Hospital food needs to be more nutritious, according to a watchdog.
About 17 million meals are served in Scotland's hospitals each year
The Audit Scotland report said patients were not routinely screened for poor nutrition, and claimed this should be a priority for the NHS.
The research also suggested catering services had improved over the past three years and patients were now being offered a greater choice of food.
Health Minister Andy Kerr said he accepted that things needed to improve across Scotland.
The Scottish Executive said it was now working on new nutritional standards, which NHS caterers will have to meet.
In 2003 Audit Scotland called for nutritional care to be given a higher priority by staff in the NHS.
The new study, based on checks of 149 hospitals across 16 health boards, suggested boards still needed to do more.
The 2003 report said health boards should carry out surveys at least every three months to find out patients' views on hospital food.
However, the new report said only 30% of hospitals were doing that and suggested almost a fifth did not carry out any patient satisfaction surveys.
Barbara Hurst, director of public reporting in health at Audit Scotland, said: "Hospital food was key to the nutritional care of patients and helped them to get better.
"Boards need to do more to ensure patients are getting the nutritional care they need as a matter of priority."
She added boards were now providing greater choice, with meals catering for vegetarians and people from different religions.
Dr Sumantra Ray of the British Medical Association in Scotland urged NHS boards to meet mandatory screening requirements for under-nutrition, introduced in 2003.
"Hospital malnutrition remains a major problem in the NHS and this must be addressed as a matter of urgency.
"It is estimated that UK-wide, malnutrition costs the NHS £7.3bn a year.
"It is ironic that, at a time when the importance of eating well is high on the health agenda, this is not mirrored in our hospitals."
Mr Kerr said the report showed "variable" practice across the NHS and that was why it was important "not to be static on the issue".
But he added: "We learn in Scotland from best practice internationally, and I think we are the front of much of that best practice - but here, we are not.
'Hardly feed a budgie'
"We are making progress. But I fully accept it is variable across the country and we need to do better."
SNP health spokeswoman Shona Robison said the report showed some good progress had been made but raised concern over "inconsistent prioritisation of nutritional care and the lack of routine screening for under-nutrition".
Scottish Conservative health spokeswoman Nanette Milne said too many NHS boards were failing to meet the nutritional requirements.
More than 17 million meals are served in Scotland's hospitals each year, at a cost of £73m or just under £4.30 a meal.
However, Scottish Socialist Party MSP Carolyn Leckie said hospitals were actually spending about £2.50 a day on food for all three of a patient's meals.
"This is a budget that would hardly feed a budgie and it is hard to see how it is possible to serve sick people three healthy meals a day for less than the price of a fish supper," she said.