Relationship between nutrient profiles, carbon footprint and water footprint of hospital menus

Purpose - This study aims to evaluate the nutrient profile, carbon footprint and water footprint of one-month menus presented in five hospitals in Turkey and compare their environmental impacts with that of the Mediterranean diet.Design/methodology/approach - The energy and nutrient content of menus were compared with recommendations of the Turkey Dietary Guidelines (TUBER) 2022. Nutrient profiles of hospital menus were evaluated using Nutrient Rich Food 9.3 (NRF 9.3) and SAIN-LIM models. The carbon and water footprints of the menus were calculated and compared with those of the Mediterranean diet.Findings - Menus' energy and nutrient content did not conform with TUBER 2022. The SAIN-LIM score of Hospital A (5.7 +/- 1.1) was significantly higher than that of Hospitals C (4.8 +/- 0.7, p = 0.001) and E (5.1 +/- 0.7, p = 0.025). The carbon footprint of Hospital A was significantly lower (2.6 +/- 0.3 kg CO2 eq/person/day) and that of Hospital D (4 +/- 0.9 kg CO2 eq/person/day) was significantly higher than those of others (p < 0.001). While other menus were similar (p > 0.05), the water footprint of Hospital A was significantly lower (3.5 +/- 0.7 L/kg, p < 0.001). In addition, if the menus were suitable for the Mediterranean diet, a reduction of 2.2-23.4% in the carbon footprint and 37.5-58.6% in the water footprint could be achieved. Moreover, menus' carbon and water footprints were negatively correlated with NRF 9.3 and SAIN-LIM scores.Research limitations/implications - The primary aim should be to ensure that the planned menus follow the dietary guidelines. In addition, it is an undeniable fact that sustainable nutrition is a complex process with many dimensions. However, it seems possible to improve the nutrient profiles of the menus and reduce their environmental footprint with minor changes to be made in food services.Practical implications - It seems possible to improve the nutrient profiles of the menus and reduce their environmental footprint with minor changes. For both health and environmental impacts, food services should switch to menus suitable for the Mediterranean diet.Originality/value - The findings provide new insights into hospital menus' quality and environmental impact.