Plate waste study among hospitalised patients receiving texture-modified diet

Identifying solutions to minimize meal tray waste: A mixed-method approach

BACKGROUND & AIMS

Over $150,000 are lost annually due to meal tray waste in a large hospital in the United States. This study aims to explore the root causes of meal tray waste within a decentralized foodservice model and strategies to mitigate waste.

METHODS

A mixed methods sequential explanatory design was used by first identifying hospital units high and low in meal tray waste using recorded food management data from January 2021 through September 2022, then conducting observations, mobile-interviews (n = 16), and in-depth interviews with hospital foodservice staff (n = 6) and nurses (n = 6) in each unit. Lastly, hospital and topic experts (n = 10) were engaged in strategizing solutions to reduce meal tray waste.

RESULTS

Findings indicate meal tray waste is increased when patients discharge and when standard trays (i.e., also known as house trays, which include items not requested by patients) are provided. Meal tray waste points to the unpredictability in a hospital that often arises due to patient circumstances, lack of coordination between nursing and foodservice staff, patients' food preferences, and the need for system and workflow improvements in a decentralized foodservice model.

CONCLUSIONS

Findings highlight considerations that may be applicable across diverse medical institutions seeking to reduce meal tray waste. Hospitals should choose the best foodservice model that suits their institution to manage operations efficiently, focusing on reducing waste, cost optimization, patient satisfaction, and sustainability.

Something to Chew on; Plate-Waste at an Ontario Veteran's Centre

There is paucity of data assessing levels of food/beverage waste in long-term care (LTC) facilities, especially in Ontario. Observations in the Veteran's Centre (VC) at Sunnybrook Health Sciences Centre (Sunnybrook) indicated food/beverage waste may be high, potentially impacting sustainability efforts within our institution. Before proceeding with waste reduction efforts, we conducted a comprehensive 3-day waste-audit of food/beverage items provided to VC residents with the goal of understanding the extent of food/beverage waste at VC, items wasted, and any other factors that may inform future changes. Our results indicate that 28% of items served to residents were wasted. Lunch was the meal with greatest waste at 31% and waste of solid items was 12% higher than that of liquids. We observed a large variability in waste between residents and within each resident, with 15% of residents wasting >50% of items provided. This study provides a deeper insight into the magnitude of food/beverage waste in a LTC population and highlights the importance of considering individualized strategies to address waste to avoid negative impact on residents.

Implementation of sustainable food service systems in hospitals to achieve current sustainability goals: A scoping review

BACKGROUND

Food waste is a pivotal contributor to environmental degradation in the modern world. Vast amounts of food are wasted and many individual efforts and collective initiatives being underway to deal with this challenge. Hospitals are institutions that produce and provide food, but at the same time contribute greatly to food waste. The objective of this scoping review is to present available data regarding quantity of food waste generated in public hospitals and summarizes studies that assess and quantify the greenhouse gas emissions (carbon footprint) associated to food service management in hospitals.

METHODS

A systematic literature research was conducted by two qualified researchers in PubMed, Scopus, ISI Web of Science and Science Direct. The publication date was set to the last ten years, i.e., 2013-2023. All the abstracts retrieved were screened, and the eligible articles were selected after a two-step process. Abstracts from the retrieved full papers' references were also screened for eligibility. The selected papers were included in the final scoping review.

RESULTS

Overall, 2870 studies were identified and 69 were included in the review. Most of the studies (n = 33) assessed the causes and quantified the amount of food waste generated in hospitals. A small number of studies (5) estimated carbon dioxide equivalent (CO2-eq) produced by food waste. Although several studies suggested strategies and measures to reduce the environmental impact of foodservice operations, none of them implemented a comprehensive foodservice management system.

CONCLUSION

This scoping review suggests that hospital diets contribute to food waste and may have a negative environmental impact. There are several internal and external factors and practices that influence positively or negatively the sustainability of hospital food service systems. Systematic efforts are needed to identify and enhance parameters that could improve the environmental footprint of hospitals in terms of more effective management of food waste.

