# Presentation: 415115

## Important note to readers

- The “bell curve” slides in this presentation (slides number 20 & 21) were designed to simply give a non-technical audience in a few seconds a feel for the implications of the complicated analytical model recommended by the Institute of Medicine for assessing the percent of a population with inadequate (or excessive) intakes.  Those seeking a more complete description of this assessment methodology should see the excellent description in  ***Dietary Reference Intakes: Applications in Dietary Assessment.  *****Institute of Medicine, 2000**

## 2005 Dietary Guidelines for Americans and the New Dietary Reference Intakes:Potential Implications for the NSLP and SBP Meals 

**Jay Hirschman, MPH, CNS**
- Director, Special Nutrition Staff
- Office of Analysis, Nutrition and Evaluation
- USDA Food and Nutrition Service

**Clare Miller, MS, RD**
- Senior Nutritionist
- Child Nutrition Division
- USDA Food and Nutrition Service

## FNS Programs

- FNS administers 15 domestic nutrition assistance programs
-  these programs serve 1 in 5 people in the U.S. each year
- While the 2005 Dietary Guidelines for Americans (DGA) will influence most programs, a few merit special attention:
**National School Lunch Program (NSLP) and School Breakfast Program (SBP)**
- Food Stamp Program (FSP)
- Special Supplemental Food Program for Women, Infants and Children (WIC)
- These four programs represent roughly 89% of FNS program spending in FY 2005

## The 2006-2007 Horizon

**Publication of Proposed Rule regarding implementation of 2005 DGA in NSLP and SBP**
**Publication of Proposed Rule regarding WIC food package changes **
**Publication of revised Thrifty Food Plan market basket  (FSP) **

## Nutrition Standards Governing FNS Programs

**NSLP:**  Meet 1/3 of the RDAs, and are consistent with goals of the DGA
**SBP:**  Meet 1/4 of the RDAs, and are consistent with the goals of the DGA
**WIC:**  Foods that promote the health of the population served...as indicated by relevant nutrition science, public health concerns, and cultural eating patterns
**FSP:**  Raise nutrition levels of low-income households; benefit levels are based on the cost of USDA’s Thrifty Food Plan, a low-cost nutritious diet for a family of four persons

## General Considerations for Program Change

- Administrative
- Cost
- Burden
- Feasibility
- Customers/Target Population
- Participation & Satisfaction
- Hunger prevention
-  Hungry children don’t learn as well
-  Disruptive children impede the learning of others
- Net Value of the Changes

## 16 Percent of Children and Adolescents are OverweightPrevalence of Overweight among Children and Adolescents

**NHANES 1999-2002   DHHS/NCHS: %  with BMI at or above 95****th**** percentile**

**16 Percent of Children and Adolescents are Overweight****Prevalence of Overweight among Children and Adolescents**

## NSLP/SBP:  Reimbursable Meals

- Key issue is defining the food and nutrient requirements for a ***reimbursable meal***
**Reimbursable meals**
- meals served through NSLP and SBP that meet the _**food and nutrient**_ requirements outlined in regulation are eligible for federal reimbursements;
- foods served outside of NSLP/SBP (e.g. a la carte, vending) are not reimbursable.

## NSLP/SBP:  Current Requirements for Reimbursable Meals

**Nutrients in meals are averaged over a school week; weekly averages must meet regulatory standards**
**1/3 of RDA for protein, calcium, iron, vitamin A and vitamin C at lunch; 1/4 of RDA for these nutrients at breakfast**
**Appropriate level of **_**calories**_** for age/grade groups**
**Consistent with the DGA**
**Limit the percent of calories from **_**total fat**_** to 30% of the actual number of calories offered**
**Limit the percent of calories from **_**saturated fat**_** to less than 10% of the actual number of calories offered**
**Reduce **_**sodium**_** ****and**** **_**cholesterol**_** levels**
**Increase the level of dietary **_**fiber**_

