Effect of meal portion size choice on plate waste generation among patients with different nutritional status. An investigation using Dietary Intake Monitoring System (DIMS)
Abstract
Background The trolley meal system allows hospital patients to select food items and portion sizes directly 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 consumption 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 recommended 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 nutritional risk further increased the extent of waste, regardless of the po…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Units who adopt meals on wheels distribution have to be aware of the nutritional risk due to possible smaller portions served.
“units who adopt these meals on wheels distribution have to be aware of the 664 nutritional risk due to possible smaller portions served [53, 54].”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [53]
Cites
KONDRUP, J. (2003) · Clinical Nutrition · doi:10.1016/s0261-5614(02)00214-5 · Cited by 3,063 · see citing works
A biometric study of basal metabolism in man
Harris, J. A., & Benedict, F. G. (2014) · Medical Entomology and Zoology · Cited by 1,847 · see citing works
Incidence and recognition of malnutrition in hospital
McWhirter, J. P., & Pennington, C. R. (1994) · BMJ · doi:10.1136/bmj.308.6934.945 · Cited by 1,504 · see citing works
Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.
Kondrup, J., Johansen, N., Plum, L., Bak, L., Larsen, I., Martinsen, A., Andersen, J. R., Baernthsen, H., Bunch, E., & Lauesen, N. (2002) · Clinical Nutrition · doi:10.1054/clnu.2002.0585 · Cited by 466 · see citing works
Comparison of digital photography to weighed and visual estimation of portion sizes
Williamson, D. A., Allen, H. R., Martin, P. D., Alfonso, A. J., Gerald, B. L., & Hunt, A. E. (2003) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(03)00974-x · Cited by 357 · see citing works
Plate waste in hospitals and strategies for change
Williams, P., & Walton, K. L. (2011) · e-SPEN the European e-Journal of Clinical Nutrition and Metabolism · doi:10.1016/j.eclnm.2011.09.006 · Cited by 334 · see citing works
Food intake in 1707 hospitalised patients: a prospective comprehensive hospital survey
Dupertuis, Y. M. (2003) · Clinical Nutrition · doi:10.1054/clnu.2002.0623 · Cited by 254 · see citing works
High food wastage and low nutritional intakes in hospital patients
Barton, A., BEIGG, C. L., Macdonald, I. A., & Allison, S. P. (2000) · Clinical Nutrition · doi:10.1054/clnu.2000.0150 · Cited by 225 · see citing works
Mowé, M., Bosaeus, I. G., Rasmussen, H. H., Kondrup, J., Unosson, M., & Irtun, Ø. (2006) · Clinical Nutrition · doi:10.1016/j.clnu.2005.11.011 · Cited by 180 · see citing works
Self-citationA review of the use of information and communication technologies for dietary assessment
Ngo, J., Engelen, A., Molag, M., Roesle, J., García-Segovia, P., & Serra-Majem, L. (2009) · British Journal of Nutrition · doi:10.1017/s0007114509990638 · Cited by 179 · see citing works
Thibault, R., Chikhi, M., Clerc, A., Darmon, P., Chopard, P., Genton, L., Kossovsky, M. P., & Pichard, C. (2011) · Clinical Nutrition · doi:10.1016/j.clnu.2010.10.002 · Cited by 157 · see citing works
A recipe for improving food intakes in elderly hospitalized patients
Barton, A., BEIGG, C. L., Macdonald, I. A., & Allison, S. P. (2000) · Clinical Nutrition · doi:10.1054/clnu.2000.0149 · Cited by 155 · see citing works
Nutrient intake and plate waste from an Australian residential care facility
Grieger, J. A., & Nowson, C. A. (2006) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1602565 · Cited by 68 · see citing works
