Professional Documents
Culture Documents
Introduction:
Our hospital is a nonprofit medical center with 250 licensed beds located in Torrance,
California. According to City-Data.com, the population of the hospital community
service area is 147,027 in 2012. The median age of the population is 41.7 and the
median household income is $71,790, which is well above the state average. The
neighborhood is culturally diverse, but the majority of the population is divided among
40% White, 33% Asian and 20% Hispanic. Additionally, 30.4% of the residents are
foreign-born in either Asian or Latin American countries. The average college level in
Torrance indicates a highly educated community close to 45% of the population have
a college degree or above, with another 30% having attended some level of college.
Torrance is a very vibrant and active community with an extensive array of dining and
entertainment options, as well as nine separate hospitals serving the Torrance
community so there are high expectations and a lot of options for where a person can
choose to receive medical services. Given that, as well as the higher income &
education level of the community, we have endeavored to provide a more
sophisticated and eclectic menu with the feel of a comfortable upscale restaurant, as
we know our clientele/patients will expect that. To further differentiate ourselves and
cater to our Asian patients, we are also featuring an Asian alternative entree at lunch
and dinner every day.
Given the age of our community, which is higher than the median age in the state, our
clientele tend to be older, hence may be patients in the hospital longer than average.
For this reason we are especially concerned with a diverse menu that is visually
interesting, delicious and offers options to meet many different tastes and avoid
boredom.
Our menus are designed to be clean, crisp and easy to read, with a striking comic
visual graphic every day, so it doesnt require any given language to understand. We
believe there is room for the hospital menu to be classy, but approachable and fun.
This ensures the patients pay attention to the menu since they need to make choices
and infuses the stereotype of hospital food with some much-needed whimsy. We
believe menu design is often overlooked in hospitals, but its definitely important since
it sets the tone for a patients expectations, so we have endeavored to convey to our
patients/clientele through the menu design that they should expect a high-quality
experience and an exceptional meal.
The day we chose to analyze was admittedly one of our less healthy days -- for our Standard
Options, it was built with a Southern-style comfort food theme and our Asian option had a
healthier dinner but the lunch option was a fried dish. However, when evaluating our menu,
many days included high-calorie or starchy entrees, so this seemed as representative as any
other day. We didnt feel that selecting our healthiest day for analysis would result in an
accurate overall picture of our menu either, hence the results as presented.
Strengths:
Nutritionally, the Standard menu has a few overall strengths. The first is its macronutrient
balance. If the patient were to consume the entire daily menu, this would contain the target
balance of protein and carbohydrates. While the numbers are within the range, they could and
should be better. The Alternate Menu actually doesnt fare as well in the macronutrient
distribution and only the Protein is within the target range. The shaded areas below are
outside of the Target ranges:
Nutrient
Target
10 35%
Average
Eaten
Standard
16%
Average
Eaten
Alternate
16%**
Protein
Carbohydrates
45 65%
46%
43%**
Fat
20 35%
40%
43%**
**As you will see from attached Nutrients Report, the total percentages of the macronutrients
mysteriously added up to 102%.
One significant strength of the Alternate menu option is the fact that it contains several
servings of healthy seafood, including our analysis day. The Asian entree includes mackerel,
which is a fatty fish that is an excellent source of Omega 3 EPA & DHA. This resulted in
increasing the Omega 3 EPA and DHA almost tenfold over the numbers of the Standard entre
choices. The American Heart Association recommends having 2 servings of fish per week in
order to increase the Omega 3s, which have numerous health benefits including lowering
blood triglycerides and helping with healthy aging.
Another strength of both versions of our menu is that they meet the daily recommendations for
dietary fiber that is often deficient in adults. The target is 38 grams per day for an adult male
and the Standard menu provides 49 grams, while the Alternate option improves to 54 grams.
This appears to be largely through the breakfast choices that include whole grains and a fiberrich whole fruit of figs.
Finally, the menu meets or exceeds the targets for recommended daily allowances of all
vitamins and minerals, except for Vitamin D in the Traditional menu. That said, the actual
intake for Vitamin D is actually about 50% higher than the results show since milk wasnt
included in the nutrients report, but even with that it would still be below the RDA. The major
strength for both of these menus is that since the intake of all vitamin and minerals are well
over the target numbers, even if the patient were to only consume part of the meals, he would
most likely still meet or come close to meeting the RDA targets. As a side note, it also means
that as hospital administrators, if we were to begin reshaping this menu to improve the
nutritional quality, we would be working from a strong base of vitamin and mineral sufficiency.