## NSLP/SBP:  Current Requirements for Reimbursable Meals

- Four menu planning options
- Two food-based systems
- schools must *offer* at least five food items
- specified quantities of milk, meat/meat alternates, fruits/vegetables, and grains
- Two nutrient-based systems
- reimbursable meals must contain a minimum of three menu items
- specific food requirements include an entrée and fluid milk
- Offer vs. Serve (OVS)
- Students may refuse certain menu items, as long as they accept the minimum number of components

## In 1998-99 More Schools Offered Students the Opportunity to Select a Low Fat Lunch ...but even a dietitian couldn’t select a low fat NSLP meal at 10 to 35% of schools 

**In 1998-99 More Schools Offered Students the Opportunity to Select a Low Fat **_**Lunch**_** *****...but even a dietitian couldn’t select a low fat NSLP meal at 10 to 35% of schools ***

**Elementary Schools**

**Secondary Schools**

**School Year 1991-92**

**School Year 1998-99**

## In 1998-99, More Schools Met the Fat and Saturated Fat Standards for Lunches Offered on Average...but most schools were not “there” yet

**In 1998-99, More Schools Met the Fat and Saturated Fat Standards for **_**Lunches**_** ****Offered on Average*****...******but most schools were not “there” yet***

**Elementary Schools**

**Secondary Schools**

**School Year 1991-92**

**School Year 1998-99**

## In 1998-99,  More Schools Met the Fat and Saturated Fat Standards for Breakfasts Offered on Average...but 1⁄4 to 1⁄2 still needed to improve

**In 1998-99,  More Schools Met the Fat and Saturated Fat Standards for **_**Breakfasts**_** ****Offered on Average...*****but 1⁄4 to 1⁄2 still needed to improve***

**Elementary Schools**

**Secondary Schools**

**School Year 1991-92**

**School Year 1998-99**

## NSLP Lunches Are (still) NutritiousProvide One-third Or More Of The Daily RDA

- Percent of 1989 RDA

**Target **
**For**
**Lunches:**
**33%**

## SBP Breakfasts Are (still) NutritiousProvide One-quarter Or More Of The Daily RDA, Except for Calories

- Percent of 1989 RDA

**Target **
**For**
**Breakfast:**
**25%**

## Why is change needed?A Bit of History on the Recommended Dietary Allowances (RDAs)

- First published in 1943 to serve as goals for planning food supplies and interpreting food consumption by groups
- 1968: 101 pages
- 1974: 128 pages
- 1980: 185 pages
- 1989: 284 pages

## Why is change needed?Dietary Reference Intakes: A New Approach to RDAs

**1994: began creation of the *****Dietary Reference Intakes***** (DRIs), including new RDAs**
**Joint US + Canada effort**
***“******there has been a significant expansion of the research base, an increased understanding of nutrient requirements and food constituents...”***

## Why is change needed?Dietary Reference Intakes: A New Approach to RDAs

**1997:**** DRIs for Calcium, Phosphorus, Vitamin D, and Flouride (a.k.a. the bone nutrients) ****432 pages**
**1998**** DRIs for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline    (a.k.a.   the   B vitamins report) ****564 pages**
**2000****: DRIs for Vitamin C, Vitamin E, Selenium and Carotenoids (a.k.a the antioxidant report) ****506 pages**
**2001**** DRIs for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (a.k.a. the micronutrient report) ****773 pages**
**2002**** DRIs for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (a.k.a. the macronutrient report) ****1331 pages**
**2004**** DRIs for Water, Potassium, Sodium, Chloride, and Sulfate (a.k.a. the electrolyte report) ****617 pages**
****** ****TOTAL: 4,223 pages**
***not including two additional reports on ***
***uses of the DRIs in assessment and planning***

## First published in 1943 to serve as goals for planning food supplies and interpreting food consumption by groups
1968: 101 pages
1974: 128 pages
1980: 185 pages
1989: 284 pages
DRIs 1997-2002: 
4,223 pages 

- 1968: 101 pages
- 1974: 128 pages
- 1980: 185 pages
- 1989: 284 pages
**DRIs 1997-2002: **
**4,223 pages**

