Alignment of Australian Hospital Nutrition Standards With National and International Evidence-Based Guidelines: A Scoping Review

Abstract

Hospital malnutrition remains highly prevalent in Australia and contributes to poorer clinical outcomes and increased healthcare costs. Hospital nutrition standards play a critical role in ensuring nutritionally adequate menus and supporting patient intake. While Australian jurisdictions have developed hospital nutrition standards, the extent of their consistency and alignment with national and international evidence-based guidelines has not been systematically examined. This scoping review aimed to identify and compare existing hospital nutrition standards across Australia and assess their alignment with the Australian Dietary Guidelines (ADG) and European Society for Clinical Nutrition and Metabolism (ESPEN) hospital nutrition guidelines. Guided by JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, grey literature searches were conducted across government websites, national repositories, and targeted Google searches. Twelve documents met inclusion criteria, including six nutrition standards and six supporting documents. Directed content analysis guided by ADG and ESPEN deductive frameworks was used to extract and compare data across jurisdictions. Findings showed strong alignment with the ADG, particularly in five food group provision and macronutrient targets. Alignment with ESPEN guidelines was more variable. All jurisdictions met minimum energy and protein targets and offered patient menu choices; however, inconsistencies were observed in therapeutic diet provisions, macronutrient distribution, food service considerations, adaptations for diverse patient groups and monitoring practices. Hospital nutrition standards in Australia are fragmented. Developing a unified evidence-based standard integrating ADG principles with ESPEN hospital nutrition recommendations could enhance consistency, quality, and equity in hospital nutrition care.