BACKGROUND Hospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal). OBJECTIVE To systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice. METHODS Eight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively. RESULTS From 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients' intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this. CONCLUSION The literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.

中文翻译：

---

整个食品供应链中医院餐饮服务的环境可持续性：系统评价

背景 医院有责任支持人类健康，鉴于人类与环境健康之间的联系，医院应考虑其对环境的影响。医院餐饮服务会对食品供应链各个阶段（生产/采购、分销、准备、消费和废物管理/处置）的环境产生负面影响。目标 系统地识别和综合医院患者食品/营养供应链中的以下内容：食品服务的环境和相关经济影响；旨在改善餐饮服务环境可持续性的战略成果；患者、员工和利益相关者对餐饮服务环境影响的看法以及旨在改善餐饮服务环境可持续性的战略。方法 从数据库中检索八个电子数据库（即护理和相关健康文献累积索引、Embase via Ovid、全球健康、国家卫生服务经济评估数据库、Ovid Medline、ProQuest Environmental Science Collection、Scopus 和 Web of Science）从开始到 2018 年 11 月，在医院食品供应链的任何阶段（从生产/采购到废物管理/处置）进行原始研究，为患者提供食物/营养，对语言或研究设计没有限制。标题/摘要然后全文由两位作者独立筛选。使用混合方法评价工具对纳入研究进行质量评价。数据是按叙事方式合成的。结果 从确定的 29,655 条记录中，80 项研究符合资格标准。结果分为生产/采购 (n=12)、分销 (n=0)、准备 (n=6)、消费 (n=49)、废物管理/处置 (n=8) 和多个食品供应链方面(n=5)。最广泛探讨的环境影响是食物浪费，许多研究报告了食物浪费的数量和相关的经济损失。策略的重点是通过各种餐饮服务模式增加患者的摄入量来减少食物浪费。观点确定了可持续食品服务的共同愿景，尽管实现这一目标存在许多实际障碍。结论 文献提供了整个医院食品供应链的例子，展示了如何优先考虑和评估环境可持续性，以及获得认证的营养和营养学从业者做出贡献的机会。