CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
CONTRIBUTION OF TITLE III CONGREGATE NUTRITION
\I
SERVICES UNDER THE COMPREHENSIVE; OLDER
AMERICANS ACT TO NUTRIENT INTAKE
A thesis submitted in partial satisfaction of the
requirements_for the degree of Naster of Science in
Home Economics
by
Delma J. Quan
------
June, 1979
The thesis of Delma J. Quan is approved:
Ann R. Stasch, Ph.D.
Committee Chairman
California State University, Northridge
ii
ACKNOWLEDGEMENTS
I \\'ish to express
my
thanks and appreciation to
Eleanor Evans, Project Director of the Ventura County
Senior Nutrition Program, and to the seniors who participated in this congregate nutrition program for their
cooperation and assistance.
Also, I would like to thank my committee chairman,
Dr. Ann R. Stasch, for her guidance and support.
iii
TABLE OF CONTENTS
• • • • • • • • • • • • • •
iii
LIST OF TABLES
• • • • • • • • • • • • • • • • • •
vi
LIST OF FIGURES
• • • • • • • • • • • • • • • • • •
vii
ACKNOWLEDGRMENTS • •
•
•
ABSTRACT • • • • • • • • •
•
• • • • • • • • • • • •
ix
Chapter
I.
INTRODUCTION
.......
Statement of Problem • • • • •
Purpose • • • • • • • • • • • • • • • • • •
Limitations of the Study • • • • • • • • • •
Assumptions • • • • • • • • • & • • • • • •
II.
. . .. .. .. .. .. . .. .. . . ..
~
•
•
~
v.
VI.
3
~
4
8
:METHODS
Significance of the Study
Research Hypotheses • • •
Null Hypothesis • • • • •
Population • • • • • • • •
Data Collection • • • • •
Data Treatment . • • • • •
.Methods of Analysis · • • •
IV.
2
REVIEW OF LITERATURE
Nutrition Program
Nutrient Intake •
I II.
1
2
FINDINGS OF THE STUDY
•
•
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• e • •
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15
15
15
16
17
H!
• • • • • • • • • • •
20
DISCUSSION • • • • • • • • • •
Sm1M.ARI AND RECOMMENDATIONS
•
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•
•
• • • • • •
•
•
$
•
•
•
•
~.0
•
Recommendations for Congregate Nutrition
Services • • ~ • • • • • • • • • • .. • ~ ..
Recommendations for !t'urther Study • " • • •
iv
14
50
51
LIST OF REFERENCES •
• • • • • • • • • • • • • • • •
52
APPENDICES
A.
Dietary Recall •
B.
Diet
~iary
...
• • • • • • • • • • • •
• • • • • • • • • • • • • • • • • •
:l
v
59
LIST OF TABLES
Table
1.
2•
Demography of Congregate
Meals Program Participants
..
.......
Nutrient Distribution in Nine
Congregate Menus Served During the Survey
21
22
3 • Carbohydrate, Protein,
~~d Fat Content
of Nine Congregate Menus Served During
the Survey Compared with U.S. Dietary Goals
vi
..
24
LIST OF FIGURES
Figure
1.
Composite contribution of the congregate meal
to total energy and nutrient intake ~ • • • • •
25
Composite intake of energy and nutrients
provided by congregate meal by percent of
subjects according to sex, age, socioeconomic
factors, and ethnic background • • • • ~ • • • •
26
3 ..
Energy intake as percent of RDA by percent
of subjects • • • • • • • •
• • • • • • • •
27
4.
Protein intake as percent of RDA by percent
of subjects • • • • • • • • • • • • • • • •
..
5.
Iron intake as percent of RDA by percent of
..
29
6.
Calcium intake as percent of RDA by percent
of subjects • • • • • • • • • • • • • • •• • •
30
Vitamin A intake as percent of RDA by percent
of subjects • • • • • • • • • • • • • • • • • •
31
8.
Thiamin intake as percent of RDA by percent
of subjects • • • • • • • • • • • • • • • • • •
32
9.
Niacin intake as percent of RDA by percent of
subjects • • • • • • • • • • • • • • • • • • • •
33
10..
Ribofla-vin intake as percent of RDA by percent
of subjects ~ • • • • • • • • • • • • • • • • •
34
Ascorbic acid intake as percent of RDA by
percent of subjects • • • • • • • • • • • • • •
35
Folic acid intake as percent of RDA by percent
of subjects • • •
• • • • •
• • •
•
•
36
•
37
2.
7.
11.
12.
13.
subjects . . . . . . . . . . . . . . . . . .
.
.
. ..
Vitamin B6 intake as percent of RDA by percent
of subjects
• • . • • • • • • . • . • •
•
~
~
vii
Vitamin B12 intake as p~rcent of RDA by
percent of subjects • • • • • • • • • • • • • •
15.
Calcium/phosphorus ratio of subjects
viii
•
• • • •
ABSTRACT
CONTRIBUTION OF TITLE III CONGREGATE NUTRI'riON
SERVICES UNDER THE COMPREHENSIVE OLDER
AMERICANS ACT TO NUTRIENT INTAKE
by
Delma J. Quan
Master of Science in Horne Economics
A survey of forty-seven participants in a Title III
congregate nutrition program in Ventura County, California,
found that the congregate meal contributed a mean 49 percent
of the total day's intake for energy and eleven selected
nutrients.
Sex, age, residential status, income, and
ethnic background had no significant effect on the contribution of the congregate meal to the total day's
nutrient in·take.
A majori·ty of the subjects had adequate intakes of
energy, protein, iron, vitamin A1 niacin, riboflavin, and
ascorbic acid on both the weekday and the weekend.
More
than 50 percent of the sample was deficient in calcium,
ix
thiamin, folic acid, vitamin B6, and vitamin Bl2 on the
weekday and/or the weekend.
There was a significant difference in the intake
of calcium, thiamin, and riboflavin between the weekday
and the weekend.
Significant relationships between nutrient intake
and the variables studied were:
1.
Sex affected the intake of protein, iron,
niacin, and vitamin B6.
2.
Income affected the intake of vitamin B6.
3.
Ethnic background affected the intake of
ascorbic acid.
X
CHAPTER I
INTRODUCTION
Statement of Problem
The Title III Grants for State and Community
Programs on Aging, Congregate Nutrition Services, under the
Comprehensive Older Americans Act, Amendments of 1978 {1),
are designed to provide at least one hot or other appropriate meal per day five days per week that meets a minimum
of one-third of the Recommended Dietary Allowances (RDA) as
established by the Food and Nutrition Board of the National
Academy of Sciences - National Research Council (NAS-NRC)
{ 2) •
As considerable flexibility is left to the states
and to individual grantees regarding the method of meal
preparation and deli very, information
~'Ould
be desirable
regarding the nutritional quality of the meal, of the
participants' total diet on a weekday- when the congregate
meal is consumed, and on the t,;eekend when the congregate
meal is not available.
This information could be of value
to thoss responsible for administering the program in
evaluating fulfillment of the intent of the Comprehensive
Older Arnericans Act in providing for the elderly.
1
2
PurEose
The federal Administration on Aging 1970 \'7orkshop
recommended the provision of meals every day in the year,
includ.ing weekends and holidays (3).
At present, nutrition
projects are required to provide a minimum of five meals
per week.
There is concern about the adequacy of partici-
pants' diets on the remaining two days.
The Statewide
Advisory Council of the Calif'ornia Commission on Aging has
suggested extension of the program from the present five
days per week to six or seven days per week ( 4).
Information regarding the diets of participants
during a weekday when they have consumed a congregate meal
and over the weekend when the congregate meal is not
available would be valuable in determining the impact and
future direction of the program.
Limitations of the
St}~
The findings pertain only to participants in the
Senior Nutrition Program administered by the Ventura .County
Public Social Services Agency.
These seniors were rela-
tively self-sufficient; they possessed the mobility to
travel to a meal site and the '\rlllingness to socialize by
lunching in a group setting.
The sample might not be
typical of' the elderly in the general population.
The study
l'l!as
conducted over a four '"'eek period in
July and August, 197S, at four meal sites.
Foods eaten
during the study period might not be representative of the
3
diet throughout the year.
Assumptions
It is assumed in the study that:
1.
The answers to the dietary recall pertaining
to food intake during the preceding twenty-four hours on
the weekday gave a true picture of the participants' diets.
2.
The
r~cording
of Saturday and Sunday food
intakes gave a true picture of the participants' diets.
3.
An overestimation of food intake by one
participant will balance statistically the underestimation
ef food intake by another participant.
4.
English and Spanish translations were conducted
in such a manner that no distortion occurred that would
affect the validity of the data.
CHAPTER II
REVIEW' OF LITERATURE
Nutrition Program
In January, 1968, Congress appropriated $2,000,000
for the establishment of a three-year national demonstra-
tion program of nutrition for the elderly to be conducted
by the Administration on Aging under Title IV of the Older
Americans Act (5).
The decision to single out nutrition as
a priority area of national policy was influenced by
several factors.
One of these was the findings of the 1965
National Food Study on Food Consumption and Dietary Level,
a study conducted in February 1965, by the Agricultural
Research Service of the U.S. Department of Agriculture (6).
No precise estimates were made in the study regarding the
total number of persons age sixty and over with deficient
diets, but later analyses indicated that the number of
older persons with deficient diets might be as high as six
to eight million nationally (7}.
Because of these findings,
the pilot national three-year demonstration program at the
$2,000,000 level annually was approved by Gongre ss.
