Comparison of patients' meal intake estimates: The eye is bigger than the plate

Abstract

Objective: To compare the dietitians' calorie count and the nurses' subjective evaluation with the patient's calculated food intake using the calorie analysis provided by the Food Service Department or computer software, and to determine the correlation of the nurses' subjective evaluation versus the dietitians' calorie count. Design: Dietitians use the Diabetic Exchange List to perform calorie counts of patients dietary intake. Physicians have come to rely on calorie count reports or nurses' reports to make decisions concerning nutritional support. A nurse's report of a patient's meal intake is visual assessment of the meal trays. The dietitians' calorie counts provide an objective assessment. The dietitians' calorie counts and nurses' subjective evaluations are compared with the calorie analysis using a prospective pilot study design. Patients: Patients with chronic or acute renal failure admitted to the Nephrology service and whose physician ordered calorie counts were studied. Main Outcome Measure: Percentage estimates of meal intakes by the dietitians' calorie counts and the nurses' subjective evaluations are compared with the calorie analysis. Results: Sixty-three meal menus were collected on 9 different patients. The diets were either standard regular or renal pattern restriction. Fifty-five percent of the dietitians' calorie counts were within 10% of calorie analysis; 18% were underestimated and 27% were overestimated. Forty-eight percent of the nurses' visual assessment of meal trays were within 10% of calorie analysis; 6% were underestimated and 46% were overestimated. Both the dietitians' and the nurses' methods of evaluating a patient's dietary intake are inaccurate. Conclusion: The findings of this pilot study indicate that renal patients' calorie intake is often overestimated or underestimated. Renal patients who could be actually consuming significantly fewer calories than suspected may become nutritionally compromised.