Nutrient Goal Standard for adult patients

Mental health facility and short stay included

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Patients choose from a range of food and fluids to achieve each nutrient goal.

Menus are designed so patients can meet:

  • protein and energy nutrient goals daily
  • micronutrient goals when averaged across a seven-day period.

Definitions

Reference person: an adult male weighing 76kg.

Short stay patient criteria:

  • Well-nourished on admission and not at risk of becoming malnourished through their admission, and
  • Expected stay in hospital is three nights or less, and
  • Does not have additional nutritional requirements

More definitions and glossary

Adult macronutrient goals

Energy

8000kJ per day

Nutrient actions

  • Offer patients three meals and two to three mid-meals.
  • Large serves, small and extra serves are available.
  • Energy-fortified and/or nutrient-dense options are available for those with smaller appetites.
  • Offer a lower-energy mid-meal snack, with not more than 400kJ per serve, at each mid-meal.
Acute care facility
  • Offer energy-dense foods and fluids (e.g. nutrient-dense soups and desserts) at each meal.
  • Offer a high-energy mid-meal snack, with at least 500kJ per serve, once per day, and have available at other times for those who require additional energy (this may be a combined high-protein and high-energy snack).
Mental health facility
  • Offer lower-energy-density meals.

Rationale

  • Reference person requirement of 105kJ/kg/day.1-4
  • Patients have varied energy requirements.
  • Patients who are malnourished, undergoing treatment or have certain diseases and/or are undergoing some treatments will have increased energy requirements.
  • Insufficient energy intake is a common cause of poor nutritional status, particularly for elderly patients.
  • Additional food options can help patients meet higher energy needs (e.g. nourishing snacks, fortified foods and additional nutrition support).
  • For patients with a significantly higher energy requirement, a therapeutic diet may be required.

Protein

90g per day

Short stay: 76g per day

Nutrient actions

  • High-quality protein options are available at each mealtime. This includes a variety of meat, poultry, fish, legumes, milk, eggs, cheese, yoghurt and custard.
  • Offer a protein source, with at least 5g protein per serve, at breakfast.
Acute care facility
  • Large protein serves or extra serves are available.
  • Protein-fortified and nutrient-dense options are available for those with smaller appetites or increased needs.
  • Offer a high protein mid-meal snack, with at least 3g protein per serve, once a day, and have available at other times (this may be a combined high-protein and high-energy snack).
Mental health facility
  • Large protein serves or extra serves are available.
  • Protein-fortified and nutrient-dense options are available for those with smaller appetites or increased needs.
  • A high-protein mid-meal snack, with at least 3g protein per serve is available for those who require extra protein (this may be a combined high-protein and high-energy snack).
Short stay
  • Protein-fortified and nutrient-dense options do not need to be available.

Rationale

  • Reference person in hospital but not severely ill or injured, requiring 1.2g/kg/day.1, 2
  • This protein requirement is higher than the recommended daily intake for healthy adults (0.75g–1.1g/kg/day).6  This is to address the fact that most hospitalised patients will have higher protein needs, including pregnant and lactating women, non-stressed older people and those recovering from surgery.
  • Patients have varied protein requirements. Patients who are malnourished, have some diseases and or are undergoing some treatments will have increased protein requirements.
  • Additional food options should be available on a standard menu for patients with higher protein needs (e.g. nourishing snacks, fortified foods, additional nutrition support).
  • It is expected that patients requiring higher protein intakes ( greater than 1.5g/kg/day) would be identified and prescribed an appropriate therapeutic diet.
Acute care facility
  • Nutrient goal of 90g is based on a 76kg reference person who is a hospital patient, but not severely ill or injured, using a mid-range protein requirement (1.2g/kg/day).1, 2
Mental health facility
  • Nutrient goal is based on a mid-range protein requirement (1.2g/kg/day).1, 2
  • Patients in mental health facilities may not always have increased protein needs. Medications can increase appetite and protein may assist with satiety management.
Short stay
  • Nutrient goal is based on a protein requirement of 1.0g/kg/day.
  • This protein requirement is in between the recommended daily intake for healthy adults (0.75-1.1g/kg/day) to address the requirement to optimise muscle health and function and also to support healing from illness for most short stay patients.

