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 4th State Units on Aging Nutritionists & Administrators Conference – August 20062006

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

Team Leader

Floristene Johnson M.S., R.D. OAA Regional Nutritionist

USDHHS Administration on AgingDallas, Texas

Florida

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

Target Nutrients

B6 0.57 mg B12 0.8mcg C 30 mg A 300 mcg (vegetable derived

carotenoid)

Florida

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

Nutrients that may be averaged over one week

Vitamin A

Sodium (however, no individual meal should exceed 1200 mg of Sodium).

Florida

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

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

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

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

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

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

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

Kentucky

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

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

FRONTIER WYOMING

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

WYOMING

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

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

NETWORKING IN WYOMING

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

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

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

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

CHANGE TAKES TIME

MAYBE THIS IS THE LAST YEAR I’M GOIN’ HUNTIN’

THANK YOU

QUESTIONS?