Chapter 11: Menu Capacity Analysis

In this chapter:

Methodology for analysing menu capacity
Worked examples
Utilising nutritional analysis software

The process of menu analysis requires an understanding of menu type, structure, planning and content. It is not all about number crunching; both qualitative and quantitative aspects of menus are equally important.

The methodology outlined in this chapter can be used to evaluate the range and capacity of menus used in a healthcare setting. A menu capacity analysis provides evidence of compliance with applicable hospital food standards. Each home country’s standards vary slightly, so it is important to check the ones that apply to your organisation. It is also recommended that a new analysis is carried out for each substantial menu change.

In addition to the standard menus, it is recommended that special and therapeutic menus (i.e., texture modified menus, paediatric menus, finger food and allergy menus) are also analysed using the same methodology to ensure energy and protein needs are met across the spectrum of menus.

It should be noted that the aim of the menu capacity analysis is to outline the hypothetical capacity of the menu and is based on patients eating 100% of their meals. Patients who are nutritionally vulnerable may consume less of their meals due to nutrition impact symptoms like swallowing difficulties, poor appetite and fatigue. Therefore, menu planners should be cautious of menu analysis figures when aiming to show compliance with any standards. Other factors that will impact a patient’s intake still need to be considered, such as taste, appearance and portion size.

Methodology for analysing menu capacity

The structure of a menu capacity analysis is based on the day parts model outlined in Chapter 10, Table 10.4. Each day has both a ‘fixed’ and a ‘variable’ component.

Fixed amounts are used to estimate the daily intake of energy and protein from breakfast, snacks and drinks. As there are multiple products available to patients at breakfast and snack/drink rounds - using the average of these products provides a more measured approach to analysing the capacity of a menu.

Variable amounts are used to reflect the range of energy and protein available from the different meal choices on the menu for the lunch and dinner meal services.

This chapter illustrates two worked examples of a menu capacity analysis based on a cyclical and à la carte standard menus. Both examples illustrate how the minimum/maximum method of menu analysis is used to show how the menus meet the needs of both nutritionally well and nutritionally vulnerable patients.

Tables 11.2, 11.3, 11.4, 11.5 and 11.6 depict a worked example of a menu capacity analysis of a sample day from a 2-week cycle menu.

Tables 11.7, 11.8, 11.9 and 11.10 depict a worked example of a menu capacity analysis of a sample à la carte menu.

