Hospital diet planning

Food and diet

17/12/2012
Liliana Fernandez Rivero
Vicente Ruiz Cordero
table of Contents

Introduction ..........................................................................................................................3
Diet concept and general aspects.............................................................................................3
Hospital diet concept................................................................................................................4
Hospital diet planning............................................................................................................5
Preparation phases...................................................................................................................5
Specific objectives....................................................................................................................5
The diet manual...........................................................................................................................6
Concept....................................................................................................................................6
Aim...........................................................................................................................................6
Conditioning ............................................................................................................................7
General structure and development........................................................................................7
Basic clothing diagram..............................................................................................................7
Clinical application. Types of diets..............................................................................................9
basal diet..................................................................................................................................9
Progressive diets.....................................................................................................................10
Bibliography ..............................................................................................................................12

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INTRODUCTION
Diet concept and general aspects

To talk about a hospital diet, we must first start from the concept of “diet” and know its
characteristics.
Etymologically the word "diet" comes from the Greek dayta , which means 'regimen of
life'. Diet can be defined as the combination of foods that a person eats daily. This aims to
provide sufficient nutrients and energy to maintain an individual's health.
It presents a percentage distribution of macronutrients as follows:
50-55% carbohydrates
30-35% fat (15-20% monounsaturated)
10-15% protein

This concept has been given various meanings, such as a lifestyle, a set of foods we
eat, or even seen colloquially as diet deprivation. But you have to understand that it is a
lifestyle, and it should not be pigeonholed exclusively as a weight loss regimen. It is,
furthermore, a tool that can be applied to both healthy and sick people, on individuals or
groups and that is also part of the therapeutic plan.

When designing diets, a series of general aspects must be considered, which are:
 Physiological and nutritional needs . It must provide enough energy and must be a
complete diet, that is, it must contain all the nutrients. In addition, it must be a
balanced diet, that is, the nutrients are in adequate proportions.
 Eating habits (eating habits and culture, meal patterns, preferences and aversions,
times of different meals,...).
 Other data related to lifestyle (physical exercise, alcohol, tobacco..., economic,
cultural, religious, or other factors that may condition the diet),
 Other personal or community characteristics (objectives of the center, human,
material and economic resources), from these last three points it is deduced that the
diet must be appropriate to the objective intended with the diet, to the health of the
people and to the habits of the individual/collective.

Hospital diet concept

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Hospital nutrition can be artificial feeding, either enteral or parenteral nutrition, or oral
feeding with natural foods.
The hospital diet refers to oral feeding with foods/nutrients appropriate to the
patients' needs at all times.
The hospital diet has several purposes:
Therapeutics : as part of the treatment plan for certain diseases.
Preventive : a balanced and correct diet to prevent the development of some
pathologies.
Educational : It is important for any patient, hospitalized or not, to follow
appropriate dietary guidelines. Healthcare personnel should try to instill in patients
and families that following their diet is a habit.

A multidisciplinary team made up of a dietitian, a food service-kitchen manager and a

management manager will be in charge of hospital food programming.
Thus, the nutritionist will consider whether the patient's intake satisfies his or
her nutritional requirements, and will be in charge of studying and creating the
“dietary guideline.”
The person in charge of the food-kitchen service will prepare the templates to
later prepare the menu calendars and, on each daily menu, the planned
diversifications.
The management manager controls the cost of food and other resources of
the center.
And, in turn, the patient will be more interested in aspects such as the impact on their
health, their ability to choose, the satisfaction of their tastes, the presentation and
temperature of the dishes, meal times, etc.

HOSPITAL DIET PLANNING

Preparation phases

The phases of preparing a menu calendar are prepared when a Nutrition Service is started or
when some modification is going to be made to the already established one. These steps

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constitute the basic work carried out by the dietician for each collective dining room, and can
also be applied in hospital diet planning.

 Collection of data on physiological and nutritional needs, dietary history and lifestyle.
 Consideration of these data when making nutritional recommendations for the healthy
population with these characteristics, nutritional objectives and dietary guidelines.
 Establishment of an appropriate dietary formula: energy content and macronutrients.
 Distribution of the total caloric value (VCT), in each of the intakes and according to
schedules.
 Basic structure of the daily menu, meal pattern by food groups.
 Development of the daily meal pattern in a “template” appropriate to each case.
 Menu preparation (weekly calendar, monthly biweekly)
 Diet evaluation: ensure its nutritional adequacy (the amounts of each food contained
in the food ingested in each meal are computed. These quantities will be compared
with food composition tables), and patient satisfaction (questionnaires and kitchen
waste control).
 Presentation of the dietary plan: in schools, it is increasingly common to give the family
the monthly meal plan; It also occurs in primary care, where there is also personalized
dietary advice.

Specific objectives

Hospital diet planning has its own objectives:

1. Nutritional adequacy: provide patients with qualified food and nutritional care that
contributes to their healing while, where possible, maintaining or improving their
nutritional status. If it is not done correctly, it may lead to malnutrition of the patient
or slowness in the expected improvement.
2. Patient satisfaction: create harmonious diets that do not have deficiencies in certain
nutrients, or low levels of acceptance, etc.

