Nutrition Service Providers Guide

1. 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

2. Remember we started talking about the challenge of moving from science�to policy�to public. Now let�s talk about how to apply the learning and materials from a general audience and bring it back to �older adults. We wanted to leverage the information from the consumer brochure but tailor it for this specific audience. By that I mean revisit the key messages so they were most appropriate to the needs/issues of older adults; and make sure it was delivered in a way that appeal and motivated them. Where do you start? More Research! Remember we started talking about the challenge of moving from science�to policy�to public. Now let�s talk about how to apply the learning and materials from a general audience and bring it back to �older adults. We wanted to leverage the information from the consumer brochure but tailor it for this specific audience. By that I mean revisit the key messages so they were most appropriate to the needs/issues of older adults; and make sure it was delivered in a way that appeal and motivated them. Where do you start? More Research!

3. 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 The Nutrition Service Providers Guide is designed to help apply the messages from the Guidelines to quantity food production. The Providers Guide includes tips for program planning, tips for meal production, an example of a 5 meals and a nutrient analysis of these 5 meals. Although designed to be used in Older Americans Act Nutrition Programs, the Providers Guide could be used in other quantity food production settings such as adult day care, nursing homes, etc. The Nutrition Service Providers Guide is designed to help apply the messages from the Guidelines to quantity food production. The Providers Guide includes tips for program planning, tips for meal production, an example of a 5 meals and a nutrient analysis of these 5 meals. Although designed to be used in Older Americans Act Nutrition Programs, the Providers Guide could be used in other quantity food production settings such as adult day care, nursing homes, etc.

4. 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

5. Nutrition Service Providers Guide Part I Purpose History & Process Importance Implementation

6. 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

7. Nutrition Service Providers Guide Implementation General DGAs Program Planning Considerations for OAA Nutrition Programs Tips for Meal Planning Resources

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. Key Recommendation:Adequate Nutrients Within Calorie Needs People over age 50Consume vitamin B-12 in its crystalline form (fortified foods or supplements)

17. 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

18. 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

19. Resources National Institute of Health: Office of Dietary Supplements http://ods.od.nih.gov/factsheets/vitaminb12.asp#h2

20. Key Recommendation:Adequate Nutrients Within Calorie Needs Older adultsConsume extra vitamin D from vitamin D-fortified food and/or supplements

21. 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

22. 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

23. Resources National Institute of Health: Office of Dietary Supplements http://ods.od.nih.gov/factsheets/vitamind.asp#h2

24. 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. Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg/day) with food

25. 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

26. 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

27. 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

28. Part II

29. 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

30. 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

31. DASH Meal Pattern Promotes Grains Vegetables Fruits Nuts & seeds Legumes Non & Low-fat dairy foods Limits Meat Fish Poultry Fats Sweets Sodium DASH stands for the Dietary Approaches to Stop Hypertension. This food plan promotes fruit, vegetable, and low fat dairy foods and limits meat, fish, and poultry. Other high fat and super sweet foods are limited along with sodium, which is especially important for those with high blood pressure. Proven to reduce hypertension DASH stands for the Dietary Approaches to Stop Hypertension. This food plan promotes fruit, vegetable, and low fat dairy foods and limits meat, fish, and poultry. Other high fat and super sweet foods are limited along with sodium, which is especially important for those with high blood pressure. Proven to reduce hypertension

32. 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

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

34. 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 A meal pattern is a menu-planning tool used to develop menus for a specific age group. Meal patterns are simple and cost efficient tools that ensure the number of servings per food group are met at each meal. For a meal pattern to function properly, meals must follow a narrow meal pattern with no deviation. This does not allow flexibility for seasonality, product availability or price fluctuation. Meal patterns can be used efficiently as a checklist They do not ensure that RDAs/AIs requirements are met for protein, fat, fiber, vitamins A, B6, B12, C, calcium, magnesium, sodium, and zinc. A meal pattern is a menu-planning tool used to develop menus for a specific age group. Meal patterns are simple and cost efficient tools that ensure the number of servings per food group are met at each meal. For a meal pattern to function properly, meals must follow a narrow meal pattern with no deviation. This does not allow flexibility for seasonality, product availability or price fluctuation. Meal patterns can be used efficiently as a checklist They do not ensure that RDAs/AIs requirements are met for protein, fat, fiber, vitamins A, B6, B12, C, calcium, magnesium, sodium, and zinc.

35. Targets Vitamins A, B6, B12, C, D, E Minerals Calcium, potassium, sodium Fiber Saturated Fat & Cholesterol Based on the report of the issue panels conducted by the CenterBased on the report of the issue panels conducted by the Center

36. 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

37. Menu Development: Nutrition Caloric range Limit fat, cholesterol, sodium Adequate protein & carbohydrate Increased fiber Adequate vitamins & minerals

38. 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)

39. Chicken Menu

40. 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)

41. Meatloaf Meal

42. 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)

43. Turkey Menu

44. 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