Nutrition Service Providers Guide

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Nutrition Service Providers Guide

• Barbara Kamp, MS, RD
• National Resource Center onNutrition, Physical
  Activity Aging
• 4th State Units on Aging Nutritionists
  Administrators Conference August 2006

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The Challenge
From the Science to Policy to the
Public
to Me
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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

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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

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Nutrition Service Providers Guide

• Part I
• Purpose
• History Process
• Importance
• Implementation

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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

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Nutrition Service Providers Guide

• Implementation
• General DGAs
• Program Planning Considerations for OAA
  Nutrition Programs
• Tips for Meal Planning
• Resources

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Key RecommendationAdequate 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

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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

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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

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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

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Key RecommendationAdequate 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

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Program Planning Considerations

• Use DASH Plan or USDA 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

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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

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Resources

• USDA MyPyramid.gov
• What counts as.
• Dietary Guidelines for Americans, 2005
• Appendices A and B
• www.health.gov/dietaryguidelines/

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Key RecommendationAdequate Nutrients Within
Calorie Needs

• People over age 50Consume vitamin B-12 in its
  crystalline form (fortified foods or supplements)

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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

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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

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Resources

• National Institute of Health
  Office of Dietary Supplements http//ods.od.nih.go
  v/factsheets/vitaminb12.asph2

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Key RecommendationAdequate Nutrients Within
Calorie Needs

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

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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

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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

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Resources

• National Institute of Health
  Office of Dietary Supplements http//ods.od.nih.go
  v/factsheets/vitamind.asph2

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Key RecommendationSodium Potassium

• Choose and prepare foods with little salt. At the
  same time, consume potassium-rich foods, such as
  fruits and vegetables
• 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

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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

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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

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Resources

• DASH Eating Plan
• www.nhlbi.nih.gov/health/public/heart/
• hbp/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

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Part II
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Nutrition Service Providers Guide

• Part II - Application
• Menu Development
• DASH Meal Plan
• USDA Food Guide Meal Plan
• Sample Menus at 550-700 Calories
• DRIs
• Recipes Menu Analysis

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Meal Planning Guides

• Meal patterns planning not compliance
• Two recommended, SUA choice
• DASH Eating Plan calorie range 1,600 to 3,100
  calorie levels
• USDA Food Guide Meal Plan calorie range 1,000 to
  3,200 calorie levels

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DASH Meal Pattern
Dietary Approaches to Stop Hypertension

• Promotes
• Grains
• Vegetables
• Fruits
• Nuts seeds
• Legumes
• Non Low-fat dairy foods

• Limits
• Meat
• Fish
• Poultry
• Fats
• Sweets
• Sodium

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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

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Menus

• Center designed Menus
• Nutrient analysis using Food Processor by ESHA
• All foods ingredients selected are USDA
  standard

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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_solution
  s/meal_patterns.asp

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Targets

• Vitamins
• A, B6, B12, C, D, E
• Minerals
• Calcium, potassium, sodium
• Fiber
• Saturated Fat Cholesterol

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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

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Menu Development Nutrition

• Caloric range
• Limit fat, cholesterol, sodium
• Adequate protein carbohydrate
• Increased fiber
• Adequate vitamins minerals

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Chicken MenuEmphasis Sodium, calcium, calories,
beans

• Stewed 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)

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Chicken Menu
Standard Meal Content
Calories 550-700 kcal 584 kcal
fat 30-35 22
Fiber 7 8 g 10 g
Calcium 400 mg 507 mg
Potassium 1566 mg 916 mg
Sodium 500 mg 254 mg
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Meatloaf SandwichSpecial emphasis whole grains,
fruit, vitamin E, calcium

• Open-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)

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Meatloaf Meal
Standard Meal Content
Calories 550-700 kcal 834 kcal
Fat 30-35 18
Fiber 7 8 g 9 g
Calcium 400 mg 1129 mg
Potassium 1566 mg 1666 mg
Sodium 500 mg 627 mg
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Turkey 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)

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Turkey Menu
Standard Meal Content
Calories 550-700 kcal 724 kcal
Fat 30-35 25
Fiber 7 8 g 13 g
Calcium 400 mg 630 mg
Potassium 1566 mg 1763 mg
Sodium 500 mg 423 mg
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Nutrition Service Providers Guide

• Print copy late September 2006
• Online version
• www.nutritionandaging.fiu.edu
• www.aoa.gov
• www.healthierus.gov/dietaryguidelines
• Other resourcesToolkit, Chapter 4