Trend to better nutrition on Australian hospital menus 1986-2001 and the impact of cook-chill food service systems.

OBJECTIVE To assess trends in the nutritional quality of hospital menus and examine differences between menus used in hospitals with cook-chill or cook-fresh food services. DESIGN Standard patient menus were analysed against 28 criteria to assess nutritional standards and compared with results from similar studies in 1986 and 1993. SETTING Menus were collected from 80 hospitals in New South Wales (NSW), Australia, including 36 using cook-chill food service systems. STATISTICAL ANALYSIS Chi-squared analysis was used to assess differences between the proportions of hospitals meeting the criteria in 1993 and 2001, and between different types of hospitals. RESULTS In 2001, compared with 1993, significantly many hospitals offered more than one hot choice at the evening meal, more menus highlighted low fat items and more calcium-rich foods were available. More than 90% of hospitals allowed patients to select their own menu, offered wholemeal breads and high-fibre breakfast cereals, fresh fruit, polyunsaturated margarine, a milk dessert at least once a day and two or more hot options at the midday meal. Hospitals with cook-chill food services had menus that were more likely to meet nutritional recommendations, although they were less likely to offer a choice of serving size. A high proportion of unpopular choices were offered in menus, especially meat dishes and desserts. APPLICATIONS/CONCLUSION Since 1986, NSW hospital menus have improved to offer choices that conform better to dietary guidelines. Cook-chill food services may have positive and negative impacts on meal choices. The assessment criteria are useful in hospitals to assess their menus.