From menu to mouth: the decay pathway of nutrient intake from planned menu to consumed and characteristics of residents in an aged care facility with greater nutrient decay rates: a cross-sectional study.

objectivesTo observe the cascade of nutrient loss from meals planned to those provided and subsequently consumed by older people in residential care. A secondary aim was to determine the characteristics of residents with higher nutrient loss resulting in lower intake of key nutrients.

designA single-centre cross-sectional study.

settingAn aged residential care facility in Christchurch, New Zealand.

participantsAll low and high level of care residents except those who are end of life, enterally fed or on short-term stay were invited to participate in the study. 54 of 60 selected residents who consumed all three main meals (breakfast, lunch and dinner) for three non-consecutive days were included in the analyses.

main outcome measuresNutrient contents of planned menu; nutrient contents of meals served and consumed using modified 3-day diet records; and percentage of planned nutrients served and consumed.

resultsVitamins C, B12 and folate had the greatest total decay rates of 50% or more from that planned to be consumed to what was actually consumed, while unsaturated fats, beta carotene, iodine and zinc had the lowest decay rates of 25% or less. Male participants and lower care level residents consumed significantly more nutrients, compared with female participants and those receiving higher level care. Increased age, female gender, higher level of care, smaller meal size, pureed diet and lower body mass index were associated with larger decay rates and lower nutrient intakes.

conclusionsNot all planned and served food and beverages are consumed, contributing to potential multiple nutrient deficiencies including energy and protein in the majority of aged-care residents. As a consequence, some nutrients may need to be oversupplied if consumption is to match planned intakes.