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IssueBRIEF

By Katherine Niland, Mary Kay Fox, and Elizabeth Gearan, Mathematica Policy Research

Nutritional Quality of Congregate and 

Home-Delivered Meals Offered in the 

Title III-C Nutrition Services Program:

An Examination Utilizing the Healthy

Eating Index Tool

Box 1. Data sources

•	 The	study	team	collected	

three days of menu data from 

92 randomly selected LSPs 

during a one-week period 

from October 2015 to 

January 2016.

•	 Telephone	interviewers	used	

the Automated Self-Administered 24-hour dietary recall 

system (ASA24) to collect 

detailed information on the 

foods provided in the midday 

meal offered or delivered to 

participants. If choices of 

entrees or sides were offered, 

information was collected only 

for the most popular options.

•	 For	each	food	reported,	

ASA24 collected descriptive details needed for an 

accurate nutrient analysis, 

including characteristics of 

the food, such as the form 

(for example, fresh, frozen, or 

canned), preparation method 

(for example, roasted or fried; 

prepared from a recipe or 

commercially prepared), characteristics that affect nutrient 

content (for example, low-fat 

or fat-free, or reduced or low 

sodium), and portion size.

•	 The	analysis	included	240	

menus for congregate meals 

and 234 menus for homedelivered meals.

BACKGROUND

The Administration on Aging (AoA) administers the Older Americans Act (OAA) Title 

III-C Nutrition Services Program (NSP). The goals of the NSP are to reduce hunger and 

food security, promote socialization, and promote the health and well-being of older adults 

by providing access to nutrition and other health promotion services. To rebalance longterm care provision away from institutionalization and toward home- and communitybased services, the NSP promotes access to nutritious meals, facilitates social contacts, 

supports family caregivers, and provides meaningful volunteer opportunities, all in an 

effort to help older adults maintain their independence in their homes and communities. 

The NSP provides meals and nutrition services to adults ages 60 and older, including 

nutrition education, screening, and counseling. These services aim to delay the onset of 

adverse health conditions that result from poor nutrition or sedentary behavior. Other 

OAA programming provides non-nutrition services such as transportation and case 

management. Meals and services are provided to older adults in congregate meal sites 

located in senior centers or other community settings. In addition, the NSP provides 

home-delivered meals and services to homebound older adults. The NSP does not have a 

financial means test; rather, it targets services to those with the greatest economic or social 

need. Participants are not charged for meals, but are encouraged to voluntarily contribute 

toward the total cost of the meal.

Local service providers (LSPs) who work under the auspices of State Units on Aging 

and Area Agencies on Aging provide congregate and home-delivered meals. Some LSPs 

offer both congregate and home-delivered meals, and some LSPs offer only one type 

of meal. The OAA requires that meals comply with federal nutrition quality standards. 

These standards require that LSPs provide meals that adhere to the current Dietary 

Guidelines for Americans, provide a minimum of one-third of the Dietary Reference 

Intakes (DRIs), meet state and local food safety and sanitation requirements, and are 

appealing to older adults (Administration for Community Living 2017). Because the 

NSP is state administered, each state unit is responsible for implementing the nutrition 

standards to meet the needs of the older adults that it serves. Some state units require 

developing menus that use nutrient analysis, a meal pattern, or a combination of both 

(Administration for Community Living 2017). 

October 2017

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Box 2. HEI-2010 

components

Adequacy components 

(maximum score)

Total fruit (5)

Whole fruit (5)

Total vegetables (5)

Greens and beans (5)

Whole grains (10)

Dairy (10)

Total protein foods (5)

Seafood and plant 

proteins (5)

Fatty	acids	(10)

Moderation components 

(maximum score)

Refined grains (10)

Sodium (10)

Empty calories (20)

PURPOSE

This issue brief describes the nutritional quality 

of congregate and home-delivered meals offered 

through the NSP and examines how well the 

meals conform to the 2010 Dietary Guidelines

for Americans, which were in effect at the time of 

the data collection. The data used in the analysis 

were collected as part of the Title III-C NSP 

Evaluation, which Mathematica Policy Research 

conducted under contract to the AoA (Box 1). 

The evaluation consisted of a process evaluation 

of program administration and service delivery 

(Mabli et al. 2015), a program cost analysis 

(Ziegler et al. 2015), and an evaluation of the 

effect of the program on participants’ outcomes 

(Mabli et al. 2017). 

