Background

Section 339 of the Older Americans Act (OAA) requires that States ensure that nutrition projects provide meals that (1) comply with the Dietary Guidelines for Americans and (2) provide to each participating older individual a minimum of 1/3 of the daily Recommended Dietary Allowances (RDAs) if the project provides 1 meal per day, a minimum of 2/3s of the RDAs if the project provides 2 meals per day, and 100% of the RDAs if the project provides 3 meals per day. To comply, State Units on Aging (SUAs) have written standards and guidelines detailing the specific requirements for menu planning and approval.

An Issue Panel convened by the National Policy and Resource Center on Nutrition and Aging (Center) in February 2002 addressed the use of the new Dietary Reference Intakes (DRIs) to plan and evaluate OAA Nutrition Program meals. The Issue Panel recommended that nutrition programs plan and evaluate meals to meet nutrient requirements using nutrient analysis software and that Registered Dietitians (RDs) or individuals with comparable expertise, be available at the SUA, Area Agency on Aging (AAA), and local provider levels to assure nutrient adequacy of meals (1). See Issue Panel report, Topic #4, page 30.

Reviewing menus involves verifying compliance with nutrition standards and menu policies established by the state to conform to the OAA. Nutrient analysis helps ensure compliance with the OAA whereas a meal pattern may not. The National Evaluation of the Older Americans Nutrition Program 1993-95 (2) found that the average meal provided more than 50% of the 1989 RDAs for many nutrients based on adult male values. When comparing the nutrient content of meals at the time of the National Evaluation to newer DRIs, the meals would have been deficient in vitamins D, E, folate, and magnesium. Other nutrients met or exceeded the DRIs. See Table 2 Nutrient Availability of an Older Americans Nutrition Program Meal Relative to the Dietary Reference Intakes and Recommended Dietary Allowances compiled by the Center.

While it is important to analyze menus for their nutrient content, it is also important that RDs review other aspects of the menu, such as variety of foods, serving sizes, color, texture, consistency, and use of seasonal foods. Menu review also includes recommending changes to address errors and discouraging the use of extra items that add to food costs. States may or may not require submission of menus for review by the SUA, but at some level, a registered and/or licensed dietitian and/or individual of comparable expertise, usually completes the review and approves or certifies the menus (3). For further guidance refer to the Older Americans Nutrition Program Toolkit. Chapter 4, Menu and Nutrition Requirements.

Nutrient Analysis Software

A variety of nutrient analysis and meal production software products are used by SUAs, AAAs, and providers. Some simply provide analysis of foods, recipes, and menus. Others offer food production, inventory, and costing capabilities. It is the State's responsibility to develop procedures to ensure meal compliance with the OAA. Therefore, States can specify the use of computer-assisted nutrient analysis and/or meal patterns to ensure compliance. Although the AoA has no authority to prescribe any particular method, AoA can provide guidance to States concerning the most effective methods to plan and approve menus to meet the intent of the Act. A chart comparing various nutrition software products was prepared by the Center.

Nutrient Analysis Software Survey

The Center asked SUA nutritionists and administrators (12/02) about their use of nutrient analysis software as well as their requirements to use nutrient analysis to show compliance with OAA regulations. Below is a summary of the responses received from 34 states.

1. SUAs analyzing nutrient content of menus use the following computer software:

• Food Processor: 6 SUAs
• Nutritionist V, Nutritionist Pro (First Databank): 3 SUAs
• FoodWorks: 1 SUA
• Computrition: 1 SUA

2. Factors influencing the selection of nutrient analysis software (i.e., costs, technical support, ease of use, other state systems, ability to modify to meet needs, completeness of database):

• Computrition: Compatible with vendor that needs to do forecasting, inventory control, etc.: 1 SUA
• Food Processor: Ease of use: 4 SUAs; Cost: 3 SUAs; Add own foods: 2 SUAs; Technical support: 1 SUA; Ability to modify: 1 SUA; Completeness of database: 1 SUA; Already in use: 1 SUA
• Nutritionist V, Nutritionist Pro (First Data Bank): All of the above: 1 SUA; Availability of quantity recipes in the program: 1 SUA
• Foodworks: Price, low cost updates, good technical support, accurate database: 1 SUA

3. SUA Nutritionists personal preferences for nutrient analysis software:

• Food Processor: 5 SUAs
• Computrition: 2 SUAs
• FoodWorks: 1 SUA
• Lunchbytes-Nutrikids: 1 SUA
• Nutritionist IV (First Databank): 1 SUA
• My Diet Program Utah State Univ: Provided through Extension Services; very easily accessed with help available from USU Extension Specialists throughout all Utah counties: 1 SUA

