Hospital meals overdo it on salt

NEW YORK Wed Jul 18, 2012 7:44pm BST

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NEW YORK (Reuters Health) - Hospital food often contains much more sodium than dietary guidelines recommend, a new study from Canada suggests.

Researchers found that almost four in five patients not on a sodium-restricted diet ordered hospital meals that exceeded the Institute of Medicine's maximum recommendation of 2,300 milligrams of salt per day. And almost half of all patients who were supposed to be watching their salt intake were served food with sodium levels above their prescribed limit.

"Hospitals are now using more prepared and outsourced meals on their menu, which tend to be higher in sodium," said JoAnne Arcand, a nutrition researcher from the University of Toronto, who led the new study.

Still, Arcand said she and her colleagues were surprised by just how much sodium was in hospital food.

In the survey of over 2,000 patient orders at three acute care hospitals in Ontario, people without any salt-related dietary restrictions or diabetes requested meals containing an average of 3,033 milligrams of sodium per day, according to nutrition analyses.

In diabetic patients, that number was even higher: 3,600 milligrams for a day's worth of meals and snacks, the research team reported Monday in the Archives of Internal Medicine. People on a 2,000-milligram restricted sodium diet - such as those with heart or kidney failure or liver problems - ordered meals with an average of 2,041 milligrams of sodium per day. Forty-seven percent of them exceeded their salt prescription cut-points.

Patients in the study included those on general medical wards, as well as people in for surgery or heart treatment. The researchers didn't know how much of their food the patients actually ate - so they couldn't be sure whether people surpassed the recommended sodium limits in their diets, or only in what arrived on their trays.

"For those patients who are admitted with conditions that are sensitive to the amount of salt they take in, I do think there's potential for the high sodium in the diets to actually cause harm," said Dr. Kirsten Bibbins-Domingo, from the University of California, San Francisco, who wrote a commentary published with the study.

"The types of nutrients they take in are as important as the medications we're giving them," she told Reuters Health.

"For most other people, I don't think there would be immediate harm. But there is the reality that for most patients in the hospital, they don't have the choice to go out and get something else."

Arcand said if hospitalized patients or their family members are concerned about the amount of sodium in hospital food, they should talk with their doctor or dietician. Dinner entrees and sandwiches tended to be especially high in salt, she added.

Even if a few days on a high-salt diet wouldn't harm most patients, Bibbins-Domingo said it's important for hospitals to be "modeling the best behaviors" when it comes to eating.

"Right now there is renewed awareness on the part of hospitals that we should be concerned that the food we serve our patients should reflect our own values and priorities in terms of overall healthy diets," she said.

One solution would be to make all hospital food low-sodium and then allow patients on a non-restricted diet to add their own extra table salt, according to Bibbins-Domingo.

Arcand suggested governments could develop guidelines for food procurement as part of a larger sodium-reduction strategy - which hospitals would then use when they sign contracts with food suppliers, agreeing to sodium limits.

SOURCE: bit.ly/Q4xOdh Archives of Internal Medicine, online July 16, 2012.

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