Menu Planning: DRIs and Dietary Guidelines

1. Menu Planning:DRIs and Dietary Guidelines Linda Miles, RD, LD – Florida Department of Elder Affairs Willa Thomas, RD, LD – Kentucky Division of Aging Services Joan Franklin, RD - Wyoming Department of Health, Aging Division 4th State Units on Aging Nutritionists & Administrators Conference – August 2006

2. Florida’s DRI and Dietary Guidelines Implementation • Appointed Nutrition Advisory Panel to assist in developing guidelines in January 2004. • Meeting in Tallahassee March 31, 2004 • Panel members were volunteers from the nutrition and aging network. This included: AAA Director, Nutrition Program Directors, program RD’s, state agency staff, a county commissioner and….. Florida

3. Team Leader • Floristene Johnson M.S., R.D. OAA Regional Nutritionist USDHHS Administration on Aging Dallas, Texas Florida

4. Target Nutrients • Calories 685 • Protein 34-60 gm (20-35% of calories) • Fat 15-27 gm (20-35% of calories) • Fiber 10 gm • Calcium 400 mg • Zinc 3.7mg • Magnesium 140 mg • Sodium <800 – 1200 mg Florida

5. Target Nutrients • B6 0.57 mg • B12 0.8mcg • C 30 mg • A 300 mcg (vegetable derived carotenoid) Florida

6. Adequate amounts daily required for: • Calories • Protein • Carbohydrate • Fat • Fiber • Calcium • Zinc • Magnesium • Vitamins B6, B12, C Florida

7. Nutrients that may be averaged over one week • Vitamin A • Sodium (however, no individual meal should exceed 1200 mg of Sodium). Florida

8. Implementation • Notice sent on August 27, 2004 to Area Agencies which included requirement for computer assisted nutrient analysis. • Target implementation data: January 1, 2005 Florida

9. Challenges • Implementation time schedule was insufficient. • Resistance from AAA’s and program RD’s. • Concerns included: increase in cost, increase in plate waste due to client dissatisfaction, increased risk of impaction from too much fiber………. Florida

10. Valid issues identified through a survey with program RD’s • Menu variety is restricted with daily 10 g. fiber requirement. • Sodium level was difficult to achieve. • Emergency Meals that met all standards are not available. Florida

11. Program RD’s recommendations • Weekly averaging of all nutrients. • Modify protein requirement • Modify fiber and sodium requirement. • Develop liberalization policy for Holidays and celebrations. Florida

12. Proposed Revisions • Calories 650 - 700 • Protein 19 gm or more. 10 – 35% • Fat < 35% of total calories. • Fiber 8 gm or more. • Sodium 1200 mg or less. • Weekly average for Vitamin A, B12, Mg Zn and Sodium. Florida

13. Kentucky Challenges • Why did we change? • How did we start? • Started talking about issue 4 ½ yrs ago • Work Group Formed about 2 years ago • RD Sub-committee • Introduced final version Spring, 2006 • Some RDs started talking about sharing menus, recipes, etc across AAA lines Kentucky

14. Approximately 655 calories 15 – 20% Protein < 30% Fat average 8 grams fiber 400 mg calcium 140 mg magnesium 3.7 mg zinc 300 mcg (RE) Vitamin A .6 mg Vitamin B6 .8 mcg Vitamin B12 30 mg Vitamin C < 1000 mg Sodium What guidelines are used in KY Kentucky

15. Status of Change in KY • Meeting with Dietitians, Nutrition Providers, and AAA staff • Introduced “new” ideas • Meal pattern and/or nutrient analysis • Cycle menu possibilities • Networking opportunities between AAA menu planners • One menu will meet needs of all • Will begin monitoring this fiscal year Kentucky

16. Kentucky FAQ • Why is the new plan so expensive? • How do you bid nutrient analysis menus? • How do I know what serving size to use? • Why does the dietitian need to know what recipe is being used? • Why are the numbers in the USDA database different from the manufacturers? • Do I still need to serve ice cream? • Isn’t it easier to use meal pattern? • Can we still have dessert? • How many ways can you serve beans? Kentucky

17. FRONTIER WYOMING

18. WYOMING 97,100 square miles Population: 509,294 Density: 5/sq. mile Least populated State One R.D. for 571 square miles Single PSA-The State Unit on Aging serves as the AAA FLORIDA 54,252 square miles Population 15,982,378 Density: 300/sq mile QUICK FACTS WYOMING

19. EARLY CHALLENGES • Aging Division administration change 6/03 • Responsibility, accountability & compliance • Statewide education on the Older Americans Act and program expectations (no AAA’s) • Early stages of Statewide menu project began 9/03 (awarded to a contractor with State funding) WYOMING

20. BEFORE 2003 • Meal pattern requirement in Rule • No nutrient analysis of menus • Few contracted R.D.’s & lack of R.D involvement • Inconsistent oversight of meal projects

21. NETWORKING IN WYOMING

22. 3 YEARS OF IMPROVEMENT • Statewide education and cooking classes • Consistent oversight from one quality assurance reviewer statewide • Menu template development (ongoing) • Must meet DRI’s and DG’s as written without modification by 10-1-06 • Nutrient analysis required by 10-1-06

23. FEEDBACK FROM NUTRITION PROJECTS ON DRI’s & DG’s • Making meals that meet the guidelines won’t guarantee that the seniors will eat that meal • Clients will stay home, eat fast-food, and could be isolated if the senior meal food isn’t what they are used to eating • More latitude on the Federal guidelines, especially sodium, 800 mg is too low • 734 calories (based on DRI’s) are not enough WYOMING

24. FEEDBACK cont. • Food costs are higher when compliance with the DRI’s is attempted • Menus that meet the DRI’s & include analyses take a lot of time to write • Vendors only deliver once per week: problematic for fresh fruits & veggies • Wyomingites are proud and independent: don’t want the government mandating their meals WYOMING

25. CHANGE TAKES TIME • Continue to educate nutrition projects • Offer technical assistance • Follow the DRI’s as written: no special averaging or allowances at this time • Follow the Dietary Guidelines as written • Compliance by 10-1-06

26. CHANGE TAKES TIME MAYBE THIS IS THE LAST YEAR I’M GOIN’ HUNTIN’

27. THANK YOU QUESTIONS?