The Healthy Eating Index-2010

The Healthy Eating Index (HEI)-2010 was used 

to assess the nutritional quality of congregate 

and home-delivered meals. The HEI-2010 is a 

tool that assesses conformance to key recommendations of the 2010 Dietary Guidelines

(Guenther et al. 2013). The U.S. Department 

of Agriculture (USDA) and U.S. Department 

of Health and Human Services (HHS) use the 

HEI as a tool to monitor the quality of foods 

consumed by the U.S. population overall, as well 

as to monitor progress toward healthier eating 

habits among participants in food assistance 

programs (HHS and USDA, 2015a; Guenther 

et al. 2007). The HEI-2010 has been used 

to measure the nutritional quality of meals 

offered in the National School Lunch Program 

and School Breakfast Program (Gearan et al. 

forthcoming) and meals offered in fast food 

restaurants (Kirkpatrick et al. 2014).

The HEI-2010 is a scoring metric comprising 

12 components, each reflecting a key aspect of 

nutritional quality, and a total score that measures overall nutritional quality. The standards 

used to assign HEI-2010 component scores are 

expressed on a density basis (that is, amounts 

per 1,000 calories or a percentage of calories) 

rather than absolute amounts of foods. The use 

of such standards reflects the recommendation 

that people should strive to meet food group and 

nutrient guidelines while maintaining calorie 

balance, rather than meeting these guidelines 

simply by consuming large quantities of food. 

The index includes nine adequacy components, 

which assess intakes of dietary components that 

people are recommended to consume, and three 

moderation components, which assess intakes of 

dietary components that people are recommended 

to limit (Box 2). Scores for individual components 

range from 5 to 20 (Guenther et al. 2013). In all 

cases, a higher score indicates better nutritional 

quality—higher concentrations for the adequacy 

components and lower concentrations for the 

moderation components. The total HEI-2010 

score is obtained by summing scores across the 12 

components, with a maximum score of 100.

For	each	LSP,	the	research	team	computed	mean	

HEI-2010 scores for congregate and home-delivered meals based on the average of three days of 

menus within a one-week period. The team used 

the population ratio method to estimate HEI 

scores. This method involves calculating mean 

amounts of calories, nutrients, and food groups 

across all LSPs, and then calculating the ratios of 

the means with calories in the denominator, and 

comparing ratios with HEI standards for scoring. 

The population ratio method is recommended 

instead of an individual-level approach because it 

may reduce bias when data do not reflect usual or 

long-term	offerings	(Freedman	et	al.	2008).	

FINDINGS

HEI-2010 component scores indicate that both 

congregate and home-delivered meals are highly 

consistent with 2010 Dietary Guidelines recommendations for six of the nine adequacy components. On average, both types of meals achieved 

perfect or nearly perfect scores (97 to 100 percent 

of the possible maximum) for total fruit, whole 

fruit, total vegetables, greens and beans, dairy, and 

total	protein	foods	(Figure	1).	Average	scores	were	

considerably lower for the other three adequacy 

components.	For	the	seafood	and	plant	proteins	

and fatty acids components, average scores for both 

types	of	meals	were	less	than	50	percent	(42	to	48	

percent) of the possible maximum. Average scores 

for whole grains were substantially lower—equivalent	to	25	to	28	percent	of	the	possible	maximum.	

The lower scores for these three components 

indicate that congregate and home-delivered meals 

were low in these dietary components, relative to 

2010 Dietary Guidelines recommendations.
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FIGURE 1:

HEI-2010 adequacy 

components: Average 

scores expressed 

as a percentage of 

possible maximum 

scores

Source: Administration on Aging Title III-C Nutrition Services Program menu survey, 2015–2016, weighted data.

Note: Higher scores for adequacy components reflect higher concentrations in meals, and thus, higher nutritional quality. 

Because recommendations focus on limiting 

intakes of refined grains, sodium, and empty 

calories, higher scores for these components 

reflect	lower	concentrations	in	meals.	For	two	

of the three moderation components—refined 

grains and empty calories1

1 Calories from solid fats, including 

the fat from animal foods in the dairy 

and total protein foods components, 

and added sugars. 