In summary: Hospital dietary planning is always a delicate, complex and unique task.
Failure to meet these objectives results in malnutrition of patients. Poor nutrition
refers to vitamin, protein or calorie deficiency.

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THE DIET MANUAL
Concept

We can define the diet manual as the compendium of dietary treatments or diets that are
established in a hospital, and that are presented in a written and structured manner according
to a planned plan. In this way, it allows the necessary information to be provided so that
nutritional needs are understood and can be followed easily and effectively.
In this sense, we must not forget to mention that one of its most important
characteristics is that this compendium can be made as appropriate to the planning and
general interests of each center.
Along with this, although a few years ago it was common to present it in written form,
currently computing can make access to information possible in a much more comfortable
way.

Aim
The diet manual aims to:
 Provide physicians and dieticians with the information to be able to use a meal plan
correctly, as well as ensure correct supervision for the nursing service.
 Provide the kitchen service with the forecasts for the accurate preparation of each of
the daily dishes.
 Provide the professionals involved with a very appropriate nutritional education tool,
with which to advise diets after leaving the hospital.

Conditioning
General hospital data: The clinical activity (general or surgical hospital), the total
number of beds and the average occupancy, the type of patients, etc. would be included here.
Organizational aspects: Situation of the kitchen service in the center's organizational
chart and relationship with other services.
Personal: Staff involved in dietary work, professional qualification of the food service,
work organization (schedules and shifts of activity).

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General structure and development

The project will be carried out by a team made up of those responsible for the UNCYD, who
will hold meetings and prior consultations with each of the services involved in the diagnosis
and dietary prescription of the different diseases, in order to reach a consensus on the diets
that will be added. In this sense, it is important that there is a great variety, so that each
patient has the possibility of receiving the diet they need according to their pathological
characteristics and eating habits.
Once the design has been made, it will be studied with the hospital's Management,
which will provide the economic planning data and decide its implementation.
Subsequently, each of the diets will be developed and its coding will be reviewed (we
will illustrate this with an example in the following section) so that it is understood and used
correctly.

Basic clothing diagram

It is necessary to include the following material in the diet manual:

The number and type of diets that it must contain. The trend is for there to be a large
number of diets, so that each patient receives the diet they need according to their
pathological characteristics.
The nutritional information and suitability of each diet, and that there is a common
system for all of them.
Diet name and code
Introduction
Goals
Indications
Features: Developed dietary formula
Template. Orientative menu. Menu calendar
Nutritional assessment and global judgment of the
diet

 Diet name and code . It must clearly and concisely express its nutritional specificity.
Regarding the code, an alphanumeric coding may be used following the mnemonic
rules based on the type of diet being applied.

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 Example: HP40 for the low protein diet of 40g of protein, or HP40SS for the low protein
diet of 40g of protein without salt.
 Introduction . It will include the general idea of each diet, with a brief
pathophysiological explanation of the situations in which it can be prescribed.
 Goals . The goals to be achieved in the short and medium term will be formulated, in
accordance with expectations.
 Indications . The pathologies in which the diet is applied will be listed, it being
necessary to specify the maximum duration of monitoring and possible
contraindications in case of pathologies already indicated.
 Characteristics
Dietary formula: Group the appropriate nutritional data in each case. It will
include the total caloric value (VCT) in Kcal, the distribution of the immediate principles
as % of the VCT, as well as the total amount of micronutrients (vitamins, minerals,
water). Other data (fiber, cholesterol, purines/uric acid...etc.) should also be added
when necessary.
Distribution: Indicates its fractionation into doses throughout the day.
Culinary aspects: Technology characteristics, seasoning that are recommended
to improve presentation and palatability.
Guidance menu: It is very useful at the time of hospital discharge, when it is
necessary to show the patient how to follow their eating plan and provide nutritional
education. It can be done by creating a template with the type of food and frequency
of consumption, or directly creating the menu specified by day.

The classification of diets. In the beginning, the classification was more based on the
medical diagnosis, currently the trend is to do it based on the nutritional values that have to be
modified.

CLINICAL APPLICATION. TYPES OF DIETS

The diets are grouped into the following categories:
 Basal diets: for adults and pediatrics
 Therapeutic diets
 Diets with ordinary modifications: these are diets without specific restrictions, where
the only thing that is modified is the texture of the food to facilitate chewing and
swallowing.

