1

IssueBRIEF

Purpose

The purpose of this issue brief 

is to identify key food sources 

of sodium, saturated fat, 

empty calories, and refined 

grains in the diets of 

congregate and homedelivered meal participants, 

and to examines differences 

between participants and 

nonparticipants in these key 

food sources.

January 2019

MATHEMATICA-MPR.COM

By Elizabeth Gearan and Katherine Niland, Mathematica Policy Research

Older Americans Act Title III-C Nutrition 

Services Program: 

Key Food Sources of Sodium, Saturated 

Fat, Empty Calories, and Refined Grains 

in the Diets of Program Participants

BACKGROUND

Following a healthy eating pattern is an important factor in reducing risks of developing 

chronic health conditions such as cardiovascular disease, hypertension, diabetes, 

osteoporosis, and certain types of cancer. The Dietary Guidelines for Americans defines a 

healthy eating pattern as one that emphasizes fruits, vegetables, whole grains, low-fat 

or fat-free dairy, and lean meats and seafood, and limits sodium, saturated fat, refined 

grains, and empty calories (U.S. Department of Health and Human Services [DHHS], 

and U.S. Department of Agriculture [USDA] 2010). For many older adults, following 

a healthy eating pattern can be challenging. For example, aging can cause a loss of 

appetite, changes in taste and smell, and difficulty chewing and swallowing, which can 

affect a person’s food choices or overall dietary intake (Institute of Medicine 2010). 

Older adults may also experience mobility constraints that can make it difficult to shop 

for and prepare foods. 

The Older Americans Act (OAA) Title III-C Nutrition Services Program (NSP)—

administered by the Administration on Aging (AoA) within the Administration for 

Community Living of DHHS—plays an important role in the health of older adults 

that participate in the program. Specifically, the purposes of the NSP are to (1) reduce 

hunger and food insecurity; (2) promote socialization of older individuals; and (3) 

promote the health and well-being of older individuals by helping them access services 

that encourage proper nutrition, prevent disease, and promote health. The program 

provides meals, nutrition education, nutrition-risk screening, and nutrition counseling 

to older adults. Services are provided in congregate meal sites located in a variety of 

settings, including senior centers, senior cafes, schools, churches, farmers markets, and 

other community settings. In addition, the NSP provides home-delivered meals and 

services to homebound older adults. Congregate and home-delivered meals must adhere 

to the current Dietary Guidelines for Americans and provide a minimum of one-third of 

the Dietary Reference Intakes (Administration for Community Living 2017). 

Previous research has shown that meals provided through the NSP make substantial 

contributions to older adults’ diets (Mabli et al. 2017). On average, older adults who 

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Empty calories are 

provided by foods that 

contain solid fats and 

added sugars. Solid fats 

mainly come from animal 

foods but also from 

vegetable oils that are 

processed.

Grains are either refined 

or whole. Refined grains 

have been processed to 

remove the bran and 

germ, which removes 

dietary fiber, iron, and 

other important nutrients.

participated in the NSP obtained about

40 percent of their daily intakes of calories, 

as well as 35 to 47 percent of daily intakes 

of nutrients, from a program meal. In 

addition, the program had positive effects 

on the nutrient intakes and overall quality 

of participants’ diets, particularly among 

congregate meal participants. However, when 

the quality of participants’ diets was assessed 

using the Healthy Eating Index-2010, their 

diets (like the diets of most Americans) were 

not fully consistent with the 2010 Dietary 

Guidelines for Americans recommendations 

for a healthy diet (Mabli et al. 2017). 

Most notably, participants’ diets exceeded 

recommended limits for sodium, saturated 

fat, empty calories, and refined grains. 

This issue brief identifies the key food 

sources of sodium, saturated fat, empty 

calories, and refined grains in the diets 

of congregate and home-delivered meal 

participants. It also examines differences 

between participants and nonparticipants 

in these key food sources. These findings 

can help target nutrition education efforts 

to promote healthier food choices among 

participants and reduce intakes of these 

dietary components. 

METHODS

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. The evaluation consisted of 

a process evaluation of program administration 

and service delivery (Mabli et al. 2015); a cost 

analysis (Ziegler et al. 2015); and an evaluation 

of the effect of the program on participants’ 

outcomes, including food security, socialization, 

and diet quality (Mabli et al. 2017). To estimate 

the effect of receiving a congregate or homedelivered meal on these outcomes, the study 

team compared outcomes for participants and a 

matched comparison group of program-eligible 

nonparticipants. The purpose of the matched 

comparison group of eligible nonparticipants was 

to represent what would happen to participants 

in the absence of the program. In constructing 

the matched comparison groups for congregate 

meal participants and home-delivered meal 

participants, the study team used statistical 

methods to control for differences in the 

characteristics of participants and their respective 

group of nonparticipants that could affect both 

outcomes and program participation decisions.

