Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Acad Pediatr. 2012 Jan-Feb;12(1):62-7. doi: 10.1016/j.acap.2011.09.004. Epub 2011 Nov 30.
Marketing strategies and food offerings in hospital cafeterias can impact dietary choices. Using a survey adapted to assess food environments, the purpose of this study was to assess the food environment available to patients, staff, and visitors at the food-service venues in all 14 California children's hospitals.
We modified a widely-used tool to create the Nutritional Environment Measures Survey for Cafeterias (NEMS-C) by partnering with a hospital wellness committee. The NEMS-C summarizes the number of healthy items offered, whether calorie labeling is present, if there is signage promoting healthy or unhealthy foods, pricing structure, and the presence of unhealthy combination meals. The range of possible scores is zero (unhealthy) to 37 (healthy). We directly observed the food-service venues at all 14 tertiary care children's hospitals in California and scored them.
Inter-rater reliability showed 89% agreement on the assessed items. For the 14 hospitals, the mean score was 19.1 (SD = 4.2; range, 13-30). Analysis revealed that nearly all hospitals offered diet drinks, low-fat milk, and fruit. Fewer than one-third had nutrition information at the point of purchase and 30% had signs promoting healthy eating. Most venues displayed high calorie impulse items such as cookies and ice cream at the registers. Seven percent (7%) of the 384 entrees served were classified as healthy according to NEMS criteria.
Most children's hospitals' food venues received a mid-range score, demonstrating there is considerable room for improvement. Many inexpensive options are underused, such as providing nutritional information, incorporating signage that promotes healthy choices, and not presenting unhealthy impulse items at the register.
医院食堂的营销策略和食品供应会影响饮食选择。本研究使用一种经过改编的评估食品环境的调查工具，旨在评估加利福尼亚州 14 家儿童医院所有餐饮场所为患者、员工和访客提供的食品环境。
我们与医院健康委员会合作，对广泛使用的工具进行修改，创建了用于自助餐厅的营养环境措施调查（NEMS-C）。NEMS-C 总结了提供的健康食品数量、是否存在卡路里标签、是否有宣传健康或不健康食品的标志、定价结构以及是否存在不健康的组合餐。可能的分数范围为零（不健康）到 37（健康）。我们直接观察加利福尼亚州 14 家三级保健儿童医院的所有餐饮场所并对其进行评分。
评估项目的两位评估者之间的一致性为 89%。对于这 14 家医院，平均得分为 19.1（SD=4.2；范围，13-30）。分析表明，几乎所有医院都提供低糖饮料、低脂牛奶和水果。不到三分之一的医院在购买点提供营养信息，30%的医院有促进健康饮食的标志。大多数场所在收银台展示高热量的冲动性食品，如饼干和冰淇淋。根据 NEMS 标准，所供应的 384 份主菜中，只有 7%（7%）被归类为健康食品。
大多数儿童医院的餐饮场所得分处于中等水平，这表明还有很大的改进空间。许多廉价的选择未被充分利用，例如提供营养信息、纳入宣传健康选择的标志以及不在收银台展示不健康的冲动性食品。