—average scores for 

both congregate and home-delivered meals 

were equivalent to 75 percent or more of the 

possible	maximum	(Figure	2).	Average	scores	

were	slightly	higher	for	refined	grains	(80	to	

83	percent	of	the	possible	maximum)	than	for	

empty calories (75 to 79 percent). These scores 

indicate that, on average, neither congregate nor 

home-delivered meals provided concentrated 

sources of refined grains or empty calories, but 

both types of meals had higher concentrations of 

these dietary components than recommended in 

the 2010 Dietary Guidelines.

For	both	congregate	and	home-delivered	meals,	

HEI-2010 scores were very low for sodium (less 

than or equal to 1 percent of the possible maximum). This finding indicates that both types 

of meals were very high in sodium, relative to 

the 2010 Dietary Guidelines recommendations. 

Foods	that	contributed	substantial	amounts	of	

sodium included processed meats such as ham 

and sausage, and mixed dishes such as chicken 

teriyaki, beef stroganoff, chili, and gumbo. 

For	the	HEI-2010	overall,	average	total	scores	for	

both congregate and home-delivered meals were 
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FIGURE 2: 

HEI-2010 moderation 

components: Average 

scores expressed as a 

percentage of possible 

maximum scores

Source: Administration on Aging Title III-C Nutrition Services Program menu survey, 2015–2016, weighted data.

Note: Higher scores for moderation components reflect lower concentrations in meals, and thus, higher nutritional 

quality.

equivalent	to	68	percent	of	the	maximum	score	(or	

68	of	a	possible	100	points;	Figure	3).	To	provide	

additional insight on the contributions program 

meals can make to participants’ overall diet quality, 

total HEI-2010 scores for congregate and homedelivered meals can be compared to the total scores 

for participants that consumed these meals. The 

total HEI-2010 scores for both types of meals 

(68	percent	of	the	maximum	score)	are	higher	

than the total HEI-2010 score for daily intakes of 

congregate (65.5 percent of the maximum score) 

or home-delivered (61.4 percent) meal participants 

(Mabli et al. 2017). This suggests that NSP meals 

make important contributions to the nutritional 

quality of NSP participants’ daily intakes and, 

on balance, are of higher nutritional quality than 

the meals and snacks NSP participants consume 

outside of the program.

Regional differences

To gain some perspective on the extent to which 

average HEI-2010 scores can vary based on 

geographic location, the research team examined 

scores for LSPs in the four U.S. Census regions (U.S. 

Census Bureau 2017). Because of small sample sizes 

of LSPs for the individual regions, findings are suggestive only and should be considered exploratory.

Overall, average HEI-2010 scores for the four 

regions did not differ substantially (by more than 5 

percentage points) from the average scores reported 

for	all	LSPs	combined	(Figures	1–3	and	the	“All”	

columns in Table 1). However, there were some 

notable exceptions, in which component scores for 

particular regions varied by 10 percentage points or 

more,	relative	to	the	national	average.	For	example,	

in the Northeast, both congregate and home5

TABLE 1: HEI-2010 scores by U.S. Census region: Average scores expressed as a percentage of possible maximum scores

Northeast region Midwest region South region West region All

HEI-2010 component

Congregate 

meals

Homedelivered 

meals

Congregate 

meals

Homedelivered 

meals

Congregate 

meals

Homedelivered 

meals

Congregate 

meals

Homedelivered 

meals

Congregate 

meals

Homedelivered 

meals

Adequacy components (higher score indicates higher concentration in meals)Total fruit 95.6 99.2 93.1 84.7 93.9 92.3 93.6 98.9 98.3 99.5

Whole fruit 99.6 98.3 100.0 100.0 99.5 99.2 99.1 100.0 100.0 100.0

Total vegetables 100.0 99.6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Greens and beans 91.5 83.2 73.2 70.1 99.8 99.4 95.4 90.6 98.8 96.6

Whole grains 24.3 32.4 21.9 31.6 20.4 20.2 32.2 27.5 25.3 27.8

Dairy 100.0 99.7 100.0 100.0 99.4 99.8 99.7 96.1 100.0 100.0Total protein foods 99.8 97.2 100.0 100.0 100.0 100.0 99.9 100.0 100.0 100.0

Seafood and plant proteins 66.7 77.0 48.7 48.0 30.6 34.4 38.6 16.4 46.8 41.9

Fatty acids 47.3 57.5 45.5 45.8 40.3 41.8 55.1 49.6 46.8 47.8

Moderation components (higher score indicates lower concentration in meals)Refined grains 76.6 83.6 82.7 77.2 84.1 76.9 85.8 78.6 82.5 79.8

