{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T09:12:10Z","timestamp":1788426730286,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nutrition &amp; Dietetics"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Healthcare systems contribute significantly to the global environmental footprint, and hospital food services have been identified as having a significant impact. However, existing sustainability studies auditing the food supply chain in the hospital setting have excluded nutrition support. This study aims to quantify the waste associated with oral, enteral, and parenteral nutrition support in a major tertiary\u2010referral hospital and to identify ways to improve waste management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational audit investigated the types of waste and waste disposal methods associated with nutrition support, to quantify the amount of waste and the cost of waste disposal and associated emissions, and to identify barriers to improved waste management practices. A draft audit checklist was developed as a tool to assist hospitals in nutrition support waste management quality improvement. Calculations and descriptive statistics were used to identify total waste weights, disposal costs and carbon dioxide equivalent emissions for nutrition support products used on the audit day.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nutrition support generated 45.89\u2009kg of waste per day or median 0.19\u2009kg per patient, approximately half of which was discarded formula. Other than the cardboard cartons, a negligible proportion of the waste was recycled; the cost of disposal was approximately $7400 per year. Improving waste management could save $900 per year and reduce total hospital emissions by 7 tonnes of carbon dioxide equivalents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients receiving nutrition support in hospital generate waste from packaging, containers and discarded formula and this is commonly sent to landfill. Improvements in waste management could benefit environmental sustainability and reduce costs in the healthcare system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1747-0080.70092","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:12:36Z","timestamp":1788423156000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Environmental sustainability of nutrition support in a hospital setting: An observational study of waste reduction and management"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4155-5240","authenticated-orcid":false,"given":"Sharon","family":"Carey","sequence":"first","affiliation":[{"name":"Department of Nutrition &amp; Dietetics Royal Prince Alfred Hospital  Camperdown Australia"},{"name":"Faculty of Health and Medicine University of Sydney  Camperdown Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6100-0117","authenticated-orcid":false,"given":"Suzie","family":"Ferrie","sequence":"additional","affiliation":[{"name":"Department of Nutrition &amp; Dietetics Royal Prince Alfred Hospital  Camperdown Australia"},{"name":"Faculty of Health and Medicine University of Sydney  Camperdown Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"issue":"7","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/S2542-5196(20)30121-2","article-title":"The environmental footprint of health care: a global assessment","volume":"4","author":"Lenzen M","year":"2020","journal-title":"Lancet Planet Health"},{"issue":"2","key":"e_1_2_8_3_1","first-page":"1","article-title":"Healthcare waste generation worldwide and its dependence on socio\u2010economic and environmental factors","volume":"9","author":"Minoglou M","year":"2017","journal-title":"Sustainability (Basel)"},{"issue":"19","key":"e_1_2_8_4_1","first-page":"2632","article-title":"Going toward green hospital by sustainable healthcare waste management: segregation, treatment and safe disposal","volume":"6","author":"Azmal M","year":"2014","journal-title":"Health (London)"},{"key":"e_1_2_8_5_1","unstructured":"Australian Packaging Convenant Organisation (APCO).About APCO and The Australian Packaging Covenant. Accessed July 27 2026.https:\/\/apco.org.au\/the-australian-packaging-covenant"},{"key":"e_1_2_8_6_1","unstructured":"Global Green and Healthy Hospitals Network. Accessed July 27 2026.https:\/\/global.noharm.org\/act\/join-our-networks\/gghh"},{"issue":"5","key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/j.jand.2020.01.001","article-title":"Environmental sustainability of hospital foodservices across the food supply chain: a systematic review","volume":"120","author":"Carino S","year":"2020","journal-title":"J Acad Nutr Diet"},{"issue":"17","key":"e_1_2_8_8_1","doi-asserted-by":"crossref","DOI":"10.3390\/su12176872","article-title":"Towards sustainable food services in hospitals: expanding the concept of \u2018plate waste\u2019 to \u2018tray waste\u2019","volume":"12","author":"Alharbi NS","year":"2020","journal-title":"Sustainability (Basel)"},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.wasman.2015.09.025","article-title":"Hospital food waste and environmental and economic indicators\u2014a Portuguese case study","volume":"46","author":"Dias\u2010Ferreira C","year":"2015","journal-title":"Waste Manag"},{"issue":"1","key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jand.2013.09.022","article-title":"Getting a taste for food waste: a mixed methods ethnographic study into hospital food waste before patient consumption conducted at three New Zealand foodservice facilities","volume":"114","author":"Goonan S","year":"2014","journal-title":"J Acad Nutr Diet"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.appet.2014.08.001","article-title":"How practice contributes to trolley food waste. A qualitative study among staff involved