Under Title IV, grants were made to various nonprofit organizations and agencies to improve the quality
of life for the older American.
4
The objective was to test
5
techniques and delivery systems and, at the same time,
foster positive attitudes of self-respect and self-reliance
( 8).
To accomplish this, it \'Tas necessary to locate and
involve the isolated individual; improving his social,
psychological, and health status.
To achieve these goals,
group meals in community settings became the core of the
program.
A variety of facilities were used throughout the
nation, including senior citizen centers, community centers,
churches, schools, and public housing.
Meals provided in
the program were planned to meet one-third of the RDA and,
also, the ethnic and cultural preferences of the participants.
Meal preparation and delivery varied.
Some meals
\'rere prepared on site, others \\rere delivered by vendors.
One of the chief objectives of the Title IV pilot
nutritional service program
and cost data.
\\~s
the collection of program
The ENKI Research Institute, Chatsworth,
California, was awarded a contract for a national analysis
and evaluation of operations and impact of the various
community demonstration projects.
There were twenty-three
individual demonstrations included in the overall Title IV
program ( 5).
Each project was to supply data on a number
of items, one of which was a twenty-four hour dietary
recall.
The recall took place both prior to the individ-
ual's initial participation in a group meals program and
again after a six month participation period.
This
procedure was one of the major means relied upon in the
6
demonstration for the determination of any changes in food
and eating habits by participants as the result of their
participation in a project on a regular basis.
Approxi-
mately 4,000 twenty-four hour dietary recalls were
administered to participants in the Title IV projects.
The 1968 RDA were used as standards of nutritional adequacy.
On March 22, 1972, the Title VII Nutrition Program
for the Elderly was signed into law (9).
The bill author-
ized $100,000,000 for the fiscal year ending June 30, 1973.
Under the Comprehensive Older Americans Act, Amendments of
1978 (1), the Title VII Nutrition Program for the Elderly
was incorporated into Title III Grants for State and
Community Programs on Aging.
For the 1979 federal fiscal
year, $350,000,000 was authorized for nutrition services
(1).
Nutrition programs under Title III are designed to be
operated by designated state agencies on aging.
Each year
a state receives an allotment of federal funds based on the
number of elderly in the state sixty years of age and older.
It is then within the discretion of the designated state
agency to make awards to recipients of grants or contracts
to conduct nutrition programs for the elderly, particularly
for the low income older American.
The awards made under
this program may be used to meet up to 90 percent of the
costs of projects that provide at least one hot or other
appropriate meal per day and any additional mealsj hot or
cold, five days or more per week in strategically located
7
centers in as close proximitr to the majority of eligible
individuals' residences as feasible.
Each meal should
provide the participant with a minimum of one-third of the
RDA.
As pre,scribed in the act, the program is designed to
!
serve those individuals v1ho are sixty and older, and their
spouses regardless of age, who do not eat adequately
because:
1) they cannot afford to do so, 2) they lack the
mobility to shop, 3) they lack the skill to cook properly,
or 4) they lack the incentive to eat alone.
According to the Ventura County 1975 Special Census
(10), there were 47,000 persons age sixty or over.
This age
group comprised 11 percent of the total county population.
The racial ethnic composition of the population age sixty or
over as defined by the California_ Office on Aging was 75
percent Caucasian, 20 percent Spanish language, 2 percent
Oriental, 1.7 percent Negro, 1 percent limited Englishspeaking, and less than 1 percent American Indian (10).
Considerable flexibility is left to the state and
to individual grantees regarding the method of meal preparation and delivery.
Project directors may choose to
contract with a food service provider, establish their
o~m
central kitchen and deliver meals to individual sttes,
allow some or all sites to prepare their own meals, or a
combination of the above methods.
The Administration on
Aging is concerned only that proje.cts explore the various
deli very approaches and select that method that \'.rill best
assure a high quality and cost efficient system for the
purchase and delivery of meals.
Nutrient Intake
Nutrition surveys conducted among the elderly show
a pattern of definable deficiency in specific nutrients,
several of which are common to a majority of the survey
populations.
The methods used to collect data on dietary
intake include the twenty-four hour recall, food record,
and dietary history.
The standards used to measure ade-
quacy of nutrient intake have varied, as have the nutrients
measured.
Most studies, including the USDA Household
Survey, have used
~he
RDA, but used varying percentages of
the RDA as the standards for adequacy.
There is little
information or basis for estimating specific RDA for the
·elderly, and generally allowances are extrapolated from
data on other age groups (11,12).
Furthermore, there is
lack of agreement over appropriate intakes of vitamin A,
vitamin D, thiamin, riboflavin, ascorbic acid, folic acid,
vitamin B12, calcium, and iron for the elderly (13).
The
Ten-State Nutrition Survey (14) and the First Health and
Nutrition Examination Survey (HANES) (15) established t,heir
own standards.
The nutrients most often measured were
energy, protein, calcium, iron, vitamin A, thiamin, niacin,
riboflavin, .and ascorbic acid.
The three major nutrition surveys conducted in the
United States included all age groups.
All three surveys
9
found indications of nutrient inadequacy in the elderly.
First, the USDA Household Survey, 1965-1966 (16) revealed
that males and females over sixty-five years of age were
significantly deficient in calcium intake, with a higher
percentage of females deficient, but the problem increased
with age in males.
Females also had problems with iron,
vitamin A, thiamin, and riboflavin.
Males over seventy-
five years old had low intakes of vitamin A, riboflavin,
and ascorbic acid.
Second, the Ten-State Nutrition Survey
was tabulated by ethnic group including white, black, and
Spanish American.
The oldest age group sampled included
persons over age sixty.
Nutrient deficits of greatest
prevalence included iron in male and female whites and
Spanish Americans, vitamin A in male and female Spanish
Americans, and riboflavin in male and female blacks and
Spanish Americans.
Ascorbic acid was deficient in males
of all racial origins, the prevalence of poor status
increased 'td th age.
Third, the HANES, conducted among
persons from the ages of one to seventy-four, was not
tabulated separately by sex for persons over age sixty.
Although mean intake for calcium, vitamin A, and ascorbic
acid exceeded the RDA, a large percentage of the sample
over age sixty consumed less than the RDA for calcium (71%),
vitamin A (62%}, iron (50%), and ascorbic acid {36%).
The USDA 1977-78 Nationwide Food Consumption Survey
(17) included a supplemental survey of the elderly.
i.
Data
10
were gathered from 5,000 households with one or more
members sixty-five years or older.
Special attention was
given to households where the elderly were living with
others because of an interest in the dietary interrelationship within such households.
Factors such as food
consumption trends and participation in Supplemental
Security Income, Social Security, Food Stamp, and medical
programs were examined.
Several smaller surveys conducted among the aged
have analyzed nutrient intake and its relationship to
various characteristics of the population.
These surveys
generally measured. the intake of energy, protein, calcium,
iron, vitamin A, thiamin, riboflavin, niacin, and ascorbic
acid.
A study of rural elderly in Pennsylvania (18)
indicated that when mean intake of nutrients was considered,
only energy and calcium were significantly deficient.
How-
ever, when the sample was analyzed for variation by sex,
males were more frequently deficient in intakes of energy,
calcium, and vitamin A, while females were more frequently
deficient in calcium, iron, and ascorbic acid.
In a survey involving food acceptance in women over
sixty in nursing homes and private homes (19}, calcium
intake 'tvas most often deficient, but the level was not
related to age.
Twenty-nine percent of the subjects stated
that they disliked milk and would not drink it.
Data
11
indicated that food intake reflected long term behavorial
patterns distinct among individuals.
A study of men and women in an Indiana nursing home
(20) found calcium the nutrient most frequently low in the
diet.
Nutrient intake did not differ significantly as a
result of age.
Sex, however, exerted a significant effect
on mean intakes of certain nutrients.
Men consumed more
calories, carbohydrate, thiamin, and ascorbic acid than
females.
In a survey of three nursing homes in Colorado
(21), calcium was found to be deficient.
Forty-three
percent of the women consumed less than 0.53 grams per day.
Except for vitamin A and ascorbic acid, the energy and
nutrient intakes by men were significantly greater than
·those by
wom~n.
There was no significant effect of age on
energy or nutrient intake.
Thiamin was the nutrient least
well supplied by food for all subjects.
A study relating nutritional adequacy of diets to
socioeconomic status, nutritional knowledge, and attitudes
and beliefs (22} found adequacy of diets was significantly
related to socioeconomic status.
Socioeconomic status in
this study was determined by education, former occupation,
and
income~
The sample had low intakes of calories,
calcium, and vitamin A.
A survey on vitamin status of women in nursing
homes and private homes (23) which measured energy, vitamin
12
A, thiamin, riboflavin, niacin, and ascorbic acid found
vitamin A and thiamin the vitamins most often deficient.
Energy intake was less than the RDA, and this was not
affected significantly by age.
The effect of age on
vitamin intake from food consumed was limited to thiamin
and niacin ..
In an Indiana Title VII project (24), the participants consumed over 50 percent of their total day's intake
of protein, calcium, phosphorus, iron, vitamin A, thiamin,
niacin, and ascorbic acid from the congregate meal.
Total
calcium intake was below the RDA, and 59 percent of the
sample consumed less than two-thirds of the RDA for zinc.
The only significant difference in dietary intake between
men and women was in regard to carbohydrate, where women
consumed a greater amount.
An analysis of Title VII menus in a Missouri
project (25) found more than 40 percent of the RDA for
energy, protein, calcium, iron, vitamin A, thiamin, niacin,
riboflavin, and ascorbic acid available in the meals.
