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Objective: Autoantibodies against DFS70 (dense fine speckles 70) antigen (also known as lens epithelium-derived growth factor) have been recently identified among the antinuclear antibodies (ANAs) in patients with atopic disorders. We undertook this study to examine the frequency of anti-DFS70 antibodies in a large number of healthy people.

Methods: Sera of 597 healthy individuals working in a hospital (142 men, 455 women) were analyzed for ANAs and for anti-DFS70 antibodies by indirect immunofluorescence (IIF) with HEp-2 cells as a substrate and by immunoblotting using DFS70 recombinant protein and whole HeLa cell extract.

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Conclusion: Considering that anti-DFS70 antibody positivity is rare in patients with systemic autoimmune diseases, introducing the anti-DFS70 antibody examination as a screening test for ANA-positive persons could be used to rule out systemic autoimmune diseases, resulting in considerable cost-saving potential. In addition, this test defines a subpopulation of healthy people in whom long-term followup might reveal health-related implications of this finding, since anti-DFS70 antibodies have been shown to be associated with some illnesses.

The Physicians Committee is proud to offer free resources through our online Healthy Hospital Program to support institutions that make these menu changes. With plant-based menu items, inpatient education tools, and printable recipes, patients will be empowered to take control of their health during their hospital stay and beyond.

Hospitals serve millions of meals and snacks each year; however, hospital food is often unhealthy. Hospitals are ideal settings for modeling healthy eating, but few programs have sought to improve nutrition in all venues where food is served.

The New York City Department of Health and Mental Hygiene created the Healthy Hospital Food Initiative (HHFI) to improve the healthfulness of food served in hospitals. The HHFI built on prior work implementing mandatory nutrition standards for patient meals and vending in public hospitals. Public hospitals joined the HHFI by voluntarily adopting standards for cafeterias and cafs. Private hospitals joined by implementing nutrition standards for patient meals, food and beverage vending machines, and cafeterias and cafs.

Hospitals were recruited from 2010 through 2014 and provided technical assistance from health department staff. Implementation in each of the 4 areas was monitored through on-site assessments and menu review. Twenty-eight hospital cafeterias and cafs were evaluated at baseline and at the end of the HHFI to assess changes.

Sixteen public hospitals and 24 private hospitals joined the HHFI. Most (n = 18) private hospitals implemented standards in at least 2 areas. In cafeterias, most hospitals introduced a healthy value meal (n = 19), removed unhealthy items from the entrance and checkout (n = 18), increased whole grains to at least half of all grains served (n = 17), and reduced calories in pastries and desserts (n = 15).

Most New York City hospitals joined the HHFI and voluntarily adopted rigorous nutrition standards. Partnerships between hospitals and local government are feasible and can lead to significant improvements in hospital food environments.

In New York City (NYC), overweight and obesity affects 56.1% of adults (1). Nearly one-quarter of New Yorkers report fair or poor dietary habits, 23% of adults drink at least one sugary drink daily, and nearly 90% consume fewer than 5 servings of fruits and vegetables each day (1). Institutions like government agencies, schools, and hospitals serve food to a large number of people and can improve diets by modeling healthful practices (2). NYC government has transformed the institutional food environment by improving the healthfulness of foods served in schools (3), limiting sugary drinks in childcare settings (4), and issuing mandatory standards for foods purchased and served by government agencies, including public hospitals (5).

Opportunities exist to improve the hospital food environment, but few programs have sought to improve nutrition in all venues where food is served. Although nutrition standards for vending machines have been widely adopted, until recently there were few models for patient meals and no models for hospital cafeterias, which are important sources of food for employees and are venues that can influence consumer perceptions of a healthy diet (12,13).

In 2008, Mayor Michael Bloomberg issued Executive Order 122, which mandated that all NYC agencies, including public hospitals, adopt nutrition standards for foods purchased and served (NYC Food Standards) (14). Over the following 3 years, nutrition standards for food and beverage vending machines were adopted. The NYC Department of Health and Mental Hygiene (health department) oversaw implementation of the NYC Food Standards and provided technical assistance to agencies. On the basis of successful implementation of these standards in 16 public hospitals, the health department explored working with private hospitals. In NYC, the health care sector is the largest private employer (15), and there are approximately 60 hospitals with potential to reach 8.4 million New Yorkers each year through improvements to the food environment (16,17). Thus, 2 private hospitals were recruited as a pilot program. Working with these 2 hospitals allowed for refinement of the program and showed that hospitals were willing to adopt nutrition standards on a voluntary basis. The pilot also led to the development of the Standards for Cafeterias/Cafs (18), which were created to comprehensively address all venues in hospitals where foods and beverages are served.