Sodium 3.6 13.1 2.5 0.5 0.7 3.0 13.4 8.7 0.5 0.1Empty calories 77.7 76.5 74.6 78.9 69.5 72.3 75.1 84.5 75.2 78.9

Total score 68.4 71.6 65.9 66.4 64.6 64.9 70.0 68.2 67.8 68.2Unweighted number of menus 51 45 78 72 72 75 39 42 240 234

Source: Administration on Aging Title III-C Nutrition Services Program menu survey, 2015–2016, weighted data.
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delivered meals had substantially higher average 

scores for seafood and plant proteins (67 versus 

47 percent for congregate meals and 77 versus 42 

percent for home-delivered meals). In addition, 

among home-delivered meals, the average score for 

greens	and	beans	was	substantially	lower	(83	versus	

97 percent) and the average score for fatty acids 

was	substantially	higher	(58	versus	47	percent).

In the Midwest, average scores for greens and 

beans were also substantially lower than the 

national average (73 versus 99 percent for 

congregate meals and 70 versus 97 percent for 

home-delivered meals). In addition, among homedelivered meals, the average score for total fruit 

was	substantially	lower	(85	versus	100	percent).	In	

the South, the average score for seafood and plant 

proteins among congregate meals was substantially 

lower than the national average (31 versus 47 

percent).	Finally,	in	the	West,	average	scores	for	

seafood and plant proteins were substantially lower 

than the national average (39 versus 47 percent 

for congregate meals and 16 versus 42 percent for 

home-delivered meals).

These variations had relatively little impact on 

total HEI-2010 scores, on average, because higher 

scores for some components tended to compensate 

for lower scores on others. Compared with average 

total scores for congregate and home-delivered 

meals overall, average scores for regions and types 

of meals varied by 3 percentage points or less.

CONCLUSIONS

Average HEI-2010 scores for congregate and 

home-delivered meals offered in the NSP indicate 

that both types of meals are highly consistent with 

2010 Dietary Guidelines recommendations for total 

fruit, whole fruit, total vegetables, greens and beans, 

dairy, and total protein foods. The data also reveal 

room for improvement in both types of meals to 

better align them with the Dietary Guidelines. The 

need for better alignment is greatest for sodium. 

Average HEI-2010 scores for sodium were 

substantially lower than for any other component, 

indicating that the concentration of sodium in congregate and home-delivered meals (sodium content 

per 1,000 calories) is well above the concentration 

recommended in the Dietary Guidelines. Given the 

magnitude of the needed reduction in sodium, it 

will likely take incremental steps over an extended 

period for NSP meals to comply fully with the 

Dietary Guidelines recommendations for sodium. 

Practical strategies that LSPs can use to reduce 

sodium content of meals include (1) omit added 

salt in food preparation; (2) limit use of cured or 

processed meats; (3) limit use of high-sodium 

products, such as brined foods (pickles, olives, and 

sauerkraut), soy sauce and other condiments, and 

prepared packaged foods, soups, mixes, sauces, 

and salad dressings, or use low-sodium alternatives; (4) offer fresh, frozen, or low-sodium canned 

vegetables rather than regular canned vegetables 

(HHS 2005). However, since LSPs are required 

to provide meals that are appealing to participants’ 

taste preferences, it will be important to also balance current dietary guidelines with participants’ 

taste preferences.

It is well documented that the U.S. food supply 

and the typical American diet are high in sodium 

and that excess sodium intake is strongly associated 

with high blood pressure, which can increase risk 

of heart attack and stroke (Institute of Medicine 

2010). In response, policymakers have instituted 

policies aimed at reducing sodium content in 

federally	funded	meals.	For	example,	nutrition	

standards for school meals that went into effect 

in 2012 included sequential goals and a 10-year 

timeline for aligning the sodium content of school 

meals with the Dietary Guidelines. This approach 

recognized the fact that food manufacturers would 

need time to reformulate products commonly 

offered in school meals and schools would need 

time to build students’ acceptance of lower-sodium 

meals (USDA 2012). In addition, the Centers for 

Disease Control and Prevention is working on 

public health strategies to promote populationwide sodium reduction. The agency has identified 

resources that LSPs can use to reduce the sodium 

content of congregate and home-delivered meals, 

and is working with the Centers for Medicare & 

Medicaid Services to lead the Million Hearts initiative, with the goal of preventing 1 million heart 

attacks and strokes (Centers for Disease Control 

and Prevention 2014; Levings et al. 2014).

