Orange napkins increase food intake and satisfaction with hospital food service: A randomized intervention

Abstract Background Increased malnutrition risk has been identified in more than 30% of hospitalized adults in Israel. Because orange has been identified as an appetite stimulant, orange napkins were considered a low cost enhancement of the meal context. Objectives The study was designed to assess the effect of an orange napkin on the meal tray on 1) food intake and 2) satisfaction with food service among adults hospitalized in an internal medicine department. Methods Patients were randomized to lunch trays with an orange (experimental) or white (control) napkin. Digital imaging was used with the modified Comstock Scale to quantify dietary intake. A validated questionnaire was used to score hospital food service satisfaction. Medical history, anthropometric measures, reason for hospitalization and meal modifications were extracted from the medical record. Results One hundred and thirty-one patients hospitalized in Internal Medicine Department E, Edith Wolfson Medical Center, Holon, Israel, participated in the study. Patients in the orange napkin group (n=66) consumed 17.6 % more hospital-provided food than those in the white napkin (control) group (n=65), driven by the significantly greater proportion of the carbohydrate side dish and the vegetable dish consumed. Subjects in the orange napkin group also reported significantly greater satisfaction with the hospital food service. Discussion The addition of an orange napkin to the meal tray of patients hospitalized in internal medicine departments can increase dietary intake and improve satisfaction with hospital food service. At about 5 cents per piece, the orange napkin is a low-cost, easily implemented strategy to address to address malnutrition risk in hospitalized adults .