Weaknesses:
The menu was designed to be widely varied and visually and gastronomically appealing. It was
designed with health in mind, but from the nutritional report, its clearly not a particularly
healthy menu. There are several serious issues with the menu, as follows:
First and foremost, the menus for both Standard & Alternate versions including all three meals
& sides include enough kcals to feed an additional adult. Clearly someone is not going to eat
all the options at every meal, but it would be pretty disastrous if they did exactly that and
stayed in the hospital for any length of time following that pattern.
While for the Standard menu, the macronutrient breakdown of carbohydrates and protein fell
within the target range, the reason those numbers were just within range is because the
percentage of fat is well over the range. The Fat distribution is 40%** instead of within the 20 35% range. Even worse, the percentage of saturated fat is 11%, over the 10% boundary of
what is recommended. (**As you will see from attached Nutrients Report, the total
percentages of the macronutrients mysteriously added up to 102%)
For the Alternate menu, only the Proteins fall within the recommended range. The percentage
of fat is too high and the carbohydrates are too low. In order to address this weakness and
realign the ratio to a healthier one, some of the higher fat dishes such as the Japanese pancake,
soup with sausage and the buttermilk biscuit could be replaced with more nutritionally dense
carbohydrates.
The added sugars/empty calories are also an issue. While there are a variety of specific
recommendations about added sugar, the American Heart Association suggests keeping the
total amount per day for an adult male to 150 kcals or 36 grams. Based on that, the 60 g in
this menu have almost doubled that number and would need to be addressed. For todays
menu, that is undoubtedly due in part to two sweetened beverages and two very sweet
desserts. But even the fruit cocktail at lunch is sweetened with fruit juice so it becomes less of
a dietary plus than a minus. The Alternate version of the menu has the same issue, even
increasing the added sugars by a few calories, probably due to the ingredients in the Japanese
pancake.
Cholesterol in the Standard menu is also a major issue as there is 655 mg of dietary cholesterol
included compared to the recommendation to stay below 300 mg. Eggs, macaroni and cheese
and fried chicken are pretty much at the top of the list of cholesterol-containing foods and we
have them all in one day, so its not a good day to be in our hospital if you have highcholesterol. The Alternate menu increases the dietary cholesterol, most likely due to the fish
and the additional egg in the pancake recipe. The fish is worth the cholesterol because of the
Omega 3 benefits, but replacing the pancake with something else will eliminate the additional
cholesterol from the egg.
Finally, while the overages in vitamin and minerals above the targets provide some cushion,
several of the nutrients are close to or above their Tolerable Upper Intake Level from the DRIs,
as shown below. The shaded bars represent vitamins or minerals that are over the ULs
including Sodium, Magnesium and Niacin for the Standard menu. The overages are very
similar between the Standard and Alternate menus, with the only difference being that in the
Alternate menu, Folate is also above the UL.
10
M inerals
Target
Average
Eaten
Standard
Average
Eaten Alternate
Sodium
Iron
Magnesium
Phosphorus
Selenium
Zinc
Vitam ins
Folate
<2300 mg
8 mg
420 mg
700 mg
55 g
11 mg
6296 mg
31 mg
666 mg
2666 mg
245 g
33 mg
5276 mg
33 mg
735 mg
2456 mg
250 g
32 mg
400 g
900 g DFE 1143 g DFE
DFE
Niacin 16 mg
58 mg
58 mg
! indicates ULs that have been exceeded
" indicates ULs that are close to being reached
Tolerable
Upper
Intake
Level
<2300
45 mg
350 mg**
4000 mg
400 g
40 mg
UL
Standard
UL
Alternate
!
"
!
"
"
"
!
"
!
"
"
"
1000 g DFE
"
35 mg
**The numbers provided by MyPlate are not in agreement with the numbers provided by the
USDAs published DRI tables, which is where the Tolerable Upper Intake levels in this chart are
referenced.