Improvements are also needed for whole grains, 

given that scores for this component were roughly 

one-quarter of the maximum possible score. 

Intakes of whole grains are also far below recommended levels for the U.S. population overall 

(HHS and USDA 2015). The Dietary Guidelines

recommend that at least half of all grains should 

be whole grain. The Dietary Guidelines provide 

several strategies for meeting this goal, which 

can be used by LSPs to increase whole grains in 

meals: (1) offer 100 percent whole-grain foods for 

at least half of the grains included in meals, and 
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(2) offer foods with at least 50 percent of the total 

weight as whole-grain ingredients. 

Average HEI-2010 scores also indicate that 

improved conformance with 2010 Dietary 

Guidelines recommendations requires that meals 

incorporate more seafood and plant proteins and 

fats that provide essential fatty acids and fewer 

foods that provide empty calories. Strategies that 

LSPs can use to address these dietary components include the following (several strategies 

address more than one component): (1) offer 

more seafood entrees (twice per week), (2) 

incorporate legumes, nuts, and seeds into mixed 

dishes to replace some of the meat or poultry; 

(3) use oils rather than solid fats in preparing 

foods; (4) limit baked and frozen desserts, as 

well as fruit drinks and other sugar-sweetened 

beverages; and (5) offer low-fat and skim dairy 

products (HHS 2005; HHS and USDA 2015). 

Regional variation in average scores for selected 

HEI components suggests regional variation in the 

types of foods included in NSP meals. These variations were most noteworthy for seafood and plant 

proteins (scores were highest in the Northeast) and 

greens and beans (scores were lowest in the Midwest). These variations had relatively little impact on 

total HEI-2010 scores, on average, because higher 

scores for some components tended to compensate 

for lower scores on others. Compared with average 

total scores for congregate and home-delivered 

meals overall, average scores for regions and types of 

meals varied by 3 percentage points or less.

REFERENCES

Administration	for	Community	Living.	“Nutrition	

Services:	Nutrition	Quality	Standards.”	Washington, DC: ACL, 2017. Available at https://www.acl.

gov/programs/health-wellness/nutrition-services.

Accessed July 25, 2017. 

Centers for Disease Control and Prevention. 

“Reducing	Sodium	in	Congregate	and	HomeDelivered	Meals.”	Atlanta,	GA:	CDC,	March	

2014. Available at https://www.cdc.gov/salt/pdfs/

sodium_resources_older_adults.pdf. Accessed 

March 1, 2017.

Freedman,	Laurence,	Patricia	Guenther,	Susan	

Krebs-Smith,	and	Phillip	S.	Kott.	“A	Population’s	

Mean Healthy Eating-Index-2005 Scores Are Best 

Estimated by the Score of the Population Ratio 

when	One	24-hour	Recall	Is	Available.”	Journal of 

Nutrition,	vol.	138,	no.	9,	2008,	pp.	1725–1729.

Gearan	E.,	M.K.	Fox,	K.	Niland,	L.	Washburn,	P.	

Connor,	L.	Olsho,	and	T.	Wommack.	“School	Nutrition	and	Meal	Cost	Study.	Final	Report	Volume	2:	

Nutritional	Characteristics	of	School	Meals.”	Report	

prepared for the U.S. Department of Agriculture, 

Food	and	Nutrition	Service.	Alexandria,	VA:	USDA,	

Food	and	Nutrition	Service,	forthcoming.

Guenther, P.M., J. Reedy, S.M. Krebs-Smith, B.B. 

Reeve,	and	P.P.	Basiotis.	“Development	and	Evaluation of the Healthy Eating Index-2005: Technical	Report.”	Washington,	DC:	U.S.	Department	

of Agriculture, Center for Nutrition Policy and 

Promotion, November 2007.

Guenther, P.M., K.O. Casavale, J. Reedy, S.I. Kirkpatrick, H.A.B. Hiza, K.J. Kuczynski, L.L. Kahle, 

and	S.M.	Krebs-Smith.	“Update	of	the	Healthy	

Eating	Index:	HEI-2010.”	Journal of the Academy of 

Nutrition and Dietetics, vol. 113, no. 4, April 2013, 

pp.	569–580.

