The National Evaluation of the Older Americans Nutrition Program 1993-95 (8) found that the average OANP meal provided more than 50% of the 1989 Recommended Dietary Allowances (RDAs) for many nutrients based on adult male values. The National Evaluation concluded that both congregate and home-delivered meals contributed significantly to participants' daily nutrient intake, and therefore, their nutritional status. When comparing the nutrient content of OANP meals at the time of the National Evaluation to newer Dietary Reference Intakes (DRIs) (including RDA and other values described below), the meals would have been deficient in vitamins D, E, folate, and magnesium. Other nutrients met or exceeded the newer DRI/RDA values. See Table 2 Nutrient Availability of an Older Americans Nutrition Program Meal Relative to the Dietary Reference Intakes and Recommended Dietary Allowances compiled by the National Policy and Resource Center on Nutrition and Aging (Center).

The use of the newer DRI/RDA values to plan and evaluate OANP meals was addressed by an Issue Panel convened by the Center in February 2002 (reviewed later in this chapter). Recommendations from this and future Issue Panels will continue to shape OANP practice and guidelines.

B. NUTRITION RECOMMENDATIONS

Congress reauthorized the Older Americans Act (OAA) in 2000 for 5 years. OAA Section 339 requires that nutrition projects meet the Dietary Guidelines for Americans (9), published by the Secretaries of Health and Human Services and Agriculture and the RDAs (which are now included in the DRIs) established by the Food and Nutrition Board, Institute of Medicine of the National Academy of Sciences. The National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101-445) requires that the Secretaries of Health and Human Services and Agriculture contract with a scientific body, such as the National Academy of Sciences, to publish reports on nutrient requirements and status of the United States on a 2 to 5 year basis and to develop Dietary Guidelines every 5 years. The Act requires that all federal food, nutrition, and health programs promote the Dietary Guidelines. Thus, the most recent versions of the DRIs and Dietary Guidelines serve as the cornerstone for federal nutrition policy.

The new DRIs (10-15) provide values for men and women aged 51-70 and over 70 years. The DRI values include an RDA or an Adequate Intake for nutrients with no established RDA, and a Tolerable Upper Intake Level. Refer to Table 1 Dietary Reference Intakes for Older Adults compiled by the Center for current nutrient values established by the Food and Nutrition Board.

• The RDA is the average daily dietary intake level that is sufficient to meet the nutrient requirement for nearly all (97-98%) healthy individuals of a specified age range and gender.
• The Adequate Intake (AI) is the daily dietary intake level of healthy people assumed to be adequate when there is insufficient evidence to set an RDA. It is based on observed mean nutrient intakes and experimental data. The National Academy of Sciences recommends that the Adequate Intake be used if an RDA is not available.
• The Tolerable Upper Intake Level (UL) is the highest daily dietary intake that is likely to pose no risk of adverse health effects to almost all individuals of a specific age range.
• The Estimated Energy Requirement (EER) is defined as the dietary energy intake that is predicted (with variance) to maintain energy balance in a healthy adult of defined age, gender, weight, height and level of activity, consistent with good health.
• An Acceptable Macronutrient Distribution Range (AMDR) is defined as a range of intakes for a particular energy source (ie, carbohydrates, proteins, fats) that is associated with reduced risk of chronic disease while providing adequate intakes of essential nutrients. The AMDR is expressed as a percentage of total energy intake because its requirement is not independent of other energy fuel sources or of the total energy requirement of the individual.

The newer DRIs include RDAs for older adults that are higher than the 1989 RDAs for vitamins B-12, C, D, E, K, folate, calcium, and magnesium. The DRIs provide equations to calculate an individual's energy requirements based on activity level (the EER). To meet the body's daily nutritional needs while minimizing risk for chronic disease, an AMDR was established for carbohydrate to be 45-65% of total calories, for fat, 20-35% of total calories, and for protein, 10-35% of total calories. The DRIs also suggests that no more than 25% of total calories come from added sugars (those incorporated into foods and beverages during production and processing). The DRIs now emphasize the importance of physical activity and recommends that adults strive for an "active" lifestyle that is equivalent to 60 minutes of moderately intense physical activity throughout each day (15).

The 2000 Dietary Guidelines for Americans (5th ed.) are the most current guidelines to be followed when planning and serving OANP meals. These guidelines are incorporated in the selection of foods and serving sizes for meals as well as the basis for nutrition guidance for individuals and groups. The 3 main themes are:

1. Aim for Fitness

• Aim for a healthy weight. Choose a lifestyle that combines sensible eating with regular physical activity. To be at their best, adults need to avoid gaining weight, and many need to lose weight. Being overweight or obese increases your risk for high blood pressure, high blood cholesterol, heart disease, stroke, diabetes, certain types of cancer, arthritis, and breathing problems. A healthy weight is key to a long, healthy life.

Be physically active each day (a new recommendation). Being physically active and maintaining a healthy weight are both needed for good health, but they benefit health in different ways. Children, teens, adults, and the elderly—all can improve their health and well-being and have fun by including moderate amounts of physical activity in their daily lives.