Mean
consumption of the total day's intake from the Title VII
meal was greater than 40 percent for every nutrient except
energy for men and calcium for women.
Participants' total
consumption for the day of protein, iron, vitamin A,
thiamin, riboflavin, niacin, and ascorbic acid was more
than 100 percent of the RDA, but less than 100 percent for
energy and calcium in women and energy and niacin for men.
13
Of·the variables surveyed, sex and age had the most effect
on nutrient intake.
~!omen
consumed a significantly larger
ratio of their intake of energy, protein, iron, and niacin
at the site than did the men.
Age was important to the
percentage of daily intake of energy, vitamin A, and
ascorbic acid from the congregate meal.
Reviewing the various surveys regarding dietary
adequacy in the elderly, calcium appears to be the most
frequently deficient nutrient.
Iron, vitamin A, and
ascorbic acid are the next most frequently deficient.
In
determining which nutrients are most commonly found to be
inadequately supplied, it is important to note the specific
nutrients evaluated in each survey.
The adequacy of the
lesser studied vitamins and trace minerals is largely
unknown (26).
However, nutrition problems seem to vary
among men and women of different ages and ethnic backgrounds.
Income and other socioeconomic factors influence
dietary adequacy of some, but not all nutrients.
In the belief that diet is an integral part of our
environment which can be modified, the Senate Select
Committee on Nutrition and Human Needs proposed "Dietary
Goals for the United States." (27)
The goals include
guidelines for the distribution of energy from carbohydrate, protein, and fat, along with recommended changes in
food selection and preparation to achieve these goals.
CHAPTER III
METHODS
Significance of Study
As suggested in the literature, nutrient deficiencies exist among the elderly, and several elements
appear to affect nutrient intake.
These elements include
sex, age, various socioeconomic factors, and ethnic
background.
In
re~ognition
of the dietary deficiencies of
the elderly and in an effort to improve their health status,
the federal government established a program of congregate
nutrition services.
The objective of this study was to survey a random
sample of participants in the Senior Nutrition Program
(congregate meals) administered by the Ventura County
Public Social Services Agency to determine the contribution
of the congregate meal to nutrient int.ake, determine weekend
nutrient intake, and the relationship of sex, age, socioeconomic factors, and ethnic background on nutrient
adequacy.
As the elderly are often considered to be at
high nutritional risk, if dietary intake is inadequate,
methods of improvement should be explored and
implemented~
15
Researcl'! Hypotheses
1.
The nutrient intake of the participant on the
weekday will differ from the weekend intake for energy and
eleven selected nutrients.
2.
The congregate meal 'V'dll provide a minimum of
one-third of the RDA for
ener~r
and eleven selected
nutrients.
3.
The amount consumed of the congregate meal will
provide a minimum of one-third of the total day's mean
intake for energy and eleven selected nutrients.
Null Hypothesis
1.
The nutrient intake of the participant on the
weekday will not differ from the weekend intake for energy
and eleven selected· nutrients.
Population
The study population consisted of approximately
450 Senior Nutrition Program participants at twelve meal
sites located in Ventura County, California.
According to
the Ventura County 1975 Special Census (10), there were
47,000 persons age sixty or OT:l'er in the nutrition project
area.
The racial ethnic
comp~sition
of this group was 75
percent Caucasian and 20 percent Spanish language.
As the
Caucasian and Spanish language groups constituted 95 percent of the· population age sixty and over, a total of fi.fty
subjects from these two groups were chosen using proportional stratified random sampling.
Subjects were selected
16
from four sites located in the communities of Camarillo,
Fillmore, Oxnard, and Saticoy.
Data Collection
All data were collected through individual interviews to standardize the reporting of amounts consumed.
Two methods of data collection were used.
First, the
twenty-four hour dietary recall was used for the weekday
food intake, including the congregate meal.
Second, a
food record was used for weekend food intake.
The twenty-four hour dietary recall method used to
collect data on weekday food intake has been shown to be
adequate to illustrate the kinds of differences in dietary
patterns desired in this study (14,28-33).
Procedure,
practice, and problems in this method are well documented
(14,17,30,33).
The twenty-four hour recall interview
(Appendix A) was conducted prior to the congregate meal.
Models were used to illustrate serving size.
Information
regarding each subject's age, residential status, and
income were also obtained at this time.
The recall period
covered food and drink consumed after lunch the previous
day up to the time of the interview.
The actual amount
eaten of the congregate lunch on the day of the interview
was recorded for each subject and included in the twentyfour hour recall.
The food record or the recording of present intake
in household measures method {3 0,3 2) was used for reporting
17
the weekend intake.
Each subject was provided a diet diary
or food record (Appendix B) and instructed on the procedure
to follow in measuring and recording Saturday and Sunday
food intakes.
A detailed interview with each subject
!
completing a food record was conducted on Monday to review,
verify, and clarify all entries.
A complete congregate meal was weighed and measured
each interview day for evaluation.
Data Treatment
The independent variables in the study were the
weekday food intake and the weekend food intake.
The controls in the study were ethnic background,
either Spanish language or Caucasian; and the RDA for
energy, protein, calcium, iron, vitamin A, thiamin, niacin,
riboflavin, ascorbic acid, folic acid, vitamin B6, and
vitamin B12.
Random selection of the sample was used to
control sex, age, residential status, and income.
Residen-
tial status was defined as living alone (alone) or not
living alone (not alone); income was defined as receiving
Supplemental Security Income (SSI) or not receiving
Supplemental Security Income (no SSI).
The dependent variables were energy, protein,
calcium, iron, vitamin A, thiamin, niacin, riboflavin,
ascorbic acid, folic acid, vitamin.B6, and vitamin B12
as percentage of RDA.
18
Methods of Analysis
A diet analysis program in the California State
University, Northridge Computer Center was used to analyze
the data.
Each item on the twenty-four hour dietary recall
and weekend food record was coded using the Food Item Code
List from the computer program.
in April 1975.
The data base was updated
Amounts eaten were translated into grams.
Nutrient composition of the congregate menus and participants' nutrient intake at the site, total daily intake,
and weekend intake were calculated by computer using values
from Agriculture Handbook Number 8 {34).
Congregate menus
and individual nutrient intakes were compared with the RDA
for ,energy and eleven selected nutrients.
For each subject,
the computer program also generated a histogram showing
·percen~age
of the RDA for each nutrient, and a nutrition
report rating dietary intake, followed by a list of
nutrients along with food sources.
Distribution of intake
in terms of carbohydrate, protein, and fat as percentage of
calories was computed and compared with the U.S. Dietary
Goals.
The analysis of variance (35,36) was used to
identify any significant differences in:
1.
Nutrient intake between the weekday and the
2.
The effect of the congregate meal on the
\'leekend.
total day's intake in relation to the characteristics of
19
the sample.
3.
Nutrient intake in relation to the character-
istics of the sample.
CHAPTER IV
FINDINGS OF THE STUDY
Forty-seven subjects completed both the twenty-four
hour dietary recall and the weekend food record.
The
characteristics of the sample and the percentages of each
group are shown in Table 1.
One-way analysis of variance was performed to
determine any significant differences between tr;eekday and
weekend nutrient intake.
percentage of the RDA.
Each nutrient '\•ras analyzed as
Significant differences at the 0.05
level were noted for calcium, thiamin, and riboflavin.
The
intake of these three nutrients was greater on the weekday.
Nine congregate menus served during the data
collection period were evaluated for mean percentage of the
RDA (Table 2).
One-third or more of the allowances for men
and women of energy, protein, calcium, iron, vitamin A,
thiamin,- niacin, riboflavin, ascorbic acid, and vitamin B12
were available in the menus.
Folic acid (16%) and
vitamin B6 (26%) were below one-third of the RDA.
Distribution of energy from nine congregate menus
served during the data collection period were compared v..ri. th
the U.S. Dietary Goals.
The total carbohydrate content
20
21
TABLE 1
DEMOGRAPHY OF CONGREGATE MEALS
PROGRA!VI PARTICIPANTS
-=====-=====================--====-========================
Characteristic
Percent
Sex
Male
Female
19
81
Age
Under 75
Over 75
70
30
Residential status
Alone
Not alone
38
62
Income
Supplemental Security Income
No Supplemental Security Income
15
Ethnic background
Spanish language
Caucasian
32
68
N
= 47
85
22
TABLE 2
NUTRIENT DISTRIBUTION IN NINE CONGREGATE
MENUS SERVED DURING THE SURVEY
%of
RDA
Men
\Afomen
Energy
33 + 1. 5)!<:
45 + 2.0
Protein
69
Iron
Nutrient
-
3.8
83 + 4.6
52
+
+
3.8
52 + 3.8
Calcium
59
+
.4
Vitamin A
90 + 18.6
113 + 23.2
Thiamin
45 _!
8.2
54 + 9.8
Niacin
43 + 3.1
-
58 + 4.1
Riboflavin
62
Ascorbic acid
75 + 13.9
75 -.;. 13 .9
Folic acid
16 + 1.9
16 f
1.9
Vitamin B6
26
2.7
26 t
2.7
Vitamin B12
59 .±. 7.1
59 t
7.1
*Standard error of the mean
-+
f
2.2
59 +
85
f
.4
2.9
23
(41%) was lower, but the protein (19%) and total fat
content ( l¥0%) were higher in the congregate menus than the
percentages recommended in the U.S. Dietary Goals (Table 3}.
