Food Preferences of Inpatients in an Australian Teaching Hospital—What Has Happened in the Last 12 Years?

Food preferences of inpatients in an Australian teaching hospital—what has happened in the last 12 years?

Suzanne Kennewell and Maria Kokkinakos

Abstract The aim of this study was to survey the food prefer- Methods ences of patients in a large teaching hospital in Australia and to compare the results to a similar study conducted in 1986. Possi- The survey instrument ble differences between genders also were examined. Five hundred and twenty-four patients completed a food preferences A slightly modified version of the questionnaire used by survey, using a nine-point hedonic scale, to indicate how much Williams was used to gather information on the food pref- they liked or disliked 223 different food items. Fresh fruit, poul- erences of hospital inpatients. The questionnaire consisted try and red meat remained the most popular food classes. Nine of of a list of 223 food names, arranged in random order. the 15 most popular individual food items were fresh fruit. Sig- Respondents were asked to indicate how much they liked nificant differences were found between the food preferences of or disliked a food item using the same nine-point hedonic males and females for a number of food classes and individual scale previously described (6). Alternatively, respondents food items. Compared to the 1986 results there appears to be a could select a ‘never tried’ category. greater preference for nutritionally desirable items, more food from various cultures and more traditionally gourmet or ‘novel’ The list included a number of foods commonly availa- foods. It is hoped that the results of this survey may assist other ble and some ‘luxury’ foods, but excluded items that are nutrition and food service staff plan menus for Australian hospi- routinely available on most menus (including breakfast tal patients. (Aust J Nutr Diet 2001;58:37–44) cereals, bread and spreads, tea and coffee). Twelve food items were added to the original survey tool used by Wil- Key words: food preferences, menu planning, male, female, liams. These represented items that were omitted from the hospital inpatients. original survey or have been introduced to Australian diets since that time—roast chicken, chocolate mousse, Fruche, satays, mixed green salad, potato salad, pasta Introduction salad, rice salad, tabouleh, lentil patties, chickpea curry and soya burger. The menu forms the heart of any food service operation. It The same eleven duplicate items as used in the 1986 dictates the complexity of meals that will be prepared, the survey were included to test the reliability of responses. equipment that will be required and the level of skill Three nonsense food names (boiled ermal, trake and needed by the staff who will provide the service. Optimal punistro) were included to estimate how often subjects menu planning assists with cost control and the provision responded to a word that looked like a food or responded of a high quality service. The menu planners must take automatically without actually reading the name. into account not only the nutritional requirements of their The questionnaire was piloted amongst staff members clients, but also their food habits and preferences (1–5). of the food services and the nutrition and dietetics depart- ments of Royal Prince Alfred Hospital, Sydney, New The first comprehensive survey of the food prefer- South Wales. The addition of 12 items did not signifi- ences of Australian hospital patients was undertaken in cantly increase the time required to complete the survey, 1986 by Williams (6). This survey demonstrated that the with 20 minutes being the average time taken to complete results of similar surveys conducted overseas are not nec- the survey. essarily applicable in Australia. Anecdotal evidence suggests that there have been changes in the food prefer- Sample selection ences of Australians in the last 12 years, but few studies The survey took place over a 12-month period, from have been conducted since the mid 1980s, and these have March 1998 to March 1999. Those patients who could not examined the changes in food preferences of patients with speak English or who were too ill to answer the question- a particular disease state (7) or have examined a particular naire, were excluded from the survey. The general age group (8). psychiatric unit was not included in the survey. Data were not collected on the number of patients who were ineligi- The aim of this study was to survey the food preferences of patients in the same large teaching hospital in Royal Prince Alfred Hospital, Food Services Department, Australia and to compare the results to those found by Camperdown, New South Wales Williams to establish if changes have occurred in food S. Kennewell, BSc, MNutrDiet, MDAA, APD, Administrative Dietitian preferences since 1986. The study also aimed to establish M. Kokkinakos, BSc, DipNutrDiet, MMgt, MDAA, APD, Deputy Director Food Service Nutrition, CSAHS whether or not significant differences existed in food pref- Correspondence: S. Kennewell, Food Services Department, Royal erences between the genders. Prince Alfred Hospital, Camperdown, NSW 2050