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Below we will proceed to explain two common dietary sheets in a hospital center, such as the
basal diet, and an example of a therapeutic diet that is used to recover from the normal diet
after a prolonged fast (progressive diet).
basal diet

Introduction :
It is the diet that has the greatest specific weight in hospitals (approximately 50% of
diets distributed in a hospital are of this type). Also called the normal diet, zero diet or free
diet, it is aimed at a healthy adult with a light activity level (typical of a hospitalized patient).
Goals :
 Use nutrition as a preventive tool against the main chronic diseases, which are related
to the individual's eating pattern.
 Cover the energy and nutrient requirements of the hospitalized patient.
 Correct possible dietary errors, using the basal diet as an educational instrument for a
healthy and balanced style.
Indications :
 Useful in those cases where it is not necessary to make any qualitative or quantitative
modification regarding a healthy and balanced diet.
BREAKFAST MEAL SNACK DINNER
MONDAY Kiwi, semi- Knuckles with Semi-skimmed Chard, grilled
skimmed milk spinach, grilled milk (with coffee chicken breast
(with coffee or hake with or cocoa), sugar, with salad, egg
cocoa), sugar, lemon, Golden white plan, and flan and white
white bread, apple and white margarine and bread
margarine and bread. jam
jam.

Progressive diets
They include all the dietary plans prescribed throughout the recovery of digestive functions
after a surgical intervention, as well as for the preparation of a diagnostic test. It is important
to know that it is not necessary to always maintain each of these diets for a specific time, and
the next step can be instituted within 24 hours, all depending on the patient's situation. Next
we will see what these diets are:

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 1. LIQUID DIET. It constitutes the first phase, being carried out in the majority of cases in
the hospital setting and under control.
Objectives : Restart oral feeding after a period of fasting, testing digestive tolerance,
contributing to the maintenance of water balance and reducing stimulation of the
gastrointestinal tract.
Indications : Preparation for digestive, preoperative and postoperative tests,
resumption of oral feeding after functional alterations...etc.
BREAKFAST Infusion. Sugar
MIDMORNING Peach juice
MEAL Defatted broth. Apple juice
SNACK Infusion. Sugar.
DINNER Defatted broth. Fruit juice
*Seeing this, it can be deduced that it is a nutritionally incomplete diet, in which liquid foods
that stimulate peristalsis (milk) or damage the mucosa (citrus fruit juices) are avoided.

2. SEMILIQUID DIET: In addition to liquids, it includes foods with a more compact texture,
such as purees or creams, although it still does not cover the patient's energy and
nutritional needs.
Objectives : Continue testing the digestive response and maintain hydroelectric
balance. The stimulation of the gastrointestinal tract is controlled and serves as a light
start to chewing and bolus formation.
Indications : Preparation for digestive tests and intermediate step between liquid and
semi-soft diet.

BREAKFAST MIDMORNING MEAL SNACK DINNER

Semi-skimmed Peach juice Mashed green Semi-skimmed Carrot cream,
milk*, infusion, beans, grape milk, infusion, pear compote,
sugar, toast*, juice, yogurt. sugar, cookies* egg plan.
jam
* Milk is introduced for the first time in the progression. Cereals also appear for the first time in
the form of toast or cookies (pasta is allowed depending on the day).

3. SEMI-SOFT DIET: Second courses are introduced in the progression, so that energy and
nutritional needs are covered for the first time.

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 Objectives : Control the evolution of the stimulation of the gastrointestinal tract,
encourage chewing and bolus formation, test individual tolerance to meat protein and
cover energy and nutritional requirements.
Indications : Intermediate step between semi-liquid and soft diet for the beginning of a
complete diet towards a normal diet.
BREAKFAST MEAL SNACK DINNER
Peach juice, Knuckles with Semi-skimmed Carrot cream, French omelette,
semi-skimmed ham, grilled milk, sugar, pear compote and white bread
milk, sugar, hake with green Maria cookies
toast and jam. beans, yogurt
and white
bread.
* Fruit juice becomes part of breakfast (a more basal pattern), the incorporation of first courses
of the basal diet is valued (modifying their ingredients and preparation), second courses are
respected (although with garnishes composed of foods that are not aggressive).

4. SOFT DIET: This is the last phase before reaching normal nutrition, and covers the
patient's nutritional requirements, with a good distribution of the immediate
principles.
Objectives : Avoid stronger foods, as a prior step to the basal diet. Cover the energy
and nutrient requirements of hospitalized patients.
Indications : Step prior to the basal diet using a soft diet template.
BREAKFAST MEAL SNACK DINNER
Peach juice, sugar, Knuckles with Semi-skimmed milk, Swiss chard, tuna
white bread, spinach, beef fillet coffee/cocoa sugar, omelette with salad,
coffee/cocoa, with beans, yogurt, cookies pear, white bread
margarine, jam white bread
*In breakfasts there is the possibility of including coffee or cocoa. In the first dishes, the mildest
recipes of the basal diet appear without modifications. The second dish will be similar to that of
the basal diet, excluding tomato or French fries as a garnish.

BIBLIOGRAPHY

Sanz ML. The evolution of the hospital diet. Ars Medica. Journal of Humanities 2004; 1:45-56

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Hernández AM, Anchía IA, Hornillos MM; et al. Hospital nutrition: Fundamentals. Diaz de
Santos; 2004

Zapatel MC, from the Heras de la Hera AR. Hospital nutrition: Hospital diets. Diaz de Santos;
2004

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