Fat

At least 80% of hot main menu items
have under 15g fat per serve

Nutrient actions

  • Include low-fat or reduced-fat products on the menu as an option in addition to full-fat options.

Rationale

  • The Nutrient Reference Values for Australia and New Zealand do not prescribe a recommended daily intake or upper limit for total fat.4
  • Low-fat diets are not appropriate for patients who require increased energy and nutrient density.
  • The menu should not be designed to be low in fat but should not be high in fat.
  • The menu must provide opportunity for patients to choose a range of lower fat foods food and fluids if preferred.
Mental health facility
  • Low-fat cooking methods and ingredients will assist in reducing the energy density of meals, which can help people maintain a healthy weight.
  • Fat may assist with satiety.

Saturated and trans fat

Less than 13% of energy

Mental health facility: Less than 11% of energy

Nutrient actions

  • Ideally less than 10% of energy.
  • Offer monounsaturated or polyunsaturated spreads at each meal.
  • Hot mains are cooked with unsaturated fat, where appropriate.
  • Vegetable dishes are cooked with unsaturated fat, where appropriate.
  • Potato, rice and pasta dishes have saturated fat levels less than 2g saturated fat per standard serve.
  • Desserts are prepared with unsaturated fat, where appropriate.
  • Sandwiches are prepared with monounsaturated or polyunsaturated margarine.
  • Offer fish at least three times per week (in main meals, salads, or sandwiches). Oily fish such as tuna, salmon, mullet or sardines are preferred.
Mental health facility
  • Reduced fat dairy foods are used in food preparation, where possible.
  • Lean meats and poultry are used.

Rationale

  • Saturated and trans fats are dietary risk factors for cardiovascular disease due to their impact on lipid profiles.
  • Patients should be able to choose lower saturated fat foods from the options.
  • Food preparation must incorporate use of lower saturated fat ingredients.
  • Therapeutic low saturated fat diet is available for those patients who require a lower prescribed saturated fat intake.
Mental health facility
  • Medications commonly used in the treatment of severe mental illness can alter lipid metabolism and are associated with dyslipidaemia.7, 8
  • Research has shown that a Mediterranean-style diet (which includes oily fish and olive oil) is associated with lower levels of inflammation, have been shown to reduce the risk of depression and can significantly improve depressive symptoms.9-18

Carbohydrate

No goal

Nutrient actions

  • At least one low glycaemic index food choice is available per meal.
  • All breakfast cereals contain less than 30g sugars per 100g.
  • All canned fruit is in natural fruit juice or water not syrup.
  • All fruit juice is 100% juice with no added sugar.

Rationale

  • The Nutrient Reference Values for Australia and New Zealand do not prescribe a recommended daily intake or upper limit for carbohydrate.4
Mental health facility
  • Medications commonly used in the treatment of severe mental illness can alter glucose metabolism and are associated with impaired glucose tolerance and Type 2 diabetes.7, 8
  • High glycaemic diets with refined carbohydrates and added sugars are associated with inflammation. Chronic inflammation is associated with depression.16, 19
  • Low glycaemic index carbohydrates can help with maintaining good glycaemic control, which is associated with improved cognition and reduced mood swings.20-22

Fibre

30g per day

Nutrient actions

  • At least 50% of cold breakfast cereals provide at least 3g fibre per serve.
  • Patients can choose from wholemeal, multigrain or standard white bread at all meals and sandwiches.
  • Patients can choose fruit (fresh or canned) at each main meal and as a mid-meal option.
  • Patients can choose vegetables at two main meals per day.
  • A main salad is offered as an alternative to a hot main or sandwich.
Mental health facility
  • One cold breakfast cereal option should provide at least 5g fibre per serve.
  • Wholemeal, multigrain or high fibre white bread is offered at all meals as an alternative to standard white bread.
  • Sandwiches made with wholemeal, multigrain or high fibre white bread are offered.