Australian Journal of Nutrition and Dietetics (2001) 58:1 37 Food preferences in hospital ble, or who declined, to participate in the survey. meat, red and yellow vegetables, salad vegetables, Therefore, a response rate for the survey could not be savoury dishes, seafood, smallgoods and soup. calculated. The mean and standard deviation of hedonic scores The intention of this survey was to compare results were calculated for each food item and class. The paired t- with those found by Williams and the patient selection cri- test was used to test if the responses between repeat items teria were the same as those used in 1986. Therefore, were consistent. The Mann-Whittney U test was used to although a paediatric ward has been opened at Royal identify significant differences between genders. Prince Alfred Hospital since the 1986 survey was conducted, patients under 10 years of age were excluded from the survey. In completing the survey, patients would occa- Results sionally miss an individual food item. As these omissions were believed to be accidental and would not affect conse- quent scores, these surveys were included, unless more Demographic data % than 10 of items were missed. A total of 524 usable sur- Table 1 summarises the demographics of the survey popu- veys were collected. lation. Information on the total inpatient population (excluding patients less than 10 years of age) in Royal Administration of the questionnaire Prince Alfred Hospital for the period July 1998 to June The questionnaire was distributed by diet aides or food 1999 is presented for comparison. While the age ranges service assistants. These staff were trained in the adminis- are represented reasonably, the survey under-represents tration of the survey by the same researcher. Patients males and patients born outside Australia when compared meeting the selection criteria were asked if they wished to to the hospital’s general population. Results of the 1996 participate in the survey. Those who agreed to participate census population (10) are also shown. were given a copy of the questionnaire, which was collected one to two hours later. Prior to attempting the Reliability of results questionnaire, the participant received oral instructions on how to complete the questionnaire, with emphasis on the Table 2 shows the difference and the standard deviation of points listed below. the difference of the 11 duplicate food items. The overall mean difference for the duplicate food items was –0.02 1. The survey was not intended to be an evaluation of and the standard deviation of the differences was 1.223 the quality of the food in the hospital—only of gen- (P = 0.232). This indicates there was no significant differ- eral preferences among a list of specific items. ence overall between the scores for duplicate food items. 2. The opinion of each person was important and infor- An average of 57.7% of subjects gave an identical score mation on items that had never been tried was also for duplicate items. This compares to 58%, 62.5% and valuable. 55.1% found in previous studies (6–8). 3. The survey was best done one food at a time. The fol- lowing prompt was used to explain the survey method Table 1. Demographic data comparing survey sample with to patients: Royal Principal Alfred Hospital (RPAH) inpatients and Australian Bureau of Statistics For each food first decide whether you have ever had it; if (ABS) census (10) not, circle the number zero and move on to the next food. If you have had the food item, circle the number that best cor- RPAH patients responds to your feelings about the food generally. Survey sample 1998/1999 NSW 1996 ABS (n = 524) (n = 52 640) census(a) 4. The response should reflect an opinion about the food (%) (%) (%) item when prepared to an average acceptable standard, not the very best or worst example the respondent Gender had tried. Male 37.8 44.9 49.4 While questions were welcome during the survey, sub- Female 62.2 55.1 50.6 jects were not told the identity of any food they were not Age range (years) sure about. If they were able to identify the food correctly, 10–19 2.3 3.1 16.0 their view was corroborated; if not, they were advised to answer ‘never tried’. 20–29 14.2 14.8 17.2 30–39 21.9 18.2 18.0 Analysis of results 40–49 11.7 13.1 16.6 50–59 19.4 14.9 12.7 Results were analysed using the Statistical Package for the Social Sciences (SPSS Inc, Cary, NC, SPSS base version 60–69 17.5 15.6 9.1 6.1.3 for Windows, 1995). Although the hedonic scale is 70–79 8.9 14.6 7.1 an equal interval scale, results were not distributed nor- 80 or over 4.1 5.7 3.3 mally. Therefore, non-parametric statistical tests were Country of birth used (9). Foods were grouped into 22 classes for the pur- pose of analysis—breakfast dishes, canned or stewed Australia 73.8 59.8 72.8 fruit, dairy products, desserts, eggs, fresh fruit, fruit juice, Other 26.2 40.2 27.2 green vegetables, nonsense foods, offal, potato and substi- (a) Australian Bureau of Statistics country of birth includes data for tutes, poultry, prepared pulses, prepared salads, pulses, red children from birth to nine years old.