4. Reasons why SUA Nutritionists recommend or specify the use of particular brands of nutrient analysis software for AAAs and local providers in their state:

• Food Processor: Recommended for cost/ease of use: 1 SUA; We purchased copies for all AAAs and did statewide training: 1 SUA; Most commonly used by AAAs: 1 SUA; Economical, easy to use, add own foods: 1 SUA
• Nutritionist IV, V, NutritionistPro: Most commonly used by AAAs: 1 SUA; Completed training for AAAs and providers. It's costly, updates are costly, and it doesn't have menu or production record features that would enhance the program's use. Two drawbacks: no feature to calculate fat absorption of fried foods, does not calculate % saturated fat (calculates grams of saturated fat and % total fat); New revision only allows for 12 analyses (looking for another program with more flexibility): 1 SUA
  
• Provided AAAs and local programs with a list of software. Recommending computer-assisted menu analysis as per new policy: 1 SUA
• AAA has sought advice re: nutrient analysis software as they assume the SUA will complete the nutrient analysis when needed: 1 SUA

5. AAAs and providers use the following nutrient analysis software:

• Food Processor: 9 SUAs
• Nutritionist IV, V, Nutritionist Pro (First Databank): 9 SUAs
• Computrition: 4 SUAs
• Master cook: 2 SUAs
• Computran: 1 SUA
• Diet Master: 1 SUA
• FoodWorks: 1 SUA
• Menu Maker (Nutritional Data Resources): 1 SUA
• Menu Miser: 1 SUA
• My Diet Program Utah State University Extension Service: 1 SUA
• Ohio Distinctive Software: 1 SUA
  

6.a. Nutrients required to be monitored by the SUA:

Nutrient	No. SUAs	SUAs
Vitamin A	15	AK, AL, CT, MA, MN, ND, NE, NJ, NY, OK, OH, PA, SD, WA, WV
Vitamin C	15	AK, AL, CT, MA, MN, ND, NE, NJ, NY, OK, OH, PA, SD, WA, WV
Protein	14	AK, AL, CT, MA, MN, ND, NE, NY, OH, OK, PA, SD, WA, WV
Calcium	13	AK, AL, CT, MA, MN, ND, NE, NJ, NY, OK, SD, WA, WV
Iron	12	AK, AL, MA, ND, NE, NJ, NY, OH, OK, SD, WA, WV
Calories	11	AK, AL, CT, MA, ND, NJ, NY, PA, SD, WA, WV
Thiamin	10	AK, AL, MA, ND, NJ, NY, OH, OK, WA, WV
Niacin	10	AK, AL, MA, ND, NJ, NY, OH, OK, WA, WV
Riboflavin	9	AK, AL, MA, ND, NJ, NY, OK, WA, WV
Fat	9	AK, AL, CT, MA, ND, NE, NY, SD, WV
Dietary Fiber	9	AK, AL, CT, MA, MN, NY, OK, SD, WV
Sodium	9	AK, AL, CT, MA, ND, NJ, NY, SD, WV
Carbohydrate	8	AK, CT, MA, ND, NJ, SD, WV
Folate	8	CT, MA, ND, NY, OH, OK, SD, WV
Vitamin D	7	AK, MA, NJ, NY, OK, SD, WV
Zinc	6	CT, MA, NJ, NY, OH, WV
Potassium	6	AK, CT, ND, NY, SD, WV
Vitamin B6	5	MA, NJ, NY, OH, WV
Magnesium	5	CT, MA, NJ, NY, WV
Saturated Fat	4	AK, CT, NY, WV
Cholesterol	4	MA, ND, NY, WV
Vitamin B12	4	MA, NJ, NY, WV
Fat (%)	3	MA, NY, WV
Vitamin E	2	NY, WV
Copper	2	NY, WV

Other comments in response to requiring specific nutrients to be monitored:

• All follow a meal pattern, but also check if there is adequate protein, fat, iron, calcium, vitamins A and C: 1 SUA
• Currently too many nutrients - reduce to those on food labels. Analysis needs to be simplified and federal programs should work together as the number of older adults increases. Aligning nutrients for analysis will be just one step in this process: 1 SUA
• Presently all required to be analyzed, but would like AoA to select leader nutrients, 12 to be analyzed daily. AAAs are having difficulty meeting all on a daily basis: 1 SUA
• State requires either nutrient analysis or meal pattern. Computer-analyzed menus must meet 1/3 RDAs and a minimum of 6 of 10 nutrients: protein, calcium, iron, vitamins A, B6, C, thiamin, niacin, folic acid, zinc. State plans to revise service specifications soon: 1 SUA
• Determined by each Consultant Dietitian at the AAA: 1 SUA
  