Rationale

  • 30g is the daily adequate intake for adult males while 25g is the daily adequate intake adult females. 27-30g is the daily adequate intake for pregnant and lactating females.4
  • Consuming adequate fibre combined with adequate fluid intake may prevent and assist with managing constipation.
Mental health facility
  • Some medications used to treat mental illness can cause severe constipation.23, 24
  • Fibre is a key component of the Mediterranean diet and is essential to support a healthy and diverse microbiome.

Fluid

2.1–2.6L per day

Nutrient actions

  • Water is available for all patients, either at the bedside or as bottled water, when clinically suitable.
  • Patients can choose from a selection of beverage options at all meals and mid-meals.
Mental health facility
  • A selection of beverages including low-joule beverages should be offered at all meals and mid-meals.
  • Water needs to be available for all patients, when clinically suitable. This may be from bottled water, drinking fountains or dedicated taps.

Rationale

  • 2.1L is the daily adequate intake for adult females and 2.7L is the daily adequate intake for adult males.4
  • Consuming adequate fluids prevents dehydration and assists with preventing constipation.
  • Dehydration can impact mood, cognition and cause fatigue.27-29
  • Fluid includes water, milk and other hot and cold drinks.4
Mental health facility
  • Use of low-joule beverages can assist in reducing overall energy intakes.

Adult micronutrients goals

Sodium

Upper limit 2300mg per day

Nutrient actions

  • Patients can choose foods each day without exceeding the upper limit nutrient goal for sodium.
  • 10% or less of hot main menu items offered across the menu cycle have more than 575mg sodium per serve.
  • High sodium options included on the menu must have an additional nutritional benefit (e.g. also high protein).
  • Vegetables are cooked without added salt.
  • Multiple ingredient potato, rice and pasta dishes have less than 300mg sodium per serve.
  • Single ingredient potato, rice and pasta dishes are cooked without added salt.
  • Bread has less than 400mg sodium per 100g.
  • Salt sachets are available as an option (salt sachets are not counted in the sodium content of a meal).
  • Design default menus to provide no more than 2300mg sodium per day.
  • Not more than 10% of the range of mid-meal and snack options to have more than 300mg sodium per serve.

Rationale

  • During acute illness, sodium intake can contribute to increased blood pressure and contribute to disorders of sodium and fluid balance.30, 31
  • The Nutrient Reference Values for Australia and New Zealand have not set an upper limit for sodium.4, 32
  • The population-based suggested dietary target is 2000mg. This level meets nutritional requirements while reducing excess sodium intake.1, 32
  • The previous edition of the Nutrition Standards set the upper level for sodium at 2300mg per day, and this continues. This balances health advice, clinical care and electrolyte management with including palatable food on the menu.
  • This level acknowledges that commercial food used in hospital catering has a higher sodium content than home cooking.
  • The menu must be designed to enable a patient to choose food items totalling less than 2300mg sodium in a day.
  • High sodium foods (such as cheese and ham) or meals can be included for patients who are unwell or eating poorly, provided they are also nutritionally dense.
  • When higher-sodium options are on the menu, lower- to moderate-sodium options within that menu group or as sides should also be on the menu.
  • Design default menus to stay below the daily upper limit for sodium.
  • Sodium intake reduction is a public health goal.4, 32, 33

Vitamin C

45mg per day

Nutrient actions

  • Uncooked sources of vitamin C options are available at each main meal and mid-meal. These include fresh fruit, raw vegetables, juices or salads.
  • Juices contain at least 20mg vitamin C per 100ml.

