Ontario hospital patients are routinely served meals that contain excessive amounts of sodium, enough to potentially exacerbate health problems and put some individuals in jeopardy.
Some of the highest-sodium meals are being given to diabetic patients, who are often advised to reduce sodium intake because they face a significant risk of high blood pressure, which can lead to stroke and cardiovascular disease.
The findings were revealed in a study published this week in the Archives of Internal Medicine.
"A lot of people are actually in hospital because there's too much salt in our foods," said Norm Campbell, who holds the Canadian chair in hypertension prevention and control and who was not involved with the study. "To me, this is very similar to hospitals selling tobacco products."
The study, believed to be the first of its kind, analyzed the sodium content of regular hospital meals, as well as those served to diabetics and individuals on sodium-restricted diets. The study was conducted at three acute-care hospitals in Ontario with a total of 1,935 beds.
Researchers, led by JoAnne Arcand, postdoctoral research fellow in the department of nutritional sciences at the University of Toronto, found the average sodium level of preset daily menus served to patients was 2,896 milligrams, nearly double the daily recommended amount for adults, which is 1,500 milligrams. The sodium levels in daily hospital menus also exceeds the upper tolerable limit for adults of 2,300 milligrams.
The average sodium content of daily menus that contain food choices selected by patients was even higher at 3,033 mg, also in excess of the upper tolerable limit.
Consuming more than the upper tolerable limit of daily sodium intake starts to increase an individual's chances of developing health problems, such as high blood pressure.
For diabetics, the situation was even worse. The average sodium content of daily hospital menus for patients with diabetes was 3,406 mg, far above the upper tolerable limit.
"There certainly [are] patient populations who are very sensitive to a higher-sodium diet, including those with congestive heart failure, liver failure and kidney failure," Dr. Arcand said.
Until now, much of the criticism with regard to hospital food has been focused on the fast-food chains or cafeterias in the institutions that cater to staff, visitors and patients. This study brings the concerns over food quality to a new level by revealing that vulnerable hospital patients are being fed excessive, potentially dangerous amounts of sodium.
"I think when the public go to hospitals and they're fed unhealthy food, whether they be visitors to patients or the patients themselves, I think it's hard for [hospitals] to be credible," said Dr. Campbell, who is also a professor of medicine at the University of Calgary and president of Hypertension Canada. "Studies like this, I think, shake the foundation that hospitals are there to serve the health of the public."
Sodium is a serious public health issue. The average Canadian consumes about 3,400 mg a day. There has been a growing push among health experts, such as Dr. Campbell, as well as many provinces, to introduce broad measures that would require food manufacturers to lower the amount of sodium added to food. However, the federal government disbanded a task force it had created to set lower-sodium targets.
Dr. Arcand highlighted the fact the sodium content of hospital meals reflects the move away from freshly prepared meals.
"Hospitals are increasingly using prepared and outsourced foods that tend to be higher in sodium as compared to preparing foods from raw ingredients," she said. "Within the Canadian population, we find this is also a challenge with regard to excessive [sodium] consumption."
Vesna Blazinovic, manager of nutrition services at University Health Network, the umbrella organization for several Toronto hospitals, said in an e-mail they "strive to ensure" sodium levels meet the 2,300 mg daily maximum.
The Ottawa Hospital said in an interview sodium reduction is a priority and they are working with vendors to cut levels. While many meals contain more than the daily upper tolerable limit, the hospital is working to change that, said Joanne Read, senior director of ambulatory care, eye care and support services at the Ottawa Hospital.
Although the study was contained to three hospitals, many health-care institutions outsource food services to large companies, which means the high sodium levels found in the three Ontario hospitals are likely reflective of trends across the board, Dr. Arcand said.
Dr. Arcand said that the researchers declined to reveal the names of the hospitals included in the study to protect their privacy. But she noted that many hospitals across the province as well as the country use large-scale food manufacturers, meaning the results are likely typical of patient meals at many hospitals.
The hospitals involved in the study had menus that were mostly made up of foods outsourced to manufacturers.