6.b. SUAs allow AAAs to require analysis of additional nutrients:

• Yes: 18 SUAs
  
• No: 4 SUAs
  

7.a. Registered or licensed dietitians are required to "certify" or "approve" menus at the SUA, AAA or provider levels:

• Yes: 27 SUAs
  
• No: 6 SUAs
  

7.b. SUAs require registered or licensed dietitians "certify" or "approve" menus at the AAA or provider levels:

• Yes: 26 SUAs
  
• No: 6 SUAs
  

7.c. Individuals other than registered or licensed dietitians that approve menus:

• Consulting or staff Dietetic Technician: 1 SUA
• Certified Dietary Managers and Home Economists: 1 SUA
• Individuals with a degree in Nutrition/Dietetics or formal training in menu planning: 1 SUA
  

8. Menu planning and/or analysis at the AAA and provider levels is completed by:

• Consulting or staff Dietitian: 20 SUAs
  
• Food Service Manager: 11 SUAs
  
• AAA Nutrition Director: 4 SUAs
  
• Consulting or staff Diet Technician: 3 SUAs
  
• Cook: 1 SUA
• Food Supplier: 1 SUA
• Menu committees: 1 SUA
• Office staff: 1 SUA
• Program Director: 1 SUA
• State dietitian (reviews and approves vendor-analyzed menus): 1 SUA
• Various staff at the provider level (plan menus certified by a consulting dietitian): 1 SUA
  

9. AAAs/providers use standardized recipes:

• All use them daily (100%): 6 SUAs
  
• Most use them daily (>50%): 16 SUAs
  
• Some use them daily (<50%): 6 SUAs
  

10. AAAs/providers use rotating or cycle menus:

• Rotating seasonal (i.e., Fall/Winter and Spring/Summer) 4-6 week cycle menus: 22 SUAs
  
• 4-6 week cycle menus (no rotating seasonal cycles): 11 SUAs
  
• Menus continuously written: 9 SUAs
  
• Minimum of a five-week cycle with seasonal modifications: 1 SUA
• Some monthly: 1 SUA
• Some 8-week cycle and some 26-week cycle: 1 SUA
• 4-week cycle menu, revised quarterly for hot and breakfast programs; 5 week cycle menu for frozen, revised annually: 1 SUA
  

Using nutrient analysis software

Additional information regarding the use of nutrient analysis software from the perspective of SUAs and a AAA provides further insight into the process involved.

Wisconsin Bureau on Aging and Long Term Care Resources
Jennifer Keeley, MS, RD, Nutrition Coordinator, addressed nutrient analysis in a memo (4/16/02) to Nutrition Directors and Aging Unit Directors as excerpted below.

A major change in policy will involve nutrient analysis of menus. As you all know, for 30 years the OAA required that all meals served meet 1/3 the RDA for older adults. A new policy to be introduced this spring will require programs to document (signed by a dietitian) that each menu meets the requirements for at least 5 nutrients. Many states already require this. Some programs in our state already have the nutrient analysis performed by their dietitian.

We will phase in the requirement and there will be some waivers for sites/routes with a small number of meals. Waivers will be given by the AAA and those meals will have to meet other stricter requirements than meals that have a nutrient analysis. Five nutrients is very manageable to do by hand, looking up nutrients in a food values book or online, especially if you use a spreadsheet program like Excel to do the math for you. Another great tool is a nutrient analysis computer program. There are several on the market and like most software, you get what you pay for and the less expensive ones offer less flexibility while the more expensive ones have a larger data base of food and allow you to average meals, and enter your own foods and recipes.

I reviewed several software applications. With the assistance of the Wisconsin Association of Nutrition Director's (WAND) we selected the Food Processor, from ESHA Research as the software to "recommend" but not require. This is to make the sharing of menus, training and problem solving within the state a little more convenient. If you already have a different, but fairly new nutrient analysis software I recommend that you continue to use it. If your software is 3 or more years old, you should consider getting updates or look into purchasing Food Processor.

