Utilization of the USDAs SuperTracker to Analyze a Vegetarian Diet in a Hospital Setting

Jacqueline Chappell. Brittany Dillon. Tirsa Reyes

Aramark Distance Learning Dietetic Internship Program
INTRODUCTION

ASSESSMENT

Diets are a growing trend in the United States. People choose a type of diet for a variety of reasons
including: religious beliefs, to help prevent or keep disease or illness under control, ethical issues,
environmental factors, maintaining health, weight loss, or simply because it is a new trend. In the
following discussion, the focus will be on a vegetarian diet. Studies of dietary pattern continue to
show a distinct relationship between diet and chronic disease. This research evaluated the
consumption of a vegetarian diet in a hospital stay where patients may possess a number of disease
states that fall under the umbrella of chronic disease. By analyzing patients diets in a hospital setting
we were able to evaluate whether a hospitals vegetarian menu, and/or a patients food intake
provided a balanced diet and met the recommended daily intake of essential macro and
micronutrients.

During our study we used the USDA SuperTracker to analyze the nutrient intake of patients who are following a vegetarian diet during their
hospital stay. By using the food tracker software we were able to see whether or not patients in a hospital setting are receiving adequate nutrients
needed for normal energy levels and recovery.

BACKGROUND
After reviewing three hospitals in different geographical regions, we came to the conclusion that the
hospitals do not cater to the needs of a vegetarian diet. We found that one of the hospitals did not
have a vegetarian specific menu to offer patients. If there was a vegetarian menu within the hospital,
the menu was found to have no nutrient analysis conducted, which would show whether or not
patients were receiving adequate amounts of macro and micronutrients. Most specialty diets in a
hospital (heart healthy, gluten free, low sodium, diabetic, and renal) all have nutrient analyses
conducted to ensure patients are receiving the proper amounts of dietary reference intakes for all
required macro and micronutrients.

EVALUATION

To collect data, we used a list of patients who are following vegetarian diets and monitored their intake each day. A sample size of 30 patients was
used. All patients varied in age, gender, and activity levels. Once patients had been identified, a 24 hour recall was conducted. Food intake was
gathered from each patient within a 24-hour period.
Staff in the dietary office were utilized to gather food intake from patients. Dietary clerks would collect patient meal ticket for breakfast, lunch and
dinner. The meal tickets were then set aside to be analyzed after a 24-hour period. Data was collected for a total of three months. Once the
sample size of 30 patients were collected, the nutrient analysis was conducted.
Each patient was entered into the USDA SuperTracker and a nutrient analysis report was created. Nutrient reports were used to evaluate nutrient
levels for all macro and micronutrients for each patient.

IMPLEMENTATION

The purpose of this study is to evaluate a vegetarian hospital diet to see whether a hospitals
vegetarian menu, and/or a patients food intake will provide a balanced diet and meet the
recommended daily intake of the nutrients listed above.

When evaluating micronutrient results, we came across larger fluctuations among vitamins and
minerals. The majority of patients met DRIs for the following vitamins: vitamin A, vitamin B,
vitamin B 12, vitamin C, vitamin K, folate, and thiamin. All patients met recommendations for
Riboflavin. Out of all vitamins, three were consistently not met by vegetarian patients and are as
follows: 90% of patients did not met DRIs for vitamin D, 77% did not met DRIs for choline, and
70% did not met DRIs for vitamin E.

CONCLUSIONS
Dissemination of our results showed that these patients are in fact not consuming adequate
nutrients necessary for recovery and energy utilization. This research study shows the
importance of taking strides to improve the nutritional quality of specialized menus offered in a
hospital setting to ensure patients are receiving high-quality care during their hospital stay.

Statistical Analysis

CBORD
CBORD is used to identify patients on a
vegetarian diet and generate meal tickets.
CBORD is a hospital database used for all patient
meals.

OBJECTIVE

Results revealed that all patients were unable to successfully meet DRIs while consuming a
vegetarian diet. The majority of patients met macronutrient recommendations with a few patients
not meeting the following macronutrients: 3% did not meet carbohydrates, 13% did not meet
protein, and 7% did not meet total fat recommendations.

Minerals among vegetarian patients in our study also concluded varying results. The majority of
the patients met DRIs for calcium (Ca), sodium (Na), copper (Cu), iron (Fe), and selenium (Se).
Phosphorus was a common mineral met by all patients. Out of all minerals, two were consistently
not met by vegetarian patients and are as follows: 93% of patients did not met DRIs for
potassium (K) and 57% did not met DRIs for magnesium (Mg).

There are many health concerns associated with a vegetarian diet, such as being deficient in protein,
iron, vitamin B12, calcium, vitamin D, and/or fatty acids (especially omega-3 fatty acids). Most
patients in a hospital are already at risk for malnutrition or other nutritionally related problems.
Therefore, it is important to ensure that all diets in a hospital setting provide appropriate amounts of
macro and micronutrients for optimal growth, health maintenance, healing, and recovery.
Studies confirm that most vegetarians whose diets do not include red meat consumption experience
lower risks in certain chronic diseases. In addition, benefits may include lower body weight, longer life
expectancy, and a lower reduction in total cancer incidences, such as colon cancer. People who eat
more red meat may have a higher risk of developing diabetes, high total cholesterol and LDL
cholesterol, increased body weight, increased amounts of calcium lost in the urine, and increased risk
for osteoporosis.

Our data was presented in several frequency distribution bar charts. The data values were
divided into three categories, which includes: Macronutrients (carbohydrates, protein, and total
fat), Minerals (calcium, potassium, sodium, copper, iron, magnesium, phosphorus, selenium, and
zinc), and Vitamins (vitamin A, vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin
K, folate, thiamin, riboflavin, niacin, and choline).

Daily meal selections are entered into CBORD to

track orders and generate meal tickets.
Meal tickets are printed daily and turned into the
kitchen for meal production.

USDA SuperTracker

Univariate Analysis was used which involves the

examination across cases of one variable at a time.

Patient profile is created including: age, sex and

activity level.

Nutrient analysis was used to compare all patient

results.

All breakfast, lunch and dinner food items are

entered into a patient profile for a 24-hour period.

Results where to be entered into an excel

spreadsheet to track patient results.

Portion sizes are entered.

A statistical analysis was then done based of data

from the excel spreadsheet.

Nutrient report is generated for each patient.

Meals along with tickets are delivered to patients

rooms.

Nutrient report shows all macro and micronutrient

levels for each patient for a 24-hour period.

Dietary clerks collect meal tickets after meal

delivery.

Nutrient report is analyzed and compared to DRIs.

The distribution in our data lists every value of

nutrients, macro/micro, and the number of
vegetarian patients (n=30) who meet/did not meet
each value.
All statistical analysis data and results were to be
represented in graphs.

CONTACT INFORMATION
For additional information, please contact:
Cyndra (Cindy) Banta, MS, RDN, LD
Dietetic Program Director
Aramark Distance Learning Dietetic Internship Program
Banta-Cyndra@aramark.com
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