Rationale

  • The recommended daily intake for adult males and females is 45mg. Pregnant and lactating females have increased requirements (60–85mg).4
  • Vitamin C has a significant role in collagen synthesis, wound healing and infection resistance.13 
  • There are large losses of vitamin C in food service handling, processing and cooking.34, 35 Uncooked sources of vitamin C must be available.
Acute care facility
  • Fruit juice is an easily consumable source of vitamin C for patients who are eating less or unable to consume raw fruits and vegetables.

Folate

400µg per day

Nutrient actions

  • Offer folate-fortified breakfast cereals daily.
  • Patients can choose at least five serves of vegetables each day.
  • A range of fruit options are available throughout the day so patients can choose two serves of fruit per day.

Rationale

  • The recommended daily intake for adult males and females is 400µg. Pregnant and lactating females have increased requirements (up to 600µg).4
  • There are large losses of folate in cooking and processing.36

Calcium

1000mg per day

Nutrient actions

  • Offer dairy products at every main meal and mid-meal.
  • Soy milk or non-dairy milk alternatives are available and contain at least 100mg calcium per 100mL.
Mental health facility
  • Offer reduced-fat dairy products.

Rationale

  • The recommended daily intake for males aged 19-70 years and females aged 19-50 years is 1000mg.
  • This requirement increases to 1300mg for males over 70 and females over 50 years. For pregnant and lactating females, the recommended daily intake is 1000-1300mg.4
  • Dairy products are a good source of calcium. Alternative (non-dairy) calcium options must be available to meet dietary requirements.
  • Additional serves of foods containing calcium should be available for patients with increased calcium needs (e.g. women or older persons).

Iron

11mg per day

Nutrient actions

  • Offer iron-fortified breakfast cereals daily.
  • Offer red meat in at least one main dish, sandwich or main salad per day.
  • Offer wholemeal breads, eggs, legumes and white meats on the menu to broaden the variety of iron sources.
  • Offer a vitamin C source at the same meal (to promote iron absorption).

Rationale

  • 18mg is the recommended daily intake for females aged 19–50 years. 8mg is the recommended daily intake for all other age groups. 27mg is the recommended daily intake for pregnant females and 9mg for lactating females.4
  • 11mg is the  minimum, noting that approximately 25% of the hospital population will need more.

Zinc

14mg per day

Nutrient actions

  • Offer meats, fish and poultry daily on the menu.
  • Offer cereals and dairy foods daily on the menu.

Rationale

  • 14mg is the recommended daily intake for adult males. 8mg is the recommended daily intake for adult females. 11-12mg is the recommended daily intake for pregnant and lactating females.4
  • Zinc is a significant mineral with respect to wound healing and immune function.37 
  • Zinc depletion is associated with decreased taste acuity and poor appetite.37, 38
  • Ensuring patients receive adequate protein and iron will give opportunities to meet the zinc requirement.

Vitamin D

No goal

Nutrient actions

    • All margarine and table spreads contain a minimum of 55ug vitamin D/kg.
    • Offer fish two to three times per week in main meals, salads or sandwiches. Oily fish, such as salmon, is preferred.
    • Patients can choose at least one of the following vitamin D-containing foods each day from the menu:
      • Eggs
      • Vitamin D-fortified breakfast cereal
      • Formulated-supplementary beverages containing vitamin D (e.g. Milo, Sustagen, Ensure)
      • Modified milk or dairy products fortified with vitamin D.

      Rationale

      • A quantitative nutrient goal has not been set for vitamin D.
      • Vitamin D can be synthesised in the skin or can be consumed in the diet.39
      • Older people are significantly less able to synthesise vitamin D in the skin than younger people.
      • Limited sun exposure depletes vitamin D stores in the body.40
      • Unwell people tend to have limited sun exposure and therefore have an increased dietary vitamin D requirement.
      • 80µg is the upper limit for adult males and females.4
      • Healthcare facilities do not need to report Vitamin D intake when being assessed to the Nutrition Standards.

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