The Challenges of DRI The Challenges of DRI Implementation in Implementation in CaliforniaCalifornia

Barbara Estrada, M.S., R.D.Barbara Estrada, M.S., R.D.

Public Health Nutrition Public Health Nutrition ConsultantConsultant

California Department of California Department of AgingAging4th State Units on Aging Nutritionists & Administrators Conference4th State Units on Aging Nutritionists & Administrators Conference

August 2006August 2006

California’s Elderly California’s Elderly Nutrition ProgramNutrition Program 33 PSAs33 PSAs 250 + service providers250 + service providers Diverse populationDiverse population

California’s Elderly California’s Elderly Nutrition ProgramNutrition Program Program DiversityProgram Diversity

– CambodianCambodian– FilipinoFilipino– HispanicHispanic– RussianRussian– AsianAsian

California’s Elderly California’s Elderly Nutrition ProgramNutrition Program Last year Elderly Nutrition Last year Elderly Nutrition

Programs in California provided Programs in California provided 18,476,009 meals18,476,009 meals

California’s Elderly California’s Elderly Nutrition ProgramNutrition Program 33 AAA RDs33 AAA RDs 88 Program RDs88 Program RDs

California’s Elderly California’s Elderly Nutrition ProgramNutrition Program Menu StandardsMenu Standards Title 22 California Code of Title 22 California Code of

RegulationsRegulations– Provided nutrition requirements Provided nutrition requirements – Must be changedMust be changed– Old ENP regulations regarding meal Old ENP regulations regarding meal

standards were very specific standards were very specific – New ENP regulations will be generalNew ENP regulations will be general

First AttemptFirst Attempt

New Menu Standards were New Menu Standards were developed and sent out to developed and sent out to stakeholders for commentstakeholders for comment

The new Standards were based The new Standards were based on 2000 Calories per dayon 2000 Calories per day

First AttemptFirst Attempt

685 Calories per meal685 Calories per meal 2 servings of bread2 servings of bread 2-3 servings of vegetables 2-3 servings of vegetables 1-2 servings of fruit1-2 servings of fruit Sodium <1,000 mgSodium <1,000 mg Protein 3 ouncesProtein 3 ounces

First AttemptFirst Attempt

First Draft was released in July of First Draft was released in July of 20052005

Comments were accepted until Comments were accepted until January of 2006January of 2006

Several programs provided Several programs provided studies or surveys that addressed studies or surveys that addressed the amount of food and costs. the amount of food and costs.

First AttemptFirst Attempt

CDA withdrew the first draft and CDA withdrew the first draft and asked the programs to continue asked the programs to continue to operate on the AoA to operate on the AoA requirement that all meals meet requirement that all meals meet the 2005 Dietary Guidelines.the 2005 Dietary Guidelines.

Updated Menu Updated Menu StandardStandard 535 Calories per meal (Based on 535 Calories per meal (Based on

1600 per day)1600 per day) 14 gm of protein per entree14 gm of protein per entree Vitamin A – 250 Vitamin A – 250 μμgg Vitamin C – 25 mgVitamin C – 25 mg Sodium ~ 800 mg Sodium ~ 800 mg Fiber > 7 gmFiber > 7 gm

California Component Meal Pattern

Food Group Required servings/ meal

Serving sizes for 1600 calorie level

Lean meat / beans 1 serving 2 ounces = 1 serving

Vegetable 1 – 2 servings ½ cup = 1 serving

Fruit 1 serving ½ cup = 1 serving

Bread or Grain 1 – 2 servings / ½ must be whole grain

1 slice Bread or ½ cup of rice or pasta = 1 serving

Milk or milk alternate

1 serving 1 cup or equivalent measure

Fat Optional

Dessert Optional - limit sweets use fruit

Select foods high in fiber and low in fat

and sugar

Dash Diet

Food Group 1,600 Calories Daily

550 calories per meal

Grains 6 servings 2 servings

Vegetables 3-4 servings 1.5-2 servings

Fruits 4 servings 1.3 servings

Low-fat or fat free dairy

2-3 servings 1 serving

Meat, poultry, fish 1-2 servings (3 oz each)

1 serving (2 oz.)

Seeds, nuts, legumes

3-4 servings 1 serving

Fats and oils 2 servings/week

Sweets 0 servings

USDA Menu Pattern

Food Group 1,600 Calories Daily 550 calories/ meal

Grains 5 ounces 1.7 ounces

Vegetables 2 cups (4 servings) .7 cups (1.3 servings)

Fruits 1.5 cups .5 cups

Milk 3 cups 1 cup

Lean meat and beans

5 ounces 1.7 -2 ounces

Oils 22g 7 g

Discretionary calorie allowance

132 calories 44 calories

California’s Elderly California’s Elderly Nutrition ProgramNutrition Program Providing guidance without Providing guidance without

writing underground regulations? writing underground regulations?

Updated Menu Updated Menu StandardStandard Sodium the real challengeSodium the real challenge Effect of Potassium Effect of Potassium Culturally appropriate mealsCulturally appropriate meals

New RegulationsNew Regulations

CDA RDs are in the process of CDA RDs are in the process of changing the California Code of changing the California Code of RegulationsRegulations

New language will be more New language will be more generalgeneral

Guidance will be provided along Guidance will be provided along with choices of how to meet the with choices of how to meet the Federal regulations. Federal regulations.