Research report Effect of meal portion size choice on plate waste generation among patients with different nutritional status. An investigation using Dietary Intake Monitoring System (DIMS) ☆ K.T. Ofei a, *, M. Holst b , H.H. Rasmussen b , B.E. Mikkelsen a a Research Group for Meal Science & Public Health Nutrition, Department of Development and Planning, Aalborg University Copenhagen, Denmark b Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark ARTICLE INFO Article history: Received 10 December 2014 Received in revised form 5 April 2015 Accepted 6 April 2015 Available online 13 April 2015 Keyword: Trolley meal delivery system Plate waste Nutritional risk status Hospital foodservice A B ST R AC T Background: The trolley meal system allows hospital patients to select food items and portion sizes di- rectly from the food trolley. The nutritional status of the patient may be compromised if portions selected do not meet recommended intakes for energy, protein and micronutrients. The aim of this study was to investigate: (1) the portion size served, consumed and plate waste generated, (2) the extent to which the size of meal portions served contributes to daily recommended intakes for energy and protein, (3) the predictive effect of the served portion sizes on plate waste in patients screened for nutritional risk by NRS-2002, and (4) to establish the applicability of the dietary intake monitoring system (DIMS) as a technique to monitor plate waste. Methods: A prospective observational cohort study was conducted in two hospital wards over five weekdays. The DIMS was used to collect paired before- and after-meal con- sumption photos and measure the weight of plate content. Results: The proportion of energy and protein consumed by both groups at each meal session could contribute up to 15% of the total daily recom- mended intake. Linear mixed model identified a positive relationship between meal portion size and plate waste (P = 0.002) and increased food waste in patients at nutritional risk during supper (P = 0.001). Conclusion: Meal portion size was associated with the level of plate waste produced. Being at nutri- tional risk further increased the extent of waste, regardless of the portion size served at supper. The use of DIMS as an innovative technique might be a promising way to monitor plate waste for optimizing meal portion size servings and minimizing food waste. © 2015 Elsevier Ltd. All rights reserved. Introduction Food waste presents a considerable challenge to many hospi- tals, not only in relation to issues of cost and sustainability, but also in terms of nutrition. Wasted food contains energy, protein, and im- portant micronutrients that could have been consumed by hospitalized patients, of whom 40% are at risk of undernutrition (Almdal, Viggers, Beck, & Jensen, 2003; Dupertuis et al., 2003; McWhirter & Pennington, 1994). Reasons for plate waste in hospitals fall within four key catego- ries; the patient’s clinical condition, food and menu, service, and environmental issues (Williams & Walton, 2011). Besides the patient’s clinical condition, there are many factors that lead to in- adequate food intake and plate waste which can be improved (Ofei, Holst, Rasmussen, & Mikkelsen, 2014; Williams & Walton, 2011). One of the strategies used for achieving reductions in plate waste, including in Danish hospitals, is the implementation of “trolley meal delivery systems” (Freil, Nielsen, Blitz, Gut, & Almdal, 2006; Marson, McErlain, & Ainsworth, 2003). Trolley meal delivery systems have been evaluated in several studies and are found to be beneficial as they provide patients with the opportunity to select the food items and portion size served directly from the food trolley. This, com- bined with the fact that health care professionals are responsible for serving the patients, is thought to lead to a reduction in plate waste (Edwards & Nash, 1999; Hartwell & Edwards, 2003; Kelly, 1999; Marson et al., 2003). Although the trolley meal delivery system has been found to reduce plate waste, it raises concerns about the adequacy of energy, protein, carbohydrate, fat and micronutrients contained in the selected portion size when the intention is plate waste reduction. This concern has been further highlighted in plate waste studies by Mahoney, Zulli, and Walton (2009) and Marson et al. (2003), who question whether the increased percentage ☆ Acknowledgments: We wish to thank all the staff at the medical and surgery gas- troenterology wards, particularly Lotte Boa Skadhauge of Aalborg University Hospital, for their contribution to this study and for their hospitality. The authors would like to acknowledge the support provided by FoodServinSPIRe project (part of the InspireFood program) funded via the Danish Agency for Science, Technology and In- novation (830005) and the Foodtura project funded via the Market Development Fund (830005). * Corresponding author. E-mail address: ofeikt@plan.aau.dk (K.T. Ofei). http://dx.doi.org/10.1016/j.appet.2015.04.043 0195-6663/© 2015 Elsevier Ltd. All rights reserved. Appetite 91 (2015) 157–164 Contents lists available at ScienceDirect Appetite journal homepage: www.elsevier.com/locate/appet