Trained interviewers conducted 24-hour 

dietary recalls with both participants and 

nonparticipants. Interviewers used the 

Automated Self-Administered 24-hour hour 

dietary recall system ([ASA24] National Cancer 

Institute 2014) to collect detailed information 

about all foods and beverages consumed during 

a midnight-to-midnight recall period. The 

24-hour dietary recall data provide amounts 

of calories, nutrients, and USDA Food Pattern 

food group equivalents (for example, ounce 

equivalents of refined grains and teaspoons of 

added sugars) for each food consumed. 

As part of a prior analysis, the study team 

classified foods reported in the dietary recalls 

into a set of major food groups and subgroups. 

The food groups were based on those developed 

by the USDA for analyzing dietary recall data 

collected in What We Eat in America, the dietary 

interview component of the National Health 

and Nutrition Examination Survey (USDA, 

Agricultural Research Service 2016). Each 

food was assigned to one of nine major food 

groups: milk and dairy; fruits; vegetables; protein 

foods; mixed dishes; grains; snacks and sweets; 

beverages other than milk and 100% juice; and 

added fats, oils, condiments, and sauces. Foods 

in each major food group were then assigned to 

one of 61 mutually exclusive subgroups based 

on specific characteristics of the food. Foods 

that included more than one component (for 

example, sandwiches, entree salads, or pasta 

or rice dishes with meat and vegetables) were 

counted as a single food.

To identify key sources of sodium, saturated fat, 

empty calories, and refined grains, the study team 

examined each food subgroup’s contribution to 

the total intake of each dietary component at 

the level of the population (Bachman et al. 2008; 

Subar et al. 1998). The team then computed 

each food group’s contribution to the intake of a 

dietary component as a percentage of that dietary 

component. We determined the percentage 

contributed by summing the amount of the 

dietary component provided by a particular food 

group for all individuals and dividing that number 

by the total amount of the dietary component 
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consumed from all foods for all individuals. 

For example, to estimate the contribution of 

sandwiches to individuals’ total daily intake of 

sodium, we used the following formula: 

Sum of sodium consumed from sandwiches ÷ sum 

of sodium consumed from all foods

For each dietary component included in 

the analysis, the study team estimated the 

percentage contribution separately for 

congregate meal participants (n = 468) and 

nonparticipants (n = 619) and for homedelivered meal participants (n = 433) and 

nonparticipants (n = 514). Differences between 

participants and nonparticipants were tested for 

statistical significance at the 0.05 level.

FINDINGS

SODIUM

For congregate meal participants, the top five 

sources of sodium were sandwiches (13 percent of 

the total sodium consumed), mixed dishes with 

meat, poultry, and seafood (including meatloaf, 

chicken pot pie, chili, chicken parmigiana, or 

Salisbury steak; 9 percent); soups (7 percent); 

sweet bakery products (such as cakes, pies, 

cookies, brownies, sweet rolls, and pastries; 

5 percent); and cured meats and poultry (5 

percent). Relative to nonparticipants, congregate 

meal participants obtained significantly larger 

proportions of their total sodium intakes from 

mixed dishes with meat, poultry, and seafood 

(9 percent versus 5 percent), and sweet bakery 

products (5 percent versus 3 percent). 

The leading food sources of sodium among 

home-delivered meal participants were 

similar to congregate meal participants, and 

included sandwiches (12 percent); cured meats 

and poultry (7 percent); mixed dishes with 

meat, poultry, or seafood (6 percent); soups 

(6 percent); and mashed potatoes (5 percent). 

Home-delivered meal participants obtained a 

significantly smaller share of their total sodium 

intakes from sandwiches compared with 

nonparticipants (12 percent versus 16 percent). 

Conversely, they obtained a significantly larger 

share of their total sodium intakes from mashed 

potatoes than nonparticipants (5 percent versus 

2 percent). 

