Anyone who has been a hospital patient or has visited someone in the hospital during mealtimes can attest, hospital food can be abysmal. Often colorless and cooked beyond recognition, what's served up in healthcare settings has, for a long time, earned itself a bad reputation.

New research by the Potsdam Institute for Climate Impact Research (PIK), Charité – Universitätsmedizin hospital in Berlin, and Stanford University has examined the quality of food served in German hospitals and nursing homes. As the first comprehensive study of its kind, the researchers also analyzed the environmental footprint of the food provided in these institutions.

"We found that meals contained too few healthy plant-based foods such as vegetables, fruits, whole grains and legumes, and too many refined grains, added sugars, salt and saturated fats," said lead and corresponding author Lisa Pörtner, MD, a researcher at PIK and Charité. "This leads to an inadequate provision of nutrients and low dietary quality."

The researchers gathered meal plans and recipes from two hospitals and three nursing homes across Germany. They measured food quality using the Healthy Eating Index-2020 (HEI-2020), which assessed how well the food met dietary guidelines, and the Planetary Health Diet Index (PHDI), which measured how well it aligned with a diet that supports both human and planetary health. The researchers also compared the provided nutrients to recommended dietary values. To measure environmental impact, they examined the impact of food procurement through factors such as land use, greenhouse gas emissions, and water use.

The HEI-2020 provides a score out of 100, based on 13 dietary components, categorized into "adequacy" (the consumption of foods like fruits, veggies, whole grains, dairy, protein, and healthy fats) and "moderation" (limiting intake of refined grains, salt, saturated fats and added sugars). The higher the score, the better aligned with dietary guidelines. The PHDI was introduced in 2019 to better align nutrition and sustainability targets. It's scored out of a total of 150 points, based on 16 dietary components. Derived from the EAT-Lancet Commission on Food, Planet, Health's recommendation, these components are categorized into adequacy, moderation, optimum, and ratio components. The framework is designed to nourish a global population while minimizing environmental harm.

In terms of dietary quality, the institutions analyzed by the researchers scored low on both HEI-2020 (39 to 57 out of 100) and PHDI (30 to 44 out of 150). Most calories came from animal-source foods like red meat and dairy, refined grains, added sugars and animal fats. Less than 20% of calories came from healthy plant-based foods such as legumes, nuts, and vegetables. The study also exposed nutritional deficiencies. Protein intake met less than 73% of recommended values in nursing homes, highlighting risks for muscle loss, frailty, and delayed recovery. Micronutrients (B vitamins, vitamin C, potassium, magnesium, calcium, iron, and zinc) were critically low, below 67% of recommended values. Whereas salt and saturated fats were far too high.