38 Australian Journal of Nutrition and Dietetics (2001) 58:1 Food preferences in hospital

Overall, 14.5% of subjects gave a score to a ‘non- prepared salads were significantly more popular with sense’ food item. This is similar to results found by other females than males. Poultry, red meat, eggs, fruit juice, studies: 15.8% (6), 20% (7), 15.1% (8) and 16 to 20% (11). desserts, canned or stewed fruit, seafood, hot breakfast Where subjects scored nonsense food items, the rating dishes, soup, smallgoods, pulses and offal were signifi- given was generally low. The mean score for this class cantly more popular with males than females (see Table was 3.48. This reflects results found in other studies (6,8). 4). Individual food items, such as fresh mangoes, pumpkin soup, raw carrot, cucumbers, spinach and cheese pie, zucchini, quiche, cottage cheese and ricotta cheese were Food preference scores significantly more popular with females than males. A number of individual food items were significantly more Table 3 lists the mean hedonic score for each class and popular with males than females (see Table 5). food item. Scores are arranged by class, with food items in each class listed in decreasing order of preference. The Unfortunately, the original data from the study con- percentage of subjects who have never tried a food item ducted by Williams in 1986 were not available for are also shown. statistical comparison to the current results. However, trends in relative popularity were observed. Table 6 lists Fresh fruit scored highest of the food classes (mean the food items with a change of 0.5 or greater in mean score 7.25) and offal the lowest (mean score 3.98). While hedonic score compared to Williams’ survey. A change of the class score may be indicative of the general popularity 0.5 or greater in the hedonic score was selected, as this is of a class, the average score of individual food items the approximate level at which significant differences within some classes varied widely. For example, baked appeared to occur between genders. Pumpkin soup is the potato (mean score 7.74) was most popular in the potato most noticeable, with a change of +1.04 in the average and substitutes class, while swedes were the least popular hedonic score. (mean score 4.41). A number of food items had a change in hedonic score The most popular individual food items (hedonic score between 0.25 and 0.49. While such a level of change is > 7.5) were fresh peaches, fresh cherries, fruit salad, not likely to be significant, it may indicate a trend. Food strawberries, baked potato, orange juice, ice cream, items which were slightly more popular included ricotta bananas, grapes, nectarines, roast chicken, watermelon, and cottage cheese, milk, spinach and cheese pie, mous- mandarins, fresh apples and prawns. saka, lasagne, okra, eggplant, avocado, steamed fish, baked beans and lentils. Food items which were slightly The least popular foods (hedonic score < 5.0) were less popular included fish fried in batter, frankfurts, grilled creamed spinach, blancmange, devon, pate or liverwurst, sausages, devon, hot chips, bacon, offal, junket, blanc- parsnips, soyabeans, blue vein cheese, radishes, turnips, mange, parsnips, turnips and swedes. fried liver, swedes, kidneys, tongue, tripe and brains. The least familiar foods, i.e. where more than 20% of subjects indicated they had ‘never tried’ the item, were Discussion eggplant (aubergine), tripe, brains, tabouleh, junket, The results of this survey suggest that the inclusion of chickpeas, eschallots, swedes, pate or liverwurst, tongue, fresh fruit in any menu may be an important factor in rabbit casserole, soyabeans, Fruche, artichokes, lentil patient satisfaction. Not only was fresh fruit the most pop- patties, canned loganberries, chickpea curry, blancmange, ular class overall, but nine of the 15 most popular food consomme, moussaka, spanish cream, soya burger, gazpa- items were fresh fruit. Stone fruit was particularly popular cho soup and okra. and fresh fruit salad was the most popular dessert. There were significant differences (P ≤ 0.01) between Care must be taken in the interpretation of class the genders in the scores given for both food classes and scores. While this score is an indicator of the overall pop- specific food items. Of the food classes, fresh fruit and ularity of a class, there were individual food items within classes that scored poorly, e.g. the class score for desserts was 6.52 but the individual score for blancmange was Table 2. Difference, ± standard deviation of difference, 4.82. However, class scores have been used previously to between hedonic scores for duplicate food items, rate the popularity of menu items (12) and may be a useful indicating reliability of responses guide to menu planners. Score 1 – score 2 Food item (± sd) P-value The gender differences found in this survey are similar to those found by previous authors. Wyant and Paw paw –0.02 ± 1.045 0.622 Meiselman (13) found that ‘women more highly preferred Lamb chops –0.18 ± 1.047 0.000 vegetables, salads and fruit’, while Werning and Apricot juice 0 ± 1.127 0.744 Baltzer (14) found that women preferred vegetables more Fried rice 0.12 ± 1.045 0.008 than men did. Canned cherries –0.03 ± 1.365 0.073 Comparing the results of this survey to those reported Steamed pumpkin –0.09 ± 1.411 0.146 by Williams in 1986, an increased popularity of dairy Cabbage –0.09 ± 1.117 0.131 foods was found, with the exception of cream, which Onion soup –0.33 ± 1.487 0.000 decreased by 0.71 in the average hedonic score. A number of other high fat foods showed a decline in popularity, Salami 0.19 ± 1.333 0.001 including fried chicken, fish fried in batter, frankfurts, Plain yoghurt 0.08 ± 1.126 0.163 devon, sausages, hot chips and bacon. Baked beans 0.13 ± 1.181 0.011 (continued page 42)