**Why is change needed?**

**The current NSLP/SBP**
**Rules are based**
**on the 1989 RDAs**

## The Old RDA Approach

**The Old RDA Approach**

**Mean **
**Intake**

**1. Mean Intake as Percent of RDA****2. Percent of Population Meeting the RDA**

## DRI Paradigm ShiftAssessing Percent Inadequate orPercent  Excessive Not Just Mean Intake

**DRI Paradigm Shift****Assessing *****Percent ******Inadequate ******or******Percent  ******Excessive *****Not Just Mean Intake**

**UL**
**Tolerable Upper**
**Intake Level**

**EAR**
**Estimated **
**Average **
**Requirement**

**Mean **
**Intake**

**INADEQUATE**
**Usual Intake**

**EXCESSIVE**
**Usual Intake**

## DRI Paradigm ShiftAssessing Percent Inadequate or Excessive Not Just Mean Intake TOTAL FAT  in 1994-96 + 1998 by Poverty LevelPercent of School-Aged Children With Excessive Usual Intake of Percent of Calories from Total Fat

**CSFII 1994-96 + 1998. Devaney et al, Oct 2005**

## DRI Paradigm ShiftAssessing Percent Inadequate or Excessive Not Just Mean IntakeTOTAL FAT  in 1994-96 + 1998 by NSLP ParticipationPercent of School-Aged Children With Excessive Usual 24-Hour Intake of Percent of Calories from Total Fat by NSLP Participation

**CSFII 1994-96 + 1998. Devaney et al, Oct 2005**

## DRI Paradigm ShiftAssessing Percent Inadequate or Excessive Not Just Mean IntakeVitamin A  1994-96 + 1998 by NSLP ParticipationPercent of School-Aged Children With Inadequate Usual Intake of Vitamin A

**CSFII 1994-96 + 1998. Devaney et al, Oct 2005**

**DRI Paradigm Shift****Assessing *****Percent Inadequate or Excessive *****Not Just Mean Intake****Vitamin A  1994-96 + 1998 by NSLP Participation****Percent of School-Aged Children With Inadequate Usual Intake of ****Vitamin A**

**<1%**

## DRI Paradigm ShiftAssessing Percent Inadequate or Excessive Not Just Mean IntakeVitamin C  1994-96 + 1998 by NSLP ParticipationPercent of School-Aged Children With Inadequate Usual Intake of Vitamin C

**CSFII 1994-96 + 1998. Devaney et al, Oct 2005**

**DRI Paradigm Shift****Assessing *****Percent Inadequate or Excessive *****Not Just Mean Intake****Vitamin C  1994-96 + 1998 by NSLP Participation****Percent of School-Aged Children With Inadequate Usual Intake of ****Vitamin C**

**<1%**

## DRI Paradigm ShiftAssessing Percent Inadequate or Excessive Not Just Mean IntakeMAGNESIUM  1994-96 + 1998 by NSLP ParticipationPercent of School-Aged Children With Inadequate Usual Intake of Magnesium

**CSFII 1994-96 + 1998. Devaney et al, Oct 2005**

**DRI Paradigm Shift****Assessing *****Percent Inadequate or Excessive *****Not Just Mean Intake****MAGNESIUM  1994-96 + 1998 by NSLP Participation****Percent of School-Aged Children With Inadequate Usual Intake of ****Magnesium**

**<1%**

## Percent InadequateHow are children doing?2001-2002

## Percent Inadequate: Magnesium 2001-2002Percent of School-Aged Children With Inadequate Usual Intake of Magnesium

**NHANES 2001-2002   USDA/ARS**

**Percent Inadequate: ****Magnesium 2001-2002****Percent of School-Aged Children With Inadequate Usual Intake of ****Magnesium**

**<3%**

## Percent Inadequate: Vitamin A  2001-2002Percent of School-Aged Children With Inadequate Usual Intake of Vitamin A

**NHANES 2001-2002   USDA/ARS**

**Percent Inadequate: ****Vitamin A  2001-2002****Percent of School-Aged Children With Inadequate Usual Intake of ****Vitamin A**

