AAA 1-B NUTRITION APPENDIX

A. Nutrition Service Acronyms and Definitions

B. Older American Act Requirements (sect 339)
C. Menu Planning Resource Information
1. Fiber Sources, Whole Grains and Health
2. Fruits and Vegetables
3. Vitamin A and C Foods
4. Three-A-Day Calcium Plus One
5. Heart Health and Trans Fats
6. Facts on Food Labels
7. Seasoning with Herbs to Lower Salt Intake
8. Tips to Reduce Sugar in Meals and Enhancing
Sweetness with Spices
9. Tips to Reduce Fat Content in Menus
10. Target Nutrients and Good Food Sources
11. Best Source of Select Nutrients
12. Fat Terminology on Food Labels
13. Tips for Cooking and Consuming Dry Beans:
D. Vegetarian Meals
E. Breakfast Meals
F. Standardized Recipes
1. Standardized Recipe Sample Form
G. Menu Planning and Nutrient Analysis
H. AAA 1-B Menu Approval Form
I. Modified and Therapeutic Diets
J. Cultural and Ethnic Meals
K. Required Nutrient Content for Meals
L. Food Safety for Older Adults
M. Choose My Plate-2011
N. Carbohydrate Counting and the Glycemic Index
O. Nutrition Screening Initiative
1. D.E.T.E.R.M.I.N.E. Your Nutritional Health
2. The Nutrition Checklist
P. 2010 Dietary Guidelines for Americans
Q. Dietary Reference Intakes and Table for Older Adults
1. Most Frequently Asked Questions
R. AAA 1-B Shelf Stable Meals
S. 2nd Meal Take Home Option
T. Nutrition Education
U. Nutrition Assessment Matrix

Nutrition Appendix Page 1

 APPENDIX A
NUTRITION SERVICE ACRONYMS
AND DEFINITIONS

AND (Academy of Nutrition and Dietetics) – www.eatright.org is the sponsor of

National Nutrition Month and the Healthy Aging Practice group; the AND membership is
composed of registered dietitians.

DASH Eating Plan (Dietary Approaches to Stop Hypertension) – The DASH diet is
rich in fruits, vegetables, low-fat or nonfat dairy. It also includes grains, especially whole
grains; lean meats, fish and poultry; nuts and beans. The DASH eating plan lowers
cholesterol and makes it easy to lose weight. It is a healthy way of eating, designed to
be flexible enough to meet the lifestyle and food preferences of most people. It contains
all the healthy foods from the Mediterranean diet. http://dashdiet.org

DRI (Dietary Reference Intake) – A set of nutrient-based reference values that expand
upon and replace the former Recommended Dietary Allowances (RDA) in the United
States and the Recommended Nutrient Intakes (RNI) in Canada. They are actually a set
of four reference values: Estimated Average Requirements (EAR), RDA, Adequate
Intakes (AI), and Tolerable Upper Intake Levels (UL).

Empty Calories – Empty calories provide the energy without the added benefit of
nutritional value such as the calories provided by table sugar and ethanol (the kind of
alcohol found in beer, wine, and spirits) and excess fatty foods.

Food Allergies – Allergic reaction to avoid i.e. anaphylactic shock (drop in blood
pressure).

Food Borne Illness (often called "food poisoning") – Any illness caused by
consuming contaminated foods or beverages. Many different disease-causing microbes,
or pathogens, can contaminate foods, so there are many different food borne infections.
In addition, poisonous chemicals, or other harmful substances, can cause food borne
diseases if they are present in food. The most commonly recognized food borne
infections are those caused by the bacteria Campylobacter, Salmonella, and E. coli
O157:H7, and by a group of viruses called calicivirus, also known as the Norwalk and
Norwalk-like viruses.

Food Code - A model for state and local regulatory to use to develop or update their
food safety rules. It is issued every four years by the Food and Drug Administration
(FDA), a federal government agency.

Hazard Analysis and Critical Control Point (HACCP) - A food safety system that can
be used to identify, evaluate and control food safety hazards throughout the flow of
food.

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HBV (High Biological Value) Proteins - HBV proteins contain all of the essential
amino acids in the correct proportions. Proteins of HBV are often referred to as high
quality are usually of animal origin like meat, fish and eggs. However, Soya is also a
high quality source of amino acids. HBV proteins are recommended for older adults at
each meal throughout the day with at least 30 grams of protein being provided per meal.

MiCafe – The Michigan electronic application process to register individuals in the

Supplemental Nutrition Assistance Program (SNAP).

My Plate - USDA – The My Plate icon replaced the Food

Pyramid in 2011, to help consumers make food choices for a
healthy lifestyle. Three visual messages for My Plate are
centered on the ideas of balancing calories, choosing foods to
eat more often, and cutting back on foods to eat less often. Key
consumer messages: 1) make at least half your grains whole
grains; 2) make half your plate fruits and vegetables; and 3)
switch to fat-free or low-fat (1%) milk.

National Health Observances (NHOs) - Special days, weeks, or months designed to

raise public awareness about important health topics. NHOs provide unique
opportunities for public health and medical professionals, consumer groups, and others
to encourage their community members to stay healthy.

National Nutrition Month® (NNM) - is a nutrition education and information campaign

created annually in March by the Academy of Nutrition and Dietetics. The campaign
focuses on the attention of making informed food choices and developed sound eating
and physical activity habits.

Nutrient-Dense Foods – Nutrient-dense or nutrient rich foods are those that are a
excellent source of nutrients and provide substantial amounts of vitamins , minerals and
phytochemicals essential for proper functioning of the immune system to protect us from
chronic diseases. These foods provide relatively fewer calories in proportion to the
vitamins, minerals and of phytochemicals present. A "high source" of nutrients is defined
as providing 20% or more of the Daily Value for a given nutrient per serving. A "good
source" is federally defined as providing 10-19% of the Daily Value for a given nutrient
per serving.

Nutritional Analysis – Uses a database of the nutrient analysis of foods with

measurement of fiber, protein, fat, carbohydrate, individual minerals and vi tamins to
calculate accurate nutrition information for nutrition claims. Information is based on the
nutrition facts of each contributing ingredient and their percentage as part of the end
product, i.e. recipe, meal, menu. These nutrition facts are totaled and factored to create
an accurate assessment for the resulting nutrition facts to assure that meals provided
under the Older American Act (OAA) meet the 1/3 DRI requirement for this federal food
program.

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RD (Registered Dietitian) –Professionals trained in the science of dietetics and have a
degree in nutrition, dietetics, public health or related field from an accredited college or
university. Passed a national examination administered by the Commission on Dietetic
Registration (CDR) and complete continuing professional educational requirements to
maintain registration.

SNAP (Supplemental Nutrition Assistance Program) – Previously called the Food

Stamp Program, Michigan also refers to SNAP as using the Bridge Card. With SNAP
you get an electronic Benefit Transfer (EBT) card to buy food at the grocery store. Call
1- 800-221-5689, or visit www.fns.usda.gov/snap. Older adults may also sign up
through MiCafe at www.micafeonline.org.

Temperature Danger Zone – The temperature that allows bacteria to multiply rapidly
and produce toxins, between 41°F and 135°F. To keep food out of the danger zone,
keep cold food cold, i.e. refrigerated, in coolers, iced on the service line; and hot food
hot, i.e. in the oven, heated chafing dishes, preheated steam tables, warming trays,
and/or slow cookers. Never leave perishable foods, such as meat, poultry, eggs, and
casseroles, in the danger zone longer than 2 hours or longer than 1 hour in
temperatures above 90°F.

Time/Temperature Control for Safety Foods (TSC Foods) - Foods that support the
growth of harmful bacteria, and therefore require time and temperature control to limit
the growth of harmful bacteria.

US Dietary Guidelines – The Dietary Guidelines for Americans 2010 released

January 31, 2011 are the cornerstone of Federal nutrition policy and nutrition
education activities. The Dietary Guidelines have been jointly issued and updated
every 5 years by the Departments of Agriculture (USDA) and Health and Human
Services (HHS). They provide authoritative advice for Americans ages 2 and older
about consuming fewer calories, making informed food choices, and being physically
active to attain and maintain a healthy weight, reduce risk of chronic disease, and
promote overall health. Two examples of eating patterns that exemplify the Dietary
Guidelines are the USDA My Plate and the DASH (Dietary Approaches to Stop
Hypertension) Eating Plan.

Vegetarian – There are several categories of vegetarians, all of whom avoid or limit
meat and/or animal products. The vegan or total vegetarian diet includes only foods
from plants: fruits, vegetables, legumes (i.e. dried beans and peas), grains, seeds, and
nuts. The lacto-vegetarian diet includes plant foods plus cheese and other dairy
products. The ovo-lacto vegetarian (or lacto-ovo vegetarian) diet also includes eggs. A
semi-vegetarian or flexitarian diet is one that is mainly vegetarian-based with the
occasional inclusion of meat products eat red meat but include chicken and fish with
plant foods, dairy products, and eggs.

Nutrition Appendix Page 4

 APPENDIX B
OLDER AMERICANS ACT
NUTRITION REQUIREMENTS

Purpose of the Older Americans Act Nutrition Program - Section 330:

 Reduce food and hunger insecurity.

 Socialization of older individuals.
 Promote the health and well-being of older individuals by assisting them in gaining
access to nutrition and other disease prevention and health promotion services to
delay the onset of advanced health conditions resulting from poor nutritional health
or sedentary behavior.

Nutrition Program Requirements from Older Americans Act - Section 339:

A State that establishes and operates a nutrition project under this chapter shall:

 Solicit the advice of a dietitian or individual with comparable expertise in the planning
of nutritional services.
 Ensure that the project provides meals that comply with the Dietary Guidelines for
Americans, published by the Secretary of Health and Human Services and the
Secretary of Agriculture.
 Provide a minimum of 33 1/3 percent of the daily recommended dietary allowances
as established by the Food and Nutrition Board of the Institute of Medicine of the
National Academy of Sciences, if the project provides one (1) meal per day, or

o 66 2/3 percent of the allowances if the project provides two (2) meals per day.
o 100 percent of the allowances if the project provides three (3) meals per day.

 To the maximum extent practicable, meals are adjusted to meet any special dietary
needs of program participants.
 Provide flexibility to local nutrition projects in designing meals that are appealing to
program participants.

In addition programs should:

 Meet the current DRIs and Adequate Intake (AI) of the 2010 US Dietary Guidelines.
 Emphasize foods high in fiber, calcium, and protein, and, to the extent possible,
target vitamins A and C, with vitamin A provided from vegetable-derived (carotenoid)
sources.
 Utilize computer assisted nutrient analysis to verify that requirements are being met.
 Meet special dietary needs when possible and plan menus that are culturally
appropriate.

Nutrition Appendix Page 5

 APPENDIX C1
FIBER SOURCES, WHOLE GRAINS,
AND HEALTH

The USDA Dietary Guidelines recommend including three 1-ounce servings of whole
grains daily. Whole grains include breads, cereals, pasta, and rice. Read food labels
carefully and look for the word “whole grain” in the first position in the ingredient list.

Whole grains are a good source of fiber which help keep us regular, may reduce risk of
colon cancer, can help maintain a healthy weight and regulate blood glucose levels.
Whole grains, fruits, vegetables and legumes are all good sources of fiber.

Increasing Fiber Intake

 Fiber should come from food sources: whole grains foods, fruits and vegetables .
 Adequate fiber intake aids in regular elimination.
 Fiber has been shown to reduce risk of several chronic diseases including colon
cancer, diabetes, and cardiovascular and diverticular disease.
 Adequate fluid intake should accompany any increase in fiber intake.
 When reading labels, whole grain products are identified by “whole grain” or
“whole wheat” listed first.
 Whole grain breads do not need to be dry, coarse crumb that can be difficult for
seniors to chew and swallow; look for soft crumb, moist whole grain breads.

