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Efficacy of commercial formulas in comparison with home-made formulas for enteral feeding: A critical review. Med J Islam Repub Iran 2017; 31:55. [PMID: 29445684 PMCID: PMC5804464 DOI: 10.14196/mjiri.31.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Indexed: 01/04/2023] Open
Abstract
Background: In several disease conditions, patients must inevitably be nourished by enteral feeding (EF). Though in many countries,
commercial formulas are routinely used for EF, in Iran still home-made formulas are commonly employed as commercial formulas
are not covered by insurance. This may pose patients to malnutrition and bring about further costs. The aim of this study was to
evaluate the efficacy of EF commercial formulas in comparison with home-made formulas and thus to make further evidence for insurance
policy-making
Methods: Medline, Cochrane, Embass and Center for Review & Dissemination (CRD) as well as IranDoc and SID databases were
searched. Keywords included formula, ICU, and enteral nutrition or tube feeding. No clinical trial study on the efficacy of EF formulas
was found. Therefore, the compositions of available formulas and their cost-effectiveness were evaluated based on the clinical guidelines
of scientific bodies such as American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Parenteral and
Enteral Nutrition (ESPEN) and relative articles available in PubMed. In addition, the expert opinions were also taken into consideration.
Results: Domestic commercial formulas seemed to less merit dietary recommended intakes, i.e. the amount of some nutrients were
much higher, and some others were much lower than the recommended values. The amount of several micronutrients including vitamins
B1, B6, C, D and K, as well as iron, calcium and magnesium were not sufficient to meet the body needs in most commercial
formulas upon receiving 2000 kilocalories and less.
Conclusion: Clinical studies on the efficacy of commercial formulas in comparison with home-made formulas are needed. Meanwhile,
making suitable conditions for increasing the diversity of artificial nutrition products in the market would help clinical nutritionists
to make better choices according to their patients conditions and to reduce the costs, as well.
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Doundoulakis I, Poulia KA, Antza C, Bouras E, Kasapidou E, Klek S, Chourdakis M. Screening for Malnutrition Among People Accessing Health Services at Greek Public Hospitals: Results From an Observational Multicenter Study. JPEN J Parenter Enteral Nutr 2017; 42:709-718. [DOI: 10.1177/0148607117722748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Christina Antza
- Third Department of Internal Medicine, Aristotle University, Papageorgiou Hospital, Thessaloniki, Greece
| | - Emmanouil Bouras
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Kasapidou
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stanislaw Klek
- General and Oncology Surgery Unit, Stanley Dudrick’s Memorial Hospital, Skawina, Poland
| | - Michael Chourdakis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bauer S, Halfens RJ, Lohrmann C. Changes in nutritional status in nursing home residents and associated factors in nutritional status decline: a secondary data analysis. J Adv Nurs 2017; 73:2420-2429. [DOI: 10.1111/jan.13297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Silvia Bauer
- Department of Nursing Science; Medical University of Graz; Austria
| | - Ruud J.G. Halfens
- Department of Health Services Research - Focusing on Value-based Care and Ageing School for Public Health and Primary Care (CAPHRI); Maastricht University; the Netherlands
| | - Christa Lohrmann
- Department of Nursing Science; Medical University of Graz; Austria
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Nutrition Screening Tools and the Prediction of Clinical Outcomes among Chinese Hospitalized Gastrointestinal Disease Patients. PLoS One 2016; 11:e0159436. [PMID: 27490480 PMCID: PMC4973995 DOI: 10.1371/journal.pone.0159436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022] Open
Abstract
Nutrition risk Screening 2002 (NRS-2002) and Subjective Global Assessment (SGA) are widely used screening tools but have not been compared in a Chinese population. We conducted secondary data analysis of a cross-sectional study which included 332 hospitalized gastrointestinal disease patients, collected by the Gastrointestinal department of Peking Union Medical College Hospital (PUMCH) in 2008. Results of NRS-2002 and SGA screening tools, complications, length of stay (LOS), cost, and death were measured. The agreement between the tools was assessed via Kappa (κ) statistics. The performance of NRS-2002 and SGA in predicting LOS and cost was assessed via linear regression. The complications and death prediction of tools was assessed using receiver operating characteristic (ROC) curves. NRS-2002 and SGA identified nutrition risk at 59.0% and 45.2% respectively. Moderate agreement (κ >0.50) between the two tools was found among all age groups except individuals aged ≤ 20, which only slight agreement was found (κ = 0.087). NRS-2002 (R square 0.130) and SGA (R square 0.140) did not perform differently in LOS prediction. The cost prediction of NRS-2002 (R square 0.198) and SGA (R square 0.190) were not significantly different. There was no difference between NRS-2002 (infectious complications: area under ROC (AUROC) = 0.615, death: AUROC = 0.810) and SGA (infectious complications: AUROC = 0.600, death: AUROC = 0.846) in predicting infectious complication and death, but NRS-2002 (0.738) seemed to perform better than SGA (0.552) in predicting non-infectious complications. The risk of malnutrition among patients was high. NRS-2002 and SGA have similar capacity to predict LOS, cost, infectious complications and death, but NRS-2002 performed better in predicting non-infectious complications.