Hospital food management: a multi-objective approach to reduce waste and costs

Food waste contributes significantly to greenhouse emissions and represents a substantial portion of overall waste within hospital facilities. Furthermore, uneaten food leads to a diminished nutritional intake for patients, that typically are vulnerable and ill. Therefore, this study developed mathematical models for constructing patient meals in a 1000-bed hospital located in Florida. The objective is to minimize food waste and meal-building costs while ensuring that the prepared meals meet the required nutrients and caloric content for patients. To accomplish these objectives, four mixed-integer programming models were employed, incorporating binary and continuous variables. The first model establishes a baseline for how the system currently works. This model generates the meals without minimizing waste or cost. The second model minimizes food waste, reducing waste up to 22.53 % compared to the baseline. The third model focuses on minimizing meal-building costs and achieves a substantial reduction of 37 %. Finally, a multi-objective optimization model was employed to simultaneously reduce both food waste and cost, resulting in reductions of 19.70 % in food waste and 32.66 % in meal-building costs. The results demonstrate the effectiveness of multi-objective optimization in reducing waste and costs within large-scale food service operations.

The Effects of Potato Presentation on Vegetable Intake in School-Aged Children: A Cross-Over Study

Vegetables are an essential component of a healthy dietary pattern in children; however, their consumption is often insufficient due to lack of preference. To address this, the influence of combining vegetables (mixed peas and carrots-MPACs) with potatoes, a generally liked food, on overall vegetable consumption among children aged 7-13 years was explored. The research involved a cross-over study design with 65 participants who completed five lunchtime meal conditions, each with different combinations of MPACs and potatoes versus a control (MPACs with a wheat roll). The meals were provided in a cafeteria setting, and plate waste was used to measure vegetable consumption. Anthropometric data and other variables were also measured. Notably, self-reported hunger did not significantly differ between conditions. Meal condition was a significant predictor of MPACs (F = 5.20; p = 0.0005), with MPAC consumption highest when combined with shaped potato faces in the same bowl (+8.77 g compared to serving MPACs and shaped potato faces in separate bowls) and lowest when combined with diced potatoes in the same bowl (-2.85 g compared to serving MPACs and diced potatoes in separate bowls). The overall model for MPAC consumption was influenced by age, height z-score, body fat percentage z-score, and condition (likelihood ratio = 49.1; p < 0.0001). Age had the strongest correlation with vegetable consumption (r = 0.38), followed by male gender, height z-score (r = 0.30), and body fat z-score (r = -0.15). The results highlight the positive impact of combining potatoes with vegetables in school meals, particularly when using shaped potato faces. These findings emphasize the potential of potatoes as a valuable vegetable option in promoting healthier eating habits among children. Additionally, future research could explore the impact of different potato combinations and investigate other factors influencing meal consumption in school settings.

Individual Differences in Plate Wasting Behavior: The Roles of Dispositional Greed, Impulsivity, Food Satisfaction, and Ecolabeling

This study examines the effects of dispositional greed, impulsivity, food satisfaction, and ecolabeling on consumers' plate waste in all-inclusive hotels. Using a moderated mediation research model, a cross-sectional survey was conducted among 1253 tourists of different nationalities, all staying in five-star hotels in Alanya, Türkiye. The results show that both dispositional greed and impulsivity positively predict and significantly contribute to plate waste. Conversely, food satisfaction was found to be an influential variable that moderates the effects of greed and impulsivity on plate waste, highlighting its critical role in waste reduction strategies. Ecolabels, despite their intended purpose, were not found to have a significant impact on consumer attitudes toward plate waste. Future research is encouraged to explore strategies to counteract dispositional greed and impulsivity, given their significant impact on plate waste behavior. At the same time, refining methods to promote food satisfaction and the effective use of ecolabels may contribute significantly to reducing plate waste in all-inclusive resorts. This research contributes to our understanding of the psychological factors that influence consumer behavior in buffet settings and provides guidance to hospitality industry practitioners seeking to reduce waste.

