OBJECTIVE: This study aimed to evaluate the nutritional adequacy and compliance with cardiovascular disease (CVD) guidelines in therapeutic diets implemented in four hospitals in General Santos City, Philippines. METHODS: The study employed a cross-sectional study and analyzed the one-day therapeutic menus of four hospitals using the Philippine Food Composition Table and the United States Department of Agriculture nutrient database. The nutrient contents calculated in this study were compared among hospitals and benchmarked against the Philippine Dietary Reference Intakes (PDRI) and CVD-specific guidelines, the Dietary Approaches to Stop Hypertension (DASH), and Therapeutic Lifestyle Changes (TLC). The nutrient adequacy ratios (NARs) and the corresponding mean (SD) values were used to interpret the data. RESULTS: Based on the PDRI, the mean (SD) NARs for proteins, simple sugars, vitamin B6, folate, and vitamin B12 were 116% (11%), 72% (16%), 139% (34%), 115% (7%), and 324% (156%), respectively, which were all interpreted as adequate. However, the mean (SD) NARs for energy, 88% (7%), and dietary fiber, 53% (33%), indicate non-compliance with the requirements for these components. As for the DASH guidelines, the hospitals failed to meet the recommendations for calcium, magnesium, and potassium, with mean (SD) NARs of 45% (14%), 49% (10%), and 51% (7%), respectively. The levels of saturated fatty acids, 195% (53%), and dietary cholesterol, 363% (177%), exceeded the limits set by the guidelines. For the TLC guidelines, the mean (SD) NARs of 70% (24%) and 40% (10%) for monounsaturated fatty acids and polyunsaturated fatty acids, respectively, were interpreted as suboptimal. Conclusive interpretations cannot be drawn for sodium, total carbohydrates, total fats due to large variations in their compositions among the hospitals. CONCLUSION: At the menu analysis level, while the therapeutic diets adhered to the recommendations for proteins, simple sugars, and the vitamins, they fell short in their provision for energy, unsaturated fats, dietary fiber, and most minerals. They also exceeded the limits for most dietary lipid parameters set by DASH and TLC. The findings of this study highlight the need for improvements in nutritional adequacy and adherence to CVD guidelines in hospital therapeutic diets. Due to the limited number of observations, future research should aim to confirm and clarify these findings.