Almdal, T., Viggers, L., Beck, A., & Jensen, K. (2003) · Clinical Nutrition · doi:10.1054/clnu.2002.0590 · Cited by 64 · see citing works
A comparison of the amount of food served and consumed according to meal service system
Wilson, A., Evans, S., & Frost, G. S. (2000) · Journal of Human Nutrition and Dietetics · doi:10.1046/j.1365-277x.2000.00235.x · Cited by 57 · see citing works
Audit of food wastage: differences between a plated and bulk system of meal provision
Kelly, L. (1999) · Journal of Human Nutrition and Dietetics · doi:10.1046/j.1365-277x.1999.00183.x · Cited by 51 · see citing works
Ofei, K. T., Holst, M., Rasmussen, H. H., & Mikkelsen, B. E. (2014) · Appetite · doi:10.1016/j.appet.2014.08.001 · Cited by 51 · see citing works
Self-citationA comparative analysis of ‘plated’ and ‘bulk trolley’ hospital food service systems*
Hartwell, H. J., & Edwards, J. S. (2003) · Food Service Technology · doi:10.1111/j.1471-5740.2003.00077.x · Cited by 48 · see citing works
The nutritional implications of food wastage in hospital food service management
Edwards, J. S. A., & Nash, A. H. M. (1999) · Nutrition & Food Science · doi:10.1108/00346659910254394 · Cited by 47 · see citing works
Visual Plate Waste in Hospitalized Patients: Length of Stay and Diet Order
Kandiah, J., Stinnett, L. J., & Lutton, D. (2006) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2006.07.015 · Cited by 44 · see citing works
Patient satisfaction and energy intakes are enhanced by point of service meal provision
Mahoney, S., ZULLI, A., & Walton, K. L. (2009) · Nutrition & Dietetics · doi:10.1111/j.1747-0080.2009.01373.x · Cited by 39 · see citing works
Does a new steam meal catering system meet patient requirements in hospital?
Hickson, M., Fearnley, L., Thomas, J. E., & Evans, S. (2007) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2007.00817.x · Cited by 26 · see citing works
Good nutritional practice in hospitals during an 8-year period: The impact of accreditation
Holst, M., Staun, M., Kondrup, J., Bach-Dahl, C., & Rasmussen, H. (2014) · e-SPEN Journal · doi:10.1016/j.clnme.2014.05.001 · Cited by 26 · see citing works
Self-citationA photographic method to measure food item intake. Validation in geriatric institutions
Pouyet, V., Cuvelier, G., Benattar, L., & Giboreau, A. (2014) · Appetite · doi:10.1016/j.appet.2014.09.012 · Cited by 24 · see citing works
Freil, M., Nielsen, M. A., Biltz, C., Gut, R., Mikkelsen, B. E., & Almdal, T. (2006) · Scandinavian Journal of Food & Nutrition · doi:10.1080/17482970600743186 · Cited by 22 · see citing works
Self-citationPlate waste among hospital inpatients
Zakiah, L., Saimy, I. S., & Maimunah, A. (2005) · Malaysian Journal of Public Health Medicine · Cited by 17 · see citing works
Catering in a large hospital – Does serving from a buffet system meet the patients' needs?
Hansen, M. F., Nielsen, M. A., Biltz, C., Seidelin, W., & Almdal, T. (2008) · Clinical Nutrition · doi:10.1016/j.clnu.2008.05.004 · Cited by 16 · see citing works
Freil, M., Nielsen, M. A., Biltz, C., Gut, R., Mikkelsen, B. E., & Almdal, T. (2006) · Food & Nutrition Research · doi:10.3402/fnr.v50i2.1563 · Cited by 16 · see citing works
Self-citationThe effect of changes in meal service systems on macronutrient intake in acute hospitalized patients
Wilson, A., Evans, S., & Frost, G. S. (2001) · Food Service Technology · doi:10.1046/j.1471-5740.2001.00014.x · Cited by 13 · see citing works
Ofei, K. T., Dobroczynski, M., Holst, M., Rasmussen, H. H., & Mikkelsen, B. E. (2014) · VBN Forskningsportal (Aalborg Universitet) · Cited by 10 · see citing works
Self-citationThe implications of food wastage on a renal ward
