In the world's first comprehensive study to evaluate both the nutritional quality and environmental footprint of food served in healthcare institutions using detailed, food-level data, researchers assessed menus and food procurement data from two hospitals and three nursing homes of average size in Germany. These institutions' foodservice likely reflects that of many healthcare institutions in high-income countries.
"We found that meals contained too few healthy plant-based foods such as vegetables, fruits, whole grains and legumes, and too many refined grains, added sugars, salt and saturated fats," says Lisa Pörtner, lead author from PIK and Charité. "This leads to an inadequate provision of nutrients and low dietary quality." At all the institutions analysed, meals fell critically short of the recommended daily intake of key nutrients such as folate, potassium and vitamin B6, with nursing homes also falling short in protein provision.
"Calories from wholesome plant-based foods made up less than one-fifth of energy provision in all institutions, which is far lower than the 80 percent recommended by the Planetary Health Diet," Pörtner adds. At the same time, refined grains made up over 20 percent of calories, and red meat accounted for 10 to 17 percent – resulting in poor overall dietary quality. Animal-source foods, namely red meat and dairy products, were also major contributors to negative environmental impacts, including greenhouse gas emissions, land use change and water pollution.
Healthcare foodservice contributes to environmental degradation and climate change
"Our results indicate that food served in healthcare settings poses a health risk if consumed over the long term, as unhealthy diets are a major cause of chronic illness", explains Nathalie Lambrecht from Stanford University. "This is particularly troubling as health care institutions should be role models for healthy diets. In addition, we find that their foodservice contributes to environmental degradation and climate change – which also threaten to undermine health." Lambrecht adds. The authors conclude that substantial changes to healthcare foodservice are essential to protect both human and planetary health.
Fortunately, both can be achieved through similar actions: reducing the overconsumption of animal-source foods while increasing the intake of healthy, plant-based options. The researchers recommend mandatory nutrition and sustainability standards for healthcare institutions – along with regular assessments of food quality and environmental impact – as important levers for improving health and protecting the planet.
Germany published a nutritional strategy last year that explicitly mentions improving foodservice in healthcare settings, but political actions have so far been lacking. The authors of the study stress that institutions are not solely to blame for the shortcomings, with financial pressures and other demands having risen over recent years. "Policymakers and healthcare providers alike urgently need to prioritise food quality, set clear standards and close existing data gaps to ensure meals truly are health-promoting – without harming the planet," says PIK researcher Pörtner. The project was funded by the Deutsche Bundesstiftung Umwelt (DBU).
Article
Pörtner,L. M., Schlenger,L., Gabrysch, S.,Lambrecht, N. J.: Dietary quality and environmental footprint of health-care foodservice: a quantitative analysis using dietary indices and lifecycle assessment data. The Lancet Planetary Health [DOI: 10.1016/j.lanplh.2025.05.004]