High Fiber Foods

 dried beans, peas and other legumes
 fresh or frozen lima beans, Fordhook limas as well as baby limas, green peas
 dried fruit: best sources are figs, apricots and dates
 raspberries, blackberries, and strawberries
 broccoli, sweet corn, green beans
 whole wheat or whole grain breads and cereals
 baked potato with skin
 plums, pears and apples
 breakfast cereals high in fiber: oatmeal, bran, whole grain flaked, puffed wheat

Easy Ways to Add More Whole Grains

Try some of the following:

 Substitute half the white flour with whole-wheat flour in recipes for cookies,
muffins, and quick breads, or add up to 20% of a whole grain flour such as
sorghum.
 Add half a cup of cooked bulgur, wild rice, or barley to bread stuffing.
 Add cooked wheat or rye berries, wild rice, brown rice, sorghum, barley to soup.
 Use whole corn meal for corn cakes, corn breads and corn muffins.
Nutrition Appendix Page 6
 Fiber Sources, Whole Grains and Health – continued
 Make risottos, pilafs and other rice-like dishes with whole grains such as barley,
brown rice, bulgur, millet, quinoa or sorghum.
 Serve whole grain salads like tabbouleh.
 Purchase whole grain breads, including whole grain pita bread.
 Purchase whole grain pasta, or one of the blends that’s part whole -grain, part
white.

Whole grain examples:

 whole Wheat, Spelt and Farro are varieties of wheat, whole rye
 whole-grain corn, popcorn
 whole oats/oatmeal
 brown rice, wild rice
 whole-grain barley
 buckwheat, soba noodles, crêpes and kasha are all made with buckwheat
 triticale, cross between wheat (Triticum) and rye (Secale)
 bulgur (i.e. cracked wheat in tabbouleh salad)
 millet, use in cereal, soups, and for making a dense, whole grain bread called
chapatti
 quinoa, incorporate into soups, salads and baked goods
 grain sorghum, use in gluten free baking mixes with sorghum flour

Comparison of whole
100 Percent Whole-Grain Enriched, Bleached, All-
grain and enriched and
Wheat Flour Purpose White Flour
refined flour

339.0 364.0
Calories, kcal
Dietary fiber, g 12.2 2.7
Calcium, mg 34.0 15.0
Magnesium, mg 138.0 22.0
Potassium, mg 405.0 107.0
Folate, DFE, µg 44.0 291.0
Thiamin, mg 0.5 0.8
Riboflavin, mg 0.2 0.5
Niacin, mg 6.4 5.9
Iron, mg 3.9 4.6

For additional information see information from The Whole Grains Council at
http://wholegrainscouncil.org.

Nutrition Appendix Page 7

 APPENDIX C2
FRUITS AND VEGETABLES

The revised 2010 USDA Dietary Guidelines have a focus on increased intake of fruits
and vegetables. Fruits and vegetables are great sources of essential nutrients,
phytochemicals and fiber. In addition they add variety to meals, color and interest.
Fruits can double as desserts and vegetables can take a starring role in many entrees.

Here are the essential nutrients in fruits and vegetables that are key to good health in
the elderly:

Vitamins Functional Aspects

C Immune function, reducing oxidative stress to body

A Vision, wound healing, liver health
D Bone health --less exposure to sunlight may increase dietary requirements
E Immune function
B-12 Anemia—reduced intakes and absorption increase needs
Folate Anemia, regulation of homocysteine levels, reduced risk of heart disease
and
B-6 certain medications may impair status of all B vitamins

Fiber

Fruits and vegetables, including legumes are an excellent source of fiber. Fiber helps to
maintain regularity, reduce risk of colon cancer and diverticulosis, aids in regulating
glucose levels, and weight management.

Phytochemicals and Antioxidants

These compounds, while not essential nutrients, are found in fruits and vegetables in
abundance. Examples include vitamins C and E, lycopene , and beta-carotene.
Regular intake has been shown to help reduce risk of chronic diseases such as heart
disease and cancer.

Minerals Functional Aspects

Zinc Immune function and wound healing

Potassium Regulation of fluid balance, muscle function and protein synthesis
Calcium Bone and tooth health, muscle contractions—intakes typically decrease
with aging and absorption can be compromised as well

Nutrition Appendix Page 8

 APPENDIX C3
VITAMIN A AND C FOODS

Rich sources of vitamins A and C are defined as meeting 33% of current adult male
DRI. The following food portions are considered rich sources of vitamin A or C.

Vitamin A Vitamin C

½ sweet potato ¼ or 1 C cantaloupe

½ C canned or fresh carrots ½ C sweet red or green peppers
½ C frozen cooked carrots ½ C frozen, sliced peaches
½ mango ½ C papaya slices
½ C cooked turnip greens ½ C orange juice
12 dried apricot halves ½ C grapefruit juice
¼ cantaloupe ½ grapefruit
¼ C cooked spinach ½ orange
¼ C cooked butternut squash ½ green or red pepper
¼ C pumpkin ½ C cooked broccoli
½ C cooked mixed vegetables ½ C Brussels sprouts
1 piece pumpkin pie ½ C strawberries or frozen
½ C cooked spinach ½ C mixed frozen fruit
½ C cooked turnip greens ½ C apricot nectar with added vitamin C
½ C raw or cooked red peppers ½ canned pineapple
½ C cooked kale ½ C tomato products (canned, paste),
½ C winter squash without added salt
½ C cooked turnip greens Equivalent of 1 chili pepper
½ C tomato products, canned, paste ½ C bottled cranberry juice cocktail
1 C chicken vegetable soup ½ C papaya
½ C collards ½ C cooked kohlrabi
1 C vegetable soup ½ C canned grape juice
Equivalent of 1 chili pepper ½ C cooked pea pods
1 C tomato soup
1 medium kiwi
1 raw mango
1 C cooked cauliflower
¾ C canned grapefruit sections
1 C cooked kale
1 C frozen chopped and cooked collards
1 C raspberries
1 C coleslaw
1 baked sweet potato
1 baked potato
1 C cooked mustard greens

Nutrition Appendix Page 9

 APPENDIX C4
THREE-A-DAY CALCIUM PLUS ONE

The 3-A-Day Program

According to the USDA, 75% of Americans do not meet their calcium needs? That is
why the National Dairy Council and the Academy of Nutrition and Dietetics promote the
3-A-Day program.

Functional aspects of calcium - value to older adults

Calcium is part of the “bone team.” These are nutrients that keep bones and teeth
healthy. In addition, calcium also functions to maintain a normal blood pressure level
and new research indicates that it may help manage weight. Adults over 51 years
should get 4 servings daily of a calcium rich food.

Calcium rich foods

Low-fat dairy products are a great source of calcium. Drink skim or 1% milk, or eat low-
fat yogurt or low-fat cheese at least 3 times a day. Tofu (soy), legumes such as dried
beans and peas, and some leafy green vegetables are also good sources. In addition,
there are now many calcium fortified products such as juices, cereals and snack foods.

What is a serving of a calcium rich food?

Best sources:
Yogurt, plain 8 ounces Choose non-fat or low-fat varieties
*Swiss cheese 1.5 ounces Choose low-fat
Calcium fortified orange juice 8 ounces
*American cheese 2 ounces
*Sardines 3 ounces
Milk 8 ounces Choose non-fat, skim or 1% milk
*Cheddar cheese 1 ounce Choose low-fat such as mozzarella

*high in sodium

Good sources:
Shrimp 3 ounces Legumes 1C
Turnip greens 1C Kale 1C
Instant oatmeal 1 packet Collard greens ½ C cooked
Tofu ½C Calcium fortified soy milk 8 ounces

Nutrition Appendix Page 10

 APPENDIX C5
HEART HEALTH AND
TRANS FATS IN THE DIET

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Nutrition Appendix Page 12
 APPENDIX C6
FACTS ON FOOD LABELS

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Nutrition Appendix Page 14
 APPENDIX C7
SEASONING WITH HERBS TO LOWER SALT INTAKE

Shake the Habit: Lower Salt Intake and Season with Herbs

Many older adults need to reduce sodium intake in order to comply with their health
care providers suggestions to limit the amount of salt (sodium) in their diets. Reducing
sodium levels is a recommendation of the Dietary Guidelines since high sodium levels
may increase risk of high blood pressure.

Here are some tips to reduce the amount of salt (sodium) in your diet:

 Choose sodium-reduced products whenever available, such as reduced sodium

soups, soy sauce, canned tuna, and spaghetti and barbecue sauces.
 Watch canned or frozen vegetables, many have added sodium
 Processed foods have more sodium; buy fresh, natural foods more often.
 Put the salt shaker in the cupboard and use it sparingly
 Offer salt-free seasoning blends such as Mrs. Dash at dining sites
 Season with herbs and spices, most of which are sodium free (see below)

Foods That Are High in Sodium

Cured meats: ham, bacon, sausage, hot dogs, Dehydrated soups

luncheon meats (bologna, salami etc) Cheeses
Fish, canned in oil or brined Buttermilk
Canned shellfish Instant cocoa mixes
Salted nuts, seeds and snack mixes Bouillon cubes
Soy protein products Olives, pickles, pickle relish
Pizza Meat tenderizers
Lasagna Seasoning salts
Frozen dinners

Read the Labels

Here are the key words that indicate that a food may be high in sodium or have
ingredients that contain sodium:

Salt Sodium Monosodium glutamate (MSG)

Baking powder Baking soda Disodium phosphate
Sodium benzoate Sodium hydroxide Sodium nitrite
Sodium propionate Sodium sulfite

Nutrition Appendix Page 15

Herb it Up!

Herbs are a great way to add flavor to your meals without adding salt. Here is a list of
herbs and the foods they compliment. Remember this rule of thumb whe n using herbs:
1/8 tsp powdered = 1/4 tsp dried = 1 tsp fresh.

Herbs Use with these vegetables

anise green salads, vegetable soup
basil tomatoes, green salads, vegetable pasta salads
chervil green salads, vegetable soups
chives Use instead of onions for a milder flavor
sweet marjoram potatoes and string beans
oregano tomatoes
mint green peas
parsley green salads, other vegetables

Try any of these herbs to compliment these foods:

Herb Foods
caraway seed, marjoram, nutmeg cauliflower
basil, caraway seeds, dill marjoram, nutmeg, savory green beans
basil, curry, marjoram, mint, orange peel, rosemary peas
basil, caraway seeds, chives, dill, garlic, onion potatoes
basil, allspice, celery seed, marjoram, oregano, thyme tomatoes
basil, celery seed, dill, paprika, tarragon green salads
lovage, marjoram, sage, tarragon poultry
basil, dill, garlic, parsley fish

Seasoning Strength

Strong herbs: bay leaves, cardamom, curry, ginger, hot peppers, mustard, pepper,
rosemary, sage. Use 1 tsp/6 servings

Medium herbs: basil, celery seed, cumin, dill, fennel, garlic, marjoram, mint, oregano,
savory, thyme, turmeric. Use 1 tsp/6 servings

Delicate herbs: burnet, chervil, chives, parsley. Use large amounts

Salt Substitute:

3 tsp basil
2 tsp each savory, celery seed, ground cumin, sage and marjoram
1 tsp lemon thyme

Nutrition Appendix Page 16

 APPENDIX C8
TIPS TO REDUCE SUGAR IN MEALS

Foods that are high in simple sugars or that have sugars added in preparation can be high
in calories and these calories are what nutritionists call “em pty calories” since the calories
and low in vitamins, minerals and protein. In contrast, seniors need nutrient dense or
nutrient rich foods to insure that all essential nutrient needs are being met. In addition,
sugar can cause dental decay at any age and will hinder consum ption of fresh healthy food.

 Use less of all sugar including: white sugar, brown sugar, honey, jam, jelly, and syrups.
 Desserts are optional, so choose to serve fruit; serve fruit breads that are usually lower
in sugar than cakes and cookies; and experim ent with recipes calling for less sugar for
baked dessert items.
 Serve fruit salads topped with yogurt or mixed with puddings as a dessert alternate.
 Choose canned or frozen fruits processed without added sugar
 Offer water at dining sites to reduce frequency of using soft drinks as thirst quenchers.
 Offer fruit as a topping on unsweetened cereals, yogurts, etc.
 Reduce the am ount of sugar in traditional recipes.
 Serve warm cinnamon applesauce over pancakes and waffles instead of syrup.
 Spread mashed bananas, or reduced sugar fruit topping instead of jam/ jelly on bread

Read Labels If any of these are listed first in the ingredient list, then the food is high in
sugar.

