Review| Volume 133, ISSUE 1, P19-25, January 2020

Successful Implementation of Healthful Nutrition Initiatives into Hospitals

Published:September 05, 2019DOI:


      Poor dietary quality is a leading contributor to mortality in the United States, and to most cardiovascular risk factors. By providing education on lifestyle changes and, specifically, dietary changes, hospitals have the opportunity to use the patient experience as a “teachable moment.” The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.


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        • Dalen JE
        • Alpert JS
        • Goldberg RJ
        • Weinstein RS
        The epidemic of the 20(th) century: coronary heart disease.
        Am J Med. 2014; 127: 807-812
        • Benjamin EJ
        • Muntner P
        • Alonso A
        • et al.
        Heart disease and stroke statistics-2019 update: a report from the american heart association.
        Circulation. 2019; 139: e56-e528
        • Micha R
        • Penalvo JL
        • Cudhea F
        • Imamura F
        • Rehm CD
        • Mozaffarian D
        Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States.
        JAMA. 2017; 317: 912-924
      1. National Institute of Diabetes and Digestive and Kidney Diseases. Overweight & obesity statistics. August 2017. Available at: Accessed July 13, 2019.

        • Whelton PK
        • Carey RM
        • Aronow WS
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.
        Hypertension. 2018; 71: 1269-1324
        • Wang F
        • Zheng J
        • Yang B
        • Jiang J
        • Fu Y
        • Li D
        Effects of vegetarian diets on blood lipids: a systematic review and meta-analysis of randomized controlled trials.
        J Am Heart Assoc. 2015; 4e002408
        • Barnard ND
        • Levin SM
        • Yokoyama Y
        A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets.
        J Acad Nutr Diet. 2015; 115: 954-969
        • Yokoyama Y
        • Nishimura K
        • Barnard ND
        • et al.
        Vegetarian diets and blood pressure: a meta-analysis.
        JAMA Intern Med. 2014; 174: 577-587
        • Yokoyama Y
        • Barnard ND
        • Levin SM
        • Watanabe M
        Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis.
        Cardiovasc Diagn Ther. 2014; 4: 373-382
        • Ornish D
        • Scherwitz LW
        • Billings JH
        • et al.
        Intensive lifestyle changes for reversal of coronary heart disease.
        JAMA. 1998; 280: 2001-2007
        • Sacks FM
        • Svetkey LP
        • Vollmer WM
        • et al.
        Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (dash) diet. DASH-sodium collaborative research group.
        N Engl J Med. 2001; 344: 3-10
        • Martinez-Gonzalez MA
        • Sanchez-Tainta A
        • Corella D
        • et al.
        A provegetarian food pattern and reduction in total mortality in the prevencion con dieta mediterranea (PREDIMED) study.
        Am J Clin Nutr. 2014; 100: 320s-328s
        • Estruch R
        • Ros E
        • Salas-Salvadó J
        • et al.
        Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts.
        N Engl J Med. 2018; 378: e34
        • Eckel RH
        • Jakicic JM
        • Ard JD
        • et al.
        2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk.
        Circulation. 2014; 129: S76-S99
      2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th ed.December 2015. Available at: Accessed July 22, 2019.

