The Challenges of DRI Implementation in California Barbara Estrada, M.S., R.D. Public Health Nutrition Consultant California Department of Aging 4th State Units on Aging Nutritionists & Administrators Conference August 2006

California’s Elderly Nutrition Program 33 PSAs 33 PSAs service providers service providers Diverse population Diverse population

California’s Elderly Nutrition Program Program Diversity Program Diversity –Cambodian –Filipino –Hispanic –Russian –Asian

California’s Elderly Nutrition Program Last year Elderly Nutrition Programs in California provided 18,476,009 meals Last year Elderly Nutrition Programs in California provided 18,476,009 meals

California’s Elderly Nutrition Program 33 AAA RDs 33 AAA RDs 88 Program RDs 88 Program RDs

California’s Elderly Nutrition Program Menu Standards Menu Standards Title 22 California Code of Regulations Title 22 California Code of Regulations –Provided nutrition requirements –Must be changed –Old ENP regulations regarding meal standards were very specific –New ENP regulations will be general

First Attempt New Menu Standards were developed and sent out to stakeholders for comment New Menu Standards were developed and sent out to stakeholders for comment The new Standards were based on 2000 Calories per day The new Standards were based on 2000 Calories per day

First Attempt 685 Calories per meal 685 Calories per meal 2 servings of bread 2 servings of bread 2-3 servings of vegetables 2-3 servings of vegetables 1-2 servings of fruit 1-2 servings of fruit Sodium <1,000 mg Sodium <1,000 mg Protein 3 ounces Protein 3 ounces

First Attempt First Draft was released in July of 2005 First Draft was released in July of 2005 Comments were accepted until January of 2006 Comments were accepted until January of 2006 Several programs provided studies or surveys that addressed the amount of food and costs. Several programs provided studies or surveys that addressed the amount of food and costs.

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

Updated Menu Standard 535 Calories per meal (Based on 1600 per day) 535 Calories per meal (Based on 1600 per day) 14 gm of protein per entree 14 gm of protein per entree Vitamin A – 250 μg Vitamin A – 250 μg Vitamin C – 25 mg Vitamin C – 25 mg Sodium ~ 800 mg Sodium ~ 800 mg Fiber > 7 gm Fiber > 7 gm

California Component Meal Pattern Food GroupRequired servings/ meal Serving sizes for 1600 calorie level Lean meat / beans1 serving 2 ounces = 1 serving Vegetable1 – 2 servings½ cup = 1 serving Fruit1 serving½ cup = 1 serving Bread or Grain 1 – 2 servings / ½ must be whole grain 1 slice Bread or ½ cup of rice or pasta = 1 serving Milk or milk alternate 1 serving1 cup or equivalent measure FatOptional DessertOptional - limit sweets use fruit Select foods high in fiber and low in fat and sugar

Dash Diet Food Group1,600 Calories Daily 550 calories per meal Grains6 servings2 servings Vegetables3-4 servings1.5-2 servings Fruits4 servings1.3 servings Low-fat or fat free dairy 2-3 servings1 serving Meat, poultry, fish1-2 servings (3 oz each) 1 serving (2 oz.) Seeds, nuts, legumes 3-4 servings1 serving Fats and oils2 servings/week Sweets0 servings

USDA Menu Pattern Food Group1,600 Calories Daily550 calories/ meal Grains5 ounces1.7 ounces Vegetables2 cups (4 servings).7 cups (1.3 servings) Fruits1.5 cups.5 cups Milk3 cups1 cup Lean meat and beans 5 ounces ounces Oils22g7 g Discretionary calorie allowance 132 calories44 calories

California’s Elderly Nutrition Program Providing guidance without writing underground regulations? Providing guidance without writing underground regulations?

Updated Menu Standard Sodium the real challenge Sodium the real challenge Effect of Potassium Effect of Potassium Culturally appropriate meals Culturally appropriate meals

New Regulations CDA RDs are in the process of changing the California Code of Regulations CDA RDs are in the process of changing the California Code of Regulations New language will be more general New language will be more general Guidance will be provided along with choices of how to meet the Federal regulations. Guidance will be provided along with choices of how to meet the Federal regulations.