Hospital Food Contains Twice Recommended Sodium Levels

by Leigh on July 25, 2012

salt question heart attack

Could hospital food actually be bad for your health?

It’s one of life’s ironies that hospital food is often lacking in nutrition if not downright unhealthy but a recent study finds that hospital food contains twice recommended sodium levels – bad news for those in hospital due to a cardiovascular condition. Keeping a good sodium and potassium balance is important for a naturally healthy heart but this study by researchers at the University of Toronto found that, on average, levels of sodium were almost two-times higher in regular and diabetic-patient menus in the hospitals they assessed.

The True Cost of Hospital Foods

Dr Joanne Arcand and colleagues published their findings in Archives of Internal Medicine this week and revealed that many hospitals are increasingly relying on processed foods rather than fresh ingredients, leading to a creeping rise in sodium levels. The challenge is for hospitals and healthcare facilities to alter their food-sourcing practices and menu-planning whilst keeping to a budget. The cost of hospital meals does not simply depend on the cost of the food products but also on the complexity of preparation as extra time and advanced culinary skills mean wage-costs are higher.

Fast Food in Hospitals

Whilst it is arguably more cost-effective long-term to have improved nutrition as part of an overall preventative medicine programme it is difficult for public institutions and other sectors of the healthcare industry to pass higher budgets for meals when they themselves see no immediate advantages in cost-reduction elsewhere. High levels of sodium in hospital food is not the only concern, however; meals given to patients also often contain high levels of fat and sugar, and the presence of fast-food outlets and snack-filled vending machines in hospitals gives patients little choice but to consume unhealthy food during their stay. These food outlets also impact hospital staff who frequently use caffeine and sugar to get them through shifts.

Cardiology Patients and High Sodium Diets

This study looked at several types of patient menus at three acute-care hospitals in Ontario, taking into account the sodium levels in the meals but acknowledging that patients may differ in terms of food intake and, therefore, sodium intake. The results are likely to be able to be extrapolated across a large number of hospitals as the foods served were often sourced from large-scale manufacturers that supply many hospitals with similar products. A fifth of the menus assessed came from cardiology wards, with a further 24% from surgical wards and 27% from general medical wards. Regular menus exceeded the tolerable upper level of sodium (2300mg/day) in 86% of cases and 100% of diabetic-standard menus were also in excess of this figure. Both of these menus also exceeded the 1500mg/day of sodium set as the level for adequate intake.

sodium in hospital food

Entrees and sandwiches were the worst for high sodium content in this study.

Diabetic Patients Face CVD Risk due to Hospital Food

The hospital food in regular menus had a level of 2896mg/day of sodium and the diabetic menu was 3406mg/day. These menus were set, however, and so the researchers also looked at patient-selected menus. These were still over the AI for sodium in 97% of cases in the regular menus (with an average level of 3033mg/day), with 79% also exceeding the UL for sodium. It was worse for diabetic patient-selected menus which were in excess of the AI and UL in 99% and 95% of cases, respectively.

Even Low-Salt Diets too High in Sodium

Worryingly, even sodium-restricted diets failed to meet expectations with 48% of the 2000mg sodium-restricted regular menus providing excess sodium when patients selected their own food (the average was 2041mg/day). Patients on these kinds of sodium-restricted menus are often those with heart failure or kidney disease and these findings suggest that efforts to treat patients are being undermined by such diets.Hospital food may actually contribute to an exacerbation or at least slow recovery of cardiovascular conditions that put the patients in hospital in the first place. Patients eating healthily at home could actually become sicker in hospital due to sudden excesses of sodium in the food.

Nutrition as Important and Medicine in Hospitals

Dr. Kirsten Bibbins-Domingo, from the University of California, San Francisco, wrote a commentary published alongside the study and said: “For those patients who are admitted with conditions that are sensitive to the amount of salt they take in, I do think there’s potential for the high sodium in the diets to actually cause harm… The types of nutrients they take in are as important as the medications we’re giving them.” Diabetics are particularly at risk as high sodium intake can increase their propensity for stroke or cardiovascular events. Patients may go into hospital with a relatively minor condition and become seriously ill simply because the hospital food contains twice recommended sodium levels. Dinner entrees and sandwiches were particularly high in sodium but patients do not get nutrition information about their meals and so are not in a position to make the best of a bad situation.

Government Action Needed on Sodium

Food companies producing goods for hospitals are being urged to lower sodium content and this action, combined with improved training of dietitians devising hospital menus, could go some way to improving the nutrition provided in hospitals. Those hospitals assessed in this study are already taking action to reduce sodium in patient menus. Dr Arcand has also stressed that “governments need to develop food procurement policies and nutrition standards for the foods that are served at hospitals, including developing criteria for maximum levels of sodium. Hospitals need to participate in implementing these standards when creating recipes, building menus, ordering food, and entering into contracts with food suppliers. Finally and importantly, the food industry needs to step up and lower sodium levels in the foods they are producing for hospitals.” The federal government in Canada recently disbanded a task force designed to reduce sodium levels in foods but there have been calls in the US for a tax on salt that could encourage food manufacturers to drastically cut sodium levels.

”Similar to Hospitals Selling Tobacco Products.”

While it is shocking that this study found hospital food contains twice recommended sodium levels it may not be that surprising as the levels of sodium were still generally below average intake in the general (non-hospitalised) population. A few days in hospital with high-sodium foods may not be too damaging for most people but it is worrying that the very industry purporting to model good health is failing so spectacularly. Norm Campbell, Canadian Chair in Hypertension Prevention and Control commented on the study by saying “To me, this is very similar to hospitals selling tobacco products,” as many patients are in hospital due to high salt levels in food.

Recent media reports and campaigns claiming salt is not responsible for high blood pressure and poor cardiac health, as well as other health conditions, have not helped reduce levels of sodium in the diet. The evidence supporting a connection between sodium and heart health is solid and those with hypertension, heart failure, and other cardiovascular issues would do well to heed doctors’ advice and restrict salt intake to improve heart health naturally.


JoAnne Arcand, PhD, RD; Katherine Steckham; Roula Tzianetas, MSc, RD; Mary R. L’Abbe, PhD; Gary E. Newton, MD., Evaluation of Sodium Levels in Hospital Patient Menus ONLINE FIRST, Arch Intern Med. 2012;(July):1-2.

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