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HomeEditor's PickHospital patients undernourished and underfed – SA study

Hospital patients undernourished and underfed – SA study

More than half of the patients admitted to South Africa’s public hospitals are undernourished – and most of them are the same, if not more undernourished when they are discharged because they are not fed properly.

A BusinessLIVE report says the consequences can mean longer stays, more chance of hospital-acquired malnutrition, and rising mortality risks, say experts, who add that even if a well-nourished minority of patients stay long enough, there’s a good chance they’ll be malnourished when they leave – because not only do they not get enough food, but they’re not being given the appropriate diet, either.

Hospital food served to patients is way below the Health Department “ration scale” and patients’ energy requirements, according to a study of meals served at three Cape Town hospitals.

“Patients would eat more if the food were appropriate: in some cases, meals are not even provided at appropriate times,” said University of the Western Cape dietetics lecturer Marieke Theron. “People who are sick need higher amounts of energy and other nutrients like protein to aid their recovery.”

According to a 2019 study led by Professor Renée Blaauw of the human nutrition division at Stellenbosch University, 54% of patients were undernourished on admission.

Theron alerted the Western Cape Health Department to her findings when the research was published in the South African Journal of Clinical Nutrition towards the end of 2021. “I wanted to give them the opportunity to do something about the situation and I wanted to assist them however I could,” she said.

However, despite a meeting organised several months later, health officials didn’t arrive, the department’s excuse being that this was “due to technical issues with virtual meeting platforms”.

In the meantime, the research may have had at least some impact. “One hospital has started the process of finding a yogurt supplier,” said Theron, possibly in response to her suggestion of regular protein-containing snacks between meals. Any extra costs will probably be offset by savings from shorter hospital stays, fewer complications and improved recovery rates, she added.

She sent final-year student dieticians to weigh and analyse plates of food and leftovers at Cape hospitals with between 945 and 172 beds, where 130 patients filled in questionnaires asking if relatives were bringing them food, what they thought of the hospital food and what their appetites were like.

Meal service quality, staff/service issues and meal size scores ranged between 60% and 100%, but on quality of food, the lowest score was 47% and the highest 88%.

Her paper acknowledges the ration scale, which specifies the raw amounts of food ingredients each patient should receive daily, and says Cape Town hospitals are far short of its guidelines. But the key metric is the energy and protein needs of patients.

Theron calculated the daily energy requirements for the 71 male patients in her study at 8 255kJ-8 970kJ, and for the 57 female patients at 7 104kJ-7 333kJ. But at the central hospital, they were consuming 32% (men) and 29% (women) less.

Protein requirements were 73g-87g for men and 78g-80g for women, but patients at the smallest hospital were eating just over half of what they needed.

There were significant differences in the amounts of energy and protein the hospitals provided and overall, the smallest hospital was bottom of the class: fruit served only once in three days, no protein in one lunch and the lowest scores in every aspect of the patient satisfaction questionnaires.

Theron sent her paper to the provincial Health Department more than a year ago and uploaded it to the national health research database, but spokesperson Mark van der Heever said officials “have not yet had the opportunity to engage the data collected by the researcher, so we are unable to comment”.

Study details

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

Marieke Theron & Siobhan O’Halloran.

Published in SA Journal of Clinical Nutrition on 16 November 2021

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.

This was an exploratory quantitative cross-sectional study.

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).

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.

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.

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.


SAJCN article – Patients in public hospitals received insufficient food to meet daily protein and energy requirements: Cape Town Metropole, South Africa (Open access)


BusinessLIVE article – Why hospital food leaves a bad taste (Open access)


See more from MedicalBrief archives:


Health Dept investigates Durban hospital over ‘maggot infested’ food for quarantine patients


EC Health to take action after pictures of poor hospital food


Medical aids, hospital administrators must help reduce patient malnutrition


Psychiatric patients go hungry and barefoot at Eastern Cape hospital


North West hospital’s patients go vegetarian as money runs out







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