Marson, H., McErlain, L., & Ainsworth, P. D. (2003) · British Food Journal · doi:10.1108/00070700310511582 · Cited by 10 · see citing works
Nutrition in the hospital setting
Jan, F., & Shen, E. (2012) · Cited by 6 · see citing works
Flagged first, then by citations
1 of the 33 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Annosi, M. C., Brunetta, F., Bimbo, F., & Kostoula, M. (2021) · Industrial Marketing Management · doi:10.1016/j.indmarman.2021.01.005 · Cited by 275 · see citing works
ESPEN guideline on hospital nutrition
Thibault, R., Abbasoglu, O., Ioannou, E., Meija, L., Ottens-Oussoren, K., Pichard, C., Rothenberg, E., Rubin, D., Siljamäki-Ojansuu, U., Vaillant, M.-F., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.039 · Cited by 259 · see citing works
Food waste drivers in Europe, from identification to possible interventions
Canali, M., Amani, P., Aramyan, L., Gheoldus, M., Moates, G., Östergren, K., Silvennoinen, K., Waldron, K., & Vittuari, M. (2016) · Sustainability · doi:10.3390/su9010037 · Cited by 230 · see citing works
A simple awareness campaign to promote food waste reduction in a University canteen
Pinto, R. S., Pinto, R. M. D. S., Melo, F. F. S., Campos, S. S., & Cordovil, C. M. D. S. (2018) · Waste Management · doi:10.1016/j.wasman.2018.02.044 · Cited by 221 · see citing works
Carino, S., Porter, J., Malekpour, S., & Collins, J. (2020) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2020.01.001 · Cited by 160 · see citing works
Food Loss and Waste in Meat Sector—Why the Consumption Stage Generates the Most Losses?
Karwowska, M., Łaba, S., & Szczepański, K. (2021) · Sustainability · doi:10.3390/su13116227 · Cited by 141 · see citing works
Bellmann, S., Lelieveld, J., Gorissen, T., Minekus, M., & Havenaar, R. (2016) · Food Research International · doi:10.1016/j.foodres.2016.01.030 · Cited by 117 · see citing works
Food-away-from-home plate waste in China: Preference for variety and quantity
Xu, Z., Zhang, Z., Liu, H., Zhong, F., Bai, J., & Cheng, S. (2020) · Food Policy · doi:10.1016/j.foodpol.2020.101918 · Cited by 95 · see citing works
Exploring the patterns of food waste generation by tourists in a popular destination
Wang, L., Filimonau, V., & Li, Y. (2020) · Journal of Cleaner Production · doi:10.1016/j.jclepro.2020.123890 · Cited by 80 · see citing works
Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review
Osman, N. S., Nor, N. M., Sharif, M. S. M., Hamid, S. B. A., & Rahamat, S. (2021) · Nutrients · doi:10.3390/nu13103649 · Cited by 74 · see citing works
Research into food portion size: methodological aspects and applications
Almiron‐Roig, E., Navas‐Carretero, S., Emery, P. W., & Martínez, J. A. (2017) · Food & Function · doi:10.1039/c7fo01430a · Cited by 61 · see citing works
Thiel, C. L., Park, S., Musicus, A. A., Agins, J., Gan, J., Held, J., Horrocks, A., & Bragg, M. A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0247616 · Cited by 43 · see citing works
McCray, S. J., Maunder, K., Norris, R., Moir, J., & MacKenzie-Shalders, K. (2018) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2018.04.012 · Cited by 36 · see citing works
Henrique, J. R., Pereira, R. G., Ferreira, Á. R. S., Keller, H., de van der Schueren, M. A. E., González, M. C., Meira, W., & Correia, M. I. T. D. (2020) · Nutrition · doi:10.1016/j.nut.2020.110961 · Cited by 38 · see citing works
Antasouras, G., Vasios, G. K., Kontogiorgis, C., Ioannou, Z., Poulios, E., Deligiannidou, G.-E., Troumbis, A., & Giaginis, C. (2022) · International Journal of Health Planning and Management · doi:10.1002/hpm.3586 · Cited by 34 · see citing works
Are energy and protein requirements met in hospital?