In 2010, the health department formally created the Healthy Hospital Food Initiative (HHFI) to improve the healthfulness of foods and beverages available in NYC hospitals. Private hospitals joined by committing to implementing 4 sets of standards: Standards for Patient Meals, Standards for Beverage Vending Machines, Standards for Food Vending Machines, and Standards for Cafeterias/Cafs. Public hospitals, which were already required to meet the Standards for Patient Meals, Standards for Beverage Vending Machines, and Standards for Food Vending Machines as part of Executive Order 122, could join the initiative by voluntarily implementing the Standards for Cafeterias/Cafs.

This article describes the process of partnering with hospitals to implement nutrition standards and assesses key outcomes. First, participation in the HHFI and implementation of each of the 4 standards is described. Second, because nutrition standards for cafeterias were newly developed for the HHFI, implementation of each criterion within the Standards for Cafeterias/Cafs was evaluated at baseline and at the end of the HHFI to assess changes made by hospitals in this setting.

The health department offered technical assistance to hospitals, which included provision of implementation guides, promotional materials, and assistance from 2 full-time registered dietitians. The health department created an HHFI toolkit, which included a description of the nutrition standards and implementation guides. Implementation guides provided general tips for implementing the standards, as well as detailed information to assist with implementation of each individual criterion. For example, the implementation guide for beverage vending machines provided an example of a diagram that could be shared with vendors, showing how machines should be stocked (18).

The health department encouraged hospitals to communicate with employees about their participation in the HHFI. Hospital communication efforts included employee newsletters, sample food tastings in the cafeteria or caf, and cooking demonstrations. The health department created and provided free promotional materials for hospitals to display on vending machines and in cafeterias and cafs, including decals for food and beverage vending machines, promotional signage, table tents (Figure 1), and posters (18).

At the end of the HHFI (September 2014), 16 public hospitals and 24 private hospitals were participating. Participating hospitals represented more than 60% of all acute-care facilities in NYC and by 2014 were located in each borough of NYC (the Bronx, Brooklyn, Manhattan, Staten Island, and Queens). All 16 public hospitals had implemented the standards for patient meals, beverage vending, and food vending before the HHFI, but none had made changes in cafeterias or cafs. By September 2014, 2 (12%) of the 16 public hospitals had implemented the Standards for Cafeterias/Cafs. Although many private hospitals had begun to improve the nutritional profile of foods served before the HHFI, none were implementing the HHFI criteria before joining the initiative. At end line, 17 (71%) private hospitals had implemented the Standards for Patient Meals, 14 (58%) had implemented the Standards for Beverage Vending Machines, 12 (50%) had implemented the Standards for Food Vending Machines, and 16 (67%) had implemented the Standards for Cafeterias/Cafs.

The progress of each participating public and private hospital, according to number of standards implemented, is represented by star status (Figure 2). Public hospitals began at silver star status for having already implemented 3 sets of standards, and 2 hospitals reached gold. For private hospitals, 9 (38%) reached gold, 7 (29%) reached silver, 3 (13%) reached bronze, and 5 (21%) joined the HHFI but did not implement standards in any of the 4 areas.

Between baseline and end line, a substantial number of hospitals implemented the breakfast pastry and dessert standards (15 [54%] for each), removed unhealthy foods and beverages from the entrance and checkout of the cafeteria (18 [64%]), offered proportionally priced half-size sandwiches (17 [61%]), offered only soups that met the sodium limit (11 [39%]), and labeled all menu items with calories (11 [39%]). Many hospitals reduced sugary drinks to 25% of all beverages (11 [39%]) and reduced portion sizes of sugary drinks to 16 ounces or smaller (12 [43%]). Fewer hospitals completely removed the deep-fat fryer (3 [11%]), met the criteria for sodium in sandwiches, salads, and entrees (6 [21%]), or met the criteria for pre-packaged snacks (8 [29%]). All hospitals meeting a criterion at baseline were also meeting the criterion at end line. ff782bc1db