Table 11.1: Outline of minimum/maximum methodology

	Cyclical menu	A la carte menu
Step 1: Nutritional breakdown
Obtain the energy (kcal) and protein (g) information for all food and drink items on the menu.	Table 11.2	Table 11.7
Notes: Data can be sourced from the food supplier, manufacturer, food labels, calculated in-house using recipe analysis software based on food composition tables, or through a combination of these.
Step 2: Calculate fixed values
Minimum	Table 11.3	Table 11.8
Calculate the minimum ‘fixed’ energy and protein values for breakfast, snacks and drinks	Breakfast - calculate the average energy and protein of the breakfast items on offer, as outlined in the standard nutritionally well breakfast in Table 10.4 Snacks - use the total energy and protein for the two snacks with the lowest amount of energy Drinks - use the energy and protein of 400ml of your lowest energy milk
Maximum	Table 11.4	Table 11.9
Calculate the maximum ‘fixed’ energy and protein values for breakfast, snacks and drinks	Breakfast - calculate the average energy and protein of the breakfast items on offer, as outlined in the standard nutritionally vulnerable breakfast in Table 10.4 Snacks - use the total energy and protein for the two snacks with the highest amount of energy Drinks – use the energy and protein of 400ml of your highest energy milk
Notes: For the worked examples in this chapter, the appropriate energy and protein values were taken from Table 10.3. In practice use actual breakfast and snack items figures. Two different types of snacks should be used.
Step 3: Calculate variable values
Minimum	Table 11.3	Table 11.8
Calculate the minimum ‘variable’ energy and protein values for lunch and dinner	Select a random day in the week and pick the appropriate minimum choice (i.e., that which provides the lowest energy value) at lunch and dinner for the starter (if applicable), main meal and dessert.	Select the 3 minimum choices on the menu (i.e., those which provide the lowest energy value) for the starter (if applicable), main meal and dessert. Add the total energy together for the 3 lowest options in each course and divide by 3 to get an average for that meal course. Repeat this for protein.
Maximum	Table 11.4	Table 11.9
Calculate the maximum ‘variable’ energy and protein values for lunch and dinner	For the same day, pick the appropriate maximum choice (i.e., that which provides the highest energy value) at lunch and dinner for the starter (if applicable), main meal and dessert	Select the 3 maximum choices on the menu (i.e., those which provide the highest energy value) for the starter (if applicable), main meal and dessert. Add the total energy together for the 3 highest options in each course and divide by 3 to get an average for that meal course. Repeat this for protein.
Notes: Pick realistic options when choosing carbohydrate and vegetable sides to make up a main course - even if that choice is not always the lowest/highest in energy for that meal service, e.g. when completing a minimum capacity analysis, pick rice to go with chilli con carne, even though mashed potato may be on the menu and provide less calories, similarly you may pick chips to pair with battered fish when completing a maximum capacity analysis, even though rice may have more calories.
Step 4: Calculate average total daily energy and protein
Minimum	Table 11.3	Table 11.8
Calculate the total minimum energy and protein provided over the day	Add together the values for energy and protein for both the minimum fixed and variable components of the day to calculate the totals for each.	If the same variable options are available and lunch and dinner, multiply the calculated average minimum values for energy and protein by 2 to represent both main meals (or simply add together lunch and dinner if different options are available). Then add these amounts to the minimum fixed values to calculate the totals for both energy and protein.
Notes: Show the percentage of the nutritional targets met for both the minimum* fixed and variable figures as demonstrated in Table 10.1*
Maximum	Table 11.4	Table 11.9
Calculate the total maximum energy and protein provided over the day	Add all the values for energy and protein together for both the maximum fixed and variable components of the day to calculate the totals for each.	If the same variable options are available and lunch and dinner, multiply the calculated average maximum values for energy and protein by 2 to represent both main meals (or simply add together lunch and dinner if different options are available). Then add these amounts to the maximum fixed values to calculate the totals for both energy and protein.
Notes: Show the percentage of the nutritional targets met for both the maximum* fixed and variable figures as demonstrated in Table 10.1*
Step 5: Calculate average energy and protein for a cycle
Minimum	Table 11.5
Calculate the average minimum energy and protein provided across the three days or three meals	Repeat steps 3 and 4 for three random days in total within the week, including one weekend day. Add the total energy together for all 3 days from the minimum menu capacity analysis and divide by 3 to get the average energy provided by the minimum choices. Repeat this for protein.	N/A
Maximum	Table 11.5
Calculate the average maximum energy and protein provided across the three days or three meals	Repeat steps 3 and 4 for three random days in total within the week, including one weekend day. Add the total energy together for all 3 days from the maximum menu capacity analysis and divide by 3 to get the average energy provided by the maximum choices. Repeat this for protein.	N/A
Notes: Including a Saturday or Sunday ensures consistency of meeting nutritional capacity over the entire week.
Step 6: Compare to nutritional Targets
Minimum	Table 11.6	Table 11.10
Compare the average energy and protein to the nutritional targets for nutritionally well patients.	The average energy and protein from your minimum menu capacity analysis should be equal to or above the targets for nutritionally well patients.
Maximum	Table 11.6	Table 11.10
Compare the average energy and protein to the nutritional targets for nutritionally vulnerable patients.	The average energy and protein from your maximum menu capacity analysis should be equal to or above the targets for nutritionally vulnerable patients.

A note on hybrid menus

If a menu contains a combination of both a la carte options (i.e. options that are available everyday) and a cyclical menu (i.e. daily specials), then the two different components of the menu should be analysed separately.

For example, if the menu has the same sandwiches and cold desserts available every day with a rotating menu of daily hot options, the sandwiches and cold desserts should be analysed using the a la carte menu method and the hot options analysed using the cyclical menu method.

Worked examples

The following worked examples of lunch and dinner menus show how the menu capacity analysis methodology can be applied to both cyclical and à la carte menus.

Some nutritional analysis packages allow selection of meal choices from specific days to carry out a menu capacity analysis. In the absence of an appropriate electronic analysis tool, calculations can be carried out manually using an Excel spreadsheet and the energy and protein information from recipe analysis.

