Association between availability of gluten-free menu options and nutritional intake of hospital inpatients: An observational study

Structured abstract Background Gluten-free diets pose nutritional risks as they are diets of exclusion, raising concerns in settings where patients often require increased nutritional support for recovery. Objective Determine the association between expanding gluten-free menu options and improved nutritional intake among hospital inpatients. Design Retrospective, observational study comparing nutritional intake and adequacy in patients across three menu groups. The standard room service menu has the least number of gluten-free options, the private menu featuring fresh herbs has additional gluten-free options (mostly animal-based proteins), and private menu featuring alternative grains had additional meals featuring naturally-gluten-free grains. Patient satisfaction and menu engagement was assessed in the cohort ordering from the private menu featuring alternative grains. Participants/Setting A large, urban hospital in Brisbane, Australia. Participants included 229 adult inpatients allocated a gluten-free diet code between September 2024 and February 2025, across the three menu groups. Main Outcome Measures Nutritional intakes and adequacy (% of requirements) for energy, protein, saturated fat and fiber and macronutrient distribution. Secondary outcomes included patient satisfaction and menu engagement. Statistical Analyses Kruskal-Wallis tests were used to assess differences in nutritional intakes across menu groups. Results Gluten-free patients ordering from the private menu featuring fresh herbs met their energy requirements (99%) and exceeded their protein needs (120%), compared to the standard room service menu (83% and 84%, respectively; p≤0.05 for both). By adding additional naturally gluten-free grain options to the enhanced private menu, patients energy and protein requirements were adequate (94% and 106%, respectively). Patient satisfaction and menu engagement were high in the private menu featuring alternative grains group, with more than 90% rating the foodservice as “good” and half had ordering a meal featuring an alternative grain. Conclusion Increasing options for gluten-free meals, through grain-free or alternative grains, may be effective strategies for improving intakes for patients in hospital.