DIETARY REFERENCE INTAKES

1
DIETARY REFERENCE INTAKES DIETARY GUIDELINES
Nutrition Standards for Todays Older Americans

• NANCY WELLMAN National Policy Resource Center
  on Nutrition Aging
• JEAN LLOYD
• Administration on Aging

6/3/02
2
Overview

• Background DRIs - EAR, RDA, AI, UL
• Nancy Wellman
• Older Americans Act Review
• Jean Lloyd
• Issue Panel Recommendations
• Nancy Wellman
• Implications Program Implementation
• Jean Lloyd

3
What are the Dietary Reference Intakes (DRIs)?

• Reference values of nutrients, primarily used by
  nutrition health professionals
• Basis for
• assessing planning diets of healthy people
• federal nutrition food programs

4
What are the purposes of the DRIs?

• To maintain nutritional adequacy
• To promote health
• To reduce risk of chronic disease
• To provide a measure for evaluating inadequacy
  and/or excess
• To assess intakes as distributions
• Across population groups
• In individuals
• To plan diets

5
What are characteristics of the DRIs?

• Separate values
• men
• women
• New values
• 51 - 70 yrs
• 70 yrs

6
What are characteristics of the DRIs?

• Apply to healthy individuals
• Refer to average daily nutrient intakes
• May vary substantially from day to day without
  ill effect in most cases

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Who established the DRIs?

• Food and Nutrition Board, Institute of Medicine,
  National Academy of Sciences
• Panels of experts chosen by the National
  Academy independently selected
• Funded by DHHS, USDA, Health Canada, private
  industry
• Serially published 1997 continuing
• www.iom.edu

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What are the different DRI values?

• Estimated Average Requirement EAR
• Recommended Dietary Allowance RDA
• Adequate Intake AI
• Tolerable Upper Intake Level UL

9
What is a nutrient requirement?

• A requirement is the lowest continuing intake
  that will maintain a defined level of nutriture.
• In the EAR.

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What is the EAR?Estimated Average Requirement

• Nutrient intake to meet the requirement of half
  the healthy people of an age gender
• The MEDIAN (Think bell curve)
• Basis for establishing an RDA

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What is the RDA?Recommended Dietary Allowance

• Nutrient intake to meet the requirement for
  nearly all (97-98) healthy people of an age
  gender
• Derived from an EAR
• EAR 2 standard deviations

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What is the AI?Adequate Intake

• Nutrient intake of healthy people assumed to be
  adequate
• Used when an RDA cannot be established
• Insufficient data to determine an EAR
• Based on observed intakes, experimental data, etc.

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What is the UL?Tolerable Upper Intake Level

• Highest daily nutrient intake likely to pose no
  risk of adverse health effects to almost all the
  general population
• Applies to daily use
• Not a recommended level
• No established benefits of higher level
• Increased risks at higher intakes

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Tolerable Upper Intake Level

• ULs vary among nutrients
• some apply to intake from all sources -- food,
  fortified food, supplements, water (eg, calcium,
  vitamin D)
• some apply to intake from synthetic forms alone
  (eg, folic acid, niacin, magnesium)
• not all nutrients have ULs established presently
  (eg, vitamin B12)

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Figure 1-1
Pg 24
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Use of DRIs Assessing Intakes

• For an Individual
• EAR Use to examine the probability that usual
  intake is inadequate
• RDA Usual intake at/above this level has low
  probability of inadequacy
• AI Usual intake at/above this level has low
  probability of inadequacy
• UL Usual intake above this level may place
  individual at risk of adverse effects from
  excessive nutrient intake

• For a Group
• EAR Use to examine the prevalence of inadequate
  intakes within a group
• RDA Do not use to assess intakes of groups
• AI Mean usual intake at/above this level implies
  a low prevalence of inadequate intakes
• UL Use to estimate population at potential
  risk of adverse effects from excessive nutrient
  intake

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RDA is inappropriate for assessing groups

