Download Provider Guide - National Resource Center on Nutrition & Aging

Nutrition Service
Providers Guide
Barbara Kamp, MS, RD
National Resource Center on
Nutrition, Physical Activity &
Aging
4th 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 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
Implementation
 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 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
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 50
Consume 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 adults
Consume 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 fatfree 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 potassiumrich 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
Program Planning
Considerations
• ~10% sodium naturally in foods
• ~75 - 77% added during processing
• Use “no added salt” or “lowsodium”
• 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/
• 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
Part II
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
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
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
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 Solutions
Meal 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 Menu
Emphasis: 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)
Chicken Menu
Standard
Meal Content
Calories
550-700 kcal
584 kcal
% fat
30-35%
22 %
Fiber
7–8g
10 g
Calcium
400 mg
507 mg
Potassium
1566 mg
916 mg
Sodium
500 mg
254 mg
Meatloaf Sandwich
Special 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)
Meatloaf Meal
Standard
Meal Content
Calories
550-700 kcal
834 kcal
% Fat
30-35%
18%
Fiber
7–8g
9g
Calcium
400 mg
1129 mg
Potassium
1566 mg
1666 mg
Sodium
500 mg
627 mg
Turkey Menu
Special 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
Standard
Meal Content
Calories
550-700 kcal
724 kcal
% Fat
30-35%
25 %
Fiber
7–8g
13 g
Calcium
400 mg
630 mg
Potassium
1566 mg
1763 mg
Sodium
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