As
~hown in Figure 1, the contribution of the
I
congregate meal to the mean percentage of the total day's
intake of energy, protein, calcium, iron, vitamin A,
thiamin, niacin, riboflavin, ascorbic acid, folic acid,
vitamin B6, and vitamin B12 was 49 percent.
One-way analysis of variance was performed to
determine if the various characteristics of the sample were
related to the percentage of the total day's intake from
the congregate meal (Figure 2).
Sex
1) male
Age
1) under 75
2) female
2) over 75
1} alone
Residential status
Income
1) SSI
The treatment groups were:
2) not alone
2) no SSI
Ethnic background
1) Spanish language
2) Caucasian
No significant differences were noted at the 0.05 level.
Each nutrient
~ms
analyzed for adequacy as
percentage of the RDA by the five variables {Figures
3 -14).
Nutrient intake was rated as:
Excellent
100 percent or above the RDA
Good
66-2/3 percent or above the RDA
Fair
50% or above the RDA
Poor
50% or below the RDA
24
TABLE 3
CARBOHYDRATE, PROTEIN, AND FAT CONTENT OF NINE
. CONGREGATE MENUS SERVED DURING THE SURVEY
COMPARED WITH U.S. DIETARY GOALS
%of
Carbohydrate
Congregate menus
.u.s.
Dietary Goals
41.4
58.0
*Standard error of the mean
+ lol*
Calories
Protein
19.1
12.0
+ .9
Fat
39.6
30.0
+ 2.6
25
30
~----------------------------------~
20
.·'I
Percent
of
subjects
10
r
I
r
0
10
20
30
40
50
70
90
1GO
Percent of total day's intake
Figure l.
Composite contribution of the congregate meal
to total energy and nutrient intake.
26
-
-- -
- -- -
.
-- ..
Percent
of
subjects
'f.lale
50
40
30
20
10
0
Percent o!: intake
100
Under 75 ;rears
Perc .e nt
of
subjects
i!l
~lb.
.
~~ ·- ,n~
I
100
50
Percent of intake
?ercent
of
subjects
50
40
30
20
10
0
Living alone
l CO
Percent
Percent
of
subjects
50
40
30
20
10
0
intake
Percent
of
subjects
Figure 2.
50
40
30
20
10
0
100
Spanish langua ge
100
50
Percent of intake
50
'40
30
20
10
0
50
40
30
20
10
0
50
40
30
20
10
0
50
40
30
20
10
0
Female
50
Percent of int ake
years
1GC
50
Percent of intake
Not living al one
100
50
Percent of intake
No Suoolemental
Secur:i. br ·Inc one
5G
Percent o!: in t a ke
50
40
30
20
10
0
,,.,,...
~ vu
100
Caucasian
50
l CO
Percent of intake
Composite intake of energy and nutrients provided by
congregate meal by percent of subjects according to
sex, age, socioeconomic factors, and ethnic background.
27
Percent
of
subject-s
i!.ale
'!: ..e e 1-:C:?. ,,
lCO
EO t-t-+-+--1
6 0 1--i=:O--+---l
40
r
1~~
1t';el<-.:>nd
!
! I
60 t--~--i--1
B0 -I--+-...!...-..L..-1
60~.:._~~
40
2('
20
0--~
- -
0 ~~~-
~
Rating*
Under 75
100
l·"ee~:cleY
eo +-;......_..r-+---l
?ercent
of
subjects
1
Over 75
T,·;o ~ ~ri;:. V
lCO
eo
60 +-+--+--i---1
40 f -(i.-l:.iJ--1---l
20
0 ~~~
40
20
0 ~~u r r
_.J
;~ot
lOO
:..lone
t-~·eekd
_.:;:.cr.e
av
lCOk~
eo 1
t, 0 +--r--.;....
1 - ;....-1
60
Percent
o:
co '
+--.,.----j
subjE:cts
ssr
t~ ·eekdav
100
80 t-f--+--l--1
co +--:----'--1
Percent
of
subjects
40
+--l"""!'t--~
No SSI
Weekd,::,v
Q -~i<ilil;IIIIIID
l~~
g
!' ~• ~I
60
subjects
~a
,(.
_,. , ..
"'1 •
0
Figure 3.
I
:
Kee~er.d
~
RQ
I : '
60
;
20
0
? ·
Energy intake as percent of
*Lezend for rating
~ - Excellent · 100~
G - Good
F - Fair
r - ?oo~
~JA
br 2b ove
cr
60
!.:.0
20
o -~~a
2 .G? ?
SSI
t:·el? ,__~~ r. d..
lOO
80
I
l :
Cat,;casic;n
t•re- C: ~~f.? :tC
I I
lCO
«o -1-!...
, ..;.,--'--1
6 0 +--..!.1--'-'---1
L.C
20
l,.,-1~~~
0
ilm~-lli
by percent of subjects.
~DA
- 66-2/3 ;; cr above ?..DA
50~
o .l.--'--+
,- - ' - I
I
I
~Jo
40
I
.... .
t c··?
lCO
Sr-anish
lanruc:ge
lOC '1'1eek:n.d
Heel:...ct~,,
40
"
v
:
.1.: .
~~r.~~ · : .
.
E G .? ·::
2.
40
.
20
.
0 L-~~~.'~~
~ _iii
_
:.. . :..; r :'
Spanish
of.
4C
2C
lCO
60 +--~
--'-~
, -1
f--'---'--'--1
la:1e:uage
Percent
. ;
eo +--'----1
! !
20
E G? ?
: ,
SSI
lOG
Q 0 +--'-'--,....--J
60
40
·
s~ov e ~[A
50% or below RD A
?-lale
Female
Percent
of
subjects
Rating*
Cnder 75
Cv~r
Over 75
~ ', "'r,
'75
T· "c c '...·p ...... ,...~
I ; !
60 ~. .:a---r-....:....--1
~: ~·
j
-0 b , - ' - - , - l
Percent
of
St!bjects
)' t r.-
-f.,~
·· 1---'----1
4 :i
2g
....,
) -~
-:<~~
- --!......j
z·c : P
Percent
o"
sub,iects
lCO
SSI
T·'eekda·,·
;~o
SSI
SSI
,.;eelcer:d
1 cc .....-'~~=-,
eo f-.!..-.!..-~1
; i
of
s:.1bjects
80 t-'--i--.,---i
Ho
100! :
··-
~0 ~:~.,•
. -'--'-
60-:--.::,J'i-~..,.....
40 +-0''1!1....:.......:...~
-: o L ~t--'-·-'--I
20
~
o -~~!'1"'1
.
~::::}...
0
s · G ? ·r
Sranish
li:m£:uage
Sr-arlish
lanrua.ze
l.'eekdc.v
lOG
z ·G :
i
of
subjects
Protein intake as oarcent
'·'l.ezend I'cr :-ating
o::.~ :\D~
by
~ercent
~
Excellent ~ 100% or above ~GA
C - Good
- 66-2/3~ or &bov ~DA
? - Fair
50~ cr a bc~e ~D
: · - ?ccr
50~ c~ bela~~ ~D
P
Caucasic:n
i•'eeke~d
?e:--ce!!t
?igure 4.
s::r
. ·c.e '. .. ~ T'\.-4
~
of subjects.
29
Female
Female
1 00
~cc ......::::,::..;:..,::.....~-.
~='"-'-=:....,
80~+-+-1-----1
EO-l--~~!......l
60
t. 0 +-·_:._..:....-1
1----4~-+--1
:vt:!~
Over 75
'~""'e k :! p_ ·r
lCO
~ c·o
eo
60
Alone
100 ~·.'eekda ".'
!
8 0 -t--cc----:-----r--t
Percent
of
~11bje
::: 0
~__;____;___L-1
-!-L-.;--l---1
Xct Alone
100
$0
75
'ft "'cc-. > o....-;~
~-~ct
:\1 cr. e
t:.'e r.kdav
'
!
J.-!..-;~ -'i.----1
+--"----l--1
cO
c ts
SSI
Ppekda·.:
lGO
+-~--'--1
$0
Fercent
of
subjects
Ho SSI
!Jo
~-·ee
I
60 t--~-:--c---1
40 +-T---'---,--1
4 0 .J.iJ'li:t--+--:-20
0 f&ldl~~illll
J;iiioliiiiioli~lil
~
.......:
...
:: 'G .F' ?
,...
SL'anish
~ranish
lam:uage
lan.e:uaf'e
10 C i''eekend
Qo +----:---i--1
100 t·.' eekde:v
s0 +--:--"--l-----1
; i
?ere en~
60 f--.;...-:---"40
of
subjects
Figure 5.
Iron intake as 9ercent of aDA bv
*Le~end
:or rating
:t; - Excellent
G - Gc.od
F - Fa:..r
,-
?oor
S~I
e ~- ~ r- !1.:,
::0 t-..,.---'----1
60 +--"---+·--l
20
0
~ · ·c:
ker:d
l 00 ,...--"'-""'~=-,
'1\,·ee:--:d a•r
~ercent
100 ~; or ~bove 1CA
66-2/3 ;; or ;:J; ov
50 ;; cr r.: 8o"'.re :i!~
50:-:; or CelOY! F:S
F:.:JA
Caucc.si;;n
Pc~">-e: ~ :1
lCO
co+-.!.._!.----+
6 0 +--1--'--'--l
of subjects.
30
;.!ale
Female
~-'-'--:-"""'-''-1
100
80+-~---+--
so
.lCO
?ercent
l4Tet kde.v
I i
I l
I i
60 I.,.
of
subjects
40
I ?. I I
20 f>:- ~
0 '::: . (j. -~ ' ?