The way to address many of these weaknesses at once is to modify or replace many of the
entrees in a healthier way, either through preparation or ingredient substitution. For example,
while there are healthier versions of macaroni and cheese and fried chicken, they would most
likely result in a different experience so those entrees would probably need to be replaced.
The chicken could be replaced with an oven-baked chicken that could still be flavorful and
crispy but have lower fat, lower saturated fat and lower cholesterol. However, often the
healthy versions of mac and cheese are undesirable so it might be best to replace that with a
different whole-grain pasta dish. We also strayed away from offering too much seafood in the
Standard menu due to food safety issues and potential budgetary issues. Increasing the
amount of seafood in the Standard menu would increase health benefits, although the fat and
cholesterol costs would have to be factored in. The desserts could be replaced or prepared
with lower-sugar variations and the beverages could easily be replaced with sugar-free or low-
11
sugar options. When not under the restrictions of attempting to not repeat beverages, it
would be easy enough to replace the high-sugar ones with other appealing options. It is more
than likely that the vitamin and mineral overages would be corrected when some of these
larger entre changes were made.
Food Groups
Target
Average Eaten
Status
Grains
8 ounce(s)
13 ounce(s)
Over
Whole Grains
RXQFHV
4 ounce(s)
OK
Refined Grains
RXQFHV
10 ounce(s)
Over
3 cup(s)
6 cup(s)
Over
Dark Green
2 cup(s)/week
1 cup(s)
Under
6 cup(s)/week
1 cup(s)
Under
2 cup(s)/week
cup(s)
Under
Starchy
6 cup(s)/week
1 cup(s)
Under
Other
5 cup(s)/week
1 cup(s)
Under
2 cup(s)
4 cup(s)
Over
Whole Fruit
No Specific Target
2 cup(s)
No Specific Target
Fruit Juice
No Specific Target
1 cup(s)
No Specific Target
3 cup(s)
2 cup(s)
Under
No Specific Target
1 cup(s)
No Specific Target
Cheese
No Specific Target
1 cup(s)
No Specific Target
6 ounce(s)
12 ounce(s)
Over
Seafood
10 ounce(s)/week
1 ounce(s)
Under
No Specific Target
10 ounce(s)
No Specific Target
No Specific Target
1 ounce(s)
No Specific Target
Oils
7 teaspoon
16 teaspoon
Over
Limits
Allowance
Average Eaten
Status
Total Calories
2400 Calories
4345 Calories
Over
&DORULHV
974 Calories
Over
Solid Fats
734 Calories
Added Sugars
239 Calories
Vegetables
Fruits
Dairy
Protein Foods
Empty Calories*
*Calories from food components such as added sugars and solid fats that provide little nutritional value. Empty Calories are part of Total Calories.
Note: If you ate Beans & Peas and chose "Count as Protein Foods instead," they will be included in the Nuts, Seeds & Soy subgroup.
NTRS414's Meals
Your plan is based on a 2400 Calorie allowance.
Date
10/22/14
Breakfast
Lunch
Dinner
1 tablespoon Bread
crumbs, plain
