Patients in public hospitals received insufficient food to meet daily protein and energy requirements: Cape Town Metropole, South Africa

  • M Theron
  • S O’Halloran


Objectives: This study aimed to determine the energy and protein content of meals served and consumed by hospitalised patients compared with their needs, to assess patients’ food satisfaction and investigate associations with energy and
protein intake.
Design: This was an exploratory quantitative cross-sectional study.
Setting: Three public hospitals within the Cape Town metropole were recruited; a central hospital (945 beds), large district hospital (372 beds) and a medium district hospital (172 beds).
Subjects: Adult inpatients 18+ years admitted to medical or surgical wards, on a non-therapeutic/normal hospital diet were recruited by purposive sampling method between 2018 and 2019.
Outcomes measures: Each participant’s weight and height were measured to calculate body mass index (BMI) and to determine energy/protein requirements. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire was administered. Meals were weighed before and after consumption to calculate energy and protein intake per patient/day.
Results: A total of 128 patients (males = 71) participated. Total protein served did not meet patient requirements in any of the hospitals. Consumed energy and protein were significantly below requirements in all hospitals (p < 0.002). Perceived food quality (r = 0.38, p = 0.039) and staff/service issues (r = 0.39; p = 0.035) were significantly positively correlated with protein intake, while appetite correlated positively (r = 0.42, p = 0.006; r = 0.41, p = 0.008) and length of stay (LOS) correlated negatively (r = −0.46, p = 0.002; r = −0.42, p = 0.008) with energy and protein intake, respectively.
Conclusion: Energy and protein served was significantly lower than participants’ requirements in all three hospitals and none achieved the official ration scale amounts. Nearly 40% reported having a normal appetite and did not receive additional food from family or friends, which may lead to hospital-acquired malnutrition and increased hospital length of stay (LOS). Improved hospital food quality, quantity, mealtimes and staff training should be a focus to improve patient energy and protein intake.

Keywords: hospital-acquired malnutrition, patient food satisfaction, protein and energy, adults, food-service management, hospital staff training, food quality, ACHFPSQ

How to Cite
Theron, M., & O’Halloran, S. (2022). Patients in public hospitals received insufficient food to meet daily protein and energy requirements: Cape Town Metropole, South Africa. South African Journal of Clinical Nutrition, 35(4), 133–141. Retrieved from
Original Research