Sucrose Maltose Molasses

Dextrose Invert sugar Levulose
Fructose Corn syrup Brown sugar
High fructose corn syrup Glucose Turbinado sugar

The Great Fakes! - These spices are great at enhancing the sweetness already in foods.
Allspice Cloves Cardamom
Cinnamon Nutmeg Fennel
Cloves Ginger
Flavored Extracts: maple, coconut, banana, and chocolate

Sugar Content of Selected Foods

Tsp Sugar
Tsp Sugar Per / Serving
Per Serving
Fruit drink-12 oz. 12 Sherbet -1/2 c 5
Soft drink-12 oz. 8 Yogurt, fruit flavor-1c 7
Cake, frosted - 5 Chocolate Shake - 9
1/16 of cake 10 oz

Hone y vs. Sugar - Some people believe that honey is a more natural and healthy form of
sugar. Yet, 1 teaspoon of honey has 22 calories and 1 teaspoon of sugar has 13 calories.
Honey is also susceptible to growth of botulism a deadly food poison. Older adults should
not be offered any foods m ade with raw honey.

Nutrition Appendix Page 17

 Appendix C9
TIPS TO REDUCE FAT CONTENT IN MENUS

Reducing intake of fat, saturated fat and cholesterol has been found to help
reduce the risk of coronary heart disease and diabetes, and aids in
maintaining a healthy body weight. Fats are frequently termed by nutrition educators as
visible fats and are added in the cooking or preparation process i.e. oils, margarine ,
butter and those found naturally in foods as invisible i.e. avocado, coconut, ground beef,
peanuts, whole milk, cheese, or marbled occurring in fatty meats.

Here is a list of substitutions that you can make so that your menus are lower in fat:

 Use nonfat or skim milk instead of whole  Serve a baked potato instead of
milk or cream in cooking french fries
 Use powdered sugar instead of cake  Chill soups and skim fat before
frosting reheating and serving
 Use plain low-fat yogurt instead of sour  Use fat-free broths in cooking
cream  Grill or poach meats instead of frying
 Try reduced or fat-free cream cheese  Limit use of commercially made
instead of regular cream cheese baked products
 Try reduced fat cheeses instead of full-  Limit high-fat meats and dairy
fat cheese products to 3 times per week
 Use skim milk and cornstarch for sauces  Increase use of mono- and
instead of whole milk, cream and fats polyunsaturated fats such as olive,
 Use plain low-fat yogurt instead of safflower or canola oils
mayonnaise  Trim all visible fat from meats
 Try angel food cake instead of yellow or  Skin poultry before cooking
pound cake  Include fish on the menu more often
 Try a low-fat muffin instead of doughnut
 Try Canadian bacon instead of
pepperoni, sausage on pizza

Nutrition Appendix Page 18

 APPENDIX C10
TARGET NUTRIENTS AND
GOOD FOOD SOURCES

Certain nutrients have been targeted as key to good overall health in the Dietary
Guidelines. A "high source" is defined as providing 20% or more of the Daily Value
for a given nutrient per serving. A "good source" is federally defined as providing 10-
19% of the Daily Value for a given nutrient per serving. These include the following
good food sources for each of these nutrients.
Calcium
 Low fat or non-fat dairy including milk, buttermilk, yogurt, cottage cheese
 Low fat cheeses such as mozzarella, reduced fat Swiss, cheddar etc.

Iron
 Red meats, legumes, dark green vegetables such as spinach, fortified grains/cereals

Thiamin, Riboflavin and Niacin

 Meat, milk, leafy green vegetables, legumes, enriched breads, cereals and grains

Sources of Vitamin A
 Bright orange vegetables like carrots, sweet potatoes, and pumpkin
 Tomatoes and tomato products, red sweet pepper
 Leafy greens such as spinach, collards, turnip greens, kale, beet and mustard greens,
green leaf lettuce, and romaine
 Orange fruits like mango, cantaloupe, apricots, and red or pink grapefruit

Sources of Vitamin C
 Citrus fruits and juices, kiwi fruit, strawberries, guava, papaya, and cantaloupe
 Broccoli, peppers, tomatoes, cabbage (especially Chinese cabbage), Brussels sprouts,
and potatoes
 Leafy greens such as romaine, turnip greens, and spinach

Sources of Folate
 Cooked dry beans and peas
 Oranges and orange juice
 Deep green leaves like spinach and mustard greens

Sources of Potassium
 Baked white or sweet potatoes, cooked greens (such as spinach, beet ), winter squash
 Bananas, plantains, many dried fruits, oranges and orange juice, and cantaloupe
 Cooked dry beans , soybeans (green and mature)
 Tomato products (sauce, paste, puree)

Nutrition Appendix Page 19

 APPENDIX C11
BEST SOURCES SELECT NUTRIENTS

Nutrient Food Serving Size Amt % DV c

Calcium - - mg -
High Yogurt, plain, low fat 8 oz 345 35
- Milk 1% w/ added Vit. A 1 cup 300 25
Good Cheddar cheese 1 oz 204 17
- Collard greens, cooked 1/2 cup 179 15
- Turnip greens, cooked 1/2 cup 125 10
- Spinach, cooked 1/2 cup 123 10
Magnesium - - mg -
High Finfish, Halibut 1/2 fillet 170 40
Good Spinach, cooked 1/2 cup 79 19
- Soybean, cooked 1/2 cup 74 18
- Beans, white, canned 1/2 cup 67 16
- Beans, black, cooked 1/2 cup 60 14
- Artichokes, Cooked 1/2 cup 51 12
- Beet greens, cooked 1/2 cup 49 12
- Lima beans, cooked 1/2 cup 47 11
- Okra, frozen, cooked 1/2 cup 47 11
- Oat bran, cooked 1/2 cup 44 10
- Brown rice, cooked 1/2 cup 42 10
Vitamin B12 - - mg -
High Yogurt, plain. low fat 8 oz 0.49 37
- Milk 1%, w/ added Vit. A 1 cup 0.41 31
- Egg whole, scrambled/hard-boiled 1 Lg 0.27 21
Good Soybeans, cooked 1/2 cup 0.25 19
- Ricotta cheese, whole milk 1/2 cup 0.24 18
- Mushrooms, cooked 1/2 cup 0.23 18
- Spinach, cooked 1/2 cup 0.21 16
- Beet greens, cooked 1/2 cup 0.21 16
- Cottage cheese, low fat 1/2 cup 0.19 14

Nutrition Appendix Page 20

 APPENDIX C11
SELECT NUTRIENTS - CONTINUED

Nutrient Food Serving Size Amt % DV c

Folate - - ug -
High Lentils, cooked 1/2 cup 179 45
- Pinto beans, cooked 1/2 cup 147 37
- Chickpeas, cooked 1/2 cup 141 35
- Okra, frozen, cooked 1/2 cup 134 33
- Spinach, cooked 1/2 cup 132 33
- Asparagus, cooked 1/2 cup 122 30
- Turnip greens, cooked 1/2 cup 85 21
- Brussels sprouts, frozen, cooked 1/2 cup 78 20
Good White rice, long-grain, cooked 1/2 cup 77 19
- Broccoli, frozen, cooked 1/2 cup 52 13
- Mustard greens, cooked 1/2 cup 52 13
- Green peas, frozen, cooked 1/2 cup 47 12
- Orange 1 med 39 10
Vitamin E - mg -
High Vegetable oil, sunflower linoleic (>60%) 1 tbsp 6.88 46
- Tomato products, canned, puree 1/2 cup 3.15 21
- Vegetable oil, canola 1 tbsp 2.93 20
Good Turnip greens, frozen, cooked 1/2 cup 2.39 16
- Peaches, canned 1/2 cup 1.86 12
- Tomato products, canned, sauce 1/2 cup 1.72 11
- Broccoli, frozen, cooked 1/2 cup 1.52 10
Fiber - gm -
High Pears, Asian, raw 1 pear 9.9 28 d
- Beans (pinto, black, kidney) 1/2 cup 7-8 20-23 d
- Dates, dry 1/2 cup 7.0 20 d
Good Chickpeas, cooked 1/2 cup 6.0 17 d
- Artichokes, cooked 1/2 cup 4.5 13 d
- Green peas, frozen, cooked 1/2 cup 4.4 13 d
- Raspberries, raw 1/2 cup 4.2 12 d
- Vegetables, mixed, frozen, cooked 1/2 cup 4.0 11 d
- Apple, raw, with skin 1 3.7 11 d

Nutrition Appendix Page 21

 APPENDIX C12
FAT TERMINOLOGY ON FOOD LABELS

Fat Free
Contains less than 0.5 gram of fat per serving

Low Fat
Contains 3 grams or less of fat per serving

Reduced Fat
Nutritionally altered product containing 25% less fat than a regular product

Low in Saturated Fat

Contains 1 gram or less of saturated fat per serving

Reduced in Saturated Fat

Nutritionally altered product containing 25% less saturated fat than the regular product

Cholesterol Free
Contains less than 2 mg of cholesterol per serving

Low Cholesterol
Contains less than 20 mg of cholesterol per serving and no more than 2 grams of
saturated fat

Reduced Cholesterol
A nutritionally altered product that contains 25% less cholesterol than the regular
product

Lean
Contains less than 10 grams of fat, less than 4.5 grams of saturated fat, and less than
95 mg of cholesterol per serving

Extra Lean
Contains less than 5 grams of fat, less than 2 grams of saturated fat, and less than 95
mg of cholesterol per serving

Percent Fat Free

A food's weight that is fat free, which can be used only on foods that are low-fat or fat
free to begin with. For instance, if a food weighs 100 grams and 3 grams are from fat, it
can be labeled "97 percent fat free." Note that this term refers to the amount that is fat
free by weight, not calories.

Nutrition Appendix Page 22

 APPENDIX C13
TIPS FOR COOKING AND CONSUMING
DRY BEANS

Legumes or dry beans and peas are a healthy and versatile protein food and are grown
locally in Michigan. In addition to being used as a vegetable, beans are growing in
popularity as an entree in place of meat with many recipes inspired by traditional ethnic
cuisine and Michigan based recipes like Senate Bean Soup. Beans and peas are:

 An economical and healthy protein substitute

 One of the oldest foods dating back at least 4,000 years
 Naturally low in fat and with a high biological value
 An excellent source of fiber that can help with regular elimination and help to
lower cholesterol
 Versatile and easy to cook
 Mild in flavor and adaptable to many different cuisines
 Easily blended with many other flavors for tasty meals and side dishes
 Are soft and easy to chew
 Available canned and may be used in place of dry beans but contain higher
amounts of sodium and should be used less frequently.

Tips for cooking beans

 First, always rinse and sort through beans to be sure they are clean and free
from dirt and pebbles.
 Soak overnight in cool water or for 4 hours prior to cooking.
 Rinse after soaking and cover with fresh water. Bring to a boil and cook until
beans are completely soft. If you eat beans that are not thoroughly cooked you
will have more trouble with gas.
 Beans are ready to eat and enjoy. Use them in soups, stews, and casseroles or
as a spread for a sandwich. Cooked beans can be frozen and used later.
 Dry beans can be stored for a year in an airtight container.

Yield in Recipes

 1 cup of dry beans yields 2 ½ -3 cups cooked beans

 1 pound of dry beans yields 6-7 cups of cooked beans

Beans are a great low-fat protein. But when you cook them with sausages, salt pork or
ham, or serve with cheese, fat content goes way up.

With all the positive aspects of beans, some people avoid eating beans if they get
excess gas or feel bloated and uncomfortable after eating beans. By increasing
consumption of beans, the adverse effect of excess gas in the digestive tract can

Nutrition Appendix Page 23

become less of a problem. To improve tolerance here are some suggestions for
cooking and consuming beans:

 Soak beans overnight and before cooking.

 Rinse and add fresh water several times while cooking ; this helps rinse away
some of the gas-producing carbohydrates.
 Cook thoroughly. Remember that well-done beans are soft and tender. If you
can smash them with your tongue against the roof of your mouth, then they are
well cooked.
 Start by eating only a serving once a week. Then build up and eat more often.
 Drink plenty of fluids when you eat beans.
 For sensitive individuals they can try using Beano. This is an over-the-counter
enzyme product that helps reduce gas from beans and cruciferous vegetables
like broccoli, Brussel sprouts, cabbage and cauliflower .

 The American Gastroenterological Association offers these additional

suggestions to help prevent feeling bloated for individuals who experience
this and other related conditions after eating beans or other gaseous
producing foods:

If you wear dentures, have your dentist check them to be sure they
fit properly.
Don't chew gum or eat hard candies, particularly those that contain
sorbitol.
Avoid eating foods that contain high fructose corn syrup. Also avoid
carbonated drinks.
If you are lactose-intolerant, restrict dairy products.
Try exercise -- especially jogging, walking or calisthenics.

(HealthDay News) Copyright © 2012 ScoutNews, LLC. All rights reserved.

