Energy accuracy of nutritional fluids provided in hospital: Comparing nutrition label values against direct bomb calorimetry.

Mandatory thresholds for accuracy of reported energy on food and beverage product labels do not exist for many countries. Accurate nutrition information is essential for ensuring nutritional adequacy among hospital patients. The aim of this study was to compare direct measures of energy of nutritional fluids provided in hospital to values determined via manufacturers' specifications. Nutritional fluids were identified as any liquid provided to hospital patients orally, enterally, or parenterally, to deliver nutrition. These were categorised into six groups aligned to food/medical standards, including: 1) local recipes, 2) pre-packaged general fluids, 3) supplementary fluids, 4) prescribed nutrition fluids - thickened, 5) prescribed nutrition fluids - oral/enteral, and 6) prescribed medical nutrition - IV and parenteral. An equivalence testing statistical approach (±10% thresholds) was used to compare energy values derived directly via bomb calorimetry against those obtained from manufacturer specifications. A total of 69 fluids were measured. One fifth (n=14) exhibited non-equivalent energy values, with majority of these (n=11; 79%) likely to contain fewer calories than that calculated from reported values. Almost all (34/35; 97%) prescribed nutrition fluids (oral/enteral (20/20; 100%), IV and parenteral (7/7; 100%) and thickened fluid (7/8; 88%) products were equivalent. In contrast, only 21/34 (62%) non-prescribed fluids (local recipes (2/11; 18%), supplementary fluids (4/5; 80%) and pre-packaged general fluid (15/18; 83%) products) demonstrated equivalence. Energy content of nutritional fluids prescribed to hospital patients typically align with manufacturers' values. Consumption of non-prescribed fluids may result in lower energy intakes than expected.