Hospital Project in JNCSA, Tokyo
Dandi Chen, Japan Nutrition Care Service Association
Nutritional Sciences Department, School o Public Health, University of Michigan-Ann Arbor
Abstract
The Japan Nutrition Care Service Association (JNCSA) of Tokyo, Japan provides a broad
range of nutritional services including; nutrition consultation, creation of disease
prevention projects and healthy recipes. For instance, the association is currently involved
in a project to build a new hospital in Beijing, China that focuses on providing medical
nutritional therapy to improve chronic disease and facilitate patients recovery during
rehabilitation. I was involved in the preparation work at JNCSA, which includes: creating
daily menus, providing recipes, modifying lifestyle assessment tools, and improving the
educational materials used in the hospital.
Internship in JNCSA provided me with an opportunity to learn about the practical
application of medical nutrition therapy and incorporate the application of food science
principles. My goals of developing nutrition educational and assessment materials, creating
recipes for patients with special needs helped me to achieve my competencies of
improving my communication skills in delivering nutritional contents in appropriate ways,
as well as organizational and analytical skills.
My initial goals were achieved during my internship. My primary responsibility was the
development of balanced daily meals for patients with lifestyle diseases, low-carb diets for
patients with diabetes, low-protein diets for patients with kidney diseases, and minced
diets for people with difficulty swallowing or chewing. We created several dishes every
week, tested their palatability with people in the community, and adjusted the recipes
based on their feedback. Besides, I modified and translated their educational tools,
including daily exercise recording sheets, electronic lifestyle assessment software and
questionnaires, so these could serve patients in China in a better way.
Nutrition plays a key role in a patients recovery. Nutritious diets and healthy lifestyle are
the most effective way of preventing and controlling chronic diseases. I found it very
rewarding that my work can help future patients in the hospital better fight against
diseases, and provide an example of utilizing medical nutrition therapy to improve chronic
diseases in China, since medical nutrition therapy were barely applied in many Chinese
hospitals. I will utilize this experience in my future work, such as establishing a home food
delivery system to provide nutrition support to people with chronic diseases.
Project background introduction
Chronic diseases account for 85% of all deaths in China, which is significantly higher than
the world average of 65% [1]. Despite that proper diets and healthy lifestyle under the
guidance of registered dietitians are the most effective way of preventing and controlling
chronic diseases, there was no consistent standard for the Registered dietitian in China
before 2017, and nutritional management and nutritional education were barely applied in
many hospitals.
The project of building a new hospital in Beijing is aiming to incorporate concepts of
traditional Chinese medicine and western nutrition knowledge, provide medical nutrition
therapies and diet therapies, conduct nutrition consultations and provide nutritional
educations to people with chronic diseases and people at risk for lifestyle diseases. JNCSA
is involved in this project by implementing an advanced nutritional management system to
the diabetes unit, dialysis unit and rehabilitation unit of this hospital.
The reason why a Japanese nutrition organization was invited to this project is that Japan
shares relatively similar food culture with China, and registered dietitians in Japan have
been accumulating practical experience in applying western nutrition knowledge to
nutritional consultation and nutritional management in various settings for a long time.
They will share these experiences with health care professionals in China. Since dietetic
profession is new to many people in China, the involvement of Japanese registered dietitian
in this project will provide a good example of what registered dietitians can do, how
nutritional management and nutritional consultation are being carried out to both Chinese
publics, governments and healthcare professionals interested in this field. The hospital is
expected to open at Nov 2017.
[1]. World Health Organization, Non Communicable Disease,
http://www.who.int/topics/noncommunicable_diseases/en/
Project Timeline Tasting dishes and adjusting recipes
My internship started at May 1st and lasted till July 23rd. I mainly worked on most of the preparation We created the dishes in the community kitchen based on the recipe created, tested their palatability with
works during May till end of July as listed in Figure.1. people in the community, and adjusted the recipes based on feedbacks. We believe nutritious and delicious
meals energize both body and mind and encourage patients in their fight against the disease.
Figure.1 Project Timeline
Competencies and Goals
Competencies Goals
Ability to communicate with Discussing project timelines, creating
team members and function dishes based on the developed
effectively as a part of team recipes with teammates.
Creating/Modifying lifestyle Assessment Questionnaires/Tools
Ability to analyze nutritional Creating recipes for patients with
contents of food and get special needs, analyzing nutritional
The lifestyle risk assessment tool (Figure.3) allows for the visualization of medical data and
familiar with recipe creations contents of each meals and adjust
behavioral risks. It creates a radial diagram that denotes ones medical status including
recipes based on that.
cholesterol level, blood pressure, BMI etc. and visualize the deviance of the medical data
Delivering audience-appropriate Developing nutrition educational and
nutritional contents in writing from the normal level. The reports generated by this software will be given to the patients,
modifying lifestyle assessment
format raising their awareness about their health status and encouraging the active improvement of
software and questionnaires.
their behaviors.
Developing Recipes and Meal Plans The lifestyle evaluation survey evaluates subjects lifestyle from following aspects: Meal
balance, eating behavioral habits, snacks preference, physical activities, living environment,
While hospital meals are the main source of nutrition for patients, patients often find these meals stress, physical condition and health awareness. It automatically evaluates subjects risks and
unappetizing and refuse to eat them. In China, patients purchase meals from external vendors, making generates suggestions based on subjects answer to the survey as shown in Figure. 4. (70
nutritional management difficult. During my internship, I created recipes and meal plans of one month and 35 questions versions available).
for future patients: balanced meals for patients with lifestyle diseases, low-carb diets for patients with
diabetes, low-protein diets for patients with kidney diseases, and minced diets for people with
difficulty swallowing or chewing. We utilized dashia traditional Japanese stockto reduce the salt
Figure.3 Lifestyle risk assessment Figure.4 Lifestyle evaluation survey
content while maintaining savory flavors. Figure.2 is an example of recipes of a dinner for diabetes
patients. Each dish/meal is carefully managed and designed based on following principles: (Meals for
different population have different principles)
Including one staple food, one main dish, at least one side dish, and one soup or dessert.
~1800 calories per day: Average calorie need for people older than 51 years old
Limit carbohydrate intake: 40mg-60mg/meal
Limit sodium intake < 2300mg per day
Limit saturated fat intake < 10% calories per meal
>25g dietary fiber per day (>8g fiber per meal)
Including mass production method using steam convection oven if possible.
Incorporate Chinese food culture (e.g. Porridge for dinner) and seasonality (e.g. White radish as a
winter vegetable)
Use carbohydrate sources that are low in GI Learning Outcomes and Future goals
Specialty food for traditional Chinese holiday (e.g. dumplings for spring festival)
Figure.2 Dinner Recipes for Diabetes Patients Through this internship, my communication, time-management and organizational skills
were improved. I got a lot of experience in recipe development and I learned the way to
assessing the risk for lifestyle disease through a questionnaire. Moreover, through discussing
about project timeline and the best structure of the hospitals kitchen and dining room, I
gained deep insight into the necessary elements to consider to maintain effective kitchen
works and good kitchen hygiene in a hospital.
In the future, I am willing to work for improving health status and life qualities of people
through nutritious and delicious meals. I want to start a home meal delivery program,
delivering meals for those people who have difficulties controlling their diets, to improve
their health status and lowering their risks for lifestyle diseases. I am also planning to
incorporate nutritional education in the program, giving suggestions and helping them
overcoming difficulties in living a healthy lifestyle.