Nutrition Appendix Page 24

 APPENDIX D
VEGETARIAN MEALS

Vegetarian diets can be a healthy alternative to the traditional meat-based US diet.

They are often lower in fat, saturated fat and cholesterol, and higher in fiber. Recent
studies have shown that seniors who choose to eat a vegetarian diet can have nutrient
intakes that are similar to meat eaters. However, because some nutrient needs increase
with aging (calcium, vitamins D, B-6) and because some nutrients may be lower in
vegetarian meals, planning vegetarian menus can require more time and attention so
that nutrient needs are met.

Nutrients that are potentially low in vegetarian diets

Here is a list of nutrients that might be low i n a typical vegetarian diet and suggested
foods to increase nutrient intake.

 Calcium: dairy products or, if vegan, calcium-fortified soy milk, collard or turnip
greens, spinach, or tofu processed with calcium salt. Use milk in soups; serve
puddings, yogurt, low fat cheese in sandwiches, salads, casseroles , etc.
 Zinc: whole grains, soybeans, enriched cereals, yogurt, peanuts, legumes.
 Vitamin B-12: fortified foods or supplements to ensure good absorption; choose
animal foods such as dairy if included in diet.
 Vitamin D: If exposure to sunlight is limited and no dairy products are consumed,
a dietary supplement may be needed. Fortified soy milk and some fortified
breakfast cereals have increased vitamin D.
 Protein: plant-based protein sources such as legumes (dried beans and peas)
grains, legumes and seeds.

Vegetarian Menu Ideas

Spinach Vegetable Lasagna Corn Chowder

Tossed Salad, Cauliflower & Broccoli Mix Spanish Rice with Beans & Tortilla
Mixed Berry Fruit Cup Green Beans, Coleslaw
Whole Wheat Bread, Milk Am brosia Fruit Cup, Milk

Macaroni and Cheese Grilled Vegetable Pita Pocket

Stewed Tom atoes, Spinach Salad Potato Wedges, Cheddar & Pear Salad
Cookie and Tropical Fruit Cup Cantaloupe or Apple Juice
Potato Roll, Milk Blueberry Bran Muffin, Milk

Vegetable Pastry or Vegetable Calzone Penne Pasta Marinara or Alfredo Sauce

filled w/ Spinach, Carrots or Artichokes, and 3 Summer Squash, Pea and Peanut salad
Cheeses, w/ Tomato Dipping Sauce Baked Bread Stick
Mixed Greens w/Pineapple Plums, Milk Baked Apple, Milk

Vegetable “Boca” Burger Deluxe, Stir Fry Vegetables over Brown Rice
Kaiser Bun, Sliced Tomato, Lettuce, Potato Sesame Green Beans, Asian Coleslaw,
Salad, Grapes, Milk Chilled Peaches, Fortune Cookie, Milk
Nutrition Appendix Page 25
 APPENDIX E
BREAKFAST MEALS

Breakfast Meal Ideas

Traditionally, congregate and home delivered meals (HDM) are provided hot, at lunch
time 5-days-per-week for older adults. For HDM participants who are assessed in need
of a second meal, it can be provided as a dinner meal (i.e. sandwich, vegetables, fruit
and milk) or as a breakfast meal for the next day. Adding a breakfast portion to the
home delivered meal program with nutrient-dense foods can further improve the lives of
individuals identified to be at risk for nutrition related issues.

Also, for congregate programs that have morning programming, breakfast can add a
nutritional boost for busy seniors who are on the go early in the day.

See sample breakfast menus below:

Menu 1
Oatmeal, 1 cup
Low Fat Vanilla Yogurt, 6 oz.
Cranberries, ¼cup
Almonds, ¼cup
Banana, 1 med., Orange Juice, ½ cup
Low Fat or Skim Milk, 4 oz

Menu 2
Whole Wheat Bagel, 1 med.
Cheddar Cheese, Scrambled Egg 1 oz ea, or Peanut Butter 2 oz
Orange Juice ½ cup, ½ c mixed melon, Banana 1 med.
Low Fat or Skim Milk, 4 oz

Menu 3
Oatmeal Muffin Squares with ½ c Cottage Cheese
Orange Juice ½ cup, Dried Mixed Fruit 2 Tbs. and Apple, 1 sm.
Low Fat or Skim Milk, 4 oz

Menu 4,
Granola with Low Fat Vanilla Yogurt, 6 oz. or
Baked French Toast Strips or
Breakfast Burrito w/Salsa with
Orange Juice ½ cup, Applesauce ½ cup, and Raisins 2 Tbs.
Low Fat or Skim Milk, 8 oz

Nutrition Appendix Page 26

 APPENDIX F
STANDARDIZED RECIPES

A standardized recipe is a written recipe that has been tested and results in the same
consistent quality product each time it is made. Standardized recipes produce the same
yield when exact procedures are followed with the same equipment, quantity and quality
ingredients. Importantly, written standardized recipes are required by OSA.

Standardized recipes produce

 Consistent quality every time it is served

 Consistent production and cost control
 Accurate costing
 Baseline recipes for computer analysis of nutrient content and adherence to
standards
 Products without substitutions that can alter flavor, acceptability and adherence
to standards
 Time savings
 Consistent portions and help prevent excessive leftovers

Key elements of standardized recipes

 Name of recipe
 File or reference number
 Yield
 Ingredient list
 Equipment needed
 Method of preparation
 Garnish/presentation/portioning
 Storage

Other Benefits

If your regular cook is unavailable, another cook will be able to fill in and meet the
participant’s expectations. Standardized recipes support creativity in cooking by helping
employees commit to continuous quality improvement. Standardized recipes are written
and detailed so anyone can understand the directions kept on file.

Meal Planning and Preparation Service Resource List

http://www.nal.usda.gov/fnic/service/mealplanning.pdf?debugMode=false

Nutrition Appendix Page 27

 APPENDIX F.1
STANDARDIZED RECIPE SAMPLE FORM

Recipe Name______________________ Yield______ Serving

Size_____
Recipe Source
Work Sheet

Supplier Item code Ingredient Description Quantity

Cooking Instructions:

Nutrition Appendix Page 28

 APPENDIX G
MENU PLANNING AND NUTRIENT ANALYSIS

In order to ensure nutrient quality for the health of older Americans and to comply with
the requirements of the OAA, providers are required to establish written standards and
guidelines detailing the specific requirements for menu p lanning and approval. Planning
menus that includes input from participants is a best practice. Information may be
obtained through focus groups, advisory councils, taste panels, suggestion boxes, or
customer surveys. Suggestions may also come from food production staff, site
managers, home-delivered meal drivers, and food purveyors, OSA, and the AAA1-B .
Additionally menus require following standardized recipes that have been analyzed for
their nutritional content as required by OSA guidelines.

A cycle menu is a schedule of meals planned in advance for a certain period of time that
can be repeated. Cycle menus are not required by AAA1-B but are strongly
encouraged. Menus must be developed in consultation with the AAA1-B registered
dietitian. The process should emphasize creativity and healthy choices that are senior
friendly.

Cycle menus allow supervisors to

 Save time - plan ahead for work scheduling; decrease paper work
 Control costs - purchase foods in season and in bulk; decrease inventory,
control labor, substitute foods in recipes that have risen in cost or are not
available , and use forecasting to reduce waste
 Increase customer satisfaction - feature signature items, follow tested
process, repeat items on menu that are customer favorites , publish menu in
advance to promote nutrition program
 Nutrient Analysis-

Menu Planning
Follow basic planning principles:
 Balance: flavors, colors and key nutrients
 Variety: vary entrees and sides day to day, present foods in varying forms
and in different combinations ; introduce new foods periodically
 Contrast: textures, flavors, shapes, and colors
 Visual appeal: Food that looks interesting and colorful will be more
acceptable

Nutrient Analysis
A variety of nutrient analysis and meal prod uction software products are available and
used by, AAA's, and providers. Some simply provide analysis of foods, recipes, and
menus; others offer food production, inventory, and costing capabilities. Menus are
required to meet 1/3 of the DRI and must be analyzed using commercial software or
calculated using reference tables and kept on file for AAA1-B review and customer
information upon request.
Nutrition Appendix Page 29
 APPENDIX H
AAA 1-B MENU APPROVAL FORM

DATE: October 01, 2013 FAX #:

TO:

FROM: Karen Jackson-Holzhauer, RD, Contract Manager

Tel: (248) 262-9241, Fax: (248) 948-9691
SUBJECT: Menu Review & Approval Number of pages:
Service MO/YR: - Meal Type: Hot

Menu Review Guidelines Findings Recommendations

(Meets Requirements unless noted)
MyPlate pattern: Grains,
Protein, Fruit, Veg, Dairy
Presentation of meals:
variety, color, de scription,
taste, visual appeal, temp.
Recipe Creativity/Combo's,
Flavor
Portions Specified in
Recipes/ Analysi s/Yield
Calorie Count (kcals meet
minimum requirement meal)
2-3 oz Meat or Vegetarian
alternative (HBV Protein)
High fiber food(s) weekly
Vitamin B: rich food s
Legumes/Veggies/Grains
Vitamin C: Fruit/Vegetable
Vitamins A, D,E, K: rich food
Fruit/Veg/Nut (i.e. carrots,
spinach, broccoli, asparagus,
green beans, cauliflower)
Sodium average/week
Cultural/Ethnic/Local Menu
choice s reflect service area
Monthly Theme Meals
Fruit, or Desse rt ½ c. frui t
w/whole grain or LF dairy
Nutri tional Analysi s meets
DRI; submitted change s

Menu is approved with required corrections.

Please make required corrections and re submit for approval.

Im portant: This message is intended for use solely by the individual or entity to which it is addressed. It may contain information tha t is
confidential, private and otherwise exempt by law from disclosure. If you or your agency are not the intended recipient, you are herewith
notified that any dis tribution, dissemination, copying, or other use of this communication is strictly prohibited. If you have received this
communication in error, please call us immediately and return this communication to us at the Southfield address.

Nutrition Appendix Page 30

Approved: ________
 APPENDIX I
MODIFIED AND THERAPEUTIC DIETS

With the direction and expertise of the program’s registered dietitian, menus can be
modified to meet the special dietary needs of meal program participants. In deciding to
offer modified meals, a program should determine if there is a sufficient number of
people who need modification so that the service is practical and cost effective. In
addition, each program should evaluate if they have access to special ingredients,
foods, and the resources to prepare, serve and deliver the meals.

The modified meal must meet the minimum standards for the meal pattern, but one or
more of the menu items might be modified. For example, a diabetic diet might offer
applesauce instead of apple crisp; or a meal might be modified to accommodate
chewing restrictions by offering a pureed entrée. Other examples include reduced
sodium or limiting concentrated sweets.

In contrast, a therapeutic meal changes the meal pattern significantly and requires a
current, written physician order. The meal must then meet the requirements of the diet
order. The requirements and considerations that must be met in preparing therapeutic
diets are as follows:

 AoA law allows therapeutic diets to the extent that it is practicable for the
program to provide them and the program has all the resources to do it correctly.
 The diet order supersedes the requirements of the nutrition program. This
assumes that there is a current diet order on file and that it is updated freq uently.
 There must be a current physician order on file and it has to be reviewed at
assessment or following a hospitalization, especially in the case of renal diets.
 The meal has to then meet the diet order as prescribed
 A registered dietitian who has a specialty in therapeutic diets has to be a part of
the menu planning process, and if the patient is on renal dialysis, then the
dialysis RD also has to be part of the team.
 Meals have to be prepared by an individual who has been trained extensively on
how to follow the prescribed diet plan. These chefs (cooks) are usually have
hospital or nursing home experience and/or have specialized training with access
to a registered dietitian.
 Recipes and menus have to be approved by a registered dietitian.
 The physician, dialysis RD, and/or in/out patient RD and the AAA 1-B RD all
have to communicate regularly about all renal participants.
 Special foods to meet requirements may have to be purchased for use in meal
preparation.

If, and only if, all these requirements can be met should a program attempt to provide
therapeutic diets of any sort, in this case, especially a renal diet. Renal diets are
dynamic and require regular modifications, especially when dialysis is ongoing. If you
have participants who require meals based on specialized or therapeutic diets, you

Nutrition Appendix Page 31

might consider obtaining them from hospitals or other facilities with the supervision of a
registered dietitian.