• RDA intake levels that exceed requirements of
  9798 of all individuals when requirements in
  the group have a normal distribution
• Thus, RDA not a cut-point for assessing nutrient
  intakes of groups-- serious overestimation of the
  proportion of the group at risk of inadequacy
  would result

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Group Prevalence of Inadequate Intakes

• What proportion of individuals in a group have
  usual intake below requirements?
• The below the EAR

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Using the EAR to assess groups

• Obtain data on usual nutrient intake from all
  sources (food supplements).
• Adjust the intake distribution for
  intra-individual variability.
• Determine the proportion with intakes below the
  EAR - this is the proportion of the population
  with inadequate intakes.
• To date, no published studies using this method.
• Software available to encourage this approach
  (see next slide).

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Impact of Additional Days of Observation in
Variance in Intake
Usual intakes observed over several days
Percent of Individuals
EAR
1-day observations
Intake of nutrient (amount/day)
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Planning for groups or individuals

• Dietary Reference Intakes for Planning
  anticipated publication in July 2002.
• RDAs can be used in planning for groups or
  individuals but not in assessing adequacy of
  intake.

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Why use the DRIs?

• Increase accuracy of dietary assessments, taking
  care that
• dietary data are complete,
• portions are correctly specified,
• food composition data are accurate,
• methodologies plans for sampling group intakes
  are appropriate.

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What are the Dietary Guidelines for Americans,
2000?

• Brief science-based statements text published
  by federal government
• Provide advice for healthy Americans, age 2 yrs,
  about food choices physical activity to promote
  health prevent disease.

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The Dietary Guidelines

• Mandated by law
• Published every 5 years
• Based on preponderance of scientific evidence
• Cornerstone of federal nutrition policy
• Basis for healthy nutrition choices
• Basis for nutrition education promotion
  activities

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How are the Dietary Guidelines revised?

• Advisory Committee appointed to review Guidelines
  open process
• Committee report presented to DHHS USDA
• DHHS USDA review report public comments
• Secretaries of DHHS USDA publish revised
  Dietary Guidelines.

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Aim for Fitness

• Aim for a healthy weight
• Be physically active each day

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Build a Healthy Base

• Let the Pyramid guide your food choices
• Choose a variety of grains daily, especially
  whole grains
• Choose a variety of fruits vegetables daily
• Keep food safe to eat

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Choose Sensibly

• Choose a diet that is low in saturated fat
  cholesterol, moderate in total fat
• Choose beverages foods to moderate your intake
  of sugars
• Choose prepare foods w/ less salt
• If you drink alcoholic beverages, do so in
  moderation

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The Food Guide Pyramid
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(No Transcript)
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Older Americans Act Review
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OAA Requirements

• SEC. 339 (2)(A)(i) State shall ensure that
  project provides meals that comply with the
  Dietary Guidelines for Americans.
• SEC. 339 (2)(A)(ii) State shall ensure that
  project provides to each participating older
  individual meals that provide a minimum of 33
  1/3 of the daily RDA if one meal per day 66
  2/3 RDA if 2 meals per day, 100 RDA for 3
  meals per day.

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What does this mean?

• Does the OAA (or AoA) require that an SUA
  implement the nutrition quality requirements of
  the OAA in a specific way?
• No, the OAA is flexible about how an SUA is to
  implement the OAA it is a State responsibility
  to ensure that the requirements of the OAA are
  met.
• Does the OAA (or AoA) require an SUA to use a
  menu pattern?
• No, the OAA does not require an SUA to use a
  specific menu pattern it is a State
  responsibility to determine HOW to implement the
  OAA nutrient requirements.

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What does this mean?

• Does the OAA (or AoA) require an SUA to monitor
  specific lead nutrients (calories, protein,
  calcium, iron, vitamin A, thiamine, riboflavin,
  niacin, vitamin C)?
• No, SUA are responsible for determining which
  nutrients to monitor to ensure that projects are
  meeting the OAA requirements.
• Many SUAs have not changed the nutrients that
  they monitor since the mid-70s.