        • Arnett DK
        • Blumenthal RS
        • Albert MA
        • et al.
        2019 ACC/AHA guideline on the primary prevention of cardiovascular disease [e-pub ahead of print].
        Circulation. 2019 Mar 17; (CIR.0000000000000678)
        • Mokdad AH
        • Ballestros K
        • et al.
        • The US Burden of Disease Collaborators
        The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states.
        JAMA. 2018; 319: 1444-1472
        • Gritz ER
        • Fingeret MC
        • Vidrine DJ
        • Lazev AB
        • Mehta NV
        • Reece GP
        Successes and failures of the teachable moment: smoking cessation in cancer patients.
        Cancer. 2006; 106: 17-27
        • Cole TK
        Smoking cessation in the hospitalized patient using the transtheoretical model of behavior change.
        Heart Lung. 2001; 30: 148-158
        • Taylor CB
        • Houston-Miller N
        • Killen JD
        • DeBusk RF
        Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention.
        Ann Intern Med. 1990; 113: 118-123
        • Boudreaux ED
        • Bock B
        • O'Hea E
        When an event sparks behavior change: an introduction to the sentinel event method of dynamic model building and its application to emergency medicine.
        Acad Emerg Med. 2012; 19: 329-335
        • Steca P
        • Monzani D
        • Greco A
        • et al.
        Stability and change of lifestyle profiles in cardiovascular patients after their first acute coronary event.
        PLoS One. 2017; 12 (e0183905-e0183905)
      3. Centers for Medicare & Medicaid Services. Hospital readmissions reduction program (HRRP). July 2019. Available at: Accessed July 16, 2019.

      4. Hospital Compare. 30-day unplanned readmission and death measures. Available at: Accessed July 13, 2019.

        • Lara KM
        • Levitan EB
        • Gutierrez OM
        • et al.
        Dietary patterns and incident heart failure in U.S. adults without known coronary disease.
        J Am Coll Cardiol. 2019; 73: 2036-2045
      5. FoodService Director. 2012 hospital census report. July 2012. Available at: Accessed July 22, 2019.

        • Moran A
        • Lederer A
        • Johnson Curtis C
        Use of nutrition standards to improve nutritional quality of hospital patient meals: findings from New York City's healthy hospital food initiative.
        J Acad Nutr Diet. 2015; 115: 1847-1854
        • Lesser LI
        • Lucan SC
        The ethics of hospital cafeteria food.
        Virtual Mentor. 2013; 15: 299-305
        • DeLuco D
        • Cremer M
        Consumers' perceptions of hospital food and dietary services.
        J Am Diet Assoc. 1990; 90: 1711-1715
        • Winston CP
        • Sallis JF
        • Swartz MD
        • Hoelscher DM
        • Peskin MF
        Consumer nutrition environments of hospitals: an exploratory analysis using the hospital nutrition environment scan for cafeterias, vending machines, and gift shops, 2012.
        Prev Chronic Dis. 2013; 10: E110
        • Champ CE
        • Iarrobino NA
        • Haskins CP
        Data of unhealthy food availability in hospitals.
        Data Brief. 2018; 21: 1738-1744
        • Joint Commission
        2012 Hospital Accreditation Standards.
        Joint Commission Resources, Inc., Oak Brook, IL2012
      6. Academy of Nutrition and Dietetics. Adult nutrition care manual. Available at: Accessed June 16, 2018.

      7. Centers for Disease Control and Prevention (CDC). Diabetes and carbohydrates. January 2019. Available at: Accessed July 13, 2019.

        • Sandhu BS
        • Sanyal AJ
        Management of ascites in cirrhosis.
        Clin Liver Dis. 2005; 9 (viii): 715-732
      8. Academy of Nutrition & Dietetics. HTN: sodium. Available at: Accessed July 13, 2019.

        • Butrum RR
        • Clifford CK
        • Lanza E
        NCI dietary guidelines: rationale.
        Am J Clin Nutr. 1988; 48: 888-895
        • Rai EM
        • Hartley GH
        An evaluation of renal inpatient meals against renal nutrition group standards.
        J Hum Nutr Diet. 2006; 19: 369-374
        • Arcand J
        • Steckham K
        • Tzianetas R
        • L'Abbe MR
        • Newton GE
        Evaluation of sodium levels in hospital patient menus.
        Arch Intern Med. 2012; 172: 1261-1262
      9. Partnership for a Healthier America. Hospital healthier food initiative. Available at: Accessed July 13, 2019.

      10. Americal Medical Association. Healthy food options in hospitals H-150.949. 2018. Available at: Accessed July 13, 2019.