Quality of diet received by the patient.

All those concerned with the welfare of patients in hospital would agree that a nutritionally adequate diet is a basic requirement for the well-being of the patient and to aid recovery. Indeed, hospitals aim to provide all the food necessary and do not require the patient to contribute towards his diet. Any foods consumed by the patient from his own private supplies are regarded as extras and luxuries but not essential for his over-all nourishment. The potential nutritional value of hospital diets depends upon the amount and types of foods included in the menu and upon the way in which the food is prepared, cooked and served. The actual nutritional value of the diet will ultimately depend upon how much the patient eats, which in turn will be a reflection of food preferences, frequency of meals and appetite. Ideally, all factors work towards producing appetising and palatable meals attractively served. All too often, however, hospital food leaves much to be desired: food is badly cooked, sloppily and hastily served and does little to stimulate the patients often already jaded appetites. This has led to disquiet being voiced on the standards of hospital feeding in this country and the most comprehensive account resulted from the Nuffield Provincial Hospitals Trust survey in which the dietary practices of 152 hospitals in England and Wales were investigated (Platt, Eddy & Pellet, 1963). There are also recent reports of malnutrition amongst hospital patients in other countries (Leevy, Cardi, Frank, Gellere & Baker, 1965; Bollet & Owens, 1973; Butterworth, 1974; Anderson, Iskasson & Warnold, 1977). These reports have largely used biochemical parameters as determinants of nutritional status and not food intake. In this paper, however, I shall concentrate on the food intakes of patients both on normal hospital diets and on special therapeutic diets. Dietary surveys, like biochemical measurements, are, of course, only one aspect of the evaluation of nutritional status and cannot be used in isolation to diagnose the presence of malnutrition. Nevertheless, they can yield much useful information as to where the weaknesses are in the chain of people involved in the provision of food for the patient i.e. at which points bad feeding practices arise due to human or technical error, and how the nutritional status of patients can best be improved if necessary. I propose to examine the hospital diet firstly from the point of view of the quality of the diet as delivered to the ward including losses of nutrients during cooking, and secondly to look in more detail at levels of food intake in patients.