## Percent Inadequate: Vitamin C  2001-2002Percent of School-Aged Children With Inadequate Usual Intake of Vitamin C

**NHANES 2001-2002   USDA/ARS**

**Percent Inadequate: ****Vitamin C  2001-2002****Percent of School-Aged Children With Inadequate Usual Intake of ****Vitamin C**

**<3%**

## Percent Inadequate: Vitamin E  2001-2002Percent of School-Aged Children With Inadequate Usual Intake of Vitamin E

**NHANES 2001-2002   USDA/ARS**

**Percent Inadequate: ****Vitamin E  2001-2002****Percent of School-Aged Children With Inadequate Usual Intake of ****Vitamin E**

**<3%**

**>97%**

**>97%**

## Why is Change Needed?A Bit of History on the Dietary Guidelines for Americans (DGAs)

**First issued in 1980 by USDA and DHHS**
**By law, updated every 5 years**

**1990: first DGA quantitative recommendations for:**** **
**percent of calories from total fat (not more than 30% of total calories)**
**saturated fat (less than 10% of total calories)**

## Why is Change Needed?The New Dietary Guidelines for Americans (DGAs)

**The current **
**NSLP/SBP**
**Rules are **
**Based on **
**the **
**1995 DGAs**

**2005 DGAs**
**10 years **
**newer;**
**Reflect **
**the DRIs**

## Why is Change Needed?The 2005 Dietary Guidelines for Americans (DGAs)

**New quantitative recommendations for certain foods and nutrients**
**Nutrients: **
**total fat:**** **
**ages 2 - 3 years = 30 to 35% of calories**
**ages 4-18 years = 25 to 35 % of calories **
**mostly from fish, nuts and vegetable oils**
**saturated fat:**** less than 10% of total calories**
**cholesterol:**** less than 300 mg/day**
**sodium****: less than 2,300 mg/day**
**fiber****: 14 grams per 1,000 calories**
**Foods:**
**fat-free or low-fat milk:**** **
**2 cups/day for ages 2-8**
**3 cups/day for ages 9-18**
**whole grains:**** at least 1⁄2 of bread/grain consumption**

## 2005 DGAs: Nine Focus Areas

**Adequate nutrients within calorie needs**
**Weight management**
**Physical activity**
**Food groups to encourage**

**Fats**
**Carbohydrates**
**Sodium and potassium**
**Alcoholic beverages**
**Food safety**

## Basic premises of the Dietary Guidelines...

***“******Good nutrition is vital to good health and is absolutely essential for the healthy growth and development of children and adolescents.”***
***“...******nutrient needs should be met primarily through consuming foods.”***

## Grain Recommendations Compared to Consumption

- Consumed*

- Recommended

***Consumption by males 9-13**

**Refined grains**

**Whole Grains**

## Vegetable Recommendations Compared to Consumption

**Vegetable Recommendations ****Compared to Consumption**

- Consumed*

- Recommended

***Consumption by females 9-13**

**Dark Green**

**Orange**

**Legumes**

**Starchy**

**Other Vegetables**

## Nutrients of Concern for Children

- Calcium
- Potassium
- Fiber
- Magnesium
- Vitamin E

**Notes:**

The 2005 DGA have now identified nutrients that are of special concern for children.
Calcium
Potassium (currently not on Nutrition Facts label)
Fiber
Magnesium (not on Nutrition Facts label)
Vitamin E (not on Nutrition Facts label)

With the SMI nutrition standards, we have been tracking or monitoring certain nutrient as an indicator of an adequate diet.  These proxy nutrients are:
 calcium, 
iron,
 vitamin A, 
vitamin C and
 fiber.  
These nutrients are also identified on the Nutrition Facts Panels, making the information readily available for schools and state reviewers.

## MyPyramid Recommendations Compared to Consumption*

**Increases**
**Current Consumption **
**Decreases**

**  ****Fruits ****	****    Vegetables      Grains     Meat & Beans      Milk**** **

- *Consumption data from NHANES 2001-2002

**Notes:**

How do the final food intake patterns compare with what Americans now eat?  This graph depicts that comparison for two age-sex groups, shown as the percent change needed to meet recommendations.