Nutrition Appendix Page 32

 APPENDIX J
CULTURAL AND ETHNIC MEALS

Whenever possible it is desirable to incorporate local, cultural and ethnic foods in

menus to reflect the preferences of various populations served by the senior nutrition
program. This can increase participant enjoyment of meals and add variety to your
menus. In addition, the OAA encourages meal programs to target low-income, ethnic,
older Americans who are representative of the community service area

This is a particular concern also to the AAA1-B, as the percentage of people at risk for
poor nutrition is higher among the ethnic populations according to the Academy of
Nutrition and Dietetics. Greater use of dietary guidelines with foods included from the
major ethnic populations in the country, i.e. Hispanic, African Americans, Asians,
Eastern Europeans, and American Indians, would have a major impact on their
nutritional health.

Additionally, condiments, herbs and spices traditional in ethnic cuisine are ways to
introduce new flavors into meals for all populations and reflect the multicultural eating
habits of communities served.

Please see the websites below for Cultural and Ethnic Food and Nutrition:

From the Canned Food Alliance:

 Professional Resource Center

http://www.mealtime.org/default.aspx?id=320
 Ethnic Ingredients
http://www.mealtime.org/uploadedFiles/Mealtime/Content/flavorsheetfinal1.pdf
 The Global Pantry
http://www.mealtime.org/uploadedFiles/Mealtime/Content/ethnicpantryfinal.pdf

National Agricultural Library/USDA - 2011 Food and Nutrition Information Center -

Cultural and Ethnic Food and Nutrition Education Materials
http://www.nal.usda.gov/fnic/pubs/bibs/gen/ethnic.html

Nutrition Analyzer- Displaying Nutrition Facts in Ethnic Foods

http://www.nutritionanalyser.com/food_composition/?group=Ethnic%20Foods
http://www.pccnaturalmarkets.com/health/Healthy_Eating/Food_Guide_Pyramid.htm#Si
debar-

University of Florida Extension-Preparing Ethnic Foods

http://edis.ifas.ufl.edu/pdffiles/FY/FY34300.pdf

Nutrition Appendix Page 33

 APPENDIX K
REQUIRED NUTRIENT CONTENT FOR MEALS

1 meal/day 2 meals/day 3 meals/day

33% DRI/AI 67% DRI/AI 100% DRI/AI
Macronutrients
Kilocalories (Kcal)(1) 685 1369 2054

Protein (gm)(2,3) 37
19 56
[20% of total Kcal (gm)] (4) 69
34 103

Carbohydrate (gm) (5) 43 130

87
[50% of total Kcal (gm)] (4) 86 257
171
Fat (gm)
23 46 68
[30% of total Kcal (gm)] (6)
Saturated Fat
Limit intake (8)
(<10% of total Kcal) (7)
Cholesterol
Limit intake (8)
(<300 gm/day) (7)
Dietary Fiber (gm)(3) 10* 20* 30*
Vitamins
Vitamin A**(ug) (3) 300 600 900
Vitamin C (mg) (3) 30 60 90
Vitamin D (ug) (3) 5* 10* 15*
Vitamin E (mg) 5 10 15
Thiamin (mg) (3) 0.40 0.80 1.20
Riboflavin (mg) (3) 0.43 0.86 1.30
Vitamin B6 (mg) (3) 0.57 1.13 1.70
Folate (ug) 133 267 400
Vitamin B12 (ug) 0.79 1.61 2.4
Minerals
Calcium (mg) 400* 800* 1200*
Copper (ug) 300 600 900
Iron (mg) 2.70 5.30 8.00
Magnesium (mg) (3) 140 280 420
Zinc (mg) (3) 3.70 7.30 11.00
Electrolyte s
Potassium (mg) (9) 1167 2333 3500
Sodium (mg) (7) <800 <1600 <2400

Nutrition Appendix Page 34

 APPENDIX L
FOOD SAFETY

Food safety
 Is the responsibility of everyone involved in food preparation
 Means preparing and serving safe foods 100% of the time
 Begins with well trained and knowledgeable food service workers

Knowledgeable and well trained food service workers know that:

 They have a professional obligation to serve safe and nutritious foods
 Seniors are at high risk for food borne illness and serious complications
(dehydration, etc.)
 Food safety guidelines are included in newly revised USDA Dietary Guidelines

USDA Dietary Guidelines – The newly revised guidelines suggest these tips to avoid
microbial food borne illness:
 Clean hands, food contact surfaces, and fruits and vegetables
 Meat and poultry should not be washed or rinsed
 Separate foods and avoid cross contamination
 Cook foods to safe temperature
 Chill perishable foods promptly
 Avoid unpasteurized milk, raw eggs, raw or undercooked meat and poultry,
unpasteurized juices, and raw sprouts

Sources of Food Borne Illness

 Biological – bacteria, viruses, parasites, yeast
 Physical – glass, toothpicks, fingernails
 Chemical – cleaners, sanitizers, pesticides
 Naturally occurring – fish or plant toxins

Symptoms of Food Borne Illness

 Flu-like conditions
 12-36 hours onset
 Diarrhea, cramping, nausea, vomiting, low-grade fever, body aches
 Serious symptoms can include system shutdown, coma, and death

Causes of Food Borne Illness

 Humans
o Contaminated hands, illness
o Improper hand washing causes 30% of all food borne illness
 Foods
o Contaminated foods
o Time and temperature problems
 High risk foods
o Food from unapproved source
Nutrition Appendix Page 35
 o Unsound condition of food or adulterated food
o Shellfish records not properly maintained
o Cooked or raw animal protein including meats, dairy, milk, cheese, fish,
seafood
o Sprouts and melons
o Tofu, raw seed spouts, cut melons, garlic in oil
o Raw honey
o Unpasteurized egg products and unpasteurized juices
o Home canned products

 Inadequate Cooking, Holding and Cooling or Reheating Temperatures

o Cooking temperatures must reach the following temperatures:
 165° Reheating cooked foods
 165° Poultry, stuffed meats and pasta reheating
 155° Ground beef or pork
 145° Whole muscle meat (beef, pork, fish)
 130° Rare roast beef
o Holding Temperatures - Minimum hot holding temperature 135°
 Use the proper equipment
 Stir frequently to distribute temperature
 Covered foods maintain temperature longer
o Holding Temperatures - Proper cold holding temperature is 41° or below
 Keep cold foods in refrigerated cases or cold holding tables
 Place foods on ice to keep chilled
 Check temperatures on a regular basis
 Cover to retain coolness
o Proper Thawing
 Never thaw on countertop
 In a cooler or refrigerator at 41° or less
 Under cold running water (70°) for two hours or less
 During the cooking process with no interruptions
 Microwaving as first step in cooking
 Improper Handling
 Contamination
 Poor Personal Hygiene
 Environmental Contamination

Conditions for Microbial Growth

 Food source  Time

 Temperature - Danger Zone 41° - 130°  Acidity
 Oxygen  Moisture

Food and Safety Websites:

Food safety for older adults -See Food Safety on the GO evidence based program
resources: http://www.nfsc.umd.edu/FoodSafety/index.cfm
Nutrition Appendix Page 36
 APPENDIX M
CHOOSE MYPLATE
Benefits of MyPlate, the USDA's communication initiative:

 MyPlate is a new generation icon intended to prompt

consumers to think about building a healthy plate at meal times
and to seek more information to help them do that by going to
www.ChooseMyPlate.gov. The new MyPlate icon emphasizes
the fruit, vegetable, grains, protein and dairy food groups.
 In an effort to create cohesion among federal agencies and
promote positive nutrition behaviors to consumers, the MyPlate
communications initiative will support the 2010 Dietary Guidelines for Americans with
consumer relevant themes and easy-to-understand, action-oriented messages.
 As comprehensive federal policy, the Dietary Guidelines informs nutrition information
delivered by industry, public health programs, community initiatives, schools and
consumers.
 The goal of the initiative will be to support Americans in building healthy diets.

Through MyPlate, the USDA:

 Provides an easy-to-understand icon that will help deliver a series of healthy eating
messages that highlight key consumer actions based on the 2010 Dietary Guidelines for
Americans.
 Empower people with information they need to make healthy food choices.

MyPlate target audiences are:

 Individuals and families who are struggling to maintain a healthy lifestyle among
numerous other challenges.
 Federal agencies that develop materials containing nutrition guidance and/or oversee
nutrition programs.
 Organizations and industry involved in promoting positive nutrition behaviors and/or
giving nutrition advice to the general public.

MyPlate will better inform consumers:

 The MyPyramid food image, while useful as a teaching tool, was perceived by many as
outdated and too complicated. MyPyramid will remain available to interested health
professionals and nutrition educators in a special section of the new website.
 Qualitative research over the years indicates frustration among consumers over what
they report as hearing contradictory nutrition information.
 The communications initiative will build on a familiar image (a plate) and actionable
messages to encourage consumers to make healthy choices.
Nutrition Appendix Page 37
Resources are available to help professionals implement MyPlate:

The USDA has set up a website, ChooseMyPlate.gov, with tools and resources
to help consumers put the Dietary Guidelines into action by building healthy
eating patterns for meal times.

Dietary Guidelines 2010: Select Messages for Consumers

Take action on the Dietary Guidelines by making changes in these three areas.
Choose steps that work for you and start today.

Balancing Calories

 Enjoy your food, but eat less.

 Avoid oversized portions.

Foods to Increase

 Make half your plate fruits and vegetables.

 Make at least half your grains whole grains.
 Switch to fat-free or low-fat (1%) milk.

Foods to Reduce

 Compare sodium in foods like soup, bread, and frozen meals, and choose
the foods with lower numbers.
 Drink water instead of sugary drinks.

Nutrition Appendix Page 38

 APPENDIX N
CARBOHYDRATE COUNTING
AND GLYCEMIC INDEX

Carbohydrate Counting

Carbohydrate counting is a way individuals with diabetes can keep track of daily intake
of carbohydrates and thereby better manage their disease. Menus are required to
indicate the number of carbohydrates in each meal which helps participants to keep
track of daily total carbohydrate intake.

Carbohydrate counting specifically measures the upward drive each meal has on blood
sugar, and allows food to be accurately balanced with insulin or with exercise. Better
control will result from knowing how much carbohydrate is in the foods eaten. To count
carbohydrates consider the total carbohydrates in a meal.

Total Carbohydrates

Research shows that it is the total amount of carbohydrates that matters most to blood
glucose control. In other words, if today for supper all carbohydrates were eaten as
pasta, and tomorrow all carbohydrates were consumed as syrup and milk, it won't likely
affect insulin needs and diabetes control as long as the two meals are fairly equal in
total carbohydrate. Of course, to get them to be the same, the number of grams of
carbohydrates must be counted.

It's like saying you have $5.00 to spend each day for supper and no matter what, you
should always spend about $5.00. What you spend it on is up to you. Some people
who master carbohydrate counting can change the amount of carbohydrate they eat at
a meal by using their carbohydrate to insulin ratio.

Sample dinner menu:

2 Starch (one starch is 15 grams) = 30 grams carbohydrate (CHO)

1 Fruit (each fruit is 15 grams) = 15 grams CHO
2 Vegetables (each vegetable is 5 grams) = 10 grams CHO
1 Milk = 15 grams CHO
1 Meat = no carbohydrate in meat

Total: 70grams CHO/15 grams CHO per Starch choice = 4 1/2 total carbs

Things to consider:

 Carbohydrate counting requires doing some math.

 Have an updated meal plan prepared by the individual with the help of a dietitian.
 Try to keep calculations to within three to five grams of the total carbohydrate per
meal; note that insulin-dependent individuals may have to calculate more closely.
Nutrition Appendix Page 39
  Remember, healthy eating means getting plenty of fruits and veggies, while
limiting fat and protein - so don't consume all carbohydrates in the form of
chocolate bars.
 When reading labels, subtract grams of fiber from the total grams of
carbohydrate. Fiber is a carbohydrate, but does not affect blood glucose levels.
 Check labels and recipe books; it is surprising to see some favorite foods
(sweets, cookies, cereals, crackers, TV dinners, beverages) list grams of
carbohydrate per serving.
 Monitor and record blood glucose regularly to learn if the technique for
carbohydrate counting needs polishing (i.e., more caution with portion sizes).

