1. Serving Size Accuracy
USC Dietetic Student Project – Danica Warren
A project to determine levels of accuracy in standard serving size & plating accuracy for main
meals & desserts in line with the Queensland Health Standards for Meals & Menus.
40%
Malnutrition
affects
approximately
40% of adults
in the acute
hospital setting1
Why is this project important?
Evidence suggests that optimal nutrition within the
hospital setting provides great opportunities for
improving health outcomes for patients.1 The
Queensland Health Nutrition Standards for Meals
and Menus (NSMM)2 provide recommendations for
serve sizes and meal types to be served to patients
with a wide range of conditions. Meeting these
specifications is an important part of improving
compliance and providing appropriate health care
to patients.
Project objectives
1. Determine levels of accuracy in standard serving size & plating accuracy
for main meals and desserts.
2. Make recommendations to improve the accuracy of serve sizes ensuring
meals are served in line with the Queensland Health Standards for Meals
and Menus with the development of an implementation plan including
benefits, costs and timeline for implementation.
3. Update and implement revised serve size tools.
What was done?
1. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. International
journal of environmental research and public health. 2011 Feb 16;8(2):514-27.
2. State-wide Foodservice Network. Queensland Health Nutrition Standards for Meals and Menus. May 2015.
DATA COLLECTION
 Meals selected for assessment based on
previous projects, menu cycle & product type
 Breakfast: hot protein
 Lunch & Dinner: hot choices, vegetables,
desserts
 Standard meal sizes – no kids meals or small
serves
 Full & soft options only – no textured modified
 Plating line observed to identify utensils &
methods used
 Meals weighed: plated at beginning & end of
plating line
DATA ANALYSIS
 Weights of meals plated at beginning & end of
plating line compared to identify variance
 Average weights of meal components
compared to NSMM specified serve sizes to
assess compliance
 Serving utensils assessed for appropriateness
 Nutritional analysis of some meals

2. The author would like to acknowledge and give thanks to all foodservice and nutrition and dietetic staff for the
assistance and support they provided throughout the course of this project.
What was found?
0
20
40
60
80
100
Hot Choices Vegetables Desserts
%ofMealsAssessed
Variation in Serve Size Between Beginning
& End of Plating Line
Nil Some
0
20
40
60
80
100
Hot Choices Vegetables Dessert
%ofMealsAssessed
Levels of Compliance with NSMM Specified
Serve Sizes
Meets Does Not Meet
What can be done?
Improve compliance with NSMM serve size specifications & reduce variance
throughout plating line by:
 Using preliminary serving size tool developed as part of this project
 Ensuring that utensils are used correctly by filling scoop appropriately &
plating all food
 Nutrition Assistants to encourage foodservice staff to plate more food
where required to better meet appropriate serve sizes
 Drain excess sauce from meat/sauce dishes & ensure that scoop is filled
with mainly meat/vegetables
Where to from here?
 Complete the development of serve size tool to include all meals
for entire 14-day menu cycle
 Print & distribute completed serve size tool to foodservice staff
 Conduct regular spot-checks to assess compliance with serve size
tool & NSMM
 Assess serve size for all new products against NSMM
 Consider development of photographic serve size guide
SERVE SIZE VARIANCE
 Serve sizes for hot choices most consistent
between meals plated at beginning & end of
plating line
 Most variance between meals found in
vegetable component
 Challenges due to different size pieces in
product provided
 Noted that at times not all vegetables in
scoop are plated
 Improved with Nutrition Assistant
encouragement
NSMM COMPLIANCE
 Desserts & hot choice components of main
meals most compliant with specifications
 Vegetables found to have highest rates of
non-compliance
 Difficulties with pre-portioned meals from
supplier
 Challenges due to different size pieces in
product provided
 Priority is to ensure adequate protein & energy
for preventing or managing malnutrition