2. Build a Healthy Base

• Let the pyramid guide your choices. Different foods contain different nutrients and other healthful substances. No single food can supply all the nutrients in the amounts you need. For example, oranges provide vitamin C and folate but no vitamin B12; cheese provides calcium and vitamin B12; but no vitamin C. Choose the recommended number of daily servings from each of the five major food groups. If you avoid all foods from any of the five food groups, seek guidance to help ensure that you get all the nutrients you need.
• Choose a variety of grains, especially whole grains. They provide vitamins, minerals, carbohydrates (starch and dietary fiber), and other substances that are important for good health. Whole grains differ from refined grains in the amount of fiber and nutrients they provide, and different whole grain foods differ in nutrient content, so choose a variety of whole and enriched grains. Eating plenty of whole grains may help protect you against many chronic diseases.
• Choose a variety of fruits and vegetables daily. Eating plenty of fruits and vegetables of different kinds may help protect you against many chronic diseases. It also promotes healthy bowel function. Fruits and vegetables provide essential vitamins and minerals, fiber, and other substances that are important for good health. To promote your health, eat a variety of fruits and vegetables—at least 2 servings of fruits and 3 servings of vegetables—each day.
• Keep food safe to eat (a new recommendation). Foods that are safe from harmful bacteria, viruses, parasites, and chemical contaminants are vital for healthful eating. Safe means that the food poses little risk of foodborne illness. Farmers, food producers, markets, food service establishments, and other food preparers have a role to keep food as safe as possible. However, we also need to keep and prepare foods safely in the home, and be alert when eating out.
  
  

  3. Choose Sensibly
  
  

• Choose a diet that is low in saturated fat and cholesterol and moderate in total fat. Fats supply energy and essential fatty acids, and they help absorb the fat-soluble vitamins A, D, E, and K, and carotenoids. Some kinds of fat, especially saturated fats, increase the risk for coronary heart disease by raising the blood cholesterol. In contrast, unsaturated fats (found mainly in vegetable oils) do not increase blood cholesterol. Eating lots of fat of any type can provide excess calories.
• Choose beverages and foods to moderate your intake of sugars. Sugars are carbohydrates and a source of energy (calories). Dietary carbohydrates also include the complex carbohydrates starch and dietary fiber. Sugars and starches occur naturally in many foods that also supply other nutrients.
• Choose and prepare foods with less salt. Many people can reduce their chances of developing high blood pressure by consuming less salt. Many studies in diverse populations have shown that a high sodium intake is associated with higher blood pressure. At present, the firmest link between salt intake and health relates to blood pressure. High salt intake also increases the amount of calcium excreted in the urine. Eating less salt may decrease the loss of calcium from bone. Loss of too much calcium from bone increases the risk of osteoporosis and bone fractures.
• If you drink alcoholic beverages, do so in moderation. Alcoholic beverages supply calories but few nutrients. Current evidence suggests that moderate drinking is associated with a lower risk for coronary heart disease in some individuals. However, higher levels of alcohol intake raise the risk for high blood pressure, stroke, heart disease, certain cancers, accidents, violence, suicides, birth defects, and overall mortality (deaths). Older adults have a decreased ability to metabolize alcohol due to physiological changes and as a result may be at greater risk of adverse consequences.
  

SECTION 339 Nutrition
A State that establishes and operates a nutrition project under this chapter shall
(1) solicit the advise of a dietitian or individual with comparable expertise in the planning of nutritional services, and
(2) ensure that the project --
(A) provides meals that --
(i) comply with the Dietary Guidelines for Americans, published by the Secretary and the Secretary of Agriculture,
(ii) provide to each participating older individual
(I) a minimum of 33 1/3 percent of the daily recommended dietary allowances as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences, if the project provides one (1) meal per day,
(ll) a minimum of 66 2/3 percent of the allowances if the project provides two (2) meals per day, and
(III) 100 percent of the allowances if the project provides three (3) meals per day, and
(iii) to the maximum extent practicable, are adjusted to meet any special dietary needs of program participants.
(B) provides flexibility to local nutrition projects in designing meals that are appealing to program participants, …

The Center convened an Issue Panel: Dietary Reference Intakes and Dietary Guidelines in OANPs in February 2002. Panelists included nutrition and aging-related researchers, individuals involved in policy development, persons working at the federal, state, and local program level, and representatives from food industries. The Issue Panel Report includes a summary, backgrounder and working documents, and a directory of Issue Panelists (16).

The Issue Panel focused on the rationale for and the use of the most recent DRIs and Dietary Guidelines in the provision of OAA nutrition services, including nutrition education, nutrition counseling, and congregate and home-delivered meals. The Issue Panel Report was provided to the US Administration on Aging for consideration. These recommendations will assist in the development of guidance and technical assistance related to implementation of the DRIs and Dietary Guidelines in the OANP. State Units on Aging (SUAs), Area Agencies on Aging (AAAs), local service providers, and Title VI grantees can use these recommendations in the development of guidance and assistance for implementation. Recommendations from the report are included in applicable sections of the Older Americans Nutrition Program Toolkit.