Glycemic Index

The Glycemic Index gives this value for a variety of foods. A high Glycemic Index
indicates a quicker rise in blood glucose. The Glycemic Index measures how fast a food
is likely to raise blood sugar levels and can be helpful for managing blood sugars. For
example, if blood sugar is low and continuing to drop during exercise, one would prefer
to eat a carb that will raise blood sugar quickly. On the other hand, to keep blood sugar
from dropping during a few hours of mild activity, consider eating a carb that has a lower
Glycemic Index and longer action time. If blood sugar tends to spike after breakfast,
consider selecting a cereal that has a lower Glycemic Index.

Glycemic Index of Selected Foods:

Glucose 100 Corn 59

Carrots 92 Peas 51
Honey 87 Oatmeal 50
Baked potato 85 Whole wheat pasta 42
White rice 72 Oranges 40
White bread 69 Low fat yogurt 33
Bananas 6

The numbers give that food's Glycemic Index based on glucose, which is one of the
fastest carbohydrates available. Glucose is given an arbitrary value of 100 and other
carbs are given a number relative to glucose. Faster carbs (higher numbers) are great
for raising low blood sugars and for covering brief periods of intense exercise. Slower
carbs (lower numbers) are helpful for preventing overnight drops in the blood sugar and
for long periods of exercise.

Discuss advanced carbohydrate counting with a dietitian or your health care

professional to learn how to determine how much extra insulin is needed to cover eating
extra carbohydrate at a specific meal time.

Nutrition Appendix Page 40

 APPENDIX O
NUTRITION SCREENING INITIATIVE

Nutrition Screening Initiative ¹

Nutrition screening is a first step in identifying individuals at nutritional risk or with

malnutrition. Screening tools, such as the Nutrition Screening Initiative (NSI) and the
"Mini Nutritional Assessment" (MNA) have been used in different settings to screen
older adults for nutrition risk. The NSI Checklist was designed to increase older adults'
awareness about nutrition and health. The Mini Nutrition Assessment (MNA®) was
designed to identify older adults (>65 years) at risk of malnutrition. Both help
differentiate among adequate nutritional status, malnutrition risk, and malnutrition.
Title III, Section 339 of the OAA requires that nutrition projects provided nutrition
screening.

The AoA as part of its reporting requirements in the State Performance Report requires
that states report on nutrition risk status of individuals who receive home-delivered and
congregate meals, nutrition counseling, and/or case management. The NSI Checklist,
was initially developed as a public awareness tool. OSA requires that the NSI Checklist
be used as part of the congregate registration/intake and HDM assessment. AoA
requests that States report, through NAPIS, the 10 questions and under ideal
circumstances when an older adult is identified as being at nutritional risk, it is
recommended that a referral be made to a dietitian or the participants health care
provider. A dietitian then conducts a nutrition assessment to obtain more specific
information regarding the individual's anthropometric, biochemical, clinical, dietary,
psychosocial, economic, functional, mental health, and oral health status.

Nutrition screenings and/or assessments may be administered at a individual's home,

congregate dining center, health fair, doctor's office.

For additional information see : Older Americans Act Nutrition Programs Toolkit -
nutritionandaging.fiu.edu/...Toolkit/toolkit%20update%202.7.06.pdf

Nutrition Appendix Page 41

 APPENDIX O.1
D.E.T.E.R.M.I.N.E. YOUR
NUTRITIONAL HEALTH

Nutrition Appendix Page 42

 APPENDIX O.2
THE NUTRITION CHECKLIST

Nutrition Appendix Page 43

 APPENDIX P
DIETARY GUIDELINES FOR AMERICANS

USDA 2010 Dietary Guidelines Communications Message Calendar

September 2011 – December 2013 Center for Nutrition Policy and Promotion

The 2010 Dietary Guidelines for Americans (DGA) are the foundation for federal dietary
guidance promotion and education efforts aimed at improving America’s health and
reversing obesity and chronic diet-related diseases. Communicating the DGA to not
only inform consumers, but to change behaviors, has never been more critical. The
DGA consumer communications initiative is a multi-modal approach in order to sustain
momentum and ultimately change behavior. One key element of this initiative is a multi-
year strategy to coordinate and streamline nutrition messages delivered by the public
and private sectors for the public. When the 2010 DGA were released, they were
accompanied by selected messages for consumers (outlined on the other side) related
to several major themes. These key Dietary Guidelines themes, and background
information for each, are:

Balancing Calories
 Calorie balance refers to the relationship between calories consumed from foods
and beverages and calories expended in normal body function and through
physical activity.
 Achieve and sustain appropriate body weight across the lifespan to maintain
good health and quality of life.
 To address current calorie imbalance in the United States, individuals are
encouraged to become more conscious of what, when, why and how much they
eat.

Foods to Reduce
 Certain foods and food components are consumed in excessive amounts and
may increase the risk of certain chronic diseases. These include sodium,
saturated fat, trans-fatty acids, added sugars, and refined grains.
 Eating less of these foods and food components can help Americans meet their
nutritional needs within appropriate calorie levels and help to reduce risk of
chronic diseases such as cardiovascular disease, diabetes and certain types of
cancer.

Foods to Increase
 Many Americans do not eat the variety of foods that will provide all needed
nutrients while staying within calorie needs.
 Intakes of vegetables, fruits, whole grains, milk and milk products, and oils are
lower than recommended. As a result, several key nutrients – potassium, dietary
fiber, calcium and vitamin D – are of public health concern for older adults
 More emphasis is placed on foods choices that are nutrient dense and from the
fruits, vegetables, whole grains, low-fat and fat-free milk and milk products food

Nutrition Appendix Page 44

 groups. These foods can help Americans close nutrient gaps and move toward
healthful eating patterns.
Be Active Your Way
 This message was developed to support the 2008 Physical Activity Guidelines
developed by the Department of Health and Human Services.

USDA’s Center for Nutrition Policy and Promotion will lead a coordinated messaging
approach among public and private sector partners to help USDA amplify the reach of
the primary DGA consumer themes and nutrition messages through media and
stakeholder outlets. The following calendar outlines the selected key messages that will
be promoted through December 2013.

 Resources, such as “how-to's,” supporting messages, and educational materials,

will be provided to support each message at www.ChooseMyPlate.gov.
 Partners will receive updates and information prior to each key message rollout.
 For more information about the Partnership program, please visit
http://www.ChooseMyPlate.gov/Partnerships/index.html.

Dates Theme Selected Key Message

Sept. – Dec. 2011 Foods to Increase Make half your plate fruits and
vegetables.
Jan. – April 2012 Balancing Calories Enjoy your food, but eat less.
May – Aug. 2012 Foods to Reduce Drink water instead of sugary drinks.
Sept. – Dec. 2012 Foods to Increase Make at least half your grains whole
grains.
Jan. – April 2013 Balancing Calories Avoid oversized portions.
May – Aug. 2013 Foods to Reduce Compare sodium in foods like soup,
bread, and frozen meals – and choose
the foods with lower numbers.
Sept. – Dec. 2013 Foods to Increase Switch to fat-free or low-fat (1%) milk.

Additional Theme: “Be Active Your Way” will be emphasized throughout this initiative.
Balancing healthy eating with regular physical activity is essential. Resources will be
available on the Department of Health and Human Services website in addition to
USDA Center for Nutrition Policy and Promotion’s forthcoming interactive tool, allowing
users to track and assess their diet and physical activity.

Nutrition Appendix Page 45

 APPENDIX Q
DIETARY REFERENCE INTAKES
AND TABLE FOR OLDER ADULTS

Dietary Reference Intakes (DRI)

What are they? The DRI's estimate the nutritional requirements of healthy people. There are
separate categories for age groups. See Table 1: Dietary Reference Intakes for Older Adults.

DRI are comprised of 4 sub-groups:

1. Estimated Average Requirement (EAR)

a. Amount estimated to meet needs of 50% people in certain gender and age
group. It is an average daily value.

2. Recommended Dietary Allowance (RDA)

a. Amount of a nutrient that would meet the nutritional need of 97-98% in a
group. These are goal values for individuals.

b. Thiamin, riboflavin, niacin, folate, E, C, B-6, B-12, phosphorus,

magnesium, selenium.

3. Adequate Intakes (AI)

a. Amount estimated to meet the need when sufficient scientific evidence is
lacking to calculate the EAR or RDA.

4. Tolerable Upper Intake Levels (UL)

a. The amount that is unlikely to harm. This amount exceeds the RDA and
should not be seen as a goal.

Table 1: Dietary Reference Intakes for Older Adults (age 50-70 years):

Fiber 30 gm/day for males

21 gm/day for females

Total Fat 20-35% total Kcal/day

Calcium 1200 mg/day

Vitamin C 90 mg/day for males

75 mg/day for females

Vitamin A 900 micro grams/day for males

700 micro grams/day for females

Nutrition Appendix Page 46

 APPENDIX Q.1
RECOMMENDED DAILY ALLOWANCES:
MOST FREQUENT QUESTIONS

Nutrition Appendix Page 47

 APPENDIX R
SHELF STABLE MEALS

Emergency meals are shelf-stable ready to eat food products that are provided to
participants determined to need such food products if the program is unable to deliver
meals due to weather or other problems.

Shelf stable meals are an excellent way to insure that seniors have access to food even
in emergency situations. Meals must meet minimum standards. These meals should
be labeled to instruct participants on when and how they should use their emergency
meal packages and to combine items for a meal with written suggestions for preparing
additional emergency food stores. Cans and packaging should be easy to open and
boxes must be labeled with use by/expiration dates. See the emergency preparedness
guidelines for additional nutrition requirements.

These meals should be replenished every six months to insure that expiration dates
have not been exceeded and that foods remain fresh and palatable. Here are some of
the foods that can be included in shelf stable meal packages:

Entrée
Fruit/vegetable juices
Crackers, breadsticks
Dry cereal
Shelf stable, canned or dry milk
Dried fruit
Vegetable or meat soups
Canned fruits and vegetables
Snack breads, cookies, pudding

SAMPLE SHELF STABLE MEALS

Six Meal Box - Each Meal Individually Wrapped and Labeled:

Emergency Use ONLY

Meal 1
Tuna 3 oz.
Saltines, Low Sodium 4 pk.
Mayonnaise, Relish 1 ea.
Raisins 1 oz.
Nutrition Bar 1 oz.
Pineapple Orange Juice 6 oz.
Instant Non Fat Dry Milk 1 ea.
Water 12 oz.

Nutrition Appendix Page 48

Meal 2
Chicken Breast, Canned 3 oz.
Grape Juice 6 oz.
Mayonnaise 1 ea.
Wheat Crackers 4 pk.
Peach Cup 4 oz.
Pudding Cup 4 oz.
Instant Non Fat Dry Milk 1 ea.
1 Water 12 oz.

Meal 3
Vegetarian Beans 3 oz.
Rye Crisp, Low Sodium 2 pk.
Vienna Sausage 1 ea.
Pudding Cup 4 oz.
Pineapple Orange Juice 6 oz.
Instant Non Fat Dry Milk 1 ea.
Water 12 oz.

Meal 4
Peanut Butter 3 oz.
Orange Juice 6 oz.
Graham Crackers 2 pk.
Peach Cup 4 oz.
Raisins 1 oz.
Instant Non Fat Dry Milk 1 ea.
1 Water 12 oz.

Meal 5 and 6
Bran Flakes 1 indiv. box
Rice Krispie 1 indiv. box
Apple Juice 6 oz. 1
Orange Juice 6 oz. 1
(or fortified Vitamin C rich juice)
Graham Crackers 4 packs
Nutrition Bar 1 oz. 2 bars
Peanut Butter ¾ oz. 2 packs
Raisins 1 oz. 1 pack
Assorted Fruit 2 cans
Instant Non-Fat Dry Milk 2 ea.
Water 12 oz. 2 ea.

Nutrition Appendix Page 49

 APPENDIX S
2ND MEAL TAKE HOME OPTION

Meals Taken Home from a Congregate Site

Nutrition providers may elect to offer second meals (2 nd Meal) at specified dining sites.
A second meal must meet the OSA nutrition standards and is defined as a shelf-
stable meal, a frozen meal, or a meal that is low-risk for food borne illness.

A meal may be taken home when a participant regularly dines at a at the meal site or is
a home delivered meal participant. The participant should request a 2nd Meal following
the nutrition provider’s process; (i.e. phone request, sign up in advance) to allow for
advance preparation and the 2nd meal should be given to the participant when they
leave the congregate site to allow for safe food handling i.e. keeping hot food ho and
cold foods cold. The meals should differs from a ready-to-eat hot meal served on site at
breakfast, lunch or dinner unless a similar or the same meal is requested by the
participant. All foods taken home must be stored properly until the participant is ready
to leave for the day. See OSA transmittal letter # 2012-257

Sample Menu 1
Chilled Chicken Salad Platter 3 oz.
WW Cranberry Muffin 1 ea.
Margarine, 1 ea.
Coleslaw 1 oz.
Apple Juice 6 oz.
2% Milk 8 oz.