SATURATED FAT

The top five food sources of saturated fat for 

congregate meal participants were sandwiches

(12 percent); added fats and oils (10 percent); 

sweet bakery products (9 percent); milk

(9 percent); and mixed dishes with meat, 

poultry, or seafood (8 percent). Compared with 

nonparticipants, congregate meal participants 

obtained a significantly larger percentage of 

their saturated fat intakes from sweet bakery 

products (9 versus 6 percent), milk (9 versus

7 percent) and mixed dishes with meat, poultry, 

or seafood (8 versus 4 percent). 

Among home-delivered meal participants, 

leading sources of saturated fat were sandwiches 

(12 percent), milk (11 percent), added fats 

and oils (10 percent), sweet bakery products 

(8 percent), and meats (6 percent). Compared 

to nonparticipants, home-delivered meal 

participants obtained a significantly larger 

proportion of their saturated fat intakes from 

milk (11 percent versus 7 percent). 

EMPTY CALORIES 

For congregate meal participants, sweet bakery 

products were the leading source of empty 

calories (contributing 21 percent of the total 

calories consumed). Other top source of empty 

calories included sandwiches (8 percent); frozen 

dairy desserts, pudding, and gelatin (8 percent); 

added fats and oils (6 percent); and milk 

(from fat in whole, reduced, and low-fat milks; 

5 percent). Compared to nonparticipants, 

congregate meal participants obtained a 

significantly higher proportion of their empty 

calories from sweet bakery products (21 versus 

13 percent) and milk (5 percent versus

4 percent). 

The top food sources of empty calories among 

home-delivered meal participants were similar 

to those of congregate meal participants 

and included sweet bakery products (which 

contributed 17 percent); sandwiches

(8 percent); sweetened beverages (8 percent); 

milk (7 percent); and added fats and oils (6 

percent). Home-delivered meal participants 

consumed a significantly higher proportion of 

their empty calories from milk compared to 

nonparticipants (7 versus 5 percent).
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Top 5

Sources of. . .

Sodium

Congregate meal 

participants

• Sandwiches

• Mixed dishes with 

meat, poultry, or 

seafood

• Soups

• Sweet bakery 

products

• Cured meats and 

poultry

Home-delivered 

meal participants

• Sandwiches

• Cured meats

and poultry

• Mixed dishes 

with meat, 

poultry, or 

seafood

• Soups

• Mashed potatoes

Saturated fat

Congregate meal 

participants

• Sandwiches

• Fats and oils

• Sweet bakery 

products

• Milk

• Mixed dishes with 

meat, poultry, or 

seafood

Home-delivered 

meal participants

• Sandwiches

• Milk

• Fats and oils

• Sweet bakery 

products

• Meats

Empty calories

Congregate meal 

participants

• Sweet bakery 

products

• Sandwiches

• Frozen dairy 

desserts, pudding, 

and gelatin 

• Fats and oils

• Milk

Home-delivered 

meal participants

• Sweet bakery 

products

• Sandwiches

• Sweetened 

beverages

• Milk

• Fats and oils

Refined grains

Congregate meal 

participants

• Sweet bakery 

products

• Sandwiches

• Bread, rolls, and 

tortillas 

• Grain-based 

mixed dishes

• Quick breads and 

bread

Home-delivered 

meal participants

• Sandwiches

• Sweet bakery 

products

• Bread, rolls,

and tortillas

• Grain-based 

mixed dishes

• Quick breads 

and bread

REFINED GRAINS 

Congregate meal participants obtained more 

than half of the refined grains they consumed 

from sweet bakery products (21 percent); 

sandwiches (18 percent); and breads, rolls, and 

tortillas (18 percent). Grain-based mixed dishes 

(such as pasta or rice, dumplings, turnovers, and 

macaroni and cheese) and quick breads (such as 

biscuits and muffins) were also among the top 

five sources of refined grains (each contributing 

7 percent to the total amount consumed). 

Congregate meal participants obtained almost 

twice as much of their refined grains from sweet 

bakery products than nonparticipants did

(21 versus 11 percent).

The top five sources of refined grains among 

home-delivered meal participants were the 

same as those reported for congregate meal 

participants—sandwiches (20 percent); sweet 

bakery products (17 percent); breads, rolls, and 

tortillas (17 percent); grain-based mixed dishes 

(7 percent); and quick breads (6 percent). 

DISCUSSION

These findings provide useful information on the 

types of foods that contributed to participants’ 

excessive intakes of sodium, saturated fat, 

empty calories, and refined grains. Participants 

consumed these dietary components from a 
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variety of food sources; however, the top five 

sources accounted for almost 50 percent of 

participants’ total intakes of sodium, saturated 

fat, empty calories, and refined grains. 