1 teaspoon Mustard
1 teaspoon Cinnamon
tablespoon Oil,
vegetable
teaspoon, ground
Pepper, black
1 tablespoon Vinegar,
balsamic
2 tablespoon Vinegar,
balsamic
ounce (14 halves)
Walnuts
cup White beans,
cooked from dry (no salt or
fat added)
Nutrients
Target
Average Eaten
Status
Total Calories
2400 Calories
4345 Calories
Over
Protein (g)***
56 g
177 g
OK
Protein (% Calories)***
10 - 35% Calories
16% Calories
OK
Carbohydrate (g)***
130 g
497 g
OK
Carbohydrate (% Calories)***
45 - 65% Calories
46% Calories
OK
Dietary Fiber
38 g
49 g
OK
Total Sugars
191 g
Added Sugars
60 g
Total Fat
20 - 35% Calories
40% Calories
Over
Saturated Fat
11% Calories
Over
Polyunsaturated Fat
7% Calories
Monounsaturated Fat
18% Calories
17 g
28 g
OK
5 - 10% Calories
6% Calories
OK
0.6% Calories
OK
1.6 g
2.8 g
OK
Omega 3 - EPA
97 mg
Omega 3 - DHA
142 mg
Cholesterol
< 300 mg
655 mg
Over
Minerals
Target
Average Eaten
Status
Calcium
1000 mg
1674 mg
OK
Potassium
4700 mg
6666 mg
OK
Sodium**
< 2300 mg
6296 mg
Over
Copper
900 g
4126 g
OK
Iron
8 mg
31 mg
OK
Magnesium
420 mg
666 mg
OK
Phosphorus
700 mg
2666 mg
OK
Selenium
55 g
245 g
OK
Zinc
11 mg
33 mg
OK
Vitamins
Target
Average Eaten
Status
Vitamin A
900 g RAE
1287 g RAE
OK
Vitamin B6
1.3 mg
4.3 mg
OK
Vitamin B12
2.4 g
5.9 g
OK
Vitamin C
90 mg
472 mg
OK
Vitamin D
15 g
6 g
Under
Vitamin E
15 mg AT
21 mg AT
OK
Vitamin K
120 g
534 g
OK
Folate
400 g DFE
900 g DFE
OK
Thiamin
1.2 mg
3.2 mg
OK
Riboflavin
1.3 mg
3.5 mg
OK
Niacin
16 mg
58 mg
OK
Choline
550 mg
611 mg
OK
Food Groups
Target
Average Eaten
Status
Grains
8 ounce(s)
11 ounce(s)
Over
Whole Grains
RXQFHV
4 ounce(s)
OK
Refined Grains
RXQFHV
8 ounce(s)
Over
3 cup(s)
8 cup(s)
Over
Dark Green
2 cup(s)/week
1 cup(s)
Under
6 cup(s)/week
2 cup(s)
Under
2 cup(s)/week
1 cup(s)
Under
Starchy
6 cup(s)/week
cup(s)
Under
Other
5 cup(s)/week
4 cup(s)
Under
2 cup(s)
4 cup(s)
Over
Whole Fruit
No Specific Target
2 cup(s)
No Specific Target
Fruit Juice
No Specific Target
1 cup(s)
No Specific Target
3 cup(s)
cup(s)
Under
No Specific Target
cup(s)
No Specific Target
Cheese
No Specific Target
0 cup(s)
No Specific Target
6 ounce(s)
14 ounce(s)
Over
Seafood
10 ounce(s)/week
5 ounce(s)
Under
No Specific Target
8 ounce(s)
No Specific Target
No Specific Target
1 ounce(s)
No Specific Target
Oils
7 teaspoon
20 teaspoon
Over
Limits
Allowance
Average Eaten
Status
Total Calories
2400 Calories
4117 Calories
Over
&DORULHV
753 Calories
Over
Solid Fats
506 Calories
Added Sugars
247 Calories
Vegetables
Fruits
Dairy
Protein Foods
Empty Calories*
*Calories from food components such as added sugars and solid fats that provide little nutritional value. Empty Calories are part of Total Calories.
Note: If you ate Beans & Peas and chose "Count as Protein Foods instead," they will be included in the Nuts, Seeds & Soy subgroup.
NTRS414's Meals
Your plan is based on a 2400 Calorie allowance.
