The influence of portion size and plate waste on meeting nutrition standards in a day centre for older people

Background:  In the UK, 13% of adults over the age of 65 years are estimated to be at medium to high risk of malnutrition(BAPEN, 2008). Community-based food projects, such as day centres, are well placed to support older people to maintain good nutrition(Wilson, 2009). Nutrition guidelines for food provision in day centres have been produced by the Caroline Walker Trust (CWT, 2004). Research is lacking on the challenges of meeting nutrition standards when providing food in this setting. This study aimed to investigate portion size and plate waste in a central London day centre providing lunchtime meals to older people. Methods:  The menu at the day centre had been assessed to meet Caroline Walker Trust standards for older people(CWT, 2004) for specified standard portion sizes. A random sample of 50 served lunch meals were audited across 10 days of a 4-week menu cycle: served portion sizes of soup, main dish, starch and vegetable accompaniments and dessert were measured and assessed against the menu standard portion sizes. Plate waste was measured for each of the 50 audited meals: each menu component was extracted and measured using digital scales. All measurements were performed by a single observer. Paired t-tests and Wilcoxon signed ranks tests were used to compare the differences in mean between portions. Results:  Served portions differed significantly (P < 0.05) from standard portions for soup, main and starch meal components. Served portions were smaller than the standard for 37 (84%) soups, and 34 (68%) main courses, whereas they were larger than the standard portion for 30 (63%) of the starch portions. There was a significant difference between served and consumed portion for all meal components, with the highest waste seen for vegetables (21%) followed by starch (12%). Nutritional analysis is underway and preliminary results indicate that recommended intakes for energy and zinc are not achieved. Table 1.   Size of standard, served and eaten portions for all meal components Component n Portion size (g), mean (SD) Waste (%) Standard Served Consumed *Significantly different from standard P < 0.05. †Significantly different from served P < 0.05. Soup 44 250 193 (51)* 184 (53)† 5 Main 50 146 123 (62)* 117 (66)† 8 Starch 48 118 133 (43)* 121 (53)† 12 Vegetable 49 80 76 (42) 63 (49)† 21 Dessert 48 182 183 (47) 170 (52)† 7 Discussion:  Specification of standard portion sizes is helpful in achieving nutrition guidelines in this setting.Nutrition guidelines are unlikely to be achieved when portion sizes are smaller than recommended and food is uneaten. Consideration should be given to the energy density of food provided given the small serving sizes requested by majority of service users. Day centre staff have a role in highlighting those with consistent poor intakes to the multidisciplinary team. Conclusions:  Guidance regarding standard portion sizes is important for day centres for older people to help in achieving nutrition guidelines (CWT, 2004). However, it is important to recognise the impact of shortfalls in serving sizes and plate waste on the nutritional intake of the service users. References:  BAPEN (2008) Combating Malnutrition: Recommendations for Action. http://www.bapen.org.uk/pdfs/reports/advisory_group_report.pdf (accessed on 24 October 2010). The Caroline Walker Trust (2004) Eating Well for Older People. London: CWT. Wilson, L. (2009) Preventing Malnutrition in Later Life. The Role of Community Food Projects. London: CWT.