36
What does this mean?

• Does the OAA (or AoA) require that each meal
  contain 30 fat or less?
• No, the OAA does not require that each meal
  contain 30 fat or less it is an SUAs
  responsibility to determine HOW to meet the
  requirements of the OAA, including the Dietary
  Guideline regarding the fat intake of older
  Americans.

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What does this mean?

• Does the OAA (or AoA) require that each meal
  contain no more than 800 mg sodium?
• No, the OAA does not require that each meal
  contain no more than 800 mg sodium it is an
  SUAs responsibility to determine HOW to meet the
  requirements of the OAA, including the Dietary
  Guideline regarding the sodium intake for older
  Americans.

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How Do States Implement the OAA Requirements?

• 1998 SUA Policies Procedures Collection
• 40 (91) had guidelines that meals comply with
  33 RDA
• 35 (79) had guidelines for compliance with
  Dietary Guidelines
• 34 (77) had guidelines for meal patterns
• Some standard meal patterns require foods high
  in vitamin C daily vitamin A 3 times/week.

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OAA Requirements

• SEC. 339(2)(A)(iii) ensure that the
  projectprovide(s) meals that to the maximum
  extent practical, are adjusted to meet any
  special dietary needs of program participants

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What are special dietary needs?

• Special dietary needs include meals that meet
• Cultural or ethnic preferences, ie, culturally
  appropriate
• Religious requirements, ie, Kosher, Hallal
• Therapeutic or meals that are modified for
  health conditions, ie, 2 gm sodium, diabetic,
  renal, texture-modified, etc.
• Other interpretations include meals that provide
  client choice or selection of different meal
  components, ie, 2 different entrees or 3
  different vegetables, choice of milk, etc.

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What Does This Mean?

• Does the OAA (or AoA) require that a local
  nutrition project provide special diets?
• No, the OAA requires that special diets be
  provided to the maximum extent practical.
• The definition of maximum extent practical has
  included such items as characteristics ofthe
  older adults to be served in the community,
  number of people with a specific need, capacity
  and capability of the provider, availability of
  different caterers/vendors, requirements of
  different funding sources, provider expertise,
  etc.

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How Do States Implement This Requirement?

• 1998 SUA Policies Procedures Collection
• 37 (84) had guidelines for special diets for
  health, religious or ethnic reasons
• 21 (48) had guidelines for sodium fat content
  of meals.

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OAA Requirements

• SEC. 339(2)(B) provides flexibility to local
  nutrition providers in designing meals that are
  appealing to program participants

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What Does This Mean?

• How does an SUA or local nutrition provider
  ensure that meals are appealing to program
  participants?
• States and AAAs allow local nutrition projects
  flexibility in writing the menus to meet local
  preferences while ensuring the menus meet
  nutrient requirements.
• States and AAAs require a customer assessment of
  meal quality, service, etc. on a regular
  schedule.
• States and AAAs may include a nutrition advisory
  council at state, AAA or local levels.

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How Do States Implement This Requirement?

• This is a new requirement in the 2000 amendments
  to the OAA and no data has been collected on how
  States are implementing it.

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Does the OAA Allow or Not Allow Specific Foods?

• FREQUENTLY ASKED QUESTIONS
• Can we serve pizza?
• Do we have to serve skim milk?
• Why cant we serve dessert?
• The OAA does not address any specific foods.
• States, AAAs, and local nutrition projects need
  to establish a common understanding of state and
  AAA requirements.
• Providing alternative selections, such as skim
  milk or 2 milk or fruit or cake are common ways
  to meet differing participant needs.

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OAA Requirements

• SEC. 339 (1) State shall solicit the advice of
  a dietitian or individual with comparable
  expertise in the planning of nutrition services.
• SEC. 339 (2)(G) State ensure that the project
  ensures that meal providers carry out such
  project with the advice of dietitians

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What Does This Mean?