Australian Journal of Nutrition and Dietetics (2001) 58:1 39 Food preferences in hospital

Table 3. Mean food preference scores (± sd) arranged in food classes and in decreasing order of preference Hedonic score Hedonic score Never tried Never tried Food item Mean ± sd n (%) Food item Mean ± sd n (%)

Fresh fruit Eggs Class score 7.25 ± 2.01 11 161 – Class score 6.74 ± 2.02 2 568 – Peaches 7.91 ± 1.38 511 1.2 Omelettes 7.01 ± 1.81 515 1.5 Cherries 7.86 ± 1.65 514 1.5 Scrambled eggs 6.87 ± 1.97 517 1.0 Strawberries 7.84 ± 1.52 515 1.3 Boiled eggs 6.83 ± 1.90 515 1.2 Bananas 7.70 ± 1.58 518 0.4 Fried eggs 6.65 ± 2.09 512 1.7 Grapes 7.67 ± 1.53 513 1.5 Poached eggs 6.35 ± 2.22 509 1.5 Nectarines 7.66 ± 1.62 505 2.9 Prepared salads Watermelon 7.57 ± 1.70 517 0.8 Class score 6.64 ± 2.07 2 401 – Mandarins 7.55 ± 1.52 512 1.9 Mixed green salad 7.33 ± 1.76 508 1.0 Apples 7.52 ± 1.60 510 0.8 Potato salad 7.01 ± 1.71 510 2.1 Oranges 7.49 ± 1.63 518 1.1 Pasta salad 6.54 ± 2.00 494 5.0 Fresh mango 7.48 ± 2.26 507 2.5 Rice salad 6.21 ± 2.05 483 6.9 Rockmelon 7.45 ± 1.81 515 1.3 Tabouleh 5.93 ± 2.56 406 21.2 Pineapple 7.45 ± 1.86 518 1.1 Fruit juice Pears 7.41 ± 1.71 515 0.8 Class score 6.61 ± 2.26 3 518 – Apricots 7.33 ± 1.86 514 1.0 Orange juice 7.73 ± 1.54 518 0.4 Passionfruit 7.13 ± 1.96 513 1.9 Apple juice 7.15 ± 1.92 517 1.3 Plums 7.13 ± 1.87 508 1.4 Pineapple juice 6.95 ± 1.98 510 1.9 Honeydew melon 6.95 ± 2.05 491 6.1 Pear juice 6.67 ± 1.94 496 4.8 Kiwi fruit 6.78 ± 2.18 498 3.1 Apricot juice 6.59 ± 2.19 486 6.2 Avocado 6.18 ± 2.65 492 5.4 Tomato juice 5.85 ± 2.48 504 3.8 Paw paw 6.10 ± 2.59 468 10.0 Grapefruit juice 5.28 ± 2.73 487 6.7 Grapefruit 5.05 ± 2.63 489 6.1 Red or yellow vegetables Poultry Class score 6.59 ± 2.10 3 565 – Class score 6.88 ± 1.93 3 026 – Baked pumpkin 7.26 ± 1.95 511 1.7 Roast chicken 7.62 ± 1.50 515 0.8 Grilled tomatoes 6.93 ± 1.92 512 1.7 Fried chicken 7.21 ± 1.75 516 1.1 Sweet corn 6.69 ± 2.04 512 1.7 Roast turkey 7.01 ± 1.86 512 1.3 Mashed pumpkin 6.59 ± 2.12 511 2.3 Chicken casserole 6.57 ± 1.85 517 1.3 Boiled carrots 6.40 ± 2.06 516 1.1 Steamed chicken 6.54 ± 1.93 506 2.1 Steamed pumpkin 6.39 ± 2.11 509 2.1 Roast duck 6.23 ± 2.34 460 11.5 Stewed tomatoes 5.84 ± 2.22 494 5.0 Red meat Savoury dishes Class score 6.75 ± 2.11 8 441 – Class score 6.53 ± 2.11 5 709 – Grilled steak 7.45 ± 1.80 512 1.7 Lasagne 7.14 ± 1.87 507 2.7 Roast lamb 7.43 ± 1.91 520 0.6 Spaghetti bolognaise 7.01 ± 1.88 504 2.1 Crumbed veal 7.31 ± 1.84 505 3.4 (schnitzel) Pizza 6.89 ± 1.99 507 2.7 Roast pork 7.26 ± 2.00 511 1.9 Satays 6.86 ± 2.07 479 7.2 Lamb cutlets 7.16 ± 1.97 515 1.0 Cottage pie 6.75 ± 1.86 490 6.0 Roast beef 7.03 ± 1.75 516 1.0 Curries 6.73 ± 2.07 507 2.3 Pork chops 6.87 ± 2.12 508 2.5 Meat pies 6.54 ± 1.94 514 1.7 Lamb chops 6.84 ± 1.96 514 1.5 Moussaka 6.19 ± 2.25 340 34.5 Corned beef 6.79 ± 2.04 502 2.5 Spinach and cheese pie 6.16 ± 2.26 475 8.5 Hamburger 6.77 ± 1.95 512 1.3 Quiche 6.05 ± 2.10 473 8.2 Roast veal 6.66 ± 2.03 497 4.2 Fish cakes 6.01 ± 1.98 492 5.2 Beef stew 6.66 ± 1.93 503 2.9 Egg and asparagus 5.70 ± 2.53 421 19.0 mornay Lamb casserole 6.59 ± 2.04 513 1.9 Meatballs 6.55 ± 1.91 510 2.5 Desserts Fricassee of veal 6.06 ± 2.28 435 16.3 Class score 6.52 ± 2.19 8 441 – Baked meatloaf 5.61 ± 2.17 479 6.1 Fruit salad 7.85 ± 1.37 520 0.6 Rabbit casserole 5.06 ± 2.77 389 25.3 Continued next page