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Tangvik RJ, Tell GS, Guttormsen AB, Eisman JA, Henriksen A, Nilsen RM, Ranhoff AH. Nutritional risk profile in a university hospital population. Clin Nutr 2015; 34:705-11. [PMID: 25159298 DOI: 10.1016/j.clnu.2014.08.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/04/2014] [Accepted: 08/03/2014] [Indexed: 01/04/2023]
Affiliation(s)
- Randi J Tangvik
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science 2, University of Bergen, Bergen, Norway; Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deacon Hospital, Bergen, Norway.
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Anne Berit Guttormsen
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science 1, University of Bergen, Bergen, Norway.
| | - John A Eisman
- Garvan Institute for Medical Research, St Vincent's Hospital, University of Notre Dame and UNSW Australia, Sydney, Australia.
| | - Andreas Henriksen
- Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deacon Hospital, Bergen, Norway.
| | - Roy Miodini Nilsen
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.
| | - Anette Hylen Ranhoff
- Department of Clinical Science 2, University of Bergen, Bergen, Norway; Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deacon Hospital, Bergen, Norway.
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Lim SL, Lin X, Chan YH, Ferguson M, Daniels L. A Pre-post Evaluation of an Ambulatory Nutrition Support Service for Malnourished Patients Post Hospital Discharge: A Pilot Study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n10p507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Malnutrition is common among hospitalised patients, with poor follow up of nutrition support post-discharge. Published studies on the efficacy of ambulatory nutrition support (ANS) for malnourished patients post-discharge are scarce. The aims of this study were to evaluate the rate of dietetics follow-up of malnourished patients post discharge, before (2008) and after (2010) implementation of a new ANS service, and to evaluate nutritional outcomes post-implementation. Materials and Methods: Consecutive samples of 261 (2008) and 163 (2010) adult inpatients referred to dietetics and assessed as malnourished using Subjective Global Assessment (SGA) were enrolled. All subjects received inpatient nutrition intervention and dietetic outpatient clinic follow-up appointments. For the 2010 cohort, ANS was initiated to provide telephone follow-up and home visits for patients who failed to attend the outpatient clinic. Subjective Global Assessment, body weight, quality of life (EQ-5D VAS) and handgrip strength were measured at baseline and five months post-discharge. Paired t-test was used to compare pre- and post-intervention results. Results: In 2008, only 15% of patients returned for follow-up with a dietitian within four months post-discharge. After implementation of ANS in 2010, the follow-up rate was 100%. Mean weight improved from 44.0 ± 8.5 kg to 46.3 ± 9.6 kg, EQ-5D VAS from 61.2 ± 19.8 to 71.6 ± 17.4 and handgrip strength from 15.1 ± 7.1 kg force to 17.5 ± 8.5 kg force; P <0.001 for all. Seventy-four percent of patients improved in SGA score. Conclusion: Ambulatory nutrition support resulted in significant improvements in follow-up rate, nutritional status and quality of life of malnourished patients post-discharge.
Key words: Home visit, Malnutrition, Outcomes, Telephone, 7-point Subjective Global Assessment
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Affiliation(s)
| | | | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University Health System, Singapore
| | | | - Lynne Daniels
- School of Exercise & Nutritional Sciences, Queensland University of Technology, Australia
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8
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Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Grosman B, Frishman S, Salai M, Beloosesky Y. The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clin Nutr 2012; 31:917-21. [DOI: 10.1016/j.clnu.2012.03.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/20/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Scognamiglio U, Salvia A, Paolucci S, Garbagnati F, Caltagirone C, Musicco M. Validity of a questionnaire for the semi-quantitative evaluation of dietary intake of hospitalised patients compared to weighed records. J Hum Nutr Diet 2012; 25:526-33. [PMID: 22906426 DOI: 10.1111/j.1365-277x.2012.01285.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Malnutrition in hospitalised patients is often underestimated. The present study aimed to evaluate the validity of a questionnaire for the semi-quantitative evaluation of food intake compared to weighed records in patients who were hospitalised for the rehabilitation of neurological disorders. METHODS Food intake at breakfast, lunch and dinner was evaluated in 319 in-patients, by weighing the meals and the residuals, and using a semi-quantitative questionnaire, during five consecutive days. The questionnaire represented, for each offered food, the pictures of the nonconsumed quantities. The consumption of each food was determined by weighing foods that were served and the residuals after the meal. As a measure of validity of the questionnaire, the agreement over chance (kappa statistic) between the questionnaire and the weight was calculated. Considering the weight as the gold standard, the sensitivity and specificity of the questionnaire in detecting patients who consumed <50% or 75% of the meals was calculated. RESULTS The agreement between the two measures was satisfactory (κ ≥ 0.70) or almost satisfactory (0.60 < κ < 0.70) for most of the foods, with the exception of fruit and the first course at dinner. The sensitivity and specificity of the questionnaire in detecting consumers of <50% or 75% of the offered foods were always >80%, except for bread and first course, as well as fruit at dinner. CONCLUSIONS The present study shows that this semi-quantitative questionnaire on food consumption reproduces with sufficient precision the measures obtained by weighing. The questionnaire appears also to be a valid and suitable instrument for the identification of patients with poor food intake in a neurorehabilitation hospital.