::tating*
lQQ
C'nder 75
Over 75
l "e el..:dav
~·,"p
I
t 0 +--:--;l,__'--i
?ercent
of
subjects
!
60 +--~"---~
lCO
?
t0
~i---+--+--1
60
~[l.--+---'---1
P-=rcent
of
I
I
75
:
2 C +--_,_-;--I
6 c +--,-+---'-1
40 +---'---'---I
2Qt=~'l!f---i
20~,.;-s.,l--c'.•.·
100
f. 0
60
!
C:v~e~
'::."'c c ~ -::::. 'i~
..... ,..:l
4C +-~--+---;>'!1111!
0 ~~~
0 "' \J
~
.
?
?~ot
I
~::.:;:;.1,..-p
20
Alone
80
60
lCO
40
0
100
"'5
:::-::~~
kd 8 ..,
.:.lcne
~=.·eekd
~-!o t
av
..~. J. c.r: e
lCO
~0
~+--'----'--!
.I.--'-,---'-,__:_I
60 .!--'-:--'-:--'--I
+--'--.;....-'----!
LO -1---'---="""~
1
subjects
20
p
SSI
?ercent
cf
st:.bj ec':s
Ho SSI
T·'eekda. v
100
SSI
lCO ,.:::~=::..!.,
? 0 +-+-...._'----!
eo
c.o
lCO
40
'
I
Vee;.cdav
Caucasian
liJO Weekd.av
+--;---'-!--l
qO+-..LI_ _-1
6 0 +--'---.,---:-1
'
20 ~~'-·f~
80
6 0 ~~'---,.........;....-!
~:e~end
~or
~s
rating
Z - Excellent :.
G - Gc-od
l•
-
F3.ir
? - ?Gor
percent of
- G F
~~
lCC 1<1eekerd.
I
l
60
4 L•,.,.
20
0
inta~e
+'-+-'----'--1
by
00;~ or a1::ove 2LA
·.: l
~
~
E
c
Qo -l--...!.1---+,- - l
I
~-·
~
o~
;,1'ct:; '---c:~~
I __.._
I, - - l
6 0 -l--.!....1
""'· ..J {:
.
·'";
Caucasi en~
lCO
:-r~-~-
~ercent
6-2/3~ or &bove ~JA
G~ or c.bo ,.re ?.L::\
0~ or belor.r Z:DA
i
i
~- ~G ' ;
0
Snanish
language
subjects
Calci~~
n
~-"ee :..... ~nd
60 4---~1--'-,-I
40
: : :.'"<1
20
100
80
Figure 6.
!
40
Spanish
lar.guage
of
l
~0
6C·
c
Percent ·
,.,·ee l<er..d
subjects.
:3 1
f·1a1e
;.:ale
lQO
1co '~';"'r·:
~~~_,
so +-+-i--!~ 1
60
?ercent
eo
1
60
1--l~---+--1
1
.
of
subject s
,_, G .:-
P..ating*
Over 75
Cnder 75
r- ·::: e l..:ria v
100
t:o +--r---+---+--1
60 -1'1'11!._~_,_-1
?ercent
of
s ubjects
l 0 0 ,..:.:.:.-'-:==-;-:-,
eo +--1-----1--+--1
-fit-+-~
60
Al one
100
80
60
40
20
Percent
o:
subjects
I ~-·~e;d~ v
I '
!:"':
1:'
.f.::
l .,:
I
.
;
'
i
i
I
I
Not .H cne
l 00
.; l0:1e
,.--.':c-=7"
1 ~_::....:....,
eo
lCO
+---:--~
: -;,--~
!
~·-sE-t .. e~d
l
2 0 +-~-:----,--- !
.
1-·-:- :_.
O E G'F?
SSI
::. 00 ..--.,:.....;...,;..o-,_._,
80 ~~~---~'--1
::o
ss:
SSI
::GO ....t.;_':;:.;e e"-'lr..;.a:"-'';:;:;...·':...,
'
<:! 0
lCC
I I
t--+-1"T""'---1
,
'•
-~ 0
0 ~~~....
-
'~·
-
Spanish
l~m:;.:uage
Feekd a v
20 +--'-+-.c.._ I
lCO
--.
· ,...,
:...
:J
• ......
r
1 - ,
~·
S'!';1nis!1
Caucasian
lang--u.c. p:e
::.OC Woelre,-.n
·•
'Feekdav
I
--~
~
co I
60 1
?ercent
'
'
!
!
I I
Caucesi;.n
lCO
1-·~ '?l· .. C.:~d
!
l
;s ~
of
subjects
!
iJ_... ...,
t... U
7.
:.co
~SI
l·Ae~ ~~1
6 0 t..r-+-.......,
?ercent
of
st.:bjec<:.s
?i~~re
!-To
~,\,ekend
Vitamin A i ntake as percent o:
~:egend
for ratin g
Z - Excellent
G - Good
F - ra1::
?cor
~D~
i !
-.~
:
r
by percent o: subjects.
lCO~ or -~b ove RCA
66-2/3 ;; or abo·: ?.D.~
50 ~ or :-,bc-.re :?. :::
50.~; or CelG\-! ED
•
32
- - -- ..
?ercent
of
subjects
1.00. . !
1
80 +-->---...;-.;..60 1--'---'--7--1
~ ice~e.
~-'e eh!av
lCO
20
60 t--:---;...1-+--1
6ot-~-r.~
lCO r-'-~~f--'-1
0 4-----'---!--!--l
60 t-.,--+-H
4c .f-~!A--'--l
20
0 ~~~
s
'"
?ercent
Ov
o:
subjects
40
. .
40 t--+----1
40,
100
80
I l I
lCO
I ! r
?err.ale
/:1
80 +---,,-;-1 -r--1
l'nder 75
?ercent
of
subjects
r-:ale
Fe::":a1e
:;:ale
!:•pe 1::~~"'"
,
Alone
r-_·ee kd 2. •,r
I
I
I
Over 75
";:e e ~d a v
lCO
80
+-+-i--'---1
6 0 +---+--'--'---1
40
20
0 ~~Xot Alone
I
i
lCO
?0
.
'
.s0
+--:--.---'--1
60
+--'--'-~
:-: ot A} cn e
..:.1 cne
t:..,.eekda.v
100
~E~,.{""er
i--'--,,- ,-
1
cc i - - -': --'- -t
40
?
100
::'ercent
of
subject-s
SSI
Feekda-r
eo
cc
SSI
No SSI
lCO
~eek da ·v·
lCO
EO
:::< 0 +--'---.;.._~
40
20
c0
I !
1--'--'----1
40
.p.!"''ll=;;;;-.,--
Scanish
1an:;:,ua:;:e
::!.00
80
Percent .
of
subjects
'-'
l'
l?
2
lan~;.1c:.ge
v
lCC 1-Tee\.::er.d
PC
60
60
40
40
20
I'
20
0
thia~in intake as ~e rcen~ s~ ~JA ~y ~G rc~~t a~ 2ub~ects.
lCO~
or above
~DA
66 -2/J ;~ O!"" z.Cove :--.~n
50~ or ~bc ve ~~A
50 ~
or below
~c;
'
I
I
i
I
t
~
;
g~~~:~~~~~
Sr-anish
0
Figure ~.
LJ
-
nd.
;:oaE'
i ' :!'.
: oo
60
40
SSI
1- ~e e '.-: ~
'"
!
60
0
,.~eek~c;
!~o
"-·ee l<er.d
3:3
r-'-"i-=7~'--,
- 1 00.
g0 +--+--"--1---l
60 1=-i---+--t-~
Percent
of
subjects
:?errc.le
?-1ale
Female
;.tale
t ..~pT.-::~~.,.,.
1 c0 ..---:'-':-"""'-'---,
eo "'=<oi--+-.-1
::tating*
Cv.::. :
Under 75
...~ekdav·
lCO
?ercent
of
subjects
20 +--+--+---+-~
60 t-7--+---'f----l
l "'c.c-
lCO ,...;.;..."'"'-""'"-"'-'-.
60+--+-+-+~
4 0 _,., ''llll!l---+--l
20
Alone
T·.'ee kd a v
100
80 +-:...___;.-i---1
?ercent
o:
.
?
4
~;o t
Alone
t.'eekd aY
lCO
I
t 0 +-7-1-:--:--1
60
40
60
subjects
+-.;.--~r-~
.J.r!"~ 'li!J--'--1
20
0
:ro
SSI
T·'eekdav
100
eo t-l....-!--'--1
? e r c e!'l t
::o
SSI
SSI
l 00
r---'7-"-'F'-=-'-,
::0
+-~-'---1
6c t::::-----:---l--1
Sp.:.nish
l "" EU" £:e
;~k d;·;,
,..
100
8 0+--;----'----H
0
f
subjects
Figure 9.
.60
Caucasian
lOO
1-:eekda-r
~0+--+--~
lCC r'--"""-'-'~~~
p0 t--i--7-7-i
+--....,---'--l
40 .......r--:---+
Niacin i::ta:Ze .ss
~Leiend~:or ~atin f
o erce~t
o: 1JA cv r:'Crcent
u .
.:..xcel.:.ent:
leo:.~
G -
G:Jcd
66-.2/3 ;; c:- c..bo
,. - F2.ir
. - ?ocr
5C~;
50 ~
or &.c ove ?..L\
or
:~ bO".'E ~
or 'c elc\·' ?.
SSI
. r- ~1
100
:: 'J -i--...L..-'---'--1
'!
of
subjects
?ercent
'75
. -c"""~..-4
c;o +-+--L...+-j
0 ~~~,.-l
!