40 Australian Journal of Nutrition and Dietetics (2001) 58:1 Food preferences in hospital

Table 3. (continued) Hedonic score Hedonic score Never tried Never tried Food item Mean ± sd n (%) Food item Mean ± sd n (%) Ice cream 7.71 ± 1.62 516 0.6 Seafood mornay 6.24 ± 2.38 495 5.2 Apple pie 7.40 ± 1.57 516 1.2 Fish fingers 5.78 ± 2.15 509 2.1 Pavlova 6.92 ± 2.15 505 2.7 Oysters 5.58 ± 3.16 477 7.9 Jelly 6.83 ± 1.80 515 1.3 Sardines 5.40 ± 2.53 503 4.0 Chocolate mousse 6.75 ± 2.11 508 1.6 Squid 5.08 ± 2.83 453 12.9 Cheesecake 6.58 ± 2.09 505 1.4 Mussels 5.03 ± 2.88 450 13.3 Steamed puddings 6.51 ± 1.98 498 4.8 Salad vegetables Trifle 6.49 ± 2.22 489 6.1 Class score 6.14 ± 2.36 7 906 – Plain iced cake 6.38 ± 1.92 507 2.7 Fresh tomatoes 7.43 ± 1.73 516 0.6 Lemon delicious 6.38 ± 2.00 475 8.5 Lettuce 7.13 ± 1.60 516 0.4 pudding Beetroot 6.88 ± 1.89 511 2.1 Baked custard 6.27 ± 2.15 493 4.5 Raw carrot 6.59 ± 2.11 514 1.7 Sweet creamed rice 6.24 ± 2.28 479 7.4 Asparagus 6.53 ± 2.41 504 2.7 Custard sauce 6.23 ± 2.17 470 9.1 Cucumbers 6.49 ± 2.20 516 0.8 Fruche 6.04 ± 2.28 374 26.4 Capsicum 6.37 ± 2.25 509 1.9 Spanish cream 5.29 ± 2.39 319 37.8 Coleslaw 6.35 ± 2.03 505 2.9 Junket 5.16 ± 2.58 401 22.0 Mushroom salad 6.05 ± 2.22 485 6.6 Blancmange 4.82 ± 2.56 351 32.4 Celery 5.93 ± 2.21 507 2.0 Potato and substitutes Eschallots 5.93 ± 2.14 398 23.3 Class score 6.49 ± 2.29 4910 – Gherkin 5.74 ± 2.43 496 5.0 Baked potato 7.74 ± 1.38 516 0.8 Raw onion 5.53 ± 2.42 503 3.6 Mashed potato 7.30 ± 1.67 518 0.2 Bean shoots 5.12 ± 2.39 478 7.7 Fried rice 7.22 ± 1.68 515 1.5 Olives 5.09 ± 3.09 472 8.5 Hot chips 7.12 ± 1.85 516 1.0 Radishes 4.67 ± 2.49 476 7.4 Sweet potato 7.03 ± 1.98 500 3.7 Soup Boiled rice 7.00 ± 1.76 519 0.2 