Institute	of	Medicine.	“Strategies	to	Reduce	

Sodium	Intake	in	the	United	States.”	Washington,	

DC: The National Academies Press, 2010.

Kirkpatrick, S., J. Reedy, L. Kahle, J.L. Harris, P. 

Ohri-Vachaspati,	and	S.	Krebs-Smith.	“Fast-Food	

Menu	Offerings	Vary	in	Dietary	Quality,	But	Are	

Consistently	Poor.”	Public Health Nutrition, vol. 17, 

no.	4,	April	2014,	pp.	924–931.

Levings, J., M. Mahar, B. Estrada, and D. Brandstetter.	“Million	Hearts	for	Millions	of	Meals:	

Reducing Sodium in Home-Delivered and 

Congregate	Meals.”	Webinar	presented	March	13,	

2014. Available at http://mowaacenter.org/webinar_handouts/nrc/million-hearts.pdf. Accessed 

March 2, 2017. 

Mabli, James, Nicholas Redel, Rhoda Cohen, Erin 

Panzarella,	Mindy	Hu,	and	Barbara	Carlson.	“Process Evaluation of Older Americans Act Title III-C 

Nutrition	Services	Program.”	Washington,	DC:	

U.S. Department of Health and Human Services, 

Administration for Community Living, September 

30, 2015. Available at https://www.acl.gov/sites/

default/files/programs/2017-02/NSP-ProcessEvaluation-Report.pdf. Accessed July 25, 2017. 

Mabli, James, Elizabeth Gearan, Rhoda Cohen, 

Katherine Niland, Nicholas Redel, Erin Panzarella, 

and	Barbara	Carlson.	“Evaluation	of	the	Effect	of	

the Older Americans Act Title III-C Nutrition 

Services	Program	on	Participants’	Food	Security,	

Socialization,	and	Diet	Quality.”	Washington,	DC:	

U.S. Department of Health and Human Services, 

Administration for Community Living, April 

1, 2017. Available at https://www.acl.gov/sites/

default/files/programs/2017-07/AoA_outcomesevaluation_final.pdf. Accessed July 25, 2017. 
8

U.S.	Census	Bureau.	“Census	Regions	and	Divisions	in	the	United	States.”	Available	at	https://

www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf. Accessed August 27, 2017. 

U.S.	Department	of	Agriculture,	Food	and	Nutrition	Service.	“Final	Rule:	Nutrition	Standards	in	

the National School Lunch and School Breakfast 

Programs	”	Federal Register, vol. 77, no. 17, Thursday,	January	26,	2012,	pp.	4088–4167.	Available	at	

https://www.gpo.gov/fdsys/pkg/FR-2012-01-26/

pdf/2012-1010.pdf. Accessed March 1, 2017.

U.S. Department of Health and Human Services 

and	U.S.	Department	of	Agriculture.	“2015–2020	

Dietary	Guidelines	for	Americans.”	8th	edition.	

Washington, DC: HHS and USDA, December 

2015a. Available at http://health.gov/dietaryguidelines/2015/guidelines/. Accessed March 2, 2017.

U.S. Department of Health and Human Services, 

and	U.S.	Department	of	Agriculture.	“Scientific	

Report of the 2015 Dietary Guidelines Advisory 

Committee.”	February	2015b.	Available	at	https://

health.gov/dietaryguidelines/2015-scientificreport/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf. 

Accessed March 2, 2017. 

U.S. Department of Health and Human Services, 

Administration on Aging. Dietary Guidelines for 

Americans, 2005: Nutrition Service Providers Guide. 

Washington, DC: HHS, 2005. Available at https://

health.gov/dietaryguidelines/dga2005/toolkit/Providers/Part1.pdf. Accessed March 2, 2017.

Ziegler, Jessica, Nicholas Redel, Linda Rosenberg, 

and	Barbara	Carlson.	“Older	Americans	Act	Nutrition	Programs	Evaluation:	Meal	Cost	Analysis.”	

Washington, DC: U.S. Department of Health and 

Human Services, Administration for Community 

Living, September 25, 2015. Available at https://

www.acl.gov/sites/default/files/programs/2017-05/

NSP-Meal-Cost-Analysis_v2.pdf. Accessed July 

25, 2017.