An Assessment of Knowledge, Attitudes and Practices on Pureed Diet Preparation (KAP DYS-PUREE) among Food Handlers in Malaysian Hospitals for Dysphagia Management

This study aims to assess the knowledge, attitude, and practice towards pureed diet preparation among food handlers using a newly developed questionnaire for dysphagia management. A descriptive cross-sectional design study with purposive sampling was conducted in three government hospitals in the Klang Valley, Malaysia. A newly developed questionnaire, comprised of 40 quantitative items, was used and distributed to 161 food handlers from three hospitals who were directly involved in preparing pureed diets. The results demonstrated a low to moderate knowledge score among food handlers (57.54 ± 12.33), with scoring at 1.95% (very low), 28.6% (low), and 68.3% (moderate). Only 1.2% scored well in the knowledge section on pureed diet preparation. The attitude among food handlers showed that they were referred to the right source of reference before preparing the pureed diet (3.97 ± 1.35). The findings also clearly showed that the practice of using the right equipment (4.41 ± 1.19) is essential for pureed diet preparation. In conclusion, this study serves as a prognosis for future improvement in knowledge, attitude, and practice among food handlers toward pureed diet preparation. Knowledge among food handlers needs to be enhanced, and a comprehensive guideline and reference module will aid in refining dysphagia management, specifically in food preparation by food handlers.

RELATIONSHIP BETWEEN NUTRITIONAL STATUS, DYSPHAGIA, AND FUNCTIONAL EATING LEVEL IN ADULT PATIENTS WITH CEREBRAL PALSY IN LONG INSTITUTIONAL STAYS

BACKGROUND

Diets with modified consistencies for patients with dysphagia in long term care health institutions may be associated with malnutrition.

OBJECTIVE

: To assess the nutritional status of adult patients with cerebral palsy and dysphagia hospitalized in a health institution for more than 10 years.

METHODS

: This prospective investigation was performed in 56 patients with cerebral palsy (ages 25 to 71 years, mean: 44±12 years) and no other neurological diagnosis in hospital stay for more than 10 years had their nutritional status, dysphagia, and food ingestion capacity assessed in two moments with a 12-month interval in between them, respectively using the body mass index, the dysphagia risk assessment protocol (PARD), and the functional oral ingestion scale (FOIS).

RESULTS

: There were no differences between December 2015 and December 2016 in the patients' weight, nutritional status, diet consistency classification, PARD, and FOIS. The limits of prescribed diet consistency (IDDSI-FDS) and the assessments of dysphagia and functional eating level influenced the nutritional status. More intense dysphagia and greater eating restrictions were associated with a worse nutritional status.

CONCLUSION

: The nutritional status of adult patients with cerebral palsy hospitalized in a health long term institution who had modified diets according to their swallowing and mastication capacity did not worsen between assessments with a 12-month interval in between them. The severity of dysphagia and diet restrictions interfere with the patients' nutritional status: dysphagia and more intense eating restrictions are associated with a worse nutritional status.

How to improve food waste management in hospitals through focussing on the four most common measures for reducing plate waste

Hospitals have a responsibility to link human health and the environment, but food waste in hospitals has traditionally been much higher than in other areas of food supply. The cause of this situation has many negative impacts on health, economy, society, and environment. As a result, food waste has become a topic of discussion in hospital food departments. Part of this problem is plate waste, the served food that remains uneaten by patients. Given the magnitude of the food problem, this systematic review is aimed to identify the most common measures used to reduce plate waste in hospitals. PubMed, Scopus, and Google Scholar databases were comprehensively searched to identify food waste studies worldwide using related search terms. Many approaches have been recommended to increase patient food intake and minimise plate waste in hospitals. Up to date, the four most common include flexible portion sizes, increased food choices through selective menus, additional nutritional support and a better ordering and delivery system. Among them, the most used and effective are flexible portion sizes which may increase the ability of patients choosing their menus and upgrade ordering and delivery system by electronic format. In most studies, plate waste covers the most significant percentage of food waste produced in hospitals, while more than one approach is recommended to minimise it. In this aspect, further well-design, multicenter, clinical studies are strongly required to highlight and establish novel and effective approaches for improving food waste management in hospitals by reducing plate waste.