Class score 6.13 ± 2.32 5 955 – Boiled potato 6.83 ± 1.72 514 0.6 Pumpkin soup 6.81 ± 2.25 507 2.5 Parsnips 4.72 ± 2.61 460 11.5 Vegetable soup 6.76 ± 1.99 512 1.5 Turnips 4.63 ± 2.43 464 9.9 Chicken noodle soup 6.66 ± 1.97 516 1.1 Swedes 4.41 ± 2.49 388 23.8 Tomato soup 6.61 ± 2.05 511 1.7 Canned or stewed fruit Minestrone soup 6.51 ± 2.14 482 7.8 Class score 6.48 ± 2.02 3 877 – Cream of chicken soup 6.33 ± 2.21 501 3.7 Canned peaches 7.04 ± 1.80 515 1.0 Pea and ham soup 6.18 ± 2.47 501 4.0 Canned pineapple 6.71 ± 1.84 514 1.7 Mushroom soup 5.92 ± 2.29 492 5.7 Stewed apple 6.70 ± 1.86 506 2.5 Cream of celery soup 5.66 ± 2.48 475 9.2 Canned pears 6.64 ± 1.88 518 1.1 Carrot soup 5.54 ± 2.42 454 13.0 Canned apricots 6.52 ± 1.91 514 1.3 Gazpacho soup 5.46 ± 2.62 204 59.8 Canned cherries 6.08 ± 2.17 475 9.2 Consomme 5.32 ± 2.08 334 33.1 Canned plums 5.99 ± 2.19 481 7.9 Onion soup 5.12 ± 2.48 466 10.6 Canned loganberries 5.96 ± 2.33 354 32.1 Breakfast dishes Seafood Class score 6.11 ± 2.26 2 504 – Class score 6.31 ± 2.50 7931 – Potato cakes 6.99 ± 1.65 498 4.4 Prawns 7.51 ± 2.09 508 2.3 Fried mushrooms 6.33 ± 2.38 504 3.4 Lobster 7.35 ± 2.37 495 4.2 Savoury mince 6.31 ± 2.07 505 3.4 Grilled fish 7.09 ± 1.97 514 1.0 Creamed corn 5.87 ± 2.31 494 5.7 Baked fish 6.94 ± 1.92 508 2.1 Canned spaghetti 5.04 ± 2.34 503 3.6 Salmon 6.86 ± 2.18 509 2.3 Dairy products Crabmeat 6.39 ± 2.50 486 6.5 Class score 6.09 ± 2.46 3 911 – Steamed fish 6.38 ± 2.24 510 1.7 Milk 7.20 ± 1.94 522 0.2 Tuna 6.35 ± 2.28 511 1.9 Cheddar cheese 6.94 ± 1.84 508 2.1 Fish fried in batter 6.34 ± 2.26 509 2.3 Smoked fish 6.26 ± 2.38 494 5.5 Continued next page

Australian Journal of Nutrition and Dietetics (2001) 58:1 41 Food preferences in hospital