1
:=:JA.
0:
subjects.
·~e ~
34
1-~a 1 e
Ferr.ale
-- 100 ..--:~~;-;...,
·;
$ Qt--+---;..-+--1
? e r cent
~1--.._i---l
60
of
sub2 ec~s
lCO _~-~
Pekdr
~0 .
6C '· "
40 -;-t'
I
. lCO
Ferr.2le
'{lr~e ~eTJd
80+--~-+----l
6 0 t--'--t-+--1
I
20 .'.:- · ,,~. I
-
~-
?ercent
of
subjects
r...·r:--:
Over 75
~C'O
s:'
~ 0 +---.....-'-'--1
h0
i'
6 0 +---:--~-'--l
~
- G , ~. . . ~
~5
I
4 c ,.: :·~
· c--;f---1--l
20 t.·.-~-.._-~·-+-l
1
t.,.·~c. :_ .. ~-:r:
eo '
~.'i....
: -+i - l - - j
~; fL -'-;_
,. .
-- · .-.. ·-· -· .
- ~ - ·-·, ,,..,.
0 ':..!:, • 'J"' -.- -
Rating*
Cnrier 75
••
1 '
lCO . ~f'K<.PV
'~g;r;
,
~-c ~~--.,..--,
O E G 'l ?
Alone
T·,'e e kd
100
?ercent
1
of
· subjects
a.,
Not
'
-~lone
r•
,..:.C:!.e
lCO 'Ve e kdav
tO ! ; 1
I
p
SSI
lCO
EO
!~ o
SSI
S3I
T·'eekdav
lCO t(eel<e:-:d
+--'---~ 1
Percent
of
subjects
!
~01--...._-~
:co
!-Io S:SI
···e e ~-. ~ !'1~L
~ 0 +-...J._-'----'---
60 -1----'--- l
i
:
:; ? ?
Sranish
:!.anEuag:e
lOO Veekd;:,y
BO
Percent
of
subjects
I
!
'
'
:
~
I
40 ~';~'-,:'J----'---r-1
20 ~,1·
l
0 s ·c. ::: ?
6o
Caucasian
lCO
~ 0 +---'------1
'·'legend :.~or rating
E - Excelle~t
G - Gocd
? .- Fair
~ - ?cor
t;ee!-:dav
Caucesio:n
lCO
ac +--'-..,..---'-+
60 "--,,---;-...-j
~DA
a Co-Je RJI~
2boye ~ C~
000 or above
6-2/J ;~
O!"
0~ or
O% cr telcw RDA
:
35
?e:rcent
of
subjects
Rating*
'Cnder 75
Over 75
lCO
,_;..:........:.....=..;...,_,
80
-"!'!1--+-'---l
·?erce!:t
of
subjects
Alone
., ..
100 '·'<>e'-da"'
"
I ! i Ii
8C ~··-,. ·
:
60 "f"r·
bO
I
' ?erce!1t
cf
subjects
40
t1 ;
T -~ .
wr" •
·1
20 i:,'
0
i
I
i'
i
'- .
~y
I
:
1
;
40
1
20
~~:.
.::.Jone
lCO ...--'"""---.....,.___,
2(; +-------'-
c0 ..:., ;~''--'---'---l
'
!~'.iii!~
:.:ot
Not Alone
lOO l:.'eekdav
I i
· 1
f.;,'
'
~-
E Gf P
SSI
SSI
T·"e e kd 0. ,~r
lCO ,,·-=el<e:-:d
f1 0
t----,..---1
: co
!!o S~I
; . ·1?. e Jr- :1d
;: e -+--'---'---'-
?ercE:nt
of
st:.bject;s
~
G? ?
~ranis~
Caucasian
:oo
lanf!l'..rc.ge
lCC \'feeker.d
"~>:P.e!rde.v
¢o I : . :
¢-'-In
_o TLr, ' -.,...'---l
.co .!;~"1-.,....,----l
i
?ercer.t
of
.subjects
l
1
40 _;;.:~·1-f--+-~
I
zo ~: _w
c ~ ·.~ .
.:....
?i§;ure
6o
-
t.=:
1:.
Ascorbic ccii
~Le~e nd
for
in-:.a~:~
~atin ~
· E: - Excellent G
7
G0cd.
-
Fi:.r
?cor
•..1
00~
:
2Cove ~0A
---~ _,r\
6-2/3 :~ or e:.Go "'le :-:JA
C ~i 'c r :-'':; on ~'-'.'
O io 0 ~ 8
l I
! I
-·
s.s !:\srcent :Jf'
Or
Cauc 2 si. ::n
el Oi·!
;c,Jn
C:' r.ercent
o:
.sub~ects .
36
?emale
1 c0 ,......::,:...::..,::'-'-;--'--.
$0 +--7--i--·":~
Fe:nale
1 CO .~·!ee kd c. \T
80
60
Percent
of
subjects
I I
I I
I
60 +-~..,..--:
40
-:-~:,•
I ~~·
40
: I ~·
20 IJ;:: _~
o_G'
Percent
of
subjects
~
i.
Rating*
L'nder 75
Over 75
•.·,~'- d " '
"r:~T?P kda "'.f
:·"'
1~~· ; . :{~>;.:
60
40
I
~:·
20
. _:
0 E ,~ · ~ :_,
'"' t
lCO
eo +-i--+---:..;;.;;~
60 +-f--i---1>'
40 +-+-+--lif:'i!
20
20 + - - -
+-~:="
ol.,-1!~~
-· G ? ?
::ns. er
100,..........................,
eo
+--'--~1<1.:11
60+--+-F'.I
40 +--4---i~
2 0 +-+-+-.>y-~
0~~~-
r'
Alone
1·,''?.
Percent.
of
subjects
e kd a ...,.
s0 t--;---o•
40
?
of
subjects
S GF P
No ssr
weekda"
.
.
100
60
l
40 +-+----;20
!
::~
40
;:o
l I
0
,;;
!
'---1--1--i·l"'
<",. .,
.::. G ?
Spanish
langu.age
~-·eekdc,'r
lOO
so+-...___~,..·?~:;~!!
?ercent
of
subjects
+-'--~·
100 _L
;;~;
E'o
......
60 +--'-....,.--+' .
I
60
+--.;.._..>.,.q
;~
t-+i .......!.....~~~
f~';
...__ .,.
0
~0
0
100
SO
0 +-.;__'--'<a
20+--'-0
~IIII!IIIUI!iill
E G F .?
lCO
tO
l
I
II
I
I
...
·-·~
':~~
i:.
.\.. ;
~ C· ? ?
20
:or :--atin.E·
? - ?air
,.. - ?cor
.::.
SSI
v.·eel<end
100
.. ;1
I
i
!
c
40
2C
0
l
~
G? ?
Caucasian
~
.t....
8y r;ercent
co;._. or acove ~I::A
6-.2/3 ;; or r: b o~Je :lJ~~
o;) or
S. ~C ...'8 ?.G:~
or beloyr ~DA
SSI
I I I..:.-.,
.1
l I ;;,;;a
'--+-+-t--
t---ilr-+--"''\~
L::-~
1 ~
I !"'!"ifl
:... G ·r.· ?
0~
I~o
1-·ee!.:Pnd
20 t----;--..;--· --~
60
?~
Caucasian
'Viee!rdav
Folic acid ints ke as oercent
E - =:xceller.t
G - Gc od
20
0
60 +-+,---7---,'-<~
4C i-t-4--...;.'.'·
.::. G .., •
~':..e:;end
~
60+--+40 +-----i----''
40
20
0
ssr
T!·e e 1:d a·'?
?e:rcent
lCO
75
V PMti
Not Alone
1 00 -:-'-'"-=-c="::...:..,
.$ 0 +------;--,-
+-"--..;--.;...
E
C·~~.. ~!'
~~ ·~o
6G
2 0 +-==c.._:
0
..
c ~~~
· --
37
Fen:e.1e
;.~ale
lCO .
~--e p t:r!-'1 '·'
.1CC
f . T~F':...: R ~~
.
i
~0
+-+-+-i-1
1
EO +-7-! -+----"----!
?(?rcent
60
1--r--,_.;-j
6c+-+-+-
of
40
l'll!!llf-~'--1
sc:bjects
:l.ating*
l:nder 75
100
veekna ·r
!
so +---T--+-!........1
?ercent
60+-i--+-~
of ·
subjects
40+-...--1-l
20+-+-~
Oliillll~~~~~~
Alone
.,
1~~ tlr:le;a~
?ercent
of
subjects
:.o
.......
! : I
4n.....
:: . ::
20
'' ' :.:_·.
i
0
'
',;.;·
.·
''
E G? ?
Over 75
E~;~
, ·;:-:~v
_,
1
lCO
tO
. 60
L.C
; '
: I
I
~""
St: Jj ects
:.. v : r
I\ot Alone
Veekdav
lOG
2 o t-~-T--'-1
60 +-+-+--1
40
20
0
!_
SSI
l!.;"ee~ d av
100
lCO
~·ee'ke!'.d
r;o SSI
:co
~~ ·~
e ,_.. and.
~0 +-+-.:..
' - '~
~0
6 0 t-+--'--'---'
6 0 +--:--'--c,
5 0.+--'--'---'---!
40+-+-~
40 +-+--~20 +-.._s--
40 t--,--:20
c '--+-~-~
· ~""
- v r r
40 +-+--T--'!<"11
1-+--'-L-1-n~¥1';)•
:::!; u
.....
o
Spmish
lan£:Uae:e
Feekdav
:!.00
?ercent
+-~--'--;
60
of
40
+--i-~-·
LO
.