Date
10/22/14
Breakfast
Lunch
Dinner
4 ounce(s), cooked,
boneless Mackerel, baked
or broiled, without fat
1 teaspoon Cinnamon
1 teaspoon Mustard
tablespoon Oil,
vegetable
teaspoon, ground
Pepper, black
1 tablespoon Mayonnaise,
regular
1 tablespoon, chopped
Onion, green, raw
2 tablespoon Vinegar,
balsamic
Nutrients
Target
Average Eaten
Status
Total Calories
2400 Calories
4117 Calories
Over
Protein (g)***
56 g
168 g
OK
Protein (% Calories)***
10 - 35% Calories
16% Calories
OK
Carbohydrate (g)***
130 g
447 g
OK
Carbohydrate (% Calories)***
45 - 65% Calories
43% Calories
Under
Dietary Fiber
38 g
54 g
OK
Total Sugars
190 g
Added Sugars
62 g
Total Fat
20 - 35% Calories
43% Calories
Over
Saturated Fat
9% Calories
OK
Polyunsaturated Fat
11% Calories
Monounsaturated Fat
20% Calories
17 g
32 g
OK
5 - 10% Calories
7% Calories
OK
0.8% Calories
OK
1.6 g
3.5 g
OK
Omega 3 - EPA
1180 mg
Omega 3 - DHA
1928 mg
Cholesterol
< 300 mg
743 mg
Over
Minerals
Target
Average Eaten
Status
Calcium
1000 mg
1273 mg
OK
Potassium
4700 mg
7086 mg
OK
Sodium**
< 2300 mg
5276 mg
Over
Copper
900 g
4867 g
OK
Iron
8 mg
33 mg
OK
Magnesium
420 mg
735 mg
OK
Phosphorus
700 mg
2456 mg
OK
Selenium
55 g
250 g
OK
Zinc
11 mg
32 mg
OK
Vitamins
Target
Average Eaten
Status
Vitamin A
900 g RAE
1045 g RAE
OK
Vitamin B6
1.3 mg
4.3 mg
OK
Vitamin B12
2.4 g
12.9 g
OK
Vitamin C
90 mg
564 mg
OK
Vitamin D
15 g
22 g
OK
Vitamin E
15 mg AT
25 mg AT
OK
Vitamin K
120 g
756 g
OK
Folate
400 g DFE
1143 g DFE
Over
Thiamin
1.2 mg
3.2 mg
OK
Riboflavin
1.3 mg
3.6 mg
OK
Niacin
16 mg
58 mg
OK
Choline
550 mg
747 mg
OK
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Breakfast:
Fruit
Cereal
Entre
Bread
Beverages
Halved Figs
Shredded wheat
Scrambled eggs
and sausage
Whole wheat toast
Orange juice
Whole Apple
Oatmeal
Vegetable
omelette
Croissant
Strawberry banana
smoothie
Grapes
Raisin bran
BLT sandwich
Chocolate muffin
Apple juice
Sliced Pears
Rice Krispies
Spanish omelette
Baguette
V8 vegetable juice
Orange wedges
Corn flakes
Buttermilk
pancakes w/
blueberries &
turkey bacon
English muffin
Apple-cranberry
juice
Pomegranate arils
Cheerios
Bacon &
asparagus fritatta
Raisin Bagel
Tropical juice
cocktail
Persimmon cubes
Granola
Broccoli & swiss
quiche
Wheat bread stick
Grape juice
Lunch:
Soup
Salad
Entre #1
Entre #2
Fruit or Vegetable
Bread
Dessert
Beverages
Italian wedding
soup
Caprese salad
#1: Grilled
chicken parmesan
sandwich on an
Italian roll
#2: Japanese
chicken meatballs
with udon noodles
in broth
Spaghetti squash
Roasted tomato
brushetta
Lemon Sorbet
Blood orange
Italian soda
Southwestern
Tortilla Soup
Pomegranate
citrus salad
#1: Grilled fish soft
tacos w/mahi-mahi
in corn tortillas
#2: Spicy soba
noodles w/
mushroom & tofu
Mandarin orange
wedges & jicama
Jalapeno &
cheese bread
Strawberries on
angel food cake
Hibiscus punch
Butternut squash
& apple soup
Red and golden
beet salad w/goat
cheese
#1: BBQ Chicken
chopped wrap
#2: Chow mein
w/chicken & vegs
Canteloupe & red
grapes
Sourdough roll
Chocolate chip
cookies
Basil lime spritzer
Corn chowder
Country salad
w/grilled corn,
market tomatoes
and Jack cheese
#1: Texas beef
burgers w/grilled
onions on baked
poppyseed roll
with sweet potato
wedges
#2: Japanese
curry rice
Roasted tomatoes
Green onion roll
Brownies
Mint iced tea
Tomato soup
Iceberg wedge
salad w/blue
cheese dressing
#1: Tri-cheese
grilled cheese
sandwich on
sourdough bread
