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�..

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

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

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

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

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

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

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���.

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.

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.

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.

13. Kentucky Challenges Why did we change? How did we start? Started talking about issue 4 � 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

14. What guidelines are used in KY 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

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

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?

17. FRONTIER WYOMING

18. QUICK FACTS 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

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)

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

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

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

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

27. THANK YOU