.
I
c -
~
~litar.d.r~
B6
inte~ke
l CC l'~eekenc
PC t---'--i~
,
: .
20
0
6 0-r--.,.--~-
i .;,.;:...
4 0 t---:---"--_.,.,"11
20
(..
. :_.:
'~': .:: ~~
u
:
:;s percent of
~DA
by :- ercent, o:,.,
:~or ratin,::
Zxce1ler.t - 100~ 6r above ~DA
G - Good
66-2/3 ;; c::- .:;,~ o ·;e c-.!J h
50 ~~ or ~ ~c~e ~C A
t -
so:; or
telow
Cat:casi&n
lCO
~ o +--i--'--+
60-1-;- - ' - l
!..C
0~~~
.-
;'Let!end
?co~
20 +--'---'---"--!
1ang-uc;ge
l~gfi~Je~kdav
+--'---T--;.......j
20 +-;.,.,- -
t--:---'--
Sranish
Caucasian
80
60
?igt!.re 13.
::ot Alon e
co+--,--20
0
subjects
.~; ; t
No ·ssr
t·'eekdav
!
so +--"------';~
::' E:- cent
..
20
~
:
r
,
0 - .· , .- --
ssr
100
'
~D~
~ub.jects.
:•:ale
'!··sP '..::~ ~,_,.
lCO
I
eo
60
?e:rcent
o!'
st.:bjects
I
I
I
40
lCO
lCO
I
so
I
I
:-:ale
Fer:-:ale
l1!ee!--:ci c:v
~!!:' o
eo
I
6o
60
?err:e.le
l,rorr:
·· ; . • •
1
1
·
. I
•
I~
Rating""
t.:'nder 75
100
e ,<:1 s. . ,_,.
~-~~
so
?ercent
of
subjects
lCO
., r .r.
~! ...-=.c- ~·-=- ~ ~
i !
to
60
Cv::::: 75
Over 75
~..~..0 f=. k~~ ~- y
60
40
40
20
0
20
0
?s::--cent
o:
subjects
SSI
100
No SSI
~-'9ekdav
eo
60
?ercent
of
subjects
LO
20
0
.~
~
"
-
SSI
40
20
+-~-+-1
0
jlii:ii"""~I<;QI
lCO
f 0 t--.L.......,.----1
l·.~eekdav
eo
Percent
~
40+-.---~
0~~:-:-f"'-
._:
..
~
~raras:J.
Caucasian
lCO ":eekcav
ls.ne:ua,E::e
l
,
.:
lCC l<.' eekend.
.~0'
~0+-+-----l
'60
of
subjects
~04--'--'--'
j
I
:. 0 -+--;--'--'--1
60 +---i--
Scanish
100
lCO
2 0 t--'::-:-::-t--:-
r
lar.~:ua ge
!:c SSI
'!:"p e ~p r;d.
i':eeJ.::er.d
l CO -r-~c;==....!.-,
~ 0 +--7---7---:--1
6 0 T--i-.L......--1
~
60
..~..
~··cp'... ~~d
...... .......
a0 +--....:_-'--1
6 0 +--'---'--l
, , Ii
I
Caucasio:n
·"('\
. ·
40
20
0
?igure 14.
"'
,.
v
- .
Vitc~in
B1 2
~
inta~e
as
pe~cent
of 2JA by
for rating
f - Excellent · 100~ 6r above 2CA
G - Gocd
- 66-_2/3 ;~ or &.bove RJ.i;,
~Le~er.d
" - Fair
•
?ocr
5C ~ ;
so:
or ::jo't.re
o::-- below
?.~A
~D~
~ercent
o:
.,;
_.
subj~:~=.
39
Dietary adequacy
w~s
considered to be an intake of 66-2/3
percent or above the RDA.
The majority of the sample
- - - - F-eG-e-i-ved~6&··2-!'3-P-e!'-c£n"t_or_mo_I'e___O_f the RDA for energy_,________
protein, iron, vitamin A, niacin, riboflavin, and ascorbic
acid on both the weekday and the v.reekend.
More than 50
percent of the sample received less than 66-2/3 percent of
the RDA for calcium, thiamin, folic acid, vitamin B6, and
vitamin B12 on the weekday and/or on the weekend.
One-way analysis of variance was performed to
identify any relationship between nutrient intake and the
characteristics of the sample.
as percentage of the RDA.
Sex
1) male
Age
1) under 75
1) SSI
Ethnic background
The treatment groups were:
2) female
Residential status
Income
Each nutrient was analyzed
2) over 75
1) alone
2) not alone
2) no SSI
1) Spanish language
2) Caucasian
The following significant relationships were noted at the
0.05 level:
Male subjects had greater. intakes of protein,
iron, niacin, and vitamin B6.
Subjects not receiving SSI had greater intakes
of vitamin B6.
Caucasian subjects had greater intakes of
ascorbic acid.
CHAPTER V
DISCUSSION
In surveying nutritional adequacy, it is necessary
to consider the variability of nutrient content and the
valid:i.ty of food composition data ( 26).
Information on the
nutrient content of foods may be incomplete because of
difficulties in analysis (37,38,39).
Losses of nutrients
in food during preparation have been extensively investigated (40).
Further, there is evidence of significant
nutrient losses in institutional food handling during
preparation 9 distribution, and serving (41,42).
The
congregate meals were prepared and assembled in a central
kitchen in
Camaril~o,
refrigerated overnight or over the
weekend, and delivered to the sites each morning.
were reheated at each site prior to serving.
The meals
Frozen or
canned vegetables were most often used and these were
prepared at the site.
The California Office on Aging, which establishes
the standards for nutrition projects in the state, assumes
that the congregate meal might contribute approximately
66-2/3 percent to 75 percent of the participants' total
daily food and nutrient intake (43).
40
The meal pattern
requirements set by the state are meant to ensure a minimum
of one-third of the basic nutrient needs of each partie!______ -pant._.__Exc_e_p_t___f_o_r_fo_li_c acid Ll6%_L_C!nd__yi tamin !!6_(?_§f,_)_L __
one--third or more of the RDA of the nutrients evaluated
were available in the congregate menus.
Two nutrients
monitored at the state level, vitamin A and ascorbic acid,
were among the highest in mean percentage of the RDA
provided in the menus.
For vitamin A, 90 percent of the
RDA for men and 113 percent of the RDA for women were
available.
For ascorbic acid, 75 percent of the RDA was
available for men and women.
For the sample, the congregate meal supplied a mean
49 percent of the total day's intake of the nutrients
studied.
There was no significant relationship between
'the characteristics of the sample and the contribution of
the congregate meal to the total day's intake.
It is recognized that low dietary intake in terms
of the RDA does not necessarily imply poor nutritional
status.
For this reason, diets were analyzed so that only
significant nutrient deficiencies were considered.
Also,
the use of mean intakes can mask the fact that substantial
proportions of individuals \dthin a group may have had
intakes far below the standard for any nutrient (18,44,45}.
Mean calcium intake for the total sample as percentage of the RDA was 103 percent on the weekday and 69.5
percent on the weekend.
Mean calcium intake was 92.7
42
percent of the RDA for men and S4 percent of the RDA for
women for the weekday and the weekend.
On the weekend,
hewe-ver-,-~onJ.yJ-3-per-cent_of_thEL men_and -~~_p_ercen1i_p_!__!_~e
women had calcium intakes at 66-2/3 percent or above of the
RDA, and only 26 percent of the Spanish language subjects
had intakes at this level.
The RDA for calcium for men and women is SOO mg.
per day, but higher intakes might be necessary.
As calcium
absorption has been shown to decrease with age, calcium
requirements are likely to increase with age (46,47).
Studies have indicated that 1.4 grams per day are needed to
maintain calcium balance in postmenopausal women (4S).
In
this study, calcium intake decreased in both men and women
on the weekend, with men experiencing a greater decrease.
Figure 15 illustrates the calcium/phosphorus ratio in
subjects, and the shift on the weekend due to decreased
calcium consumption.
Calcium absorption is greatly
affected by the ratio of dietary calcium to phosphorus.
This imbalance in calcium/phosphorus ratio, along with
decreased efficiency of the body to absorb calcium
~~th
increasing age and inadequate dietary calcium may lead to
serious problems of skeletal health (47).
body is interrelated with phosphorus.
Calcium in the
Whenever phosphorus
is in excess of calcium, bone loss is likely to occur (46).
There are indications that approximately 30 percent of women
over fifty-five and 30 percent of men over sixty years of
43
;,:ale
""eekday
?e!'cent
o:'
subjects
l•:a lP.
··ee ~ : enc
50
50 . . . - - - - - - - - - - . .
40
40
30
20
10
0
.2
.4
Calciun/phos p~ orus
l.O ::. . 2
r at io
C&l cium/pnos~horus
?em&.le
:·:eekd ay
ratio
~ eoa le
i··eekend
50
Per~ent
40
40
3C
30
20
20
10
10
of.'
subjects
o L--..Jl!B2~ollllllli0i~~~~!lia......J
_,2 .4 . 6 . 3 1. 0 1.2
Calcium/phosphorus ratio
Figure 15.
.2
.4
~
.3
Calcium/phos~horus
Calcium/phosphorus ratio of subjects.
1 . 0 1.2
ra tio
age have had sufficient mineral loss to have produced at
least one fracture (47).
On the weekday, when 59 percent
- or--che -RDA-for·· -calcium--was--avai-l-able-i-n- -the .congregat_e __
menus, calcium intake was higher in the total sample.