Alabama Department of Senior Services
Sarah Strawn, MS, RD, Nutritionist, says the vendor is required to provide the SUA with real time access to the computer software (currently Computrition) and database without charge. A dedicated database for recipes and nutritional data and utilization of product specific nutrient data are also contractual requirements. SUA Registered Dietitians review and certify the analyses. In working with large contract vendors, the SUA has learned that there are often multi-users of the nutrition software at different facilities making modifications to the same recipe and product data base. Likewise, errors sometimes occur in the product data base and costing information (Computrition does menu costing and generates product purchase orders also). Requiring the dedicated data base with SUA access seems to work well from both the vendor and the Alabama SUA perspective.

Connecticut Department of Social Services, Elderly Services
Doug Buck, PhD, Nutritionist, says that their food service providers are free to choose nutrient analysis software, a strict state-approved food pattern, or a list of approved standardized menus (in development). He suggested FoodWorks nutrient analysis software because it costs about one-third as much as other programs, updates are inexpensive, and its nutrient database is among the best although less extensive than some. He suggested that every database should include new folacin values.

Massachusetts Executive Office of Elder Affairs
Shirley Chao, RD, Nutritionist, provided excerpts from their OAA Nutrition Program standards.

• Programs that prepare their own meals (and not using a set of rotating menus) must submit the nutrition analysis for three days of meals each fiscal year quarter to the SUA. Programs using a set of rotating menus (such as frozen meals under state contract, catered Kosher or ethnic meals) must submit the nutrition analysis for all menus annually to the SUA.
• A complete nutritional analysis of the menu shall contain a minimum of:
  • macronutrients: calories, protein, fat (including the % of total calories from fat).
  • vitamins: A, B-6, B-12, C, and D, thiamin, riboflavin, niacin, and folate.
  • minerals: calcium, iron, zinc, and magnesium.
• The nutritional analysis form or equivalent computer analysis sheet should be used for the submission of the nutritional analysis. Nutrition projects are encouraged to utilize the nutrition information of the actual food products. However, if sources of food products vary, an average nutritional analysis may be used (ie, USDA Handbook No. 8).
• If a 2nd (and 3rd) meal is provided to any participants for consumption on the same day as the meals mentions above, nutrient analysis shall be performed on the same Nutritional Analysis Form. For example, if an evening, multiple meal or breakfast menu is provided to clients in addition to a noon, regular meal, the 2nd (and 3rd) meal(s) should be submitted along with the "main" meals.
• The specific meals that are analyzed may be chosen by the Nutrition Project. Different meals should be selected each quarter (ie, analyzed meals may not be identical to those chosen previously). The SUA may request that a nutritional analysis be performed on any meal which appears not to meet State requirements or for "spot-checking" purposes.
• Nutritional analysis and/or full product descriptions for individual items used within Title III meals must be provided or made available by caterers. For consortium or joint menus, only one menu/nutritional analysis is required per menu cycle. It is the decision of the Nutrition Projects which agency(s) shall submit this information to Elder Affairs. If more than one Nutrition Project provides the same frozen/limited selection meal, only one nutritional analysis needs to be submitted. It is the decision of the Nutrition Projects which agency(s) shall submit this information to the SUA.

New York City Department for the Aging (DFTA)
Diane Wuestman, MBA, RD, Director Nutrition Unit, recently implemented nutrient analysis of menus, starting with a few contract agencies at a time. There are 347 dining centers, with almost as many menus. NYC's older population is very ethnically diverse. Most centers not only cook on site but use a different 4-week cycle menu each quarter. Menus are submitted to DFTA 4-6 weeks prior to service. Staff nutritionists have begun (in a very limited fashion at this time) to input the data using Nutritionist Pro (First DataBank) nutrient analysis software. Prepared food items may require product information; even juices require brand identification. Standard food data for analysis is used at this time rather than actual recipes. For some ethnic foods, First Databank is assisting in finding nutrient composition data.

Nutrient Values and Requirements

The table below presents the most current nutrient values to use when planning and evaluating meals. Values are provided for 1, or a combination of 2 or 3 meals for one day's consumption for the average older adult population served by the Older Americans Act Nutrition Porgram. The nutrients include those recommended for emphasis by the Issue Panel because of deficiencies found in a number of studies of older adults. Refer to Table 1 Dietary Reference Intakes for Older Adults compiled by the Center for all DRI values and footnotes.