Hospital Services to Improve Nutritional Intake and Reduce Food Waste: A Systematic Review

BACKGROUND AND AIMS

Patients' nutritional intake is a crucial issue in modern hospitals, where the high prevalence of disease-related malnutrition may worsen clinical outcomes. On the other hand, food waste raises concerns in terms of sustainability and environmental burden. We conducted a systematic review to ascertain which hospital services could overcome both issues.

METHODS

A systematic literature search following PRISMA guidelines was conducted across MEDLINE, Web of Science, and Scopus for randomised controlled trials (RCTs) and observational studies comparing the effect of hospital strategies on energy intake, protein intake, and plate/food waste. The quality of included studies was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Risk of Bias tool from the Cochrane Handbook for Systematic Reviews of Interventions for RCTs.

RESULTS

Nineteen studies were included, assessing as many hospital strategies such as food service systems-including catering and room service-(n = 9), protected mealtimes and volunteer feeding assistance (n = 4), food presentation strategies (n = 3), nutritional counseling and education (n = 2), plant-based proteins meal (n = 1). Given the heterogeneity of the included studies, the results were narratively analysed.

CONCLUSIONS

Although the results should be confirmed by prospective and large sample-size studies, the personalisation of the meal and efficient room service may improve nutritional intake while decreasing food waste. Clinical nutritionist staff-especially dietitians-may increase food intake reducing food waste through active monitoring of the patients' nutritional needs.

Strategies to Reduce the Rate of Plate Waste in Hospitalized Patients: A Scoping Review

There is evidence that hospital waste is indisputably high, and various strategies have been used to reduce the hospital's rate of plate waste. This study aimed to map the currently implemented strategies in lowering the rate of plate waste in hospitals and categorize the different types of strategies used as interventions, as well as determine their impact based on specific parameters. The scoping review method included a search of three databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-SCR). The duplicate articles (n = 80) were removed. A total of 441 articles remained for the title and abstract screening. After 400 were excluded, 41 articles were reviewed for eligibility. Thirty-two full articles were eliminated due to a lack of focus on plate waste evaluation. Finally, nine accepted studies were grouped into five categories: menu modification, room service implementation, menu presentation, meal-serving system, and dietary monitoring tool. In conclusion, results showed that the majority of the studies implemented either of the five strategies to reduce plate waste; however, the cook-freeze system and staff training for both kitchen and ward staff were not yet part of any intervention strategy. The potential of this method should be explored in future interventions.

Effects of hydrolysed meat on dietary intake and nutritional status in aged care residents requiring pureed diets: a crossover randomised controlled trial

BACKGROUND

As a result of the high prevalence of dysphagia in aged care facilities, demand for pureed diets is increasing. One of the biggest challenges for pureed diets is the reduced nutritional density due to the cooking process, such as when blending or softening with liquid. This study aimed to investigate the impact of innovative energy and protein-enriched meat puree on the nutrition intake and nutritional status of aged care residents requiring pureed diets.

METHODS

This is a single-blinded randomised controlled trial conducted in two aged care facilities using a crossover design. Twenty-two residents aged 83.2 ± 7.3 years participated in a 12-week study. Participants were blocked randomised into two groups and received a 6-week of either control (unaltered freshly made pureed diets by facilities) or intervention diet, followed by a 2-week washout and then 6-week of alternative treatment. During the intervention, freshly made meat pureed portions were swapped to hydrolysed meat, which contained 144 -392 kcal and 5.6-6.8 g more energy and protein per 100 g. Nutrition intake was collected using a validated visual estimation method over 24 h on two non-consecutive days during the control and intervention phases. A two-tailed t-test was used to compare the significance.