• Does the OAA require that an SUA or a local
  nutrition service provider hire an RD or ICE?
• No, the OAA does not require an SUA to hire an RD
  or ICE.
• However, the OAA does require an SUA to solicit
  the advice of a RD or ICE.
• Nutrition services are more than menu review and
  includes other functions.

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How Do States Implement This Requirement?

• In 2002, 60 of SUAs have an RD on staff.
• In 1995, Serving Elders at Risk found
• 85 SUAs, 73 AAAs, 60 nutrition projects had
  access to staff with nutrition credentials
• 69 SUAs, 61 AAAs, 41 nutrition projects had
  access to an RD
• 40 SUAs, 36 AAAs, 41 nutrition projects had
  access to staff with other nutrition credentials

50
How Do States Implement This Requirement?

• 1998 SUA Policies Procedures Collection
• 35 (77) had guidelines for the use of an RD or
  ICE at any level.
• 20 (45) had guidelines for the services of an RD
  /or Licensed Dietitian or ICE at the AAA or
  local provider level.

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OAA Requirements

• SEC. 331 (3) State plans establishment
  operation of nutrition projects which may include
  nutrition education services other appropriate
  nutrition services for older individuals.
• SEC. 339 (2) (J) State shall ensure that
  projects provide for nutrition screening , where
  appropriate, for nutrition education
  counseling.
•  1998 SUA Policies Procedures Collection
• 41 (93) had guidelines for nutrition education
• 19 (43) had guidelines for health promotion
  disease prevention activities

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Summary ISSUE PANEL February 11, 2002
53
Dietary Reference Intakes Dietary Guidelines in
Older Americans Act Nutrition Programs

•  Summary ISSUE PANEL
• February 11, 2002

National Policy Resource Center on Nutrition
Aging Florida International University, Miami,
FL Conducted by Cogent Research
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Cogent Research
http//www.cogentresearch.com

• Full-service marketing research strategic
  facilitation firm, offering an array of
  qualitative quantitative research tools.
• Expertise in food nutrition issues working
  with associations serving food industry, food
  companies, supermarkets, pharmaceutical
  companies, food-related product manufacturers.
• In-house team of session facilitators -- experts
  in session design, moderating, strategic plan
  development, session analysis. In food health,
  facilitated sessions on obesity, scientific
  reporting, caffeine, allergies, clinical trials,
  etc.

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Panelists University

• YVONNE BRONNER, ScD, RD, Director, Public Health
  Program, Morgan State University, Baltimore, MD
• NOEL CHAVEZ, PhD, RD, Associate Professor, School
  of Public Health, University of Illinois, Chicago
• EDWARD FRONGILLO, JR., PhD, Associate Professor,
  Cornell University, Ithaca, NY
• GORDON JENSEN, MD, PhD, Director, Vanderbilt
  Center for Human Nutrition, Nashville, TN
• MARY ANN JOHNSON, PhD, Professor, University of
  Georgia, Athens
• ROBERT RUSSELL, MD, Director Senior Scientist,
  Jean Mayer USDA Human Nutrition Research Center
  on Aging, Tufts University, Boston, MA
• JOE SHARKEY, MPH, RD, Nutritionist Doctoral
  Candidate, University of North Carolina, Chapel
  Hill, NC

