For many hospital patients, proper food intake can support healing, maintain strength and reduce the risk of malnutrition, a condition linked to longer hospital stays and poorer outcomes. However, without a clear, data-driven picture of what patients are served and what they actually consume, hospitals are unable to improve menus, manage waste or protect the already vulnerable patients.  

That gap is the focus of the study “Evaluating adherence of hospital meals to Mediterranean diet: the case of a developing country,” led by Dr. Hussein F. Hassan, professor at the School of Arts and Sciences, and Dr. Maha Hoteit, professor of nutrition at the Lebanese University, and published in the Journal of Health, Population and Nutrition.

Between April 2023 and September 2023, a team of graduate students conducted a cross-sectional study involving 155 adult patients from 16 hospitals in Lebanon. Dietitians weighed the food served and the leftovers, then calculated what was consumed and analyzed the nutritional content using specialized software. 

On average, hospitals served about 1.24 kilograms of food per patient per day, providing roughly 1,489 calories. Even before accounting for waste, that amounted to about 79 percent of patients’ estimated daily energy requirement. Once intake was measured, the gap widened: The patients consumed an average of 0.85 kilograms of food, translating to roughly 1,084 calories, or 57 percent of their estimated energy requirement.

When the researchers compared energy intake across age groups and between men and women, the differences were not statistically significant, suggesting that the shortfall is widespread rather than concentrated in one subgroup. 

The quality of the menu raised a second red flag. Compared with Mediterranean diet recommendations, hospitals served far more sweets, dairy products, meat and poultry than suggested, while falling short on nutrient-dense foods such as vegetables, fruits and legumes. This deficiency in fiber, vitamins and minerals can lead to “hidden hunger” in patients, namely a lack of key micronutrients that can be hard to detect but still affects the patient’s health. 

Dr. Hassan remarked that hospitals serving an inadequate quantity and quality of food “is less about a lack of knowledge and more about a business and economic environment,” such as the economic crisis in Lebanon, “that makes high-quality food service nearly impossible to maintain.” 

Moreover, the Mediterranean diet is an ideal baseline as “it is one of the most extensively researched and clinically validated dietary patterns in modern medicine,” stated Dr. Hoteit, noting its effectiveness in “reducing cardiovascular mortality, managing type 2 diabetes, and improving overall patient outcomes such as shorter hospital stays and lower in-hospital mortality.”

The team also looked at eating patterns in the wards. Patients reported finishing snacks more often than lunch or dinner, and the difference in consumption between men and women was statistically significant for lunch and snacks with more males consuming all of the provided meals. 

These findings suggest several practical entry points for hospitals: Revising menus to meet the guidelines of a Mediterranean diet, improving meal appeal and timing, and paying closer attention to what patients are actually consuming rather than what they are served. The baseline evidence provided by the study can help guide hospitals, policymakers and dietitians toward meals that meet nutritional needs. 

To browse more scholarly output by the LAU community, visit our open-access digital archive, the Lebanese American University Repository (LAUR).