Pullen, K., Collins, R., Stone, T., Carter, H., Sadler, H., & Collinson, A. (2018) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12485 · Cited by 30 · see citing works
The State of America’s Wasted Food and Opportunities to Make a Difference
Vogliano, C., & Brown, K. A. (2016) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2016.01.022 · Cited by 28 · see citing works
Weijzen, M. E. G., Kouw, I. W. K., Verschuren, A. A. J., Muyters, R., Geurts, J. A. P., Emans, P. J., Geerlings, P., Verdijk, L. B., & van Loon, L. J. C. (2019) · The journal of nutrition health & aging · doi:10.1007/s12603-019-1157-2 · Cited by 27 · see citing works
Plate Food Waste in Food Services: A Systematic Review and Meta-Analysis
Guimarães, N. S., Reis, M. G., Fontes, L. D. A., Zandonadi, R. P., Botelho, R. B. A., Alturki, H. A., Saraiva, A., & Raposo, A. (2024) · Nutrients · doi:10.3390/nu16101429 · Cited by 23 · see citing works
Chatzipavlou, M., Karayiannis, D., Chaloulakou, S., Georgakopoulou, E., & Poulia, K. (2024) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2024.03.030 · Cited by 18 · see citing works
Ofei, K. T., Mikkelsen, B., & Scheller, R. A. (2018) · Public Health Nutrition · doi:10.1017/s1368980018001064 · Cited by 17 · see citing works
Self-citationInstitutional and Individual Effects of Greenwashing on Food Waste
Cavazos, R. L., Taylor, K., Eary, R. B., & Doty, S. (2022) · Sustainability · doi:10.3390/su15010221 · Cited by 17 · see citing works
Ferguson, C. E., Tatucu-Babet, O. A., Amon, J. N., Chapple, L. S., Malacria, L., Htoo, I. M., Hodgson, C. L., & Ridley, E. J. (2023) · Nutrition Research Reviews · doi:10.1017/s0954422423000288 · Cited by 14 · see citing works
Food waste in Indonesian hospitals: a systematic review
Diana, R., Martianto, D., Baliwati, Y. F., Sukandar, D., & Hendriadi, A. (2022) · Nutrition & Food Science · doi:10.1108/nfs-05-2022-0150 · Cited by 13 · see citing works
Guimarães, N. S., Reis, M. G., de Matos, F. E., Fontes, L. D. A., Raposo, A., Saraiva, A., Zandonadi, R. P., Alturki, H. A., Albaridi, N. A., & de Carvalho, I. M. M. (2024) · Sustainability · doi:10.3390/su16209099 · Cited by 13 · see citing works
Hoteit, M., Antar, E., Malli, D., Fattouh, F., Khattar, M., Baderddine, N., Cheikh, J. E., Chalak, A., Abiad, M. G., & Hassan, H. F. (2024) · Journal of Agriculture and Food Research · doi:10.1016/j.jafr.2023.100959 · Cited by 17 · see citing works
Sustainability initiatives in inpatient psychiatry: tackling food waste
Liwinski, T., Bocek, I., Schmidt, A., Kowalinski, E., Dechent, F., Rabenschlag, F., Moeller, J., Sarlon, J., Brühl, A. B., Nienaber, A., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1374788 · Cited by 10 · see citing works
Strategies to Reduce the Rate of Plate Waste in Hospitalized Patients: A Scoping Review
Manimaran, S., Razalli, N. H., Manaf, Z. A., Ludin, A. F. M., & Shahar, S. (2023) · Nutrients · doi:10.3390/nu15020301 · Cited by 12 · see citing works
Green food transformation systems: Role of young people in engagement and digital literacy
Mikkelsen, B. E., & Chapagain, M. R. (2023) · International Journal of Food Design · doi:10.1386/ijfd_00049_1 · Cited by 9 · see citing works
Self-citationManimaran, S., Razalli, N. H., Manaf, Z., & Shahar, S. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12365-w · Cited by 8 · see citing works
Rochmah, T. N. (2020) · Amerta Nutrition · doi:10.20473/amnt.v4i4.2020.335-341 · Cited by 5 · see citing works
Man or machine? Will the digital transition be able to automatize dietary intake data collection?