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Affiliation(s)
- U Scognamiglio
- Centre of Research on Nutrition and Rehabilitation (CeSAR), IRCCS Santa Lucia Foundation, Rome, Italy.
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Velasco C, García E, Rodríguez V, Frias L, Garriga R, Alvarez J, García-Peris P, León M. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr 2010; 65:269-74. [PMID: 21081958 DOI: 10.1038/ejcn.2010.243] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVES The prevalence of malnutrition in hospitals is high. No nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate nutritional risk in hospitalized patients using four nutritional screening tools. SUBJECTS/METHODS Four nutritional screening tools were evaluated: nutritional risk screening (NRS-2002), the malnutrition universal screening tool (MUST), the subjective global assessment (SGA) and the mini nutritional assessment (MNA). Patients were assessed within the first 36 h after hospital admission. Date of admission, diagnosis, complications and date of discharge were collected. To compare the tools, the results were reorganized into: patients at risk and patients with a good nutritional status. The statistical analysis included the χ(2)-test to assess differences between the tests and the κ statistic to assess agreement between the tests. RESULTS The study sample comprised 400 patients (159 women, 241 men), mean age 67.3 (16.1) years. The prevalence of patients at nutritional risk with the NRS-2002, MUST, SGA and MNA was 34.5, 31.5, 35.3 and 58.5%, respectively. Statistically significant differences were observed between the four nutritional screening tools (P<0.001). The agreement between the tools was quite good except for the MNA (MNA-SGA κ=0.491, NRS-2002-SGA κ=0.620 and MUST-SGA κ=0.635). Patients at nutritional risk developed more complications during admission and had an increased length of stay. CONCLUSIONS The prevalence of nutritional risk in hospitalized patients was high with all the tools used. The best agreement between the tools was for NRS-2002 with SGA and MUST with SGA. At admission, NRS-2002 and MUST should be used to screen for nutritional status.
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Affiliation(s)
- C Velasco
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, c/Doctor Esquerdo no. 46, Madrid, Spain.
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Neelemaat F, Thijs A, Seidell JC, Bosmans JE, van Bokhorst-de van der Schueren MAE. Study protocol: cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care. Nutr J 2010; 9:6. [PMID: 20146794 PMCID: PMC2829481 DOI: 10.1186/1475-2891-9-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 02/10/2010] [Indexed: 11/29/2022] Open
Abstract
Background Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients, starting at hospital admission until three months after discharge. Methods This study is a randomized controlled trial. Patients are included at hospital admission and followed until three months after discharge. Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective standards: Body Mass Index (BMI in kg/m2) < 20 and/or ≥ 5% unintentional weight loss in the previous month and/or ≥ 10% unintentional weight loss in the previous six months. We will compare usual nutritional care with transmural nutritional support (energy and protein enriched diet, two additional servings of an oral nutritional supplement, vitamin D and calcium supplementation, and consultations by a dietitian). Each study arm will consist of 100 patients. The primary outcome parameters will be changes in activities of daily living (determined as functional limitations and physical activity) between intervention and control group. Secondary outcomes will be changes in body weight, body composition, quality of life, and muscle strength. An economic evaluation from a societal perspective will be conducted alongside the randomised trial to evaluate the cost-effectiveness of the intervention in comparison with usual care. Conclusion In this randomized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge, compared to usual care. Primary endpoints of the study are changes in activities of daily living, body weight, body composition, quality of life, and muscle strength. An economic evaluation will be performed to evaluate the cost-effectiveness of the intervention in comparison with usual care. Trial registration Netherlands Trial Register (ISRCTN29617677, registered 14-Sep-2005)
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Affiliation(s)
- Floor Neelemaat