There may be a relationship between the consumption of the
congregate meal and the higher calcium intake on the weekday.
Both folic acid and vitamin B6 were deficient
among the sample.
Folic acid was deficient in every group
with no significant difference
intakes.
be~ween
weekday and weekend
Vitamin B6 was deficient in every group except
males, where 66 percent had adequate weekday intakes and
77 percent had adequate weekend intakes.
Approximately
60 to 100 percent of the other groups had inadequate
intakes of vitamin B6 on the weekday and on the weekend.
Vitamin B12 was deficient among subjects receiving SSI and
Spanish language subjects.
Only 2g percent of the subjects
receiving SSI had adequate intakes on the weekday and weekend, and only 40 percent of the Spanish language subjects
had adequate intakes on the weekend.
Thiamin intake was
deficient on the weekend among three groups, those over
seventy-five, not living alone, and Spanish language.
The
intake of folic acid, vitamin B6, and vitamin B12 was
highest in men and lowest in subjects receiving SSI.
One of the more common specific nutrient deficiencies of dietary origin in the elderly are nutritional
45
anemias; both iron deficiency and macrocytic anemia
resulting from a deficiency of folic acid, vitamin B6, or
···· · - - vi-tamin B1-2- ( 13,49 ,-~0, $1-,52) • _Eolic a.e_i_d_
d§.fici~I1C:Y
is
thought to be common in the aged as well as being one of
the most prevalent nutrient deficiencies in the general
population (50).
Depletion states occur often in the aged
and may be caused by inadequate dietary intake, destruction
in cooking, maldigestion, malabsorption, impaired utilization, increased tissue demands, or increased excretion or
destruction (50,53,54}.
The most consistent absorption
problem in the elderly is reduction of iron absorption due
to decreased secretion of acid by the stomach ( 44) .
Both
folic acid and vitamin B12 have primary roles in maintaining the absorptive ·surface of the gastrointestinal tract
'(44).
Vitamin B12 and iron deficiencies can interfere with
the utilization of folic acid (54).
It appears that each
vitamin may take part in multiple metabolic reactions and
many effects of different vitamins are interrelated.
Folic acid values in tables of food composition are
generally results of food assays which have not been fortified with folacin {3S).
In this study, 34 percent of the
sample consumed dry breakfast cereals.
A check of the
cereals showed that many were fortified with vitamins and
minerals such as iron, folic acid, vitamin B6, and vitamin
B12·
The vitamins and minerals added and the amounts added
of each varied among the brands, with some providing as much
46
as· 100 percent of the U.S. RDA (55) for iron, folic acid,
vitamin B6, and vitamin B12.
Some brands were fortified to
-------- supply- 25--percent -0-f'.-the_ U.S. RDA
only 10 percent.
_whil~- Qt_h.~r.s -~'l!PPl!eci__
Some fortified cereals did not contain
folic acid, others lacked vitamin B12·
Fifty percent of the sample consumed a variety of
vitamin or vitamin mineral supplements on a regular basis
and these supplements were not included in this study.
Therefore, the intake of fortified dry breakfast cereals
and vitamin or vitamin mineral supplements might affect the
nutrient intake considerably.
Energy intake has often been cited as inadequate in
dietary studies.
Among the subjects, mean intake on the
weekday and on the·weekend was 75 percent of the RDA.
Two
·factors need to be considered when analyzing energy intake.
First, caloric intake is often underestimated by the
twenty-four hour recall method (29,30).
Second, the RDA
or the energy standards used in the various surveys may
be too high for the elderly (32).
The prevalence of
obesity among seniors has been cited in several studies
(14',15 ,56).
The RDA for individuals over fifty-one years
of age do not call for a reduction in nutrients such as
protein, vitamins, and minerals comparable to the decrease
in
energy~
This implies increased nutrient density to
provide larger quantities of these nutrients per 1,000
calories.
Realistically a diet less than 2,000 calories is
47
likely to be deficient in vitamins, especially with the
wide variation in nutrient content of identical foods
- ( 26, 54) • -Also, there _is experimentaL a_nd_cl_iniGal_ eyj.depce
suggesting an increased need for certain nutrients with
advancing age.
These nutrients include folic acid, thiamin,
ascorbic acid, vitamin B6, vitamin B12, iron, and calcium
(39,51,57).
The energy provided in the congregate menus for men
was at the minimum requirement of one-third of the RDA.
Forty-five percent of the energy allowance was available
for women in the congregate menus.
There was no signifi-
cant difference in weekday and weekend energy intake among
the subjects, yet more nutrients were adequately supplied
on the weekday.
The weekend intake when the congregate
meal was not available was significantly lower in calcium,
thiamin, and riboflavin.
On the weekend, 70 percent of the total subjects,
S9 percent of the men and 66 percent of the women, ate at
least one meal away from horne.
These meals were consumed
in a variety of places -- fast food, coffee shop, restaurant, or social function.
CHAPTER VI
SUMMARY AND RECOMMENDATIONS
A random sample of participants in the Senior
Nutrition Program administered by the Ventura County Public
Social Services Agency l'ras surveyed to determine the
contribution of the congregate meal to nutrient intake,
determine weekend nutrient intake, and the relationship
of sex, age, socioeconomic factors, and ethnic background
on nutrient adequacy.
One-way analysis of variance was performed to
determine any significant differences between weekday and
weekend nutrient intake.
The following significant
differences were noted at the 0.05 level:
Calcium, thiamin,
and riboflavin intakes were greater on the weekday.
The
research hypothesis was accepted that the nutrient intake
of the participant on the weekday will differ from the
.weekend intake for energy and eleven selected nutrients.
Nine congregate menus were evaluated for nutrient
adequacy as percentage of the RDA for men and women over
age fifty-one.
The menus provided one-third or more o.f the
RDA for energy, protein, calcium, iron, vitamin A, thiamin,
niacin, riboflavin, ascorbic acid, and vitamin B12·
The
menus provided 16 percent o.f the RDA for folic acid and
49
26 percent of the RDA for vitamin B6.
The research
hypothesis may be partially accepted that the congregate
meal will provide a minimum of one-third of the RDA for
energy and
~ine
nutrients, but will provide less than one-
third of the RDA for folic acid and vitamin B6.
The contribution of the congregate meal to the total
day's mean intake of energy, protein, calcium, iron,
vitamin A, thiamin, niacin, riboflavin, ascorbic acid, folic
acid, vitamin B6, and vitamin B12 was 49 percent.
The
research hypothesis was accepted that the amount consumed
of the congregate meal will provide a minimum of one-third
of the total day's mean intake for energy and eleven
selected nutrients.
One-way analysis of variance was performed to
determine if sex, age, residential status, income, or
ethnic background were related to the percentage of the
total day's intake from the congregate meal.
No signifi-
cant differences were noted at the 0.05 level.
Individual nutrients were analyzed for adequacy
among the total sample.
The majority of the sample
received 66-2/3 percent or more of the RDA for energy,
protein, iron, vitamin A, niacin, riboflavin, and ascorbic
acid on the weekday and on the weekend.
More than 50
percent of the sample had intakes below 66-2/3 percent of
the RDA for calcium, thiamin, folic acid, vitamin B6, and
vitamin B12 on the weekday and/or on the weekend.
50
One-way analysis of variance was performed to
identify any relationship between nutrient intake and the
characteristics of the sample.
The followingsignificant
relationships were noted at the 0.05 level:
Sex - males had greater intakes of protein, iron,
niacin, and vitamin B6 than females.
Income - subjects not receiving Supplemental
Security Income had greater intakes of vitamin B6 than
subjects receiving Supplemental Security Income.
Ethnic background - Caucasian subjects had greater
intakes of ascorbic acid than Spanish language subjects.
Recommendations for Congregate
Nutrition Services
l.
Monitor as many of the nutrients as possible
at the state level to ensure adequacy.
The state is more
likely to have the facilities and capability to evaluate
menus for nutrient levels than the individual projects.
2.
Explore the feasibility of providing meals six
or seven days a week.
If the budget prohibits operation of
the sites on this basis, consider the provision of frozen,
.freeze dried, or canned foods for the seniors to prepare
easily on the weekend.
3.
Direct nutrition education at developing an
awareness of food sources and food choices to include
nutrients that are most often found deficient, and motivate
the seniors to make the necessary adaptations.
51
4.
Review the current practice of providing one
eight-ounce serving of milk per participant.
In recogni-
tion of the widespread prevalence of calcium deficiency,
milk consumption at the site might be encouraged.
Explore
the possibility of offering milk on an open basis such as
coffee is now offered.
Recommendations for Further Study
1.
Conduct a nutritional assessment of each
participant based upon biochemical measurements, anthropometric measurements, clinical observation, past medical
history, and dietary intake.
This would provide valuable
information on nutritional status and aid in identifying
problems such as the various nutritional anemias, along
with other specific nutrient deficiencies.
2.
Investigate the fortification of suitable foods
with the least expensive form of milk.
Research and
develop recipes using milk and incorporate into standard
food preparation procedure.
Vehicles of fortification
might include gravies, puddings, various ground meat
entrees, and baked products such as cookies, biscuits,
muffins, quick breads, etc.
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56
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APPENDICES
57
APPENDIX A
(
---
.
DIETARY RECALL
Date:
Meal site:
Name:
Ethnic backr-round:
Sex:
Number of people in
household:
Age:
Income:
Height:
Health problems:
Weight:
Time
of day
Descriotion
Item No.
Serving Size
Grams
I
'