The OAA states that a project shall provide a meal that complies with the Dietary Guidelines and a stated percentage of the RDAs which varies with the number of meals served to a participant. Because it is the responsibility of the SUA to implement the OAA, SUAs have incorporated these standards into their policies and procedures.

1. OANP meals should meet the current RDAs and AIs, and the 2000 Dietary Guidelines for Americans, as these reflect the most recent scientific evidence and provide the best-known guidance for meeting the nutrition needs of older adults in America.
2. OANPs should strive to ensure that each meal is reasonably well-balanced nutritionally and reflects the 2000 Dietary Guidelines since the meals provide a positive nutrition education model for participants. To best serve the nutrition and educational needs of participants, OANPs that serve 1 meal per day should ensure that each meal offers at least 33 1/3% of the RDAs/Adequate Intakes. OANPs that serve two meals per day should ensure that the sum of the two meals offers at least 66 2/3% of the RDAs/Adequate Intakes (but each meal itself does not have to be 33 1/3%) and those serving three meals per day should ensure that the sum of these three meals offers 100% of the RDAs/Adequate Intakes.
3. In addition to providing meals that meet the 2000 Dietary Guidelines and 1/3 of the RDAs/Adequate Intakes, OANPs should emphasize foods high in fiber, calcium, and protein. To the extent possible, programs should continue to target vitamins A and C, with vitamin A provided from vegetable-derived (carotenoid) sources. However, targeting specific nutrients such as those mentioned in this recommendation should not be misinterpreted as permission to ignore other nutrients. More specific recommendations regarding targeting nutrients should be addressed at a future Issue Panel.
4. OANPs should plan and evaluate meals for meeting the 2000 Dietary Guidelines and 1/3 RDA/Adequate Intake standards by computer-assisted analysis. Furthermore, Registered Dietitians (or individuals with comparable expertise) should be available at the SUA, AAA, and local provider level to assure nutrient adequacy of meals. If a meal pattern is used, it should be based on the food servings delineated in the Food Guide Pyramid that combined would meet 1/3 the RDAs/Adequate Intakes and the 2000 Dietary Guidelines, be tested for meeting standards, and include increased servings of fruits, vegetables, and whole grains.
5. Assuming culturally appropriate meals, OANPs should accommodate specific dietary needs to the extent possible. To better serve defined groups and individuals who require customization or therapeutic diets, OANPs would benefit from the availability of Registered Dietitians (or individuals with comparable expertise) -- who could also conduct needs assessments of the populations their programs serve.

The table below presents the most current DRIs and other nutrient values to use when planning and evaluating meals. Values are provided for serving 1, or a combination of 2 or 3 meals for 1 day's consumption for the average older adult population served by the OANP. The nutrients selected include those recommended for emphasis by the Issue Panel and those found in a number of studies to be deficient or of concern in the diets of older adults. (See "Enhancing the Nutritional Quality of the Meal" section of this chapter). Refer to Table 1 Dietary Reference Intakes for Older Adults compiled by the Center for all DRI values and footnotes.

* RDAs are in bold type and Adequate Intakes (AIs) are in ordinary type followed by an asterisk (*).
**Vitamin A should be provided from vegetable-derived (carotenoid) sources. See Issue Panel Report on Dietary Reference Intakes and Dietary Guidelines in Older Americans Act Nutrition Programs.
(1) Value for 75 year old male, height of 5'7", " low active" physical activity level (PAL). Using Table 5-22 Estimated Energy Requirements (EER) for Men and Women 30 Years of Age, calculated the median BMI and calorie level for men and subtracted 10 kcal/day (from 2504 kcal) for each year of age above 30.
(2) The RDA for protein equilibrium in adults is a minimum of 0.8g protein/kg body weight for reference body weight.
(3) Used highest DRI value for ages 51+ and male and female.
(4) Acceptable Macronutrient Distribution Ranges (AMDRs) for intakes of carbohydrates, proteins, and fats are expressed as percent of total calories. The AMDR for protein is 10-35%, carbohydrate is 45-65%, total fat is 20-35%.
(5) The RDA for carbohydrate is the minimum adequate to maintain brain function in adults.
(6) Because the percent of energy that is consumed as fat can vary greatly while still meeting daily energy needs, an AMDR is provided in the absence of an AI, EAR, or RDA for adults.
(7) Recommendations from the Dietary Guidelines for Americans 2000.
(8) Saturated fats, trans fatty acids, and dietary cholesterol have no known beneficial role in preventing chronic disease and are not required at any level in the diet. The recommendation is to keep intake as low as possible while consuming a nutritionally adequate diet, as many of the foods containing these fats also provide valuable nutrients. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academy Press; 2002.
(9) National Research Council, Food and Nutrition Board. Recommended Dietary Allowances. 10th ed. Washington, DC: National Academy Press; 1989.

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

• The OANP meal can provide a good example of healthy