1. You are here:
  2. Home
  3. Practice & Education
  4. Nutrition and Dietetic Practice
  5. The Nutrition and Hydration Digest 3rd Edition
  6. Chapter 12: Menu Coding, Therapeutic Diets and Patient Groups

Chapter 12: Menu Coding, Therapeutic Diets and Patient Groups

In this chapter:

All special diets should be based upon the normal requirements of the individual... If one food substance must be restricted, the diet must in all other respects be adequate.

Rose Simmonds, Handbook of Diets (1937)

Food and drink dietary descriptors

Menu planners must devise a standard menu that meets the nutritional needs of most of the population. Any special dietary requirements or nutritional needs of specific patient groups can be met by separate à la carte or cyclical menus.

Standard hospital menus should:

  1. Provide patients with access to suitable and nutritious food and drink that is adequate to sustain life and good health.
  2. Have the capacity to meet the nutrition needs of both the nutritionally well and nutritionally vulnerable (1).  

Table 12.1: Food and drink dietary descriptors

Type of Diet

Description
  1. Standard diets

Meet the nutritional needs of most of the population spanning nutritionally vulnerable to nutritionally well
  1. Religious, cultural, personal and lifestyle considerations

Diets that cater to cultural, religious or lifestyle beliefs (including veganism) and reasonably meet the personal preferences of patients
  1. Therapeutic diets

Dietary modifications as a prescribed part of the treatment of a medical condition e.g., renal disease, swallowing difficulties, food allergies
  1. Specific patient groups

The nutritional requirements for specific patient groups that vary from the standards specified e.g. children, mental health service users, older adults

Menu coding guidance

Menu coding provides information for patients, carers and staff to enable them to make an informed choice whilst in hospital. The purpose is to highlight dishes that are suitable for patients’ specific requirements.

Patients requiring more specialist therapeutic diets should be catered for via a specialist à la carte menu so as not to limit choice for most other patients.

The four key diets that should be identified on standard inpatient menus are:

  • Healthier Eating
  • Higher Energy
  • Easy to Chew
  • Vegetarian

Other optional menu codes that hospitals can choose to use on their standard menus depending on the dietary needs of their patients include:

1. Standard Diets

The following diets should be met by the standard menu and highlighted using menu coding. This section covers the following standard menu codes:

1.1 Healthier Eating

1.2 Higher Energy

1.3 Higher Protein (Optional)

1.4 Easy to Chew

1.5 Vegetarian

2. Religious, Cultural, Personal and Lifestyle Considerations

The following special diets are typically met by separate à la carte menus. This section will cover the following religious, cultural, personal and lifestyle considerations:

2.1 Halal

2.2 Kosher

2.3 Asian Vegetarian

2.4 Vegan

3. Therapeutic Diets

The details here are given so that any changes to the general standards can be considered and incorporated at the menu planning stage.

Therapeutic diets covered in this section:

3.1 Modified Texture 

3.2 Finger Foods

3.3 Renal Suitable

3.4 Food Allergy

3.5 Gluten Free

3.6 Other Therapeutic Diets

3.6.1 Low FODMAP

3.6.2 Catering for Immune-supressed Patients (Previously Neutropenic)

3.6.3 Liver Disease (Decompensated)

3.6.4 Test or Investigation

4. Specific patient groups

There are several special patient groups within the general hospital population whose nutritional requirements may vary from the standards already specified. These may include but are not limited to children, patients in critical care and mental health patients and those most vulnerable or those highlighted through nutritional screening. Menus need to be planned or additional options offered to take varied requirements into consideration. Operational processes and cost need to be considered in these cases.

The following section covers the following specific patient groups:

4.1 Children

4.2 Critical illness

4.3 Obesity

4.4 Older adults

4.5 Cancer

4.6 Mental health

Click here to go to the Digest homepage.

Click here to return to the top of the page.