in serving meals to hospital patients","volume":"83","author":"Ofei KT","year":"2014","journal-title":"Appetite"},{"issue":"13","key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1017\/S1368980014002936","article-title":"Evaluation of the balanced menus challenge: a healthy food and sustainability programme in hospitals in Maryland","volume":"18","author":"Ranke TD","year":"2015","journal-title":"Public Health Nutr"},{"issue":"3","key":"e_1_2_8_13_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0247616","article-title":"Waste generation and carbon emissions of a hospital kitchen in the US: potential for waste diversion and carbon reductions","volume":"16","author":"Thiel CL","year":"2021","journal-title":"PLoS One"},{"issue":"2","key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1177\/0734242X231176733","article-title":"An in\u2010depth analysis of hospital food waste in terms of magnitude, nutritional value, and environmental and financial perspectives: a cross\u2010sectional study","volume":"42","author":"Anari R","year":"2024","journal-title":"Waste Manag Res"},{"issue":"19","key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.12968\/bjon.2024.0273","article-title":"Enhancing food sustainability in the acute hospital setting\u2014a nurse\u2010led study of patient food","volume":"33","author":"Moody SC","year":"2024","journal-title":"Br J Nurs"},{"issue":"2","key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1136\/ejhpharm-2016-001197","article-title":"Application of quality improvement techniques to reduce parenteral nutrition wastage in a national intestinal failure unit","volume":"25","author":"Allan P","year":"2018","journal-title":"Eur J Hosp Pharm"},{"key":"e_1_2_8_17_1","unstructured":"ReFED Incorporated.Food Waste Impact Calculator. Accessed July 27 2026.https:\/\/insights-engine.refed.org\/impact-calculator"},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.resconrec.2014.03.011","article-title":"Evaluation of life cycle inventory data for recycling systems","volume":"87","author":"Brogaard LKS","year":"2014","journal-title":"Resour Conserv Recycl"},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1177\/0734242X09347796","article-title":"Collection, transfer and transport of waste: accounting of greenhouse gases and global warming contribution","volume":"27","author":"Eisted R","year":"2009","journal-title":"Waste Manag Res"},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.resconrec.2012.08.006","article-title":"Greenhouse gas impact of dual stream and single stream collection and separation of recyclables","volume":"69","author":"Fitzgerald GC","year":"2012","journal-title":"Resour Conserv Recycl"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"5470","DOI":"10.1021\/es200721s","article-title":"Is biodegradability a desirable attribute for discarded solid waste? Perspectives from a national landfill greenhouse gas inventory model","volume":"45","author":"Levis JW","year":"2011","journal-title":"Environ Sci Technol"},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1016\/j.wasman.2011.03.001","article-title":"CO2 emission factors for waste incineration: influence from source separation of recyclable materials","volume":"31","author":"Larsen AW","year":"2011","journal-title":"Waste Manag"},{"issue":"2","key":"e_1_2_8_23_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/1747-0080.12768","article-title":"Food and food\u2010related waste management strategies in hospital food services: a systematic review","volume":"80","author":"Cook N","year":"2022","journal-title":"Nutr Diet"},{"key":"e_1_2_8_24_1","unstructured":"Sydney Local Health District.Environmental Health and Sustainability Plan 2023\u20132027. NSW Government. 2023. Accessed July 27 2026.https:\/\/slhd.health.nsw.gov.au\/sites\/default\/files\/2024-03\/Environmental_Health_Sustainability_Plan.pdf"},{"issue":"2","key":"e_1_2_8_25_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/1747-0080.12801","article-title":"Packaged hospital food appears safe and feasible to reuse","volume":"80","author":"Lewandowski PA","year":"2023","journal-title":"Nutr Diet"},{"key":"e_1_2_8_26_1","volume-title":"White Paper: Strategies to Reduce Waste in Patient Food Services","author":"Mior C","year":"2010"},{"key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/pol.20210495","article-title":"Sustainability performance of polyethylene terephthalate, clarifying challenges and opportunities","volume":"60","author":"Sarda P","year":"2022","journal-title":"J Polym Sci"},{"key":"e_1_2_8_28_1","volume-title":"Australian Packaging Consumption & Recovery Data 2021\u201322","author":"Blue Environment and Industry Edge for APCO","year":"2024"},{"key":"e_1_2_8_29_1","volume-title":"Preventing Disease Through Healthy Environments: A Global Assessment of the Burden of Disease from Environmental Risks","author":"Pr\u00fcss\u2010Ust\u00fcn A","year":"2016"}],"container-title":["Nutrition &amp; Dietetics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1747-0080.70092","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1747-0080.70092","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1747-0080.70092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:12:40Z","timestamp":1788423160000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1747-0080.70092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":28,"alternative-id":["10.1111\/1747-0080.70092"],"URL":"https:\/\/doi.org\/10.1111\/1747-0080.70092","archive":["Portico"],"relation":{},"ISSN":["1446-6368","1747-0080"],"issn-type":[{"value":"1446-6368","type":"print"},{"value":"1747-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"assertion":[{"value":"2025-03-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1747-0080.70092"}}