- Departments of Nutrition and Dietetics, Internal Medicine and EMGO+ institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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GOUT BS, BARKER LA, CROWE TC. Malnutrition identification, diagnosis and dietetic referrals: Are we doing a good enough job? Nutr Diet 2009. [DOI: 10.1111/j.1747-0080.2009.01372.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Weekes CE, Spiro A, Baldwin C, Whelan K, Thomas JE, Parkin D, Emery PW. A review of the evidence for the impact of improving nutritional care on nutritional and clinical outcomes and cost. J Hum Nutr Diet 2009; 22:324-35. [PMID: 19624401 DOI: 10.1111/j.1365-277x.2009.00971.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The association between malnutrition and poor clinical outcome is well-established, yet most research has focussed on the role of artificial nutritional support in its management. More recently, emphasis has been placed on the provision of adequate nutritional care, including nutritional screening and the routine provision of food and drink. The aim of this literature review is to establish the evidence for the efficacy of interventions that might result in improvements in nutritional and clinical outcomes and costs. METHODS A structured literature review was conducted investigating the role of nutritional care interventions in adults, and their effects on nutritional and clinical outcomes and costs, in all healthcare settings. Ten databases were searched electronically using keywords relating to nutritional care, patient outcomes and healthcare costs. High quality trials were included where available. RESULTS Two hundred and ninety-seven papers were identified and reviewed. Of these, only two randomised, controlled trials and six other trials were identified that addressed the major issues. A further 99 addressed some aspects of the provision of nutritional care, although very few formally evaluated nutritional or clinical outcomes and costs. CONCLUSIONS This review reveals a serious lack of evidence to support interventions designed to improve nutritional care, in particular with reference to their effects on nutritional and clinical outcomes and costs. The review suggests that screening alone may be insufficient to achieve beneficial effects and thus more research is required to determine the most cost-effective interventions in each part of the nutritional care pathway, in a variety of healthcare settings and across all age ranges, to impact upon nutritional and clinical outcomes.
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Affiliation(s)
- C E Weekes
- Department of Nutrition & Dietetics, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
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Bavelaar J, Otter C, van Bodegraven A, Thijs A, van Bokhorst-de van der Schueren M. Diagnosis and treatment of (disease-related) in-hospital malnutrition: The performance of medical and nursing staff. Clin Nutr 2008; 27:431-8. [PMID: 18387718 DOI: 10.1016/j.clnu.2008.01.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 01/03/2008] [Indexed: 01/15/2023]
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Lelovics Z, Bozó-Kegyes R, Bonyár-Müller K, Figler M. Results of nutritional risk screening of patients admitted to hospital. ACTA ACUST UNITED AC 2008; 95:107-18. [DOI: 10.1556/aphysiol.95.2008.1.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Garcia RWD. A dieta hospitalar na perspectiva dos sujeitos envolvidos em sua produção e em seu planejamento. REV NUTR 2006. [DOI: 10.1590/s1415-52732006000200001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Conhecer as razões objetivas e subjetivas, materiais e simbólicas que fundamentam a atitude das instituições hospitalares frente à alimentação, considerando-as como uma construção social, produto de concepções e práticas de profissionais que, direta ou indiretamente, a determinam e a reproduzem. MÉTODOS: Trata-se de uma pesquisa qualitativa para a qual foram realizadas 32 entrevistas em profundidade, semi-estruturadas, aplicadas aos sujeitos que participam do processo de produção das dietas: cozinheiros, copeiros, nutricionistas, médicos, enfermeiros, auxiliares de enfermagem e diretores clínico e administrativo e observação de campo em dois hospitais, um público e um privado. RESULTADOS: A análise de conteúdo das entrevistas e dos dados de observação de campo foi organizada em duas categorias: aspectos nutricionais desagregados da comida, na qual se constatou a valorização do aspecto nutricional, principalmente em ações de suporte nutricional, em detrimento dos aspectos sensoriais e simbólicos da alimentação hospitalar; e dieta hospitalar, sobre a qual observou-se escassez de informações técnicas e a influência da própria hospitalização nas representações sociais sobre esta, no que diz respeito à condição de controle e disciplina, a pouca autonomia e poder de voz do doente. A importância dada à dieta hospitalar é limitada e a atenção nutricional hospitalar é ainda embrionária. CONCLUSÃO: São necessários esforços para mudanças na cultura alimentar hospitalar, a fim de constituir uma visão da assistência nutricional hospitalar na qual a dieta hospitalar e a atenção nutricional possam ser parte importante no tratamento do paciente hospitalizado e colaborem com a qualidade da experiência de internação.
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