Table 11.2: Nutritional breakdown cycle menu A

Menu structure	Menu items from Tuesday, week 1	Portion size	Energy (kcal) / portion	Protein (g)
Breakfast
	Breakfast for Nutritionally Well (Table 10.3)	Varies	400	10
	Breakfast for Nutritionally Vulnerable (Table 10.3)	Varies	545	18
Lunch
Starter	Tomato Soup*	150g	105	2.1
	Bread Roll Wholemeal	50g	122	5.2
	Bread Roll White	50g	127	4.7
	Butter Portion	7g	52	0
Main meals	Chilli Con Carne*	170g	171	14
	Sausage Casserole*	240g	359	16
	Vegetable Cheese Bake*	250g	354	13
Gravy	Gravy	100ml	30	0.3
Carbohydrate	Rice*	120g	175	3.1
Carbohydrate	Mashed Potato *	100g	122	1.7
Vegetables	Broccoli*	90g	30	3.5
Vegetables	Sweetcorn*	90g	91	3.1
Cold dessert	Strawberry Cheesecake*	94g	210	3.4
Hot dessert	Stewed Apple and Custard*	300g	263	1.9
Custard	Low Sugar Custard*	150g	164	1.8
Supper
Main meals	Smoked Haddock and Spinach Crumble*	186g	356	17
	Chicken Breast in Tomato and Basil Sauce*	188g	166	25
	Lentil and Vegetable Pie*	250g	353	13
Carbohydrate	Mashed Potato *	100g	122	1.7
Carbohydrate	Potato Wedges*	100g	120	2.2
Vegetables	Peas*	90g	70	5.1
Vegetables	Swede*	100g	29	0.7
Gravy	Gravy	100ml	30	0.3
Cold dessert	Rice Pudding Pot	150g	128	5
Hot dessert	Chocolate Chip Sponge	110g	281	4.2
Custard	Low Sugar Custard*	150g	164	1.8
Other menu day parts
2 Snacks	Snacks for nutritionally well	Varies	150	2
2 Snacks	Snacks for nutritionally vulnerable	Varies	300	7
7 Drinks	400 ml semi-skimmed milk for drinks including evening milky drink	400ml	184	14
7 Drinks	400 ml full-fat milk for drinks including evening milky drink	400ml	264	13

Data sources:

All nutrition data taken from Nutridex.org.uk (1), sourced from McCance & Widdowson Composition of Foods Integrated Dataset (2), except for options marked with an *, these were taken from the apetito Nutridata App (3)

Table 11.3: Worked example from cycle menu A (minimum capacity analysis)

	Minimum capacity analysis for menu A	Energy (kcal)	Protein (g)	% of Daily nutrition
Fixed	Nutritionally well breakfast	400	10
	Snacks	150	2
	Drinks	184	14
	Fixed total	734	26	40%
Variable	Lunch
	Starter: Tomato Soup	105	2.1
	Main Meal (Chilli Con Carne) + Carbohydrate (Rice) + Vegetable (Broccoli)	376	20.6
	Dessert: Low Sugar Custard	164	1.8
	Dinner
	Main Meal (Chicken Breast in Tomato and Basil Sauce) + Carbohydrate (Potato Wedges) + Vegetable (Swede)	315	27.9
	Gravy and Condiments	30	0.3
	Dessert: Rice Pudding Pot	128	5
	Variable total	1118	57.7	60%
	Total minimum choice for the day	1852	84

Table 11.4: Worked example from cycle menu A (maximum capacity analysis)

	Maximum capacity analysis for menu A	Energy (kcal)	Protein (g)	% of Daily nutrition
Fixed	Nutritionally vulnerable breakfast	545	18
	Snacks	300	7
	Drinks	264	13
	Fixed Total	1109	38	34%
Variable	Lunch
	Starter: Tomato Soup + White Roll + Butter	284	6.8
	Main Meal (Sausage Casserole) + Carbohydrate (Mashed Potato) + Vegetable (Sweetcorn)	572	20.8
	Gravy and Condiments	30	0.3
	Dessert: Stewed Apple and Custard	263	1.9
	Dinner
	Main Meal (Smoked Haddock and Spinach Crumble) + Carbohydrate (Mashed Potato) + Vegetable (Peas)	548	23.8
	Dessert: Chocolate Chip Sponge + Custard	445	6
	Variable total	2142	59.6	66%
	Total maximum choice for the day	3251	98

Repeat the minimum capacity analysis and maximum capacity analysis for 3 random days for each week. Then, take the average total energy and protein from the 3 days and compare this to the nutrition targets for both nutritionally well and nutritionally vulnerable patients (targets outlined in Table 10.1).