Nutrient Values for Meal Planning and Evaluation
	1 meal/day 33% RDA/AI	2 meals/day 67% RDA/AI	3 meals/day 100% RDA/AI
Macronutrients
Kilocalories (Kcal) 1	685	1369	2054
Protein (gm) 2,3 [20% of total Kcal (gm)] 4	19 34	37 69	56 103
Carbohydrate (gm) 5 [50% of total Kcal (gm)] 4	43 86	87 171	130 257
Fat (gm) [30% of total Kcal (gm)] 6	23	46	68
Saturated Fat (<10% of total Kcal) 7	Limit intake 8
Cholesterol (<300 gm/day) 7	Limit intake 8
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
Electrolytes
Potassium (mg) 9	1167	2333	3500
Sodium (mg) 7	<800	<1600	<2400

* RDAs are in bold type and Adequate Intakes (AIs) are in ordinary type followed by an asterisk (*).
**Vitamin A should be provided from vegetable-derived (carotenoid) sources. See Issue Panel Report on Dietary Reference Intakes and Dietary Guidelines in Older Americans Act Nutrition Programs.

Issue Panelists generally agreed that there might be circumstances when it is not always necessary for a single meal to meet the 1/3 requirement for every nutrient for which an RDA (or AI) has been established. The idea of averaging nutrients over a longer period of time, such as a few days, or week was discussed. However, averaging was rejected overall by the Issue Panel for periods longer than one day for the following reasons:

Targeting Specific Nutrients

Since the inception of the Nutrition Program, the aging network has emphasized "lead" nutrients, such as vitamins A and C, for which daily consumption offers benefits in preventing disease and promoting health beyond just eating a balanced diet. Most Issue Panelists agreed that there are multiple benefits to emphasizing specific nutrients and that this will be a topic of a future Issue Panel.

Issue Panelists agreed on several principles in selecting targeted or "key" nutrients:

Issue Panelists agreed that fiber, calcium, and possibly protein should be targeted in OAA Nutrition Programs. Due to age-related problems with absorbing vitamin B12 and absorbing or metabolizing vitamin D, these nutrients should come primarily from fortified foods or supplements. Vitiamin/mineral fortified foods such as milk with vitamins A and D or calcium fortified orange juice are an allowable expense under the OAA. However, the OAA does not pay for vitamin or mineral supplements. Other nutrients that were discussed included fat, vitamins E, B6, folate, and magnesium. Any emphasis on vitamin A should be modified to focus on vegetable-derived vitamin A food sources (eg, those rich in carotenoids), rather than animal-derived sources of vitamin A which may have adverse effects at higher intake levels.

The Center will hold another Issue Panel (July, 2003) on implementation of the DRIs. Panelists will develop more specificity for energy (calories), the percentage of carbohydrate, protein, and fat to total calories, and identify key nutrients for computer-assisted menu analyses.

Resources

Older Americans Nutrition Program Toolkit. Chapter 4, Menu and Nutrition Requirements developed by the Center.

Leppart S. Gerontological Nutritionists Utilize Computer Technology Part 1, Gerontological Nutritionist Newsletter, Summer, 2000.

Leppart S. Gerontological Nutritionists Utilize Computer Technology Part 2, Gerontological Nutritionist Newsletter, Fall, 2000.

Contributors

• Doug Buck, PhD, Nutritionist, Department of Social Services, Elderly Services, 25 Sigourney St., 10th Floor, Hartford, CT 06106. (860) 424-5299. douglas.buck@po.state.ct.us
• Shirley Chao, RD, Nutritionist, Executive Office of Elder Affairs, 1 Ashburton Place, 5th Floor, Boston, MA 02108. (617) 222-7469. shirley.chao@state.ma.us
• Jennifer Keeley, MS, RD, Nutrition Coordinator, Wisconsin Bureau on Aging and Long Term Care Resources, 1 West Wilson St., Room 450, Madison, WI 53701. (608) 266-5743. keelejl@dhfs@state.wi.us
• Sarah Strawn, RD, Nutritionist, Alabama Department of Senior Services, Suite 470 RSA Plaza, 770 Washington Ave., Montgomery, AL 36130. (334) 242-5757 SStrawn@adss.state.al.us
• Diane Wuestman, MBA, RD, CNSD, Director Nutrition Unit, New York City Department for the Aging, 2 Lafayette St., 8th Floor, New York, NY 10007. (212) 442-1331. dwuestman@aging.nyc.gov

References

Compiled by Lester Rosenzweig, MS, RD, and staff of the National Policy and Resource Center on Nutrition and Aging, Florida International University, Miami, FL.
Contact: nutritionandaging@fiu.edu

This project is supported, in part, by a grant from the Administration on Aging,
Department of Health and Human Services (DHHS). Grantees undertaking projects under government sponsorship
are encouraged to express freely their findings and conclusions.
Points of view or opinions do not, therefore, reflect official DHHS policy.

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