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Panelists Government

• JOSEPH CARLIN, MS, RD, FADA, Regional AoA
  Nutritionist, Boston, MA
• JOHANNA DWYER, DSc, RD, Assistant Administrator,
  Human Nutrition, USDA, Agricultural Research
  Service, Washington, DC
• NANCY GASTON, MA, RD, Senior Nutritionist, USDA,
  Center for Nutrition Policy Promotion,
  Alexandria, VA
• YVONNE JACKSON, PhD, RD, Director, Office of
  American Indian, Alaskan Native and Native
  Hawaiian Programs, AoA, Washington, DC
• FLORISTENE JOHNSON, MS, RD, Senior Aging
  Prg.Specialist, AoA, Dallas,TX
• JEAN LLOYD, MS, RD, Nutritionist, AoA,
  Washington, DC
• BRIAN LUTZ, Acting Director, Office for
  Community-Based Services, AoA, Washington, DC
• KATHRYN MCMURRY, MS, Nutrition Food Science
  Advisor, ODPHP, USDHHS, Washington, DC
• LINDA MEYERS, PhD, Deputy Director, Food
  Nutrition Board, IOM, Washington, DC
• DEBRA NICHOLS, MD, MPH, PH Advisor, ODPHP,
  USDHHS, Washington, DC
• JO ANN PEGUES, MPA, RD, Regional AoA
  Nutritionist, Denver, CO

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Panelists Aging Network Industry

• DOUGLAS BUCK, PhD, FACN, State Nutritionist, CT
  Dept. Social Elderly Services, Hartford
• JENNIFER DRZIK, MS, RS, LD, State Nutritionist,
  MD Dept. of Aging, Baltimore
• JULIE HODGES, PhD, RD, FADA, Director, Health
  Care Services, Zartic Foods, Rome, GA
• BERTHA HURD, BS, Nutritionist, Dept. of Aging,
  City of Los Angeles, CA
• LINDA LAVINE, RD, LD/N, Corporate Dietitian, GA
  Food Service, Inc., St. Petersburg, FL
• LINDA NETTERVILLE, MA, RD, Nutrition Prog. Mgr,
  Johnson County AAA, Olathe, KS
• MARTHA PEPPONES, MS, RD, Nutr Dir, Senior
  Services Snohomish County, Mukilteo, WA
• SUE ZEVAN, RD, State Nutritionist, Aging Adult
  Administration, Dept. Economic Security, Phoenix,
  AZ

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Panelists National Policy Resource Center
on Nutrition Aging

• Heidi Silver, PhD, RD, CNSDAssociate Director
  Research FacultyIssue Panel Project Director
• Lester Rosenzweig, MS, RDAssociate Director
• Peggy Schafer, RD, Graduate Assistant
• Dian Weddle, PhD, RD, FADA Associate Professor
  Co-Director
• Nancy Wellman, PhD, RD, FADA Professor Director

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Discussion Topics

1. Why must Older Americans Act Nutrition Program
   meals meet the most current Recommended Dietary
   Allowances Adequate Intakes (as components of
   the Dietary Reference Intakes), the 2000
   Dietary Guidelines for Americans?
2. Must each Older Americans Act Nutrition Program
   meal individually meet these requirements?
3. Assuming that all Older Americans Act Nutrition
   Program meals are culturally appropriate, what
   nutrients should be targeted?

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Discussion Topics

1. How can Older Americans Act Nutrition Program
   meals be evaluated for meeting the Recommended
   Dietary Allowances, Adequate Intakes, 2000
   Dietary Guidelines?
2. How can Older Americans Act Nutrition Program
   meals be adjusted to meet special dietary needs?
3. How can nutrition services, including nutrition
   screening, education, counseling, incorporate
   the Dietary Reference Intakes, 2000 Dietary
   Guidelines, targeted nutrients recommendations?
4. What nutrition-related issues need attention at
   future Issue Panels /or in outcomes research?

61
1 Why must Nutrition Program meals meet most
current RDA AIs, and the 2000 Dietary
Guidelines?

• BACKGROUND
• National Nutrition Monitoring Related
  Research Act of 1990
• Any new standards supercede previous ones
• All federal programs must promote these
  requirements.

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1 Why must Nutrition Program meals meet most
current RDA AIs, and the 2000 Dietary
Guidelines?

• RECOMMENDATION
• OAA Nutrition Program meals should meet the
  current RDAs and AIs and the 2000 Dietary
  Guidelines.
• RATIONALE
• Reflect most recent scientific evidence
• Best-known guidance to meet nutritional needs
  of most older adults

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2 Must each Nutrition Program meal individually
meet these requirements?