References

  1. United Kingdom. Health and Social Care Act 2012: Elizabeth II. Chapter 7. London: The Stationary Office; 2012.  
  2. Public Health England. Healthier and Sustainable Catering: Nutrition Principles. London: PHE; 2017  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/648744/healthier_and_more_sustainable_nutrition_principles.pdf [Accessed 3rd April 2023]
  3. Department of Health. Guide to creating a front of pack (FoP) nutrition label for pre-packed products sold through retail outlets. 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/566251/FoP_Nutrition_labelling_UK_guidance.pdf  [Accessed 3rd April 2023]
  4. British Association for Parenteral and Enteral Nutrition. ‘MUST’ Report. https://www.bapen.org.uk/screening-and-must/must/must-report [Accessed 3rd April 2023]
  5. NHS Scotland. Food in Hospitals: National Catering and Nutrition Specification for Food and Fluid Provision in Hospitals in Scotland. Edinburgh: APS Group Scotland; 2016. https://www.nss.nhs.scot/media/1097/1479818118-food-in-hospitals-revised-march-2016.pdf [Accessed 3rd April 2023]
  6. International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI Framework and Detailed Level Definitions. 2019. https://iddsi.org/IDDSI/media/images/Complete_IDDSI_Framework_Final_31July2019.pdf  [Accessed 3rd April 2023]
  7. NHS Improvement. Patient safety alert: Resources to support safer modification of food and drink. 2018. https://www.england.nhs.uk/publication/patient-safety-alert-safer-modification-of-food-and-fluid/ [Accessed 3rd April 2023]
  8. International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI Framework. https://iddsi.org/ [Accessed 3rd April 2023]
  9. Vegetarian Society. Health and Nutrition: Protein. https://vegsoc.org/info-hub/health-and-nutrition/protein/ [Accessed 3rd April 2023]
  10. Care Quality Commission. Regulation 14: Meeting nutritional and hydration needs. https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-14-meeting-nutritional-hydration-needs [Accessed 3rd April 2023]
  11. Halal Food Authority. Definition of Halal. http://www.halalfoodauthority.com/WhatisHalal.html [Accessed 3rd April 2023]
  12. Henley A, Schott J. Culture, religion and patient care in a multi-ethnic society: A handbook for professionals. Third Edition. London: Age Concerns Books; 1999.
  13. Kashrut Division of the London Beth Din (KLBD). What is Kosher? https://www.kosher.org.uk/article/what-kosher [Accessed 3rd April 2023]
  14. The Vegan Society. Key Facts. https://www.vegansociety.com/about-us/further-information/key-facts [Accessed 3rd April 2023]
  15. The Committee on Climate Change. The Sixth Carbon Budget: The UK’s path to Net Zero. https://www.theccc.org.uk/publication/sixth-carbon-budget/ [Last accessed 23.06.22] 
  16. International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI Testing Methods. https://iddsi.org/Testing-Methods [Accessed 3rd April 2023]
  17. NHS Digital. Patient-Led Assessments of the Care Environment (PLACE). https://digital.nhs.uk/data-and-information/areas-of-interest/estates-and-facilities/patient-led-assessments-of-the-care-environment-place#place-assessment-forms-and-supporting-guidance-documents [Accessed 3rd April 2023]
  18. Crawley H, Hocking E. Eating Well: supporting older people and older people with dementia Practical guide. London: Caroline Walker Trust; 2011. https://cwt.org.uk/wp-content/uploads/2014/07/EW-Old-Dementia-Practical-Resource.pdf [Accessed 3rd April 2023
  19. BDA Renal Nutrition Group. British Dietetic Association evidence-based guidelines for the protein requirements for adults undergoing haemodialysis and peritoneal dialysis. https://onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1111%2Fjhn.12052&file=jhn12052-sup-0001-DataS1.pdf [Accessed 3rd April 2023]
  20. Food Standard Agency for Guidance. Allergen guidance for food businesses. https://www.food.gov.uk/business-guidance/allergen-guidance-for-food-businesses [Accessed 3rd April 2023] 
  21. British Dietetic Association. Allergen Toolkit for healthcare catering. http://www.hospitalcaterers.org/media/1162/allergen-toolkit.pdf [Accessed 3rd April 2023]
  22. Food Standard Agency. Allergen labelling changes for prepacked for direct sale (PPDS) food. https://www.food.gov.uk/allergen-labelling-changes-for-prepacked-for-direct-sale-ppds-food [Accessed 3rd April 2023] 