Sample Menu 2
Chicken Breast, Canned 3 oz.
Grape Juice 6 oz.
Mayonnaise 1 ea.
Wheat Crackers 4 pk.
Peach Cup 4 oz.
Pudding Cup 4 oz.
Instant Non Fat Dry Milk 1 ea.
1 Water 12 oz.

Meal 3
Vegetarian Beans 3 oz.
Rye Crisp, Low Sodium 2 pk.
Vienna Sausage 1 ea.
Pudding Cup 4 oz.
Pineapple Orange Juice 6 oz.
Instant Non Fat Dry Milk 1 ea.
Water 12 oz.

Nutrition Appendix Page 50

 APPENDIX T
NUTRITION EDUCATION

Health promotion and evidence based programs for older adults focus on increasing
control over and improving their health in a variety of areas; for example, nutrition,
physical activity, mental health, alcohol and substance reduction, tobacco use. Wellness
and evidence based programs--a type of health promotion program--involve all aspects
of the individual: mental, physical, and spiritual. These types of programs provide
structured opportunities to increase knowledge and skills in specific areas, such as
chronic disease self management, pain management stress management, fall
prevention and exercise. The supportive environment nurtures the emotional and
intellectual aspects of participants, and helps them become increasingly responsive to
their health needs and quality of life. These programs are usually short -term i.e. 6
weeks and educational rather than therapeutic in nature.¹ Programs are encouraged to
refer participants to programs being held at senior nutrition sites and other AAA1-B
affiliated locations in addition to recruiting and referring potential lay leaders from the
community to be trained to facilitate these programs.

Monthly Focus for Nutrition Education

As part of the AAA1-B senior nutrition program contractors are required to provide
monthly nutrition education for nutrition services provided. If you are looking for good
ideas for some of your nutrition education efforts, focus on National Health
Observances (NHOs) are special days, weeks, or months designed to raise public
awareness about important health topics. NHOs provide unique opportunities for public
health and medical professionals, consumer groups, and others to encourage their
community members to stay healthy.

Go to national health observances at healthfinder.gov, nho toolkits help programs make

a difference.. Use NHO toolkits to: share important health messages, promote fun,
interactive resources, organize events to create change in your community
March is National Nutrition Month® (NNM) and promotes a theme that can be
carried out the year long. See http://www.eatright.org/NNM for additional information.

Promote Nutrition Education

 newsletters, chef and RD demo's taste samples
 guest speakers providing healthy snacks, recipes
 host classes post nutritional information
 local cable TV, radio spots table top discussions

For additional information see : Older Americans Act Nutrition Programs Toolkit -
nutritionandaging.fiu.edu/...Toolkit/toolkit%20update%202.7.06.pdf

Nutrition Appendix Page 51

 APPENDIX U
NUTRITION ASSESSMENT
DATA COLLECTION MATRIX

AAA 1-B Nutrition Assessment Data Collection Matrix

Definition of Terms: Data Key:

Inputs=Resources used to assess, produce and deliver a service. All=All Services
Outputs=Information data elements resulting from participant assessment/intake. ADL's=Activ ities of Daily Living ADHS=Adult Day Health Services
IADL's= Independent Activities of NAPIS=National Aging Program
Protocol/Method to Document=Procedures that w ill be follow ed by agency staff. Daily Living Information System
Outcomes=This is the affect on the partic ipant servic e component. Bridge Card=SNAP Nutri=Nutrition
Benchmarks=Identifies best practice and targeting information. CM=AAA1-B Care Management RA=Resource Advocates
Cong=Congregate UI-Universal Intake
Agency: HDM=Home Delivered Meals MNT=Medical Nutrition Therapy
Software:
Revised October 12, 2011

HDM ASSESSMENT PROTOCOLS/METHOD TO OUTCOMES AND OTHER

DATA DEFINITION OF IT EMS OUTPUTS
ITEMS DOCUMENT BENCHMARKS
KEY
Intake Date The date information is obtained or Default to today's date. N/A Benchmark trends for service
entered into the database. Prior to utilization (i.e., snowbirds,
assessment, this is the date that holidays) local, regional, state data
eligibility is determined and enough issues.
information is gathered to start the
meal.

Referral Source Person/relationship or organization Hospital Discharge, Home Care, Chore, This shall include categorical Benchmark referral sources;
requesting the meal for . Resource Advocacy, DHS, Food information. Hospital discharges indicators to identify potential
Pantry/Bridge Card, AAA 1-B, Other, Self, 1st priority for HDM and CM (AAA1-B) referrals; indicators for
Spouse, Family, refused to provide. participants. Local specific additional training and outreach.
referral info. May be gathered by
Nutri providers.
1. Assessment 1. Assessment (In-Person); Initial Assessment Date; Reassessment Date N/A Timely follow -up for
2. Reassessment visit with partic ipant. Per RFP Month, Date, Year reassessment.
guidelines. 2. Next Reassessment,
document any contact after initial
assessment for purpose of
evaluation. Per RFP guidelines.

Nutrition Appendix Page 52

Participant Name (first, Self Explanatory Name, phone, address, dob. Attempt visual verif ication of birth Accurate/non-duplicative
last, and middle initial), date. participant data; Benchmark age
Phone, Address, Birth
date
Marital Status/Living This explains the participant’s status Tw o drop downs: STATUS (single, w idow, Caregiver, spouse, partner Benchmark marital status, lives
Situation (single, widow, married, partner or married, partner, other) and LIVES WITH eligibility shall be considered in w/status, caregiv er status
other). Liv ing Situation (alone, (alone, family (caregiv er-spouse, family, development of the service plan.
w/caregiver, or other living situation). other, refused). Also description of
Caregiver is defined as spouse, Caregiver (b/date, race, gender, refused).
family, or other. Consider obtaining Also consider housing situation (I.e.,
caregiv er birth date, race, and assis ted living, single family,
gender. Example of other living apartment)/Refused
situation may be assisted living.
Race/Ethnicity Afric an American, Not of Hispanic Same categories as previous box include: N/A Benchmark race
Origin - A person having origins in refused
any of the black racial groups of
Afric a. Hispanic Origin - A person of
Mexican, Puerto Rican, Cuban,
Central or South American or other
Spanish culture or origin, regardless
of race. American Indian or Alaskan
Native - A person having origins in
any of the indigenous peoples of
North America, and who maintain
cultural identification through tribal
affiliation or community recognition.
Asian American/Pacif ic Islanders - A
person having origins in any of the
indigenous people of the far east,
Southeast Asia, the Indian
Subcontinent (includes India,
Afghanistan and Pakistan), or the
Pacific Islands. This includes China,
Japan, Korea, the Philippine Island,
Samoa, and the Haw aiian Islands.
Other - Refers to persons whose
response to the race item on the
census could not be categorized in a
specif ic group. The census data is
based on individual’s self-
identification, that is, their perception
of their own racial identity.

Below poverty level Drop dow n w ith current poverty Below poverty participants should Benchmark poverty. Indicator of
amount Check Yes or No or Refused be advised of other food need for additional food or social
programs (i.e., Bridge cards, food service programs.
pantries, or other social services);
Referrals to Resource Advocates
at least at reassessment

Nutrition Appendix Page 53

Physician Business Name, Phone, Address, Space for more than 1 1. If there is no physician give # Benchmark types of physicians
Specialty to hospital referral line, or vis iting
physic ian; participant may refuse.
2. Do not recommend a specif ic
physic ian.

Pharmacy Business Name, Phone, Address Space for more than 1 1. If more than one pharmacist: Benchmark Pharmacies
recommend using only 1
pharmacist or medication review
with physician or pharmacy.
Include OTC and prescriptions.
2. Do not recommend a specif ic
pharmacist.

*Sensory Impair ments: Drop dow ns: Sight, Hearing, Speech, Taste, Referrals to the AAA 1-B Increase referrals to aging
Sight, Hearing, Speech, Check Yes or No Smell, and Tooth/mouth problems. Level of vision/hearing contractors for network, vis ion/hearing/dental
Taste, Smell, From Determine Risk Screen Impair ment (1-3). 1=None; 2=Some; those newly impaired. Referrals specialties. Education of
Tooth/Mouth problems 3=Total. Use of assistive devic es would be to the AAA 1-B Resource Center participant regarding taste.
considered #2. for resources or family including Educate drivers regarding
dental. If vision problem, ask if vision/hearing. Improve quality of
they can see pills. If chewing participant's lif e. (Note: If trouble
problem recommend with many ADL's recommend
mechanically altered meals or contacting AAA1-B)
liquid supplements.

Use of Prostheses Above Knee Amputee (AKA), Below Knee 1. If difficulty eating, recommend Increase referrals to aging
Check Yes or No Amputee (BKA), Right Arm (RA), Left Arm adaptive devic es; 2. If difficulty network. Improve quality of
(LA), Right Foot (RF), Left Foot (LF), Eye ambulating, indicate participant participant's lif e.
may be slow getting to door; 3.
Referrals to Chore/Home Injury
Control; and 4. Recommend
participant contact physician if
having diffic ulty with prosthesis.

Nutrition Appendix Page 54

Medical History/ Cognitive Impairment Information sheets dis tributed for Awareness for any nutritional
Diagnosis Check Boxes. 1. Medical (Dementia/Alzheimer's, etc.), Arthritis, top 10 DX's. DX impedes kind or implications. Referrals to aging
History (HX) - taken only once, at Cancer, Stroke, Diabetes, High Blood amount of food eaten, instruct on network.
the initial assessment. "Include Pressure, Heart Disease, Neurological availability of nutri. Supplements,
information about injuries and (Parkinson's/Multiple Sclerosis, etc.), frequency of meals, referral to
diseases that continue to impact a Respiratory/Lung Disease, Gastro intestinal, physic ian or dietary counseling
participant's mobility or cognition." allergy (latex or other); Other; Refused (hand out to be developed). If
2. Medical Diagnosis (DX) - taken at participant indicates they don't
initial assessment, and added to at feel well, recommend contact
each reassessment as needed. doctor or ask if participant would
like assessor or caregiver to
contact. Offer to dial the phone.

Change in Recent Cognitive Impairment This question shall be asked at Awareness for nutritional
Medical Condition, Check Box , list hospital stays (Dementia/Alzheimer's, etc.), Arthritis, reassessment. Information implications. Referrals to aging
Including Hospitalization Information taken at each Cancer, Stroke, Diabetes, High Blood sheets distributed for top 10 DX's. network.
reassessment Pressure, Heart Disease, Neurological See protocols above.
(Parkinson's/Multiple Sclerosis, etc.),
Respiratory/Lung Disease, Gastro intestinal,
allergy (latex or other); Other; Refused

Nutrition Appendix Page 55

*Medication use and risk 3 or more meds/day; more than 1 1. If 3 or more meds recommend Relief from med. costs. Decrease
factors Check Yes or No prescribing physic ian, more than 1 to contact/follow -up with instance of misuse/or need for
From Determine Risk screen pharmacy. Takes 1 or more of follow ing: physic ian or pharmacist to review med management.
Digoxin, Theophylline, Phenoytain (Diantin), interaction issues. 2. Takes 1 or
Lithium, Comadin more of the follow ing: Digoxin,
Theophylline, Phenoytain
(Diantin), Lithium, Comadin. Ask
about ongoing follow -up and
physic ian monitoring. 3. Discuss
ability to pay for medications.
Assis tance w ith med costs
referrals to AAA 1-B Resource
Center (MMA P) or Resource
Advocacy contractor. 4. Ask
participant if they take vitamins or
herbal supplements? If yes,
recommend discussing with
doctor. 5. If on insulin, and
skipping meal or snack
recommend to follow prescribed
diet or see physician. 6. Ask do
you have your blood checked? If
or can't remember not done
within 6 months refer to
physic ian. 7. If participant is on
Comadin, assessor may not
include liquid supplement in care
plan w ithout discussion w ith
physic ian.