RESULTS

The intervention diet significantly increased energy (147 ± 285 kcal, p = .02), protein (4 ± 7 g, p = .04), and fat (3 ± 8 g, p = .07) intake in comparison to the control diet. Nutritional status was improved by the end of the intervention as evidenced by a higher nutritional assessment score using Mini-Nutritional Assessment - Short Form (9.1 ± 1.8) and a weight gain of 1.3 ± 1.7 g, p = .04. No significant differences were found in body composition using bioelectrical impedance analysis, calf circumference and mid-upper arm circumference. Though handgrip strength did not differ at the end of control and intervention, significance was found between the changes in control and intervention period. Plasma branched-chain amino acid increased significantly with hydrolysed meat consumption.

CONCLUSIONS

As a dietary enrichment, hydrolysed meat is a promising intervention for pureed diet consumers in aged care facilities, improving residents' dietary intake and reducing malnutrition risk. Future larger multicentre studies with longer intervention periods are required to confirm the effectiveness and residents' acceptance.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12622000888763).

Behavior of Polish Consumers in Relation to Meals Ordered in Food Service Establishments in the Context of Plate Waste

In the food service industry, food is wasted at every stage of the process. A significant part of food wastage is the so-called plate waste, i.e., food left by the consumer on the plate. The purpose of this research was to analyze the behavior of Polish consumers in relation to meals ordered in food establishments. The following issues were taken into account: leaving an unfinished meal on a plate and reasons for it, taking an unfinished meal home, and ordering half portions. The study was conducted on a representative group of 1115 adult Polish citizens using the CAPI method. Segmentation (cluster analysis) of respondents differing in their behavior in relation to ordered meals was carried out. It turned out that about 53% of Polish citizens do not use food services at all. Men with secondary and higher levels of education and other sources of income (cluster C) less frequently declared leaving unfinished meals on a plate and taking an unfinished meal home, especially in canteens, compared to other clusters. Few respondents declared buying half portions. Excessively large portions and inadequate taste of dishes were indicated by almost 50% of respondents as the main reasons for the generation of plate waste. Measures should be promoted to encourage consumers and food service providers to reduce the generation of plate waste.

Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study

Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.

Can hospitalized patients adequately estimate their own food intake? A cross-sectional pilot study

ABSTRACT Objective To assess and identify factors linked to the accuracy of patients’ food intake estimations through a self-monitoring instrument filled in by the patient. Methods This cross-sectional study approached adult hospital patients subjected to regular or therapeutic diets. The actual food intake percentage was obtained by the ratio between the actual food intake and the amount of food served x 100. Patients had to complete a food chart including 9 circles representing plates of food in percentages (increasing scale of 12.5%) to represent their food intake at lunch and/or dinner. The Bland-Altman method assessed the agreement between the actual and the estimated values. The associations between variables (age, sex, hospitalization day, diet prescription, amount of food served and actual food intake percentage) and the accuracy of the food intake estimation (adequate ±10%, overestimated and underestimated) were evaluated through univariate multinomial logistic regression. Results Ninety-six patients were evaluated (51.0% male; 44.0±15.8 years of age). The Bland-Altman analysis showed good agreement between the actual and the estimated food intake. The actual food intake percentage was the only variable associated with the accuracy of the food intake estimation. Conclusion Most patients (~70%) adequately estimated their food intake using the 9-point food chart tested. Furthermore, the only factor linked to the accuracy of the food intake estimation was the actual food-intake percentage. These findings provide preliminary support for the usefulness of this instrument. However, it must be tested in a representative sample of hospitalized patients.