Table 11.5: Worked example from cycle menu A (average totals for three days)

	Energy (kcal)	Protein (g)
Minimum capacity analysis
Day 1 (from Table 11.2)	1852	84
Day 2	1938	78
Day 3	1810	84
Average	1867	82
Maximum capacity analysis
Day 1 (from Table 11.3)	3251	98
Day 2	3273	97
Day 3	3171	92
Average	3231	96

Table 11.6: Worked example from cycle menu A (comparison of nutrition targets to menu capacity analysis)

	Energy (kcal)	Protein (g)
Nutritionally well
Nutrition targets	1840	56
Total average minimum choice from Menu A	1867	82
Percentage of target met	101%	146%
Nutritionally vulnerable
Nutrition targets	2772	79-92
Total average maximum choice from Menu A	3231	96
Percentage of target met	117%	104%

Table 11.7: Nutritional breakdown à la carte menu B

Menu structure	Menu items	Portion size(g)	Energy (kcal)	Protein (g)
Breakfast
	Breakfast for nutritionally well (Table 10.2)	Varies	400	10
	Breakfast for nutritionally vulnerable (Table 10.2)	Varies	545	18
Lunch and dinner
Starters	Fruit juice	85ml	38	0.5
	Chunky vegetable soup*	200g	106	2.7
	Tomato, red pepper & lentil soup*	150g	117	4.2
	Wholemeal bread roll	50g	122	5.2
	White bread roll	50g	127	4.7
	Butter Portion	7g	52	0
Sandwiches	Tuna mayonnaise sandwich	157g	365	18
	Cheese sandwich	120g	328	16
	Egg mayonnaise sandwich	150g	400	14
Salads	Four bean salad with a bread roll and spread	212g	377	15
	Boiled egg and coleslaw salad with a bread roll and spread	289g	318	12
	Chicken and cous cous salad with a bread roll and spread	267g	508	27
Hot mains	Vegan curry with basmati rice and onion bhaji*	160g	353	16
	Provençale vegetable bake with green beans, peas and broccoli*	435g	339	12
	Cheese and tomato omelette with fried potatoes and mixed vegetables*	375g	514	23
	Macaroni cheese*	290g	513	22
	Tuscan salmon with boiled potatoes, carrots and green beans*	405g	369	24
	Fish bake with carrots and peas*	405g	402	21
	Chicken tikka masala with yellow rice and onion bhajis*	398g	506	26
	Roast chicken in gravy with roast potatoes, carrots, sprouts and a pork chipolata sausage*	398g	328	30
	Pork meatballs and spaghetti*	405g	533	21
	Sausages and mashed potato with peas*	398g	448	17
	Beef casserole with mashed potato and carrots*	390g	389	23
	Shepherd’s pie with carrots and peas*	380	346	16
Gravy	Gravy	100ml	30	0.3
Hot desserts	Apple crumble*	120g	246	3
	Sticky toffee pudding*	160g	349	4
	Gluten free lemon Sponge*	120g	370	4
	Rice pudding*	160g	181	5
	Chocolate chip sponge*	135g	267	4
Custard	Low sugar custard*	150g	164	1.8
Cold desserts	Vanilla ice cream	80ml	130	2.7
	Thick and creamy yoghurt	110g	140	5.6
	Fruit salad	150g	56	0
	Raspberry jelly	115g	70	1.4
	Chocolate mousse	90ml	189	4.3
	Cheese and crackers	56g	234	11.6
Other menu day parts
2 Snacks	Snacks for nutritionally well	Varies	150	2
2 Snacks	Snacks for nutritionally vulnerable	Varies	300	7
7 Drinks	400 ml semi-skimmed milk for drinks including evening milky drink	400ml	184	14
7 Drinks	400 ml full-fat milk for drinks including evening milky drink	400ml	264	13

Data sources:

Table 11.8: Worked example from a la carte menu B (minimum capacity analysis)