Table 3. (continued) Hedonic score Hedonic score Never tried Never tried Food item Mean ± sd n (%) Food item Mean ± sd n (%) Fruit yoghurt 6.50 ± 2.24 499 3.3 Frankfurts 5.69 ± 2.21 502 3.1 Cream 6.26 ± 2.27 512 1.7 Salami 5.54 ± 2.45 494 5.0 Cottage cheese 5.75 ± 2.39 496 4.6 Devon 4.80 ± 2.37 476 7.0 Plain yoghurt 5.55 ± 2.57 498 4.8 Pate or liverwurst 4.78 ± 2.79 392 24.3 Ricotta cheese 5.53 ± 2.48 439 14.8 Pulses Blue vein cheese 4.67 ± 2.94 437 15.8 Class score 5.52 ± 2.45 1 743 - Green vegetables Baked beans 6.24 ± 2.24 514 1.2 Class score 6.05 ± 2.41 6 911 – Lentils 5.48 ± 2.49 444 14.5 Peas 6.99 ± 1.91 514 0.8 Chickpeas 5.44 ± 2.39 403 22.4 Green beans 6.91 ± 1.87 518 0.6 Soyabeans 4.70 ± 2.48 382 26.3 Cauliflower 6.78 ± 1.99 515 1.3 Prepared pulses Broccoli 6.74 ± 2.16 517 1.0 Class score 5.19 ± 2.64 1 028 - Baked onions 6.49 ± 2.20 501 3.7 Lentil patties 5.30 ± 2.65 366 29.6 Zucchini 6.13 ± 2.19 507 2.3 Chickpea curry 5.22 ± 2.72 353 32.2 Cabbage 5.98 ± 2.22 513 1.5 Soya burger 5.02 ± 2.54 310 39.7 Boiled spinach 5.98 ± 2.32 508 2.1 Offal Broad beans 5.69 ± 2.44 472 9.1 Class score 3.98 ± 2.96 2 136 – Egg plant (aubergine) 5.69 ± 2.59 417 20.0 Fried liver 4.57 ± 3.06 458 12.3 Brussel sprouts 5.56 ± 2.57 496 5.0 Kidneys 4.35 ± 2.89 466 10.6 Okra 5.44 ± 2.47 186 63.6 Tongue 3.84 ± 2.85 384 25.0 Choko 5.35 ± 2.67 439 15.7 Tripe 3.59 ± 2.90 415 20.5 Artichokes 5.09 ± 2.66 374 27.5 Brains 3.46 ± 2.96 413 20.7 Creamed spinach 4.84 ± 2.65 434 16.7 Nonsense foods Smallgoods Class score 3.48 ± 2.34 219 – Class score 5.91 ± 2.39 3 376 – Punistro 3.79 ± 2.39 89 82.3 Bacon 7.21 ± 1.74 510 2.3 Boiled ermal 3.46 ± 2.36 63 87.5 Ham 7.01 ± 1.71 497 2.7 Trake 3.10 ± 2.23 67 86.8 Grilled sausages 6.02 ± 2.22 505 1.9

(continued from page 39)

Patients were more familiar (≥ 5% decrease in the ‘never tried’ score) with nectarines, honeydew melon, kiwi fruit, avocado, eggplant, okra, bean shoots, minestrone, pumpkin soup, chickpeas, lentils, moussaka, Table 4. Food classes with significant differences between genders (P ≤ 0.01) lasagne, quiche, spinach and cheese pie, mussels, squid and ricotta cheese in 1998/99 than in 1986. They were less Mean score familiar (≥ 5% increase in the ‘never tried’ score) with Class Male Female blancmange, junket, canned loganberries, chokos, creamed spinach, pate, roast duck, fricassee of veal, rabbit Fresh fruit 7.18 7.29 and most offal. Poultry 7.12 6.72 Red meat 7.06 6.54 Although a statistical comparison of these results with Eggs 7.01 6.58 those found in the earlier survey of Williams could not be Prepared salads 6.52 6.70 conducted, we believe they show some interesting trends. Fruit juice 6.81 6.50 There appears to be a greater preference for a number of Desserts 6.61 6.46 nutritionally desirable items, more foods from various cultures, and more traditionally gourmet or ‘novel’ foods. Canned or stewed fruit 6.67 6.37 Others have noted behaviour reflective of such preference. Seafood 6.57 6.13 The 1993 Australian food survey (15) noted that Austral- Breakfast dishes 6.40 5.91 ians were experimenting with new and varied cuisines and Soup 6.29 6.04 tastes. There is an increased number of international cui- Smallgoods 6.29 5.67 sine products on the market (16) and there has been considerable growth in the number of low fat products Pulses 5.73 5.40 available (17). Offal 4.28 3.74

