Menu changes and their effects on the nutritional content of menus and nutritional status of elderly, hospitalized, mental health patients

As part of the competitive tendering process for a National Health Service catering contract in a UK psychiatric hospital, new menus were devised. The theoretical nutritional content of the pre- and post-tender menus was assessed, and the nutritional status of elderly, mental health patients determined before and after the introduction of the new menus. Results indicated that the pre-tender menu did not provide recommended intakes for vitamin D, and that theoretical intakes of sodium exceeded recommendations by 100%. Fat comprised 47% of total energy and carbohydrate 36% of energy. Total energy intakes were theoretically above the estimated average requirement, despite the wasted appearance of some patients. Clinical assessments of patients' nutritional status showed notable proportions of patients with low levels of serum folate, serum vitamin D and plasma vitamin C, evidence of low body weights and depleted protein stores. The new menus supplied less energy overall, owing to a reduction in fat content. Intakes of vitamin D and folate theoretically increased, although vitamin D intakes still failed to meet recommendations. The proportion of fat as total energy fell to 34%, and the proportion of carbohydrate rose to 47%. The increase in carbohydrate was the result of an increased starch content. After 1 year consuming the new menu, the fat stores of the elderly mental health patients fell (probably as a result of the decreased energy intake). In addition, levels of serum and red cell folate, and vitamin D fell. Whilst acknowledging that nutritional status is affected by many factors this study shows the importance of considering all aspects of the diet, and all causes of nutritional losses when devising new menus to attempt to counter nutritional deficiencies.