Nutrition Service Nutrition Service Providers GuideProviders Guide

Barbara Kamp, MS, RDBarbara Kamp, MS, RDNational Resource Center onNational Resource Center onNutrition, Physical Activity &Nutrition, Physical Activity &

AgingAging

4th State Units on Aging Nutritionists & Administrators Conference August 20064th State Units on Aging Nutritionists & Administrators Conference August 2006

The Challenge

From the Science … to Policy … to the Public …

… to “Me”

Nutrition Service Providers Guide

Provides assistance in applying the Dietary Guidelines for Americans to:• Programs • Group Menu Planning• Food Production • Food Service

Parallels messages from other materials

Nutrition Service Providers Guide

• AoA & National Resource Center on Nutrition, Physical Activity & Aging

• Input - n4a, NANASP

• Reviewed - SUA nutritionists

• Reviewed - HHS Office of Disease Prevention and Health Promotion

Nutrition Service Providers Guide

Part IPart I Purpose History & Process Importance Implementation

Importance

• Good nutrition is vital to health

• Older adults need nutritious, tasty, culturally appropriate, safe meals for successful aging

• DGAs help assure appropriate food choices to ensure DRIs are met

Nutrition Service Providers Guide

ImplementationImplementation General DGAs Program Planning

Considerations for OAA Nutrition Programs

Tips for Meal Planning Resources

Key Recommendation:Adequate Nutrients

Within Calorie Needs

Consume a variety of nutrient-dense foods and beverages within and

among the basic food groups while choosing foods that limit intake of

saturated and trans fat, cholesterol, added sugars, salt, & alcohol

Program Planning

Consideration

• Provide meals that include all food groups

• Provide meals & beverages high in nutrients but within calorie needs of program participants (nutrient dense)

• Provide opportunities for food choices based on individual needs & cultural food preferences

Tips for Meal Planning

• Seek menu ideas from program participants

• Choose foods with little or no added sugar, sodium or fat

• Control portion sizes to control calories and meal costs

• Limit use of processed food items

Resources

• Dietary Guidelines for Americans, 2005 Appendices A and B www.health.gov/dietaryguidelines/

• 5 A Day for Better Health Program, tips and recipes www.5aday.gov/recipes/tips.html

Key Recommendation:Adequate Nutrients

Within Calorie Needs

Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the DASH Diet

Plan or the USDA Food Guide

Program Planning

Considerations

• Use DASHDASH Plan or USDA Food GuideUSDA Food Guide Both plans take into consideration a range of calorie levels to meet the nutrient needs of men and women at various ages and activity levels

• Provide meals in a calorie range of 550 – 700 calories per meal; the daily recommended level is 1600 to 2000 calories depending on level of activity

Tips for Meal Planning

• Use lists of foods rich in selected nutrients (see DGAs appendices & tables)

• Use standardized recipes & portion sizes specified in recipes

• Identify high sodium foods; offer them infrequently; & offer lower sodium alternatives

• Identify & offer high potassium foods

Resources

• USDA – MyPyramid.gov What counts as….

• Dietary Guidelines for Americans, 2005 Appendices A and B www.health.gov/dietaryguidelines/

Key Recommendation:

Adequate Nutrients Within Calorie Needs

People over age 50People over age 50Consume vitamin B-12 in its

crystalline form (fortified foods or supplements)

Program Planning

Considerations

• Use fortified foods to meet the vitamin B-12 requirements since man people over age 50 have reduced ability to absorb naturally occurring vitamin B-12

Tips for Meal Planning

• Include fortified ready to eat whole grain cereals for breakfast meals

• Use fortified ready to eat whole grain cereals in casseroles, in meatloaves, or as breading for fish

• Use fortified ready to eat whole grain cereals in baked goods, i.e. crisp toppings, muffins, cookies

Resources

• National Institute of Health:

Office of Dietary

Supplements http://ods.od.nih.gov/factsheets/vitaminb12.asp#h2

Key Recommendation:Adequate Nutrients

Within Calorie Needs

Older adultsOlder adultsConsume extra vitamin D from vitamin D-fortified food and/or

supplements

Program Planning

Considerations

• Select foods rich in vitamin D, a nutrient important for optimal calcium absorption and muscle functioning

• Include vitamin D fortified low-fat or fat-free milk, soy beverage, or orange juice with each meal

Tips for Meal Planning

• Provide low-fat, vitamin D-fortified soy beverage or lactose-free milk as an alternate for those who are lactose intolerant

• Include vitamin D fortified, ready to eat whole grain cereal in food products such as muffins, crisps, or cookies

Resources

• National Institute of Health:

Office of Dietary Supplements http://ods.od.nih.gov/factsheets/vitamind.asp#h2

Key Recommendation:

Sodium & Potassium

Choose and prepare foods with little salt. At the same time, consume potassium-

rich foods, such as fruits and vegetables

Older adults.Older adults. Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation

(4,700 mg/day) with food

Program Planning

Considerations

• ~10% sodium naturally in foods

• ~75 - 77% added during processing

• Use “no added salt” or “low-sodium”