Mikkelsen, B. E. (2019) · Public Health Nutrition · doi:10.1017/s1368980018003993 · Cited by 4 · see citing works
Self-citationBeyond the tray: analyzing hospital plate waste for economic and environmental sustainability
Abiad, M. G., Hoteit, M., Khattar, M., Fattouh, F., Malli, D., Antar, E., Mohammad, J. E. C., Badereddine, N., Khatib, S. E., & Hassan, H. F. (2025) · Frontiers in Sustainable Food Systems · doi:10.3389/fsufs.2025.1516331 · Cited by 2 · see citing works
Rethinking Food Waste in Aged Care: A Systematic Review Framing Food Waste as an Ecosystem Issue
Piere, E., O'Kane, P., & Mirosa, M. (2026) · Australian Journal on Ageing · doi:10.1111/ajag.70151 · Cited by 2 · see citing works
Rastmanesh, R., & Flack, K. D. (2023) · JMIR Research Protocols · doi:10.2196/42846 · Cited by 1 · see citing works
Samiun, N. A. A., Razalli, N. H., Shahar, S., Manaf, Z. A., Kefeli, Z., Khudzari, J. M., & Jamhuri, N. (2024) · JANUARY 2024 · doi:10.47836/mjmhs.20.1.39 · Cited by 1 · see citing works
Fotografi som visuel metode i ernærings- og sundhedsfaglige studier
Justesen, L., Laub, M. T., & Poulsen, B. R. (2018) · Arbejdspapirer Professionshøjskolen Metropol · doi:10.7146/map.v3i1.106186 · Cited by 1 · see citing works
The Knowledge Triangle Programme
Gottlieb, H., & Backlund, M. M. (2015) · Nordic Council of Ministers eBooks · doi:10.6027/tn2015-567
Healing Through Nutrition: Evaluating Dietary Support in Jordanian Hospitals
Alnimer, L., Omoush, R. M., Al-Shalabi, A., Jahrami, H., Amawi, A. T., & Ghazzawi, H. (2025) · Nutrients · doi:10.3390/nu17040615
Time to rethink the food chain for sustainable patient meals in hospitals: A scoping review
Kumar, V. K., Yuan, M., Chan, V., & Iyer, P. (2026) · Food and Humanity · doi:10.1016/j.foohum.2026.101188
Fiori, F., Menis, D., Mansutti, E., Graziani, C. L., Cautero, P., Zago, D., Driutti, M., Lesa, L., Scarpis, E., Conte, A., et al. (2026) · Applied Sciences · doi:10.3390/app16136453
Environmental Performance Indicators Used in Healthcare Foodservices: A Scoping Review
Ong, S., Lawrence, M. A., Forrester, M., & Porter, J. A. (2026) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70316
Ni, H., Willmott, T., McGrath, D., Mikelsons, S., Teo, E., Crane, R., Bianco-Miotto, T., & Morris, H. (2026) · Sustainable Production and Consumption · doi:10.1016/j.spc.2026.08.018
Yang, J., Tai, J., & Dong, C. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1951971
- Authors
- Ofei, K. T., Holst, M., Rasmussen, H. H., & Mikkelsen, B. E.
- Affiliations
- Aalborg University (DK)
- Aalborg University Hospital (DK)
- Corresponding author
- Ofei, K.T.
- Venue
- Appetite
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 91
- Pages
- 157-164
- ISSN
- 0195-6663 (ISSN-L)
- OpenAlex
- W2064127044
- Cited by
- 44
- References
- 33
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 1
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Appetite (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- Danish Agency for Science, Technology and Innovation (830005)
- Market Development
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Food Waste Reduction and Sustainability
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- plate waste, food waste, hospitalized patients, nutritional status, nutritional risk screening, NRS-2002, energy intake, protein intake, food waste reduction
- MeSH terms
- Aged, Anorexia, Energy Intake, Dietary Proteins, Eating, Feeding Behavior, Female, Food Service, Hospital, Hospitalization, Humans, Male, Middle Aged, Nutritional Status, Prospective Studies, Malnutrition, Meals, Recommended Dietary Allowances, Portion Size
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