Focusing nutrition education efforts with 

program staff that plan and prepare congregate 

and home-delivered meals could help improve 

participants’ diets, given that program meals 

make such substantial contributions to 

participants’ dietary intakes. For example on 

average, a program meal contributed to 39 to 

41 percent of congregate and home-delivered 

meal participants’ daily intake of saturated fat, 

and nearly half of the daily sodium consumed by 

participants was contributed by program meals 

(46 to 47 percent; Mabli et al 2017). Reducing 

or modifying these specific foods in program 

meals and targeting them through nutrition 

education efforts with participants is another 

strategy that can help improve the quality of 

older adults’ diets.

It is important that nutrition education focus 

on healthier alternatives, rather than just 

eliminating specific types of foods from the 

diet. For example, the Dietary Guidelines for 

Americans recommend replacing saturated fats 

with unsaturated fats; refined grains with whole 

grains; red meat with leaner meats, poultry, 

and seafood; and higher-fat dairy with fat-free 

or low-fat varieties. For both congregate and 

home-delivered meal participants, sandwiches 

were a leading contributor to all four dietary 

components included in this analysis. 

Sandwiches with meat (ham, roast beef, and 

pork) were the most common type of sandwich 

consumed by participants (Gearan and Niland 

forthcoming). This fact suggests that modifying 

sandwich ingredients could help lower intakes of 

sodium, saturated fat, empty calories, and refined 

grains—for example, by including leaner meats 

and seafood, lower-sodium meats and cheeses, 

and whole grain breads. 

Similarly, sweet bakery products were among 

the top five contributors to sodium, saturated 

fat, empty calories, and refined grains for both 

groups of participants. Over the course of a day, 

61 percent of congregate meal participants and 

48 percent of home-delivered meal participants 

consumed at least one sweet bakery product 

(mostly cookies, brownies, cakes, and pies). 

Encouraging older adults to limit these types 

of foods or opt for lower-fat, lower-sodium, or 

whole-grain varieties of these types of foods 

in their daily diets could help reduce intakes 

of sodium, saturated fat, empty calories, and 

refined grains. 

Modifying the types of foods older adults 

consume can help improve their overall diet 

quality. Program staff can play an important role 

in this effort by providing high quality meals 

and targeted nutrition education to participants. 

Moreover, staff should evaluate program menus 

and participants’ diets to aim for consistency 

with the Dietary Guidelines for Americans. These 

efforts will help ensure that the NSP is fulfilling 

its goal of promoting the health of older adults. 

While program staff can help participants 

reduce intakes of sodium, additional policies and 

strategies at local, state, and national levels in 

both the private and public sectors are necessary 

to support these efforts since most of the sodium 

consumed in the United States comes from 

salt added during commercial food processing 

(DHHS and USDA 2015).

REFERENCES

Administration for Community Living 

(ACL). “Nutrition Services: Nutrition Quality 

Standards.” Washington, DC: ACL, 2017. 

Available at https://www.acl.gov/programs/

health-wellness/nutrition-services. Accessed 

August 9, 2018. 

Bachman, J.L., J. Reedy, A.F. Subar, and S.M. 

Krebs-Smith “Sources of Food Group Intakes 

Among the US Population, 2001–2002.” 

Journal of the American Dietetic Association, vol. 

108, no. 5, 2008, pp. 804–814. doi:10.1016/j.

jada.2008.02.026. 

Gearan, E., and K. Niland. “Older Americans 

Act Title III-C Nutrition Services Program for 

Older Adults: Examining the Types of Foods 

Consumed from Program Meals and Over 24 

Hours.” Washington, DC: U.S. Department of 

Health and Human Services, Administration for 

Community Living, forthcoming.

Institute of Medicine (IOM). “Providing 

Healthy and Safe Foods as We Age: Workshop 

Summary.” Washington, DC: The National 

Academies Press, 2010.
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Mabli, J., E. Gearan, R. Cohen, K. Niland, N. 

Redel, E. Panzarella, and B. Carlson. “Evaluation 

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

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U.S. Department of Health and Human Services 

(DHHS), and U.S. Department of Agriculture 

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dga2010/DietaryGuidelines2010.pdf. Accessed 

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at https://health.gov/dietaryguidelines/2015/

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files/programs/2017-05/NSP-Meal-CostAnalysis_v2.pdf. Accessed August 9, 2018.