• RECOMMENDATION
• Each meal should be reasonably nutritionally
  well- balanced reflect 2000 DGs.
• Meals provide a positive nutrition education
  model for participants.
• Nutrition Programs that serve 1 meal/day should
  ensure each meal offers at least 33 1/3
  RDAs/AIs.
• Programs that serve 2 meals/day should ensure
  the sum of meals offer at least 66 2/3 RDAs/AIs,
  but each meal itself does not have to equal 33
  1/3.
• Programs serving 3 meals/day should ensure the
  sum of meals offers 100 RDAs/AIs.

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3 Assuming all meals are culturally
appropriate, what nutrients should be targeted?

• RECOMMENDATION
• Nutrition Programs should emphasize foods high
  in fiber, calcium, protein.
• Programs should continue to target vitamins A
  C with Vit A from vegetable-derived (carotenoid)
  sources.
• Targeting specific nutrients does not give
  permission to ignore other nutrients.
• Future Issue Panel should address more specific
  recommendations regarding targeting nutrients.

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4 How can meals be evaluated for meeting RDAs,
AIs, 2000 DGs?

• RECOMMENDATION
• Nutrition Programs should plan evaluate meals
  for meeting the 2000 DGs 1/3 RDA/AI standards
  by computer-assisted analysis.
• RDs (or ICE) should be available at state, area,
  local provider levels to assure nutrient
  adequacy of meals.
• If meal patterns are used, they should be
• based on food servings delineated in Food Guide
  Pyramid
• combined to meet 1/3 RDAs/AIs 2000 DGs
• (computer) tested for meeting requirements
• including more servings of fruits, vegetables,
  whole grains.

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Use of Meal Patterns

• OAA does not specify using a meal pattern.
• Only a 1st step in menu planning
• Does not guarantee that meals will meet OAA
  standards thus does not assure adequate intake
• Needs evaluation using computer analysis before
  being used to assure that it meets requirements
• Do state agencies use or require AAAs to use meal
  patterns?
• 1998 SUA Policies Procedures Collection
• 34 (77) had guidelines for meal patterns.

67
1972 Meal Pattern

• 1 bread / alternatives
• 2 vegetables / fruits
• 1 milk / alternate
• 1 meat / alternate
• 1 fat
• Dessert, optional
• Beverages, optional

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Sample Meal Pattern to meet 1/3 RDA / AI

• 3 breads / alternative
• 2 vegetables
• 1 fruit
• 1 milk / alternate
• 1 meat / alternate
• 1 fat
• Dessert, optional
• Beverages, optional

69
Use of Standardized Recipes

• OAA does not specify use of standardized recipes.
  
• standardized recipes ensure consistency in
  preparation of food items nutrient content.
• Do state agencies use or require AAAs to use
  standardized recipes?
• 1998 SUA Policies Procedures Collection
• 16 (36) had guidelines for use of standardized
  recipes.

70
Use of Menu Analysis

• OAA does not specify use of menu analysis to
  ensure compliance with nutrient requirements.
• Menu analysis ensures menus meet requirements.
• Do state agencies use or require AAAs to use menu
  analysis with specific software data sources?
• 1998 SUA Policies Procedures Collection
• 23 (52) had guidelines for use of menu analysis.

71
Use of Menu Analysis

• OAA does not specify different requirements when
  providing gt1 meal a day.
• Menu analysis is method to ensure that 2 or 3
  meals combined provide 67 or 100 RDA / AI,
  respectively.
• Some states have different meal patterns for
  different meals of the day each meal provides
  all items on meal pattern.

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5 How can Nutrition Program meals be adjusted
to meet special dietary needs?

• RECOMMENDATION
• Assuming culturally appropriate meals, Nutrition
  Programs should accommodate specific dietary
  needs to the extent possible.
• RDs (or ICE) should be available to customize
  for individuals/groups, provide therapeutic
  diets.
• Could also conduct needs assessmentsof
  populations their programs serve.