ADLs Level of impairment 1=None, 2=Some, If more than 3 late loss ADLs, Benchmark referrals. Keep
Check Box means requires 3=Total. Use of assistive devic es is referral to AAA 1-B Resource independent in home as long as
assis tance. Review OSA NAPIS considered #2. Eating/Feeding, Dressing, Center or Resource Advocacy. possible.
website for definitions. Bathing, Walking, Stair Climbing, Bed Respite referrals to AAA 1-B for
Mobility, Toileting, Bladder Function, Bow el caregiv ers (visit www.aaa1b.com
Function, Wheeling, Transferring, Mobility for caregiver resources tab).
Level

Nutrition Appendix Page 56

IADLs Level of impairment 1=None, 2=Some, Referrals to AAA1-B or Resource Benchmark referrals. Keep
Check Box means requires 3=Total. Use of assistive devic es is Advocacy for assistance if no people independent in home as
assis tance considered #2. Shopping, Handling caregiv er or caregiver is unable long as possible.
Finances, Heating Home, Taking or unwilling to provide assis tance.
Medication, Light Cleaning, Doing Laundry, Referrals to Resource Advocacy
Cooking Meals in oven/microw ave, for assistance if no regular
Reheating Meals, Heavy Cleaning, Keeping assis tance available.
Appointments, Using Phone, Using Public
Transportation, Using Private Transportation

Who Provides ADL/IADL Caregiver (paid or informal): Name Respite referrals to AAA 1-B for Benchmark referrals.
Assis tance (add categories for relationship [I.e., caregiv er resources; visit
agency, other]), Phone, None www.aaa1b.com.
Services in Place ADHS, Chore, Homemaking, Congregate N/A Benchmark services
Check Yes or No Meals, Home Delivered Meals, Home Care-
Private Duty, Personal Care, Respite, DHS
Home Help, MI Bridge Card/Food
Assis tance (SNAP), Home Injury Control,
Transportation, Other

Services Needed Resource Advocacy-AAA1B funded Referrals to appropriate services, Referrals to Aging Netw ork. Keep
Check Yes or No services: MMAP, Emergency Needs, AAA 1-B i.e. CLP, Resource independent for as long as
Options Counseling, and Community Living Advocacy or other agency. possible. Benchmark referrals
Program (CLP). Other community funded Education info (i.e., and services identif ied.
services (non AAAA1-B) Shelter/Eviction, brochures/fliers).
Tax Assis tance, Prescription Assist (under
65 years), Bridge card/food pantry,
Furniture/Appliances, Utility Shut-Off, Home
Care-Private Duty, Home Injury Control,
Weatherization, Veteran's, Home Help
Grant, Financial Management,
Transportation. Medication Management,
Personal Emergency Response, Nutri
Counseling (MNT - Part B Medicare).

Nutrition Appendix Page 57

"Determine" Total Score a. I have an illness or condition that Score: 0-2 = No Risk, 3-5 = Moderate Risk, a. Discuss liquid meal or other Benchmark risk factors.
made me change the kind and/or 6+ = High Risk option. b. Refer to *Food Pantry. Benchmark total score.
amount of food I eat. (2); b. I eat c. Refer to *Food Pantry. d.
fewer than 2 meals per day. (3), Refer to *Alcohol. e. Refer to
(refer to *Food Pantry and/or Bridge *Sensory Impair ments. f. Refer
Card); c. I eat few fruits or to *Food Pantry. g. Refer to
vegetables, or milk products. (2) *Social Isolation. h. Refer to
(refer to *Food Pantry and/or Bridge Medication use and risk factors.
Card); d. I have 3 or more drinks of i. Refer to *partic ipant Weight for
beer, liquor or wine every day. (2), Liquid Meals or MNT/ Nutri
(refer to *Alc ohol); e. I have tooth or Intervention. j. Referral to AAA
mouth problems that make it hard for 1-B.
me to eat. (2) (refer to *Sensory
Impair ments); f. I don't alw ays have
enough money to buy the food I
need. (4) (refer to *Food Pantry
and/or Bridge Card); g. I eat alone
most of the time. (1), (refer to *Social
Isolation); h. I take 3 or more
different prescribed or over-the-
counter drugs a day. (1), (refer to
*Medication use and risk factors); i.
Without w anting to, I have lost or
gained 10 pounds in the last 6
months. (2), (refer to *partic ipant
Weight for Liquid Meals or Nutri
Intervention); j. I am not alw ays
physic ally able to shop, cook and/or
feed myself. (2) (Note: Numbers in
parenthesis are Nutri Risk Scores).

Nutrition Appendix Page 58

Special Dietary Needs List: Low Sodium, Calories (High/Low ), Identify specif ic food allergies. Benchmark need for special
Check Yes or No Protein, Diabetic, Pureed, Liquid, Allergies, Alert staff immediately if latex therapeutic diets. partic ipant
participant Refuses special diet allergy is identified. This may dietary and nutrial requirements
require a change in food handling needs are met.
procedures. If lactose intolerant,
ask if they want milk.
Recommend seeing physician
about vitamin D
supplement/fortif ication. Discuss
special diet needs. Ensure
participant choice is met. Obtain
physic ian's release for special
therapeutic diets as appropriate
(i.e., Renal diets, liquid meals).
Overly restrictive diets and those
with multiple restrictions should
be discouraged.

HDM Eligibility Criteria Determination of eligibility and non-eligibility. If eligible start meal immediately All eligible persons will be served.
(8) Check Box Yes or No or as soon as program is Positive health outcomes.
The follow ing criteria must be met: available based on wait list Improve or maintain nutrial status.
1) Must be 60 years or the spouse of criteria. If not eligible give notice Ineligible w ill be referred for other
an individual 60 years of age and and document reason for services.
older, or disabled individual who ineligibility. Refer to other area
resides in non-institution with a meal programs (i.e., congregate,
person eligible and receiving meals; food pantry's, food kitchens, and
2) No adult able/w illing to prepare fee for service).
meal; 3) Homebound (doesn't leave
under normal circumstances); 4)
Dietary needs can be met by the
HDM program; 5) participant able to
feed self (or has someone able to
assis t with feeding); 6) Unable to
obtain food/prepare complete meals;
7) Agrees to be home when meal
delivered
Other criteria that may override
eligibility criteria: 1) Meal for spouse
is in the best interest of the
participant; 2) Unable to partic ipate
in the congregate program on a
regular basis . When transportation
is available and/ or support to
accompany, participant they may
participate in congregate program
and the home delivered meal
program at the same time.

Nutrition Appendix Page 59

Termination Date/Reason of termination for Moved, Nursing Home/Assisted Care, With If individuals are no longer Monitor individual trends for going
Date/Reason participant and/or caregiver. Refer Family, Unsatisfied, Status Improved, eligible based on provider on/off program.
back to eligibility criteria. Deceased, Caregiver No Longer Eligible, determination participant must be
Other, No longer eligible. formally notified. If appropriate
refer to other area programs. If
participant terminates meal,
document the reason (see
outputs). Benchmark reasons
with AoA data or regional data.

Participant Choice Meals(s) Check all that apply. Hot, Cold, Liquid Supplement, Liquid Only, List # of meals per day which w ill Participant receives appropriate
Service Plan Frozen, Special Diet (Sodium, Calories, be integrated into the service types of meals as
Renal, Diabetic, Pureed, Liquid, if available) plan: If participant needs a needed/preferred. Participant
Shelf Stable, Emergency Meals, Participant second meal, document ability to receiv es referrals to other services
Refuses, Special Diet, Vegetarian (type i.e. provide this. Liquid protocols - as needed.
Lacto, Lacto-Ovo, Vegan, Flexitarian). physic ian prescription, participant
Check M, T, W, Th, F, Sa, Su. Indicate # of weight. Also identify who
meals needed per day. donation statement should go to.

Start Date/Waitlist Enter date 1st meal delivered. Month, Day, Year Assessment must be completed Waitlist information provided to
within 14 days of meal start date. participant and/or contact person
Days, Usual source of Document how partic ipant receives M, T, W, Th, F, Sa, Su If there is no usual source of participants nutrial needs are met
Sat/Sun Meals meals w hen HDM not available 7 Spouse, Family, ER Contact, Other Sat/Sun recommend frozen or
days per week. other options.
# of Meals # Meals served per day
Use Microw ave, Microw ave Y__ N__, Oven Y__ N__, Ref If unable to use either microwave participant receives appropriate
Standard Oven, Check Yes or No Y __ N__, Storage for frozen Y __ N__ or standard oven and lack of second meal/shelf stable
Refrigerator. Freezer freezer space then frozen meals
space to accommodate may not be used. Ask if
frozen meals. participant can open milk carton.
If can use microwave but don't
have one, referral to resource
advocate to identify resources to
assis t.

*Social Isolation Risk indicator from Determine Nutri Screen If socially isolated ask if Reduction of social isolation
interested in friendly visiting,
Check Yes or No telephone reassurance, or
This is a risk indicator from the Resource Advocacy. If language
Determine nutri Screen. I eat alone barrier is identified as a reason
most of the time. I do not have for social isolation, refer to the
neighbors nearby or individuals that Cultural, Ethnic, and Minority
visit me regularly. Directory and Resource
Advocates for assistance.

Nutrition Appendix Page 60

*Alcohol Risk indicator is more than 3/day Educate on counseling Encourage safe use of alc ohol.
Check Yes or No assis tance (if appropriate). Benchmark needs and work with
From Determine nutri Screen Educate on nutrial implications of drug prevention providers as
not eating (because alc ohol needed.
reduces appetite).

*participant weight for Goal (Gain/lose w eight, maintain/improve If not a result of known medical Weight stabilization
Liquid Meals or If Yes From Determine Nutri nutritional status) and current wt. condition, recommend physician
Nutritional Intervention Screen contact or nutri counseling.

Shelf Stable Meals Reason: Emergency, Weekend, Identify if participant can use pull- Nutritional needs w ill be met w hen
Check Yes or No Other: _______ tops or can-opener. Does HDM not available.
participant have can opener.

*Food Pantry and/or If yes, Food Pantry, Bridge card If participant doesn't have enough Increase referrals to other food
Bridge Card. Check Yes or No money to buy food, make referral assis tance programs.
From Determine nutri Screen to local food pantry, note
assis tance with delivery of food
may be needed; Resource
Advocacy referral to help with
emergency food needs and to
complete forms to obtain SNAP
and other resources (I.e.,
Gleaners, food pantry). Refer to
MICafe for Bridge Card.

Nutrition Education If yes, date Nutri Distribute materials as Participant or family states
Review Check Yes or No Literature (specif y: _______) appropriate to understanding of education.
participant/caregiver. Information is receiv ed by
participant/family.

Participant Satisfaction Good, Fair, Poor for each category. If poor, To be asked at re-assessment. Benchmark. Determine region
Level for Services, Check Good, Fair, or Poor. provide brief explanation. Ask participant if eat entire meal. wide benchmark. Consumer
Performance, Services: menu items offered, type If identify most meals are involvement.
Consistency of meal, nutri education, liquid nutri, uneaten, referral to AAA1-
and appearance of food. B/Resource Advocacy/family to
Performance: temperature, hot determine if need add'l servic es.
food hot and cold food cold, and
taste. Service Consistency: time of
delivery, and adherence to menu.

Nutrition Appendix Page 61

HDM Value Indicators All home delivered meal providers 1. Annual number of hours contributed by 1. If you volunteer for the 1. Total number of volunteer hours
shall record and report data on the home delivered meal program volunteers. program in any capacity, record reported.
outcomes and value of the home 2. Amount of food purchased that is either your hours as indicated by
delivered meal program that produced in Michigan or purchased from agency policy 2. N/A
measures the program impact on at Michigan-based companies.
least two leading indicators.
HDM Outcome Data All home delivered meal providers 1. Annual number of incidents where a meal 1. Report any incident where 1. Number on individual incidents
shall record and report data on the deliverer/assessor finds a HDM recipient in meal recipient is found in a 2. Percent change on the
outcomes and value of the home a distressed or vulnerable condition, such as distressed or vulnerable DETERMINE Risk Score
delivered meal program that having fallen in their home and unable to get condition.
measures the program impact on at up, and notified their emergency contact or 2. Complete the DETERMINE
least two program outcomes. authorities, and potentially saved them from score and verify if the partic ipant
further harm or death. is eating fewer than two meals
2. Percent decrease in the number of HDM per day and record in the
participants who report eating fewer than participant file.
tw o meals per day, as recorded in the
Nutrition risk Assessment

Nutrition Appendix Page 62