#2: Chinese mapo
tofu
Chunky
applesauce
Pretzel breadstick
Pound cake
Passion fruit iced
tea
Dinner:
Soup
Salad
Entre #1
Entre #2
Fruit or Vegetable
Bread
Dessert
Beverages
Hearty Minestrone
Caesar salad
#1: Whole wheat
turkey lasagna
#2: Grilled salmon
w/ spinach & rice
Squash & zucchini
Garlic knots (rolls)
Cannoli
Orange-Cranberry
Limonata
Garden vegetable
soup
Kale salad with
cashews, quinoa
and dried
cranberries
#1: Turkey
meatloaf w/onion
mashed potatoes
#2: Teriyaki
chicken breast
w/carrots & rice
Green beans
Ciabatta roll
Pumpkin
cheesecake
Peach iced tea
Vegetable chili in
bread bowl
Watermelon,
endive & pistachio
salad w/goat
cheese
#1: BBQ-glazed
broiled salmon on
basmati rice
#2: Potato & beef
croquette
w/cabbage
Brussel sprouts
Spicy cornbread
Apple pie a la
mode
Lemonade
Fruit:
Entree:
Cereal:
Bread:
Beverage:
Lunch:
Soup:
Entrees:
Japanese pancake
Bread:
Salad:
Fruit:
Dessert:
Beverage:
Dinner:
or
Soup:
Entree:
Salad:
Vegetable:
Bread:
Dessert:
Beverage:
or
Fruit:
Entree:
Cereal:
Bread:
Croissant
Beverage:
Lunch:
Fruit:
Entree:
Bread:
Salad:
Vegetable:
Dessert:
Beverage:
Dinner:
or
Soup:
Entree:
Bread:
Salad:
Vegetable:
Dessert:
Beverage:
or
Orange-cranberry limonata
Breakfast:
Fruit:
Cereal:
Entree:
Bread:
Beverage:
Lunch:
Apple juice
Fruit:
Salad:
Entree:
Grilled fish soft tacos with mahi-mahi, shredded cabbage, lemon-yogurt sauce and
black beans in corn tortillas
Bread:
Fruit:
Dessert:
Beverage:
Dinner:
or
Soup:
Salad:
Entree:
Arroz con pollo with Spanish rice sauteed in jalapeno sauce with grilled chicken,
bell pepers & onions topped with Tillamook cheddar cheese
Bread:
Beverage:
Fruit:
Dessert:
or
Fruit:
Entree:
Cereal:
Bread:
Beverage:
Lunch:
V8 vegetable juice
Fruit:
Entree:
Chicken and egg rice bowl with onion and Japanese wild parsley
Bread:
Salad:
Vegetable:
Dessert:
Beverage:
Dinner:
or
Soup:
Entree:
Grilled tilapia prepared with olive oil, lemon, garlic & fresh herbs on a bed of
minted cous-cous
Bread:
Salad:
Greek salad with romaine, feta cheese, assorted olives, tomatoes & onions
Vegetable:
Dessert:
Beverage:
or
Visinadya (cherry-ade)
Fruit:
Entree:
Cereal:
Bread:
English muffin
Beverage:
Lunch:
Apple-cranberry juice
Soup:
Entree:
BBQ Chicken chopped wrap with lettuce, tomatoes and creamy ranch dressing
Salad:
Red and golden beet salad with goat cheese and raspberry viniagrette
Bread:
Fruit:
Dessert:
Beverage:
Dinner:
or
Soup:
Entree:
Salad:
or
Bread:
Ciabatta roll
Vegetable:
Dessert:
Beverage:
Fruit:
Pomegranates arils
Entree:
Cereal:
Bread:
Raisin bagel
Beverage:
Lunch:
Soup:
Corn chowder
Entree:
Texas beef burgers with grilled Vidalia onions on baked poppyseed roll with
Sweet potato wedges and garlic aioli
Salad:
Country salad with grilled corn, market tomatoes and shreeded Jack cheese
Bread:
Vegetable:
Dessert:
Beverage:
Dinner:
or
Soup:
Entree:
BBQ-glazed broiled salmon on a bed of basmati rice with carrots and pearl onions
Bread:
Spicy cornbread
Salad:
Watermelon, endive & pistachio salad with goat cheese in a balsamic viniagrette
Vegetable:
Dessert:
Beverage:
or
Fruit:
Entree:
Cereal:
Bread:
Beverage:
Lunch:
Grape juice
Soup:
Entree:
Tri-cheese grilled cheese sandwich on sourdough bread with fresh dill pickle
Salad:
Fruit:
Dessert:
Pound cake
Bread:
Pretzel-roll breadstick
Beverage:
Dinner:
or
Soup:
Entree:
Salad:
or
Vegetable:
Dessert:
Tapioca pudding
Bread:
Beverage:
Focaccia