Child and Adult Care Food Program

1. Child and Adult Care Food Program Aligning Dietary Guidance for All Released in 2010 Norma Birckhead District of Columbia’s Office of the State Superintendent of Education

2. The Committee’s Task • The USDA requested that the Institute of Medicine convene a panel of experts to: • Review and assess the nutritional needs of the target populations based on the Dietary Guidelines for Americans and the Dietary Reference Intakes, and • Use that review as a basis for recommended revisions to the meal requirements for CACFP. 2

3. The Committee took a broad view (“Dietary Guidance for All”) • The recommended meal requirements should: • Cover all age groups from infants to older adults • Be applicable to all meals and snacks across a full day • Build on and extend the WIC and school meals recommendations 3

4. Criteria for Meal Requirements • Criterion 1. Consistent with current dietary guidance and nutrition recommendations to promote health; encourage and support breastfeeding for infants. • Criterion 2. Provide the basis for menus that are practical to plan, purchase, prepare, and serve in different settings. • Criterion 3. Provide the basis for menus that incorporate healthful foods and beverages and are appealing to diverse age ranges and cultural backgrounds.

5. Criteria (con’t) • Criterion 4. Facilitate the planning of menus that are compatible with the capabilities and resources for the variety of program providers. • Criterion 5. Allow the planning of menus that are sensitive to considerations of cost.

6. Recommended Age Groups and Calorie Levels 6

7. Process for setting meal requirements for other CACFP age groups • Use the MyPyramid food group patterns as the basis of the CACFP meal patterns; controls calorie and nutrient levels • Use food specifications to limit solid fats, trans fats, added sugars, and sodium

8. Control energy intake by specifying food patterns • Food groups and portions should match MyPyramid for the appropriate energy level. • For example, a 1300 kcal/d pattern would have the following across all meals and snacks: • Fruits 1.25 cups • Vegetables 1.5 cups • Grains 4.5 ounce equivalents • Milk 2 cups

9. Apply meal percentages to MyPyramid food groups Small Grains (4.5 ozeq/d if Children 1300 kcal/d) • Breakfast 20% 1 ozeq • Lunch 26 1 • Dinner 26 1 • Snacks (2) 28 2

10. Allocate these calories to each meal Small Older Children Children/Adults • Breakfast 20% 22% • Lunch 26 32 • Dinner 26 32 • Snacks (2) 28 14

11. Within each pattern, food specifications further control calories • By limiting foods with solid fats and added sugars • By substituting nutrient dense foods

12. Recommendations for Meal Requirement • USDA should adopt the recommended meal requirements for healthy infants and toddlers up to one year of age Align Infant Requirements with WIC Requirements (IOM 2006) • Only breast milk or formula under 6 months of age • Gradual introduction of baby meats, cereals, fruits, and vegetables beginning at 6 months of age • No fruit juice of any type before 1 year of age

13. Recommended Meal and Snacks for Infants

14. Infant Meal and Snack

15. Children 1 and older & adults 2. For all children age 1 year and older and for adults, USDA should adopt Meal Requirements that increase the variety of fruits and vegetables, increase the proportion of whole grains, and decrease the content of solid fats, added sugars, trans fats, and sodium.

16. Recommendations for Children To Align with School Meals (IOM, 2010) • Same age groups • Same calorie targets • Similar recommended meal patterns for both breakfast and lunch • Only skim and low fat milk products • Increased whole grains • Decreased saturated fat and added sugars

17. Recommended Meal Patterns - Breakfast

18. Recommended Meal Patterns – Lunch/Supper

19. Meal Requirement Recommendations • USDA should give CACFP providers the option of serving one enhanced snack in the afternoon in place of a smaller snack in both the morning and the afternoon: • Can only be served to adults and children at least age 5 • Enhanced snack is nutritionally equivalent to two regular snacks • Would have 4 food group components instead of 2

20. Recommended Meal Patterns – Snack (Choose 2 Food Groups per Snack)

21. Food Specifications that Align with the Dietary Guidelines • Low fat milk products: Milk and yogurt will be fat-free or 1 percent fat • Increase whole grains: At least half of grain products must be whole grain-rich • Decrease saturated fat and added sugars: Limit milk fat and flavored milk, only 100% fruit juice, cereals will contain less than 6 grams of sugar per ounce, limit high fat meats

22. Limit energy-dense foods • Only non-fat and low-fat milk if ≥ 2 years • Flavored non-fat milk allowed if ≥ 5 years • No added sugars in fruits or juices • No deep-fried vegetables • Limit high-fat meats • Limit grain desserts (cookies, muffins, cake, etc.)

23. Increase nutrient-dense foods • Increase the variety and amounts of fruits and vegetables • Increase the proportion of whole grains

24. What are the recommended: • Implications • Strategies • Evaluation • Research

25. Meal Cost Implications • The recommended Meal Requirements will increase overall food costs: • Increased amounts and variety of vegetables • Addition of meat at breakfast • Increases in whole grain-rich foods • Examples of increases for breakfast, lunch, and a regular snack: • 31% for children 1 year of age • 44% for children 2-4 years • Non-food costs will also increase, at least initially

26. Implementation • The effectiveness of the recommended Meal Requirements will be determined in large part by the way they are implemented and monitored • Key strategies include: • Engaging families, food industry stakeholders, and the community • Providing nutrition education to participants • Providing training for state agencies and providers • Partnerships (e.g., with EFNEP) will be helpful

27. Recommendations for Implementation Strategies • USDA, working together with state agencies and health and professional organizations, should provide extensive technical assistance to CACFP providers to implement the recommended Meal Requirements. • USDA should work strategically with the CACFP administering state agencies, CACFP associations, and other stakeholders to reevaluate and streamline the system for monitoring and reimbursing CACFP meals and snacks.

28. Recommendations for Program Evaluation • USDA, in collaboration with relevant agencies, should provide support for research to evaluate the impact of the Meal Requirements on: • Participants’ total and program-related dietary intake and consumption patterns, • The food and nutrient content of the meals and snacks served, • Impact to participate in CACFP, and • Barriers to Program access by participants

29. Recommendations for Program Evaluation (con’t) • USDA should take appropriate actions to establish the current baselines prior to implementation of the new Meal Requirements for comparison purposes. • To the extent possible, USDA should take steps to ensure that the final rule for the new Meal Requirements is informed by the results of evaluation of program impact.

30. Recommendations for Research • USDA and other relevant agencies and foundations should support research on topics related to the implementation of the Meal Requirements and to fill important gaps in knowledge of the role of CACFP in meeting the nutritional needs of program participants. • USDA should review and update as appropriate the CACFP Meal Requirements to maintain consistency with the Dietary Guidelines and other relevant science.

31. Summary • CACFP recommendations address overconsumption of energy by: • Setting food group intake targets for the day and for each meal • Limiting high-calorie, energy-dense foods • Encouraging low-calorie, nutrient-dense foods