The zero line indicates the amount currently consumed, and the bars indicate the percent increase (above the zero line) or decrease (below the zero line) in consumption that is needed to meet recommendations.  This slide shows the five food groups. To meet recommendations individuals need a substantial increase in consumption for four food groups—fruits, vegetables, meat and beans, and milk.   

Consumption data is based on NHANES 01-02 data

## Specific Questions:  NSLP/SBP Calories

**How should **_**calorie**_** levels be determined?**
**School meal calorie levels are currently based upon the 1989 RDA for calories; this RDA provided one calorie level per age**
**The 2005 DGA and the new DRIs provide calorie ranges based on activity level (sedentary, low active, active, very active) at each age**
**Challenge to meet individual needs of children in a group feeding situation while minimizing both hunger and obesity**

## DRI Estimated Energy Requirements (EER) by Activity Level, Ages 6 to 11 Yearsvs. Current Basis for NSLP/SBP Calories

## Specific Questions:  NSLP/SBP Sodium

**Should a maximum level be set for **_**sodium**_**?**
**Previous DGAs have not recommended a specific value for sodium intake, rather to consume sodium in moderation**
**Both DGA 2005 and the Dietary Reference Intakes (DRI) now recommend a clear Tolerable Upper Intake Level (UL)  for daily sodium intake**
**Data from the *****School Nutrition and Dietary Assessment Study-II***** (SNDA-II) indicate that high school lunches contain about ****1,380 mg**** of sodium**
****** ****if current DGA/DRI guidance is followed, the maximum amount of sodium allowable in a high school lunch would be about ****770 mg**** *****(44% reduction)***

**Notes:**
UL:  
4-8 yrs = 1900mg
9-13 yrs = 2200mg
≥14 yrs = 2300mg

## Current Sodium Intake

- Source:  http://www.cdc.gov/nchs/data/nhanes/databriefs/calories.pdf

**3877**

**2896**

**3500**

**2993**

## Specific Questions:  NSLP/SBP Trans Fats

**Should a maximum level be set for *****trans***** fats?**
***trans***** fats have not previously been addressed in the DGA or monitored in school meals**
**The 2005 DGA recommends that intake of *****trans***** fats be minimized; *****trans***** fats will be added to the nutrition facts panel of food products in January, 2006**
**Challenge in minimizing planning & monitoring requirements while following DGA**

## Specific Questions:  NSLP/SBP Fiber

**Should a minimum level be set for **_**fiber**_**?**
**Currently, schools are encouraged to increase fiber in school meals, but a specific numeric target is not set**
**The 2005 DGA offers clear recommendation of **
**   ****14 g/1000 kcal**** for fiber intake across all ages**
**Data from CSFII 1994-96 indicate that the mean intake of fiber **
**at lunch by NSLP participants was about 5 g**
**SBP participants consumed about 3 g at breakfast**
**The new guidelines would necessitate offering approximately**
**6 to 8 g of fiber at breakfast**
**7 to 11 g at lunch**
**depending on the age group being served**

## Specific Questions:  NSLP/SBP

**Which nutrients should be regulated?**
- Three of the “nutrients of concern” for children in the 2005 DGA are not on the nutrition facts panel
- magnesium
- potassium
- vitamin E
_*Challenge*_*:*
- determining which nutrients are the best “proxies” for overall diet quality among school children
- how to reliably estimate the content of nutrients not on the nutrition facts panel of school foods

## FNS Program Considerations Beyond the DGA

- Reducing the prevalence of inadequate and excessive nutrient intakes among participants (DRI)
-  including reducing excess calories that contribute to overweight and obesity
- Foods are readily acceptable, widely available and commonly consumed; take into account cultural food preferences; and provide incentives for program participation
- Program design must facilitate good management and integrity
***And in the non-school programs...*** Foods are available in forms suitable for low-income persons who may have limited transportation, storage, and cooking facilities

## Slide 49