73
6 How can nutrition services, including
nutrition screening, education, counseling
incorporate DRIs, 2000 DGs, targeted nutrients
recommendations?

• RECOMMENDATION
• Nutrition Programs should emphasize nutrition
  screening, education, counseling.
• New or existing nutrition screening, education,
  counseling tools services should reflect the
  standards established by the DRIs 2000 DGs.

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Nutrition Education

• Defined as any set of learning experiences
  designed to facilitate voluntary adoption of
  eating other nutrition-related behaviors
  conducive to health well-being

Contento I, Balch GI, Bronner YL, Lytle LA,
Maloney SK, Olson CM, Swadener SS. The
effectiveness of nutrition education and
implications for nutrition education policy,
programs, and research a review of research. J
Nutr Educ. 199527(6)277-422.
75
Nutrition Counseling

• An individualized process that can help manage
  personal nutrition care effectively.
• It is an essential service, particularly for
  those at risk.
• May be used to obtain more information, to review
  strengthen acquired knowledge or desirable
  habits, or to help set personal goals make
  individualized decisions.

Position of the American Dietetic Association.
Child and adolescent food and nutrition programs.
J Am Diet Assoc. 199696913-917.
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7 What nutrition-related issues need attention
at future Issue Panels /or in outcomes research?

• Nutrients to be targeted in Older Americans Act
  Nutrition Programs
• Outcomes-based research demonstration projects
• Creating a balance between national uniformity
  local autonomy
• Resource development

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7 What nutrition-related issues need attention
at future Issue Panels /or in outcomes research?

• Implementing the forthcoming Dietary Reference
  Intakes Applications in Dietary Planning report
  of the NAS
• Health disparities and minority issues
• Weight management, including underweight,
  overweight, and obesity
• Food service, including technology, food
  preparation and delivery, and food costs
• Food safety issues
• Title VI programs and services
• Food security and hunger

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7 What nutrition-related issues need attention
at future Issue Panels /or in outcomes research?

• Nutrition and physical activity, in relation to
  functionality
• Nutrition care planning including screening and
  assessment, therapeutic interventions and
  supplement use
• Effective nutrition education programs
• Programmatic issues unmet needs, waiting lists,
  screening criteria, customer assessment,
  resources and Registered Dietitian (or ICE)
  involvement and
• Assessments of what Nutrition Program
  participants actual eat vs. what is served.

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Implications Implementations
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How will DRIs/RDAs DGs affect OAA Nutrition
Programs?

• Provide a basis for
• nutrition services, which is more than meal
  provision
• standards for meal provision
• nutrition screening
• service interventions

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How will DRIs (RDAs/AIs) DGs affect the OAA
Nutrition Programs?

• Provide the basis for
• nutrition education
• nutrition counseling
• lifestyle modification
• health and functionality risk reduction
• outcome measurement.

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Next steps for the Aging Network

• SUAs, AAAs, local nutrition service providers
  should begin to revise
• Policies, procedures, guidelines
• Program guidance
• Quality assurance standards
• Monitoring, assessment, evaluation tools.

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Next steps for the Aging Network

• SUAs, AAAs, local nutrition service providers
  should begin to revise
• Outcome measurement tools
• Program planning
• Program operations such as menu planning, menu
  costing, nutrition screening, nutrition
  education, nutrition counseling.

84
Next steps for the Aging Network

• SUAs, AAAs, local nutrition service providers
  should begin to revise
• Consumer education materials
• Health promotion/disease prevention programs
  materials
• Provision of meals to meet special dietary needs.

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Next steps for the Aging Network

• SUAs, AAAs, local nutrition service providers
  should begin to revise
• Food service catering / vending contracts
• Training technical assistance.

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Why do we need to assure nutrient quality?

• To impact nutritional status
• To impact health
• To impact functionality
• To impact quality of life
• To assist older adults in making healthy choices
• To measure document outcomes