Minimum capacity analysis for menu B			Total energy (Kcal)	Total protein (g)	% of Daily nutrition
Fixed		Nutritionally well breakfast	400	10
		Snacks	150	2
		Drinks	184	14
		Fixed total	734	26	38%
Variable	Lunch and dinner
	Starters (3 lowest options)	Fruit juice	38	0.5
		Chunky vegetable soup + wholemeal bread roll	228	7.9
		Tomato, red pepper and lentil soup + wholemeal bread roll	239	9.4
		Average	168	5.9
	Mains (3 lowest options)	Boiled egg and coleslaw salad with a bread roll and spread	318	12
		Roast chicken in gravy with roast potatoes, carrots, sprouts and a pork chipolata sausage	328	30
		Cheese Sandwich	328	16
		Average	325	19.3
	Gravy	Gravy and condiments	30	0.3
	Desserts (3 lowest options)	Fruit salad	56	0
		Raspberry jelly	70	1.4
		Vanilla ice cream	130	2.7
		Average	85	2.3
		Average variable total for single meal service	608	27.5	31%
		Variable total (x2 meal services)	1216	55	62%
		Total average minimum choice (Fixed total + variable total)	1950	81	100%

Table 11.9: Worked example from a la carte menu B (maximum capacity analysis)

Maximum capacity analysis for menu B			Total energy (Kcal)	Total protein (g)	% of Daily nutrition
Fixed		Nutritionally vulnerable breakfast	545	18
		Snacks	300	7
		Drinks	264	13
		Fixed total	1109	38	31%
Variable	Lunch and dinner
	Starters (3 highest options)	Tomato, red pepper and lentil soup + white bread roll + butter	296	8.9
		Chunky vegetable soup + white bread roll + butter	285	7.4
		Fruit juice	38	0.5
		Average	206	2.9
	Mains (3 highest options)	Pork meatballs and spaghetti	533	21
		Cheese and tomato omelette with fried potatoes and mixed vegetables	514	23
		Macaroni cheese	513	22
		Average	520	22
	Gravy	Gravy and condiments	30	0.3
	Desserts (3 highest options)	Gluten free lemon sponge + custard	534	5.8
		Sticky toffee pudding + custard	513	5.8
		Chocolate chip sponge + custard	431	5.8
		Average	493	5.8
		Average variable total for single meal service	1249	31	35%
		Variable total (x2 meal services)	2498	62	69%
		Total average maximum choice (Fixed total + variable total)	3607	100	100%

Table 11.10: Worked example from a la carte menu B (comparison of nutrition targets to menu capacity analysis)

	Energy (kcal)	Protein (g)
Nutritionally well
Nutrition targets	1840	56
Total average minimum choice from Menu B	1950	81
Percentage of target met	106%	145%
Nutritionally vulnerable
Nutrition targets	2772	79-92
Total average maximum choice from Menu B	3607	100
Percentage of target met	130%	107%

Utilising nutritional analysis software

A way to show that a whole menu has capacity to meet the needs of patients, rather than parts of a menu (as shown in the above methodology), is to utilise nutrition analysis software where uptake figures are entered for each menu item (either known or average).

This method shows the capacity of the menu when related to actual (or estimated) patient uptakes. Uptake figures can be entered in percentages, assuming 100% is the whole patient population (e.g. of the main meal options, 65% of patients chose Shepherd’s Pie, 25% had Chicken Pasta and 10% opted for Vegetarian Sausages).

An advantage of this method of analysing capacity is that it includes the actual choices that patients make. The main disadvantage of this methodology is that, if it is based on actual choices, patients may not choose the combination of meals or meal components that reflect how their nutrition targets can be met.

However, users can set uptake figures to show higher energy or healthier choices to show compliance where necessary – like in the methodology outlined in this chapter where specific choices were made to show compliance for those nutritionally well and nutritionally vulnerable.

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References

Nutridex. Nutridex. https://www.nutridex.org.uk [Accessed 22nd March 2023]
Public Health England. Composition of foods integrated dataset (CoFID). https://www.gov.uk/government/publications/composition-of-food-integrated-dataset-cofid [Accessed 22nd March 2023]
Apetito Ltd. Nutridata [Mobile App] 2023 https://apps.apple.com/gb/app/apetito-nutridata/id1088291791 [Accessed 22nd March 2023]