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Identifying feasible ways for cafeteria operators to comply with calorie and sodium nutrition standards in hospitals

Implementing nutrition standards for foods sold in public food service venues such as hospitals is a public health strategy to improve diet quality and prevent chronic diseases for employees and visitors. However, no studies have examined the nutrition quality of foods offered in hospitals implementing Partnership for a Healthier America (PHA) Hospital Healthier Food Imitative (HHFI) nutrition standards. To aid food service venues trying to implement similar requirements, study objectives were to 1) examine the percentage of entrees and sides meeting PHA HHFI calorie and sodium standards and 2) identify the food categories that most often met the standards. We used data on two days (i.e., breakfast, lunch, and dinner) of cafeteria entrée and side offerings from 63 U.S. based hospitals that participated in PHA HHFI during 2012–2013. We calculated 1) percentage of entrees and side dishes that met HHFI calorie and sodium standards both overall and by hospital and food category and 2) rank food entrée and side categories with the highest of percentage of items meeting these requirements. A total of 3,975 entrees and 13,541 sides were identified as reported by cafeteria managers or nutritionists; 85% of entrees and 77% of sides met calorie requirements of <525 kcal and ≤175 kcal, respectively. A total of 56% of entrees and 75% of sides met sodium requirements of <600 mg and ≤200 mg, respectively. For entrees, the range that met the calorie requirements at each hospital was 52%–100% (median=88%) and 22%–86% (median=54%) for sodium. The range of sides that met calorie requirements at each hospital was 42%–93% (median=74%) and 25%–85% (median=75%) for sodium. Food categories with the highest percentage of entrees meeting calorie requirements were dairy protein combinations with fruits or grain (e.g., yogurt cups with granola and fruits), chicken or turkey based entrees, and breakfast omelets; and for sides were fruits, vegetable dishes, and yogurts. The categories with the highest percentage of entrees that did not meet the calorie requirement were pizza and Mexican entrees, and for sides were pancakes/waffles and cookies/pastries. The top three food categories meeting sodium requirements for entrees were hot/cold cereal, fish dishes, and dairy protein combo with fruits or grain; and for sides were fruits, yogurt, frozen dairy items. For sodium, top categories that did not meet the requirements for entrees were pizza, chicken entrée, and soups, and for sides were Asian dishes, stew or soup, and pancake or waffles. These findings can help inform the development of strategies to aid food service venues in understanding the landscape of food offerings and help them successfully implement nutrition standards.