Temple University Hospital heart patients can get Mediterranean meals during their stay. Will it help them eat healthier at home?

Like any cardiologist, Lily Nedda Dastmalchi urges patients with heart disease to eat more vegetables while laying off foods that are high in salt and added sugars.

But when she started a fellowship at Temple University Hospital, Dastmalchi worried that her dietary advice would be a challenge for some to follow. On her first drive through the surrounding neighborhoods of North Philadelphia, the only food stores she came across were corner markets where the shelves were mostly stocked with sweets and other processed carbs. No fresh produce.

“It’s hard for me to tell patients to be on a Mediterranean or plant-based diet when they don’t even have access,” she said.

She is trying to bridge that gap with a new study of 100 patients. Participants are assigned to get their meals from one of three heart-healthy menus during their hospital stay: the traditional cardiac menu that Temple has always offered, a revamped vegan menu, and a new Mediterranean regimen heavy on grains and seafood.

Study volunteers also receive enhanced nutritional counseling, recipes, a list of area farmers markets, and information on food pantries and government assistance with food bills.

One month after patients go home from the hospital, researchers call them to ask if they have changed their diet at home.

Dastmalchi devised the study with the help of chief hospital dietitian Michele Ondeck Williams and executive chef Jeffery Klova, who incorporated the new meal offerings into the workflow for his busy kitchen staff of 32.

No one is expecting miracles. Study participants are typically in the hospital for less than a week, which is not much time to change eating habits.

And patients are being asked to avoid the tempting trio of sugar, salt, and fat upon returning home, building on what they learned from a hospital kitchen.

Klova, who worked in hotel dining before coming to Temple, knows that institutional food can evoke visions of limp vegetables and overcooked meatloaf. But he is confident he can win over anyone.

Among the offerings on his Mediterranean menu:

“There’s a lot of similarities with fine dining,” he said. “It really tries to achieve the same feel.”

The Temple study is not the first to examine whether patients could develop new dietary preferences while in the hospital.

Dastmalchi herself undertook such a study in her previous job as a resident at George Washington University Hospital in Washington, theorizing that when people are sick enough to be admitted to a hospital, they are more motivated to learn healthy habits.

In that study, patients who received nutritional counseling and a heart-healthy diet while in the hospital were more likely than other patients to adopt healthy behaviors upon returning home, such as reading nutrition labels and monitoring their salt intake.

But that hospital is in relatively affluent northwest Washington, with plenty of well-stocked grocery stores nearby. In North Philadelphia, on the other hand, many people in low-income households lack easy access to a supermarket, as city health officials have identified in the past and Dastmalchi discovered during her initial drive through the neighborhood, back in 2021.

Williams, the hospital dietitian collaborating with Dastmalchi on the study, said the key is to suggest realistic choices. The new items on Temple’s hospital menu can all be cooked with ingredients found in a typical grocery store, she said.

“It’s not fancy,” she said.

But several of the meals, particularly those containing fish, may be pricey for patients on limited budgets, said Jule Anne Henstenburg, a registered dietitian with the Philadelphia-based nonprofit MANNA, which is not involved with the study.

“You need to have some guidance” on how to find inexpensive seafood, she said.

Still, all of Temple’s menu offerings are sound from a heart-health perspective, said Henstenburg, whose organization delivers meals to patients recovering from a variety of ailments.

Williams, the Temple dietitian, said the key is to meet patients halfway. For instance, the program’s meals include ingredients that for many are familiar favorites and household staples, such as collard greens and sweet potatoes.

“You want people to make positive changes, but you’re not unrealistic,” she said. “What you do is you guide people to healthier choices.”

For those who like sugary cereal for breakfast, Williams will suggest substituting one that’s lower in sugar and higher in fiber — perhaps easing the transition by starting with a half-and-half blend. For people who like salads with creamy dressing, Williams steers them toward oil and vinegar, with chickpeas or nuts for an added flavor twist.

So far, just 15 volunteers have enrolled in the study, which continues into next year. The hospital’s new meal offerings are available to nonstudy participants as well — accounting for 6% of the 1,500 meals the kitchen produces every day, said Klova, its executive chef.

One popular new dish is a sweet potato, cauliflower, chickpea, and tomato curry, served over a blend of quinoa and couscous.

For those who crave lots of salt, Klova deploys a range of sodium substitutes. One is a blend of lemon peel, cumin, and coriander, sometimes with pepper or paprika. Garlic and onion powder also can fill the void.

Will it lead to new eating habits once patients return home? Klova is cautiously optimistic.

“It’s a tough task,” he said. “You want to instill a diet into somebody in a week when their whole life they have been eating something that’s different.”