospital menus are blueprints to ensure successful meal provision as a key to
meet nutritional goals in hospitals. To achieve optimal nutrition for all clients in
health establishments, foodservice unit efforts to plan and provide nutritionally
adequate menus to diverse hospitalised patients’ groups need to be co-ordinated
to reduce the risk of chronic diseases and to maximise recovery levels. Ideally,

258 Jiyana, Ncube and Nesamvuni
well-planned menus are aimed at delivering a range of balanced diet menus with
all the required nutrients and with the appropriate amount of energy.
Health Policy Implications and Recommendations
Poorly planned menus reflect either the non-existence or non-implementation of
hospital foodservice provision policies, guidelines and standards, non-existence
of a monitoring system, dieticians/foodservice managers’ unavailability or
incompetence. It is imperative that government health officials, especially at
provincial and district level, work closely with clinical dieticians and foodservice
managers to ensure adherence to the diverse menus with recommended food
items, foodservice operations and established in-patients’ meal standards.
Collaboration with personnel responsible for menu and meal planning, food
procurement, preparation and serving should guarantee accurate adherence to the
DRI and in cases of menu changes, practicality, maintainability and acceptance
by patients.
The following recommendations are proffered for future studies:
x On-going analysis of planned hospital menus and served meals in different in-
patients’ wards should be done to ensure adequate nutritional provision of
meals that meet in-patients’ needs.
x Periodic analysis of the nutrient-controlled hospital-planned menus and
served meals in different in-patients’ wards should be done to ascertain that
adequate nutritional meals are provided which meet in-patients’ RDI needs.
x Future research should analyse the nutrient contents of served meals through
laboratory testing to evaluate the extent to which cooking methods of various
food items could guarantee healthy nutrient retention.
Acknowledgements
The authors’ sincere gratitude is extended to the NRF for financial assistance and
the Department of Hospitality Studies for their unwavering support.
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