42 Australian Journal of Nutrition and Dietetics (2001) 58:1 Food preferences in hospital

This survey was conducted amongst inpatients in a these data may not be appropriate in making judgment on large tertiary referral hospital and the results may not the potential popularity of menu items for a very young reflect those to be found in a well population. The survey population. is under representative of patients born outside Australia when compared to the Royal Prince Alfred Hospital popu- Consideration of age demographics is an important aspect of successful menu planning. In a study examining lation, although may be more reflective of the patient the food beliefs and behaviours of Australians, Worsley profile of the general population (10). The results exclude noted that: ‘As the age of the respondents increased, their all patients under 10 years of age and encompass a rela- food, dietary and health concerns became more unlike tively small number of patients under 20 years of age those of young people’ (18). Significant differences were when compared to the general population. We suggest that found in the food preferences of an older, predominantly male inpatient population compared to a younger, pre- Table 5. Food items with significant differences between dominantly female staff population (19). The gender ≤ genders (P 0.01) differences found in this and previous surveys (13,14,19) Mean score should be noted by those developing menus for a population dominated by a particular gender such as obstetrics Food item Male Female and gynaecology services. Fresh mango 7.09 7.70 Grilled steak 7.88 7.19 Food preferences also are influenced by a patient’s Roast pork 7.61 7.03 state of health. Studies of patients with cancer (20) and patients with chronic renal failure undergoing dialysis (7) Roast turkey 7.41 6.74 have shown differences in food preferences when com- Pork chops 7.36 6.55 pared to control groups. Therefore, the specialty areas, Jelly 7.21 6.59 and subsequent patient profile, of an individual hospital Pumpkin soup 6.47 7.03 may impact on the food preferences of that hospital’s Corned beef 7.27 6.49 patient population. Other factors which have been found to influence food preferences include cultural values (21, Beef stew 7.03 6.42 22), socioeconomic status (23) and food beliefs (24). While Fried eggs 7.03 6.42 these factors have not been explored in this study, they Canned pears 7.00 6.41 should be considered when evaluating or planning a Lamb casserole 6.92 6.37 menu. Understanding a population, and its inherent food Raw carrot 6.14 6.85 beliefs and values, is an important step in designing an Meatballs 6.87 6.33 acceptable menu. Meat pie 7.03 6.23 Customisation of the menu has been found to be an Cucumbers 5.95 6.81 important determinant in overall patient satisfaction with Baked onions 6.94 6.19 food services (25) and there have been recommendations Poached eggs 6.75 6.09 to take food preferences into account in menu planning (12,26,27). However, menu customisation is just Fish fried in batter 6.80 6.04 one predictor of patient satisfaction; food quality, food Savoury mince 6.72 6.04 temperature, variety, presentation and staff attitude are Roast duck 6.67 5.94 also important factors in patients’ overall satisfaction with Pea and ham soup 6.74 5.83 the food services (25,28–30). Baked beans 6.72 5.93 The authors have found the results of this survey to be Spinach and cheese pie 5.72 6.42 useful in menu planning decisions, particularly in relation Zucchini 5.78 6.32 Quiche 5.45 6.38 Table 6. Food items with 0.5 or greater change in hedonic Grilled sausages 6.68 5.62 score compared with Williams’ survey (6) Creamed corn 6.19 5.65 Current study Williams’ study Fish fingers 6.19 5.49 Change in Cottage cheese 5.35 5.96 Food item Mean ± sd Mean ± sd mean Frankfurts 6.37 5.25 Pumpkin soup 6.81 ± 2.25 5.77 ± 2.80 + 1.04 Cream of celery soup 6.04 5.40 Plain yoghurt 5.51 ± 2.61 4.77 ± 2.88 + 0.74 Baked meatloaf 6.17 5.26 Olives 5.09 ± 3.09 4.37 ± 3.13 + 0.72 Oysters 6.02 5.26 Fruit yoghurt 6.50 ± 2.24 5.87 ± 2.71 + 0.63 Ricotta cheese 5.11 5.75 Fresh mango 7.48 ± 2.26 6.96 ± 2.62 + 0.52 Sardines 5.46 5.11 Grilled tomatoes 6.93 ± 1.92 6.41 ± 2.49 + 0.52 Rabbit casserole 5.74 4.55 Blue vein cheese 4.67 ± 2.94 4.16 ± 2.96 + 0.51 Canned spaghetti 5.60 4.68 Artichokes 5.09 ± 2.66 4.59 ± 2.75 + 0.50 Devon 5.37 4.45 Fried chicken 7.21 ± 1.75 7.73 ± 1.59 - 0.52 Blue vein cheese 5.21 4.29 Cream 6.26 ± 2.27 6.97 ± 2.02 - 0.71 Kidneys 4.77 4.04 Brussel sprouts 5.56 ± 2.57 6.29 ± 2.36 - 0.73 Tongue 4.28 3.46 Baked meatloaf 5.61 ± 2.17 6.35 ± 2.07 - 0.74

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