• Prepare foods without adding salt

• Serve potassium rich fruits & vegetables frequently

Tips for Meal Planning

• Prepare baked or boiled potatoes instead of boxed mashed potatoes

• Select fresh or frozen vegetables or low sodium canned vegetables

• Use fresh or frozen lean meats instead of cured cuts of meat

• Avoid processed meats or pre-prepared items

Resources

• DASH Eating Plan• www.nhlbi.nih.gov/health/public/heart/www.nhlbi.nih.gov/health/public/heart/• hbp/prevent/sodium/sodium.htmhbp/prevent/sodium/sodium.htm

• Dietary Guidelines for Americans, 2005 Appendix B-1 Food Sources of Potassium Table 15: Range of Sodium Content for

Selected Foods

Part IIPart II

Nutrition Service Providers Guide

Part II - ApplicationPart II - Application Menu Development•DASH Meal Plan

•USDA Food Guide Meal Plan

• Sample Menus at 550-700 Calories

•DRIs

•Recipes & Menu Analysis

Meal Planning Guides

• Meal patterns – planning not compliance

• Two recommended, SUA choice DASH Eating PlanDASH Eating Plan calorie range:

1,600 to 3,100 calorie levels USDA Food Guide Meal PlanUSDA Food Guide Meal Plan calorie

range: 1,000 to 3,200 calorie levels

DASH Meal Pattern

PromotesPromotes Grains Vegetables Fruits Nuts & seeds Legumes Non & Low-fat

dairy foods

LimitsLimits Meat Fish Poultry Fats Sweets Sodium

DDietary AApproaches to SStop HHypertension

USDA Food Guide Meal Plan

• Grains Whole grain,

Other grains

• Vegetables Dark green,

Orange, Legumes, Starchy, Other

• Fruits

• Milk

• Lean meat & beans

• Oils

• Discretionary calorie allowance

Menus

• Center designed Menus

• Nutrient analysis using Food Processor by ESHA

• All foods & ingredients selected are USDA standard

Computer Assisted Analysis vs Meal

Pattern

• Creative SolutionsMeal Patterns: Only a First Step in Menu Planning

• Designed 2 menus Met meal pattern & met RDA / AI Met meal pattern & DID NOT met RDA / AI

• http://nutritionandaging.fiu.edu/creative_solutions/meal_patterns.asp

Targets

• Vitamins A, B6, B12, C, D, E

• Minerals Calcium, potassium, sodium

• Fiber

• Saturated Fat & Cholesterol

Menu Development:

Appeal

• Variety of Foods

• Different forms, shapes, textures, colors

• Different Temperatures

• Vary flavors w/in meal & day to day

• Seasonal, traditional, ethnic foods

Menu Development:

Nutrition

• Caloric range

• Limit fat, cholesterol, sodium

• Adequate protein & carbohydrate

• Increased fiber

• Adequate vitamins & minerals

Chicken MenuChicken MenuEmphasis: Sodium, calcium, calories, beans

Stewed chicken with vegetablesStewed chicken with vegetables 2oz chicken + 1/2 vegetables + broth = 1cup

• Egg noodles (1 cup)• Five bean salad (1/2 cup)• Fresh fruit salad with citrus and yogurt dip• (1/2 cup, includes melons, orange, grapes + 2

TB yogurt dip)• Fat-free milk (1 cup)

Chicken Menu

StandardStandard Meal ContentMeal Content

CaloriesCalories 550-700 kcal 584 kcal

% fat% fat 30-35% 22 %

FiberFiber 7 – 8 g 10 g

CalciumCalcium 400 mg 507 mg

PotassiumPotassium 1566 mg 916 mg

SodiumSodium 500 mg 254 mg

Meatloaf SandwichMeatloaf SandwichSpecial emphasis: whole grains, fruit, vitamin E, calcium

Open-faced Meatloaf SandwichOpen-faced Meatloaf Sandwich 2 oz meatloaf w/ 1 sl. 7 grain bread

• Gravy (2 Tb)• Baked Winter Squash (1/2 cup)• Waldorf Salad on Greens (1/2 cup, apples,

walnuts, raisins on romaine)• Orange Rice Pudding (1/2 cup)• Fat-free Milk (1 cup)

Meatloaf Meal

StandardStandard Meal ContentMeal Content

CaloriesCalories 550-700 kcal 834 kcal

% Fat% Fat 30-35% 18%

FiberFiber 7 – 8 g 9 g

CalciumCalcium 400 mg 1129 mg

PotassiumPotassium 1566 mg 1666 mg

SodiumSodium 500 mg 627 mg

Turkey MenuTurkey MenuSpecial Emphasis: Fiber, potassium, sodium, vitamin E

• Roast turkey (2 oz)

• Baked sweet potato (1 small)

• Broccoli (1/2 cup)

• Whole wheat roll (1 2.5” roll)

• Apple raisin Crisp (1/2 cup, includes topping of whole wheat flour, fortified flake cereal; almonds & raisins)

• Fat-free milk (1 cup)

Turkey Menu

StandardStandard Meal ContentMeal Content

CaloriesCalories 550-700 kcal 724 kcal

% Fat% Fat 30-35% 25 %

FiberFiber 7 – 8 g 13 g

CalciumCalcium 400 mg 630 mg

PotassiumPotassium 1566 mg 1763 mg

SodiumSodium 500 mg 423 mg

Nutrition Service Providers Guide

• Print copy: late September 2006

• Online version:

• www.nutritionandaging.fiu.edu

• www.aoa.gov• www.healthierus.gov/dietaryguidelines

• Other resources:Toolkit, Chapter 4