  23. Food Standard Agency. Food allergy and intolerance training. https://allergytraining.food.gov.uk/ [Accessed 3rd April 2023] 
  24. Food Standards Agency. Precautionary allergen labelling. https://www.food.gov.uk/business-guidance/precautionary-allergen-labelling [Accessed 3rd April 2023]
  25. Coeliac UK. Gluten free and the law. https://www.coeliac.org.uk/food-businesses/caterers-and-restaurateurs/gluten-free-and-the-law/ [Accessed 3rd April 2023] 
  26. Coeliac UK. Caterers and restaurateurs. https://www.coeliac.org.uk/food-businesses/caterers-and-restaurateurs/ [Accessed 3rd April 2023] 
  27. Dr Schar Institute. Irritable Bowel Syndrome (IBS) Treatment. http://www.drschaer-institute.com/uk/irritable-bowel-syndrome/therapy-1079.html [Accessed 3rd April 2023] 
  28. Food Standards Agency. Safer food, better business for caterers. https://www.food.gov.uk/business-guidance/safer-food-better-business-for-caterers [Accessed 3rd April 2023]
  29. British Dietetic Association Haematology Sub-Group of the Oncology Specialist Group. Guidance: Safer eating with Neutropenia. https://www.bda.uk.com/uploads/assets/dc580f02-2a3f-400e-908cca4e91dffa63/Neutropenic-Diets-Guidance-Jan-2020.pdf [Accessed 3rd April 2023]
  30. Saunders J, Brian A, Wright M and Stroud M. Malnutrition and Nutrition Support in Patients with Liver Disease. Frontline Gastroenterology. 2010;1:105-111. https://fg.bmj.com/content/flgastro/1/2/105.full.pdf
  31. Swart GR, Zillikens MC, van Vuure JK, van den Berg, JW. Effect of a late evening meal on nitrogen balance in patients with cirrhosis of the liver. The British Medical Journal. 1989; 299(6709):1202-1203. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838097/pdf/bmj00258-0032.pdf
  32. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition. 2017;36:623-650.  https://www.espen.org/files/ESPEN-guideline_Clinical-nutrition-in-surgery.pdf
  33. Crawley H. Eating well at school: Nutritional and practical guideline. London: The Caroline Walker Trust; 2005. https://www.cwt.org.uk/wp-content/uploads/2014/07/EatingWellatSchool.pdf [Accessed 3rd April 2023]
  34. Scientific Advisory Committee on Nutrition (SACN). Dietary Reference Values for Energy. London: TSO; 2011 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/339317/SACN_Dietary_Reference_Values_for_Energy.pdf [Accessed 3rd April 2023]
  35. Scientific Advisory Committee on Nutrition (SACN). Salt and Health report: recommendations on salt in diet. London: TSO; 2003.  https://www.gov.uk/government/publications/sacn-salt-and-health-report [Accessed 3rd April 2023]
  36. Public Health England. Government Dietary Recommendations: Government recommendations for energy and nutrients for males and females ages 1-18 and 19+ years. London: Public Health England; 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/618167/government_dietary_recommendations.pdf [Accessed 3rd April 2023]
  37. Scientific Advisory Committee on Nutrition (SACN). Carbohydrates and Health Report. London: TSO; 2015. https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report [Accessed 3rd April 2023]
  38. Puthucheary ZA, Rawal J, McPhail M, et al. Acute Skeletal Muscle Wasting in Critical Illness. Journal of the American Medical Association. 2013;310(15):1591–1600. https://jamanetwork.com/journals/jama/fullarticle/1879857
  39. Singer P, Reintam Blaser S, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2018;38(1):48 – 79. https://www.clinicalnutritionjournal.com/article/S0261-5614(18)32432-4/fulltext
  40. van Zanten ARH, De Waele E, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Critical Care 2019; 23(1): 368. https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2657-5
  41. Tsai MH, Ku SC, Wang TG, et al. Swallowing dysfunction following endotracheal intubation: Age matters. Medicine (Baltimore). 2016;95(24): e3871. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998458/
  42. Chapple LS, Deane AM, Heyland DK, et al. Energy and protein deficits throughout hospitalization in patients admitted with a traumatic brain injury. Clinical Nutrition. 2016;35(6):1315-1322. https://pubmed.ncbi.nlm.nih.gov/26949198/
  43. Ridley EJ, Parke RL, Davies AR, et al. What Happens to Nutrition Intake in the Post-Intensive Care Unit Hospitalization Period? An Observational Cohort Study in Critically Ill Adults. JPEN J Parenter Enteral Nutr. 2019;43(1):88-95. https://pubmed.ncbi.nlm.nih.gov/29924393/
  44. Albrich L, Chapple LS, Nock A, Ridley EJ, Hickson M. Nutrition-related symptoms in adult survivors of critical illness who are eating orally: a scoping review protocol. JBI Evidence Synthesis. 2020;18(6):1326-1333. https://journals.lww.com/jbisrir/Fulltext/2020/06000/Nutrition_related_symptoms_in_adult_survivors_of.13.aspx
  45. Merriweather JL, Griffith DM, Walsh TS. Appetite during the recovery phase of critical illness: a cohort study. European Journal of Clinical Nutrition. 2018;78:986–992. https://doi.org/10.1038/s41430-018-0181-3
  46. Public Health England. The Eatwell Guide: The Eatwell Guide Booklet. 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/742750/Eatwell_Guide_booklet_2018v4.pdf [Accessed 3rd April 2023].
  47. NHS Digital. Hospital Admitted Patient Care Activity 2019-20. 2020. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/2019-20 [Accessed 3rd April 2023]
  48. Age Platform Europe. PRevention Of Malnutrition In Senior Subjects in the EU (PROMISS). https://www.age-platform.eu/project/promiss#:~:text=PROMISS%20%3E%20Theme%3A%20Malnutrition%20%3E%20Timeline%3A%20April%202016,Europe%2C%2090-95%25%20of%20older%20adults%20live%20at%20home. [Accessed 3rd April 2023]
  49. Volkert D, Beck AM, Cederholm T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition. 2019;38(1):10-47. doi: 10.1016/j.clnu.2018.05.024
  50. Natalwala A, Potluri R, Uppal H, Heun R. Reasons for hospital admissions in dementia patients in Birmingham, UK, during 2002-2007. Dementia and Geriatric Cognitive Disorders. 2008;26(6):499-505. doi: 10.1159/000171044.
  51. Alzheimer’s UK. 2016 All-Party Parliamentary Group Report. https://www.alzheimers.org.uk/about-us/policy-and-influencing/2016-appg-report [Accessed 3rd April 2023]
  52. Abdelhamid A, Bunn D, Copley M, et al. Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis. BMC Geriatrics 2016;16:26. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-016-0196-3
  53. NHS England. Dementia. https://www.england.nhs.uk/mental-health/resources/dementia/ [Accessed 3rd April 2023]
  54. Yu, D. Eating and Drinking Difficulties in Dementia. https://www.bda.uk.com/resource/eating-and-drinking-difficulties-in-dementia.html [Accessed 3rd April 2023]
  55. Department of Health and Social Care. Code of practice: Mental Health Act 1983. London:TSO; 2015. https://www.gov.uk/government/publications/code-of-practice-mental-health-act-1983 [Accessed 3rd April 2023]
  56. Clarke H, Gardner M. Standards for Adult Inpatient Eating Disorder Services - Second Edition. London: Royal College of Psychiatrists; 2017. https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/eating-disorders-qed/2nd-edition-standards-for-adult-inpatient-eating-disorder-services.pdf?sfvrsn=86374031_2 [Accessed 3rd April 2023]
  57. Georgiou M, Oultram M, Haque Q. Standards for Forensic Mental Health Services: Low and Medium Secure Care - Third Edition. London: Royal College of Psychiatrists; 2019.   https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/secure-forensic/forensic-standards-qnfmhs/standards-for-forensic-mental-health-services-fourth-edition.pdf?sfvrsn=2d2daabf_6 [Accessed 3rd April 2023]
  58. National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults: prevention and management [CG178]. 2014. https://www.nice.org.uk/guidance/cg178 [Accessed 3rd April 2023]
  59. Public Health England. Working together to address obesity in adult mental health secure units: a systematic review of the evidence and a summary of the implications for practice. PHE; 2017   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/591875/obesity_in_mental_health_secure_units.pdf [Accessed 3rd April 2023]
  60. Hart S and McMaster C. THE REAL Food Guide for CBT-T Clinicians: Basic Food and Eating Training for Eating Disorders. http://www.leicestereatingdisorders.co.uk/uploads/uploads/CBTT/real-food-guide.pdf. [Accessed 3rd April 2023]
  61. Jacka FN, O'Neil A, Itsiopoulos C, et al. The SMILES trial: an important first step. BMC Medicine. 2018;16(1):237. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1228-y
  62. Mental Health Foundation. Diet and mental health. https://www.mentalhealth.org.uk/sites/default/files/food-for-thought-mental-health-nutrition-briefing-march-2017.pdf [Accessed 3rd April 2023]
  63. Department of Health and Social Care. Vitamin D - advice on supplements for at risk groups. https://www.gov.uk/government/publications/vitamin-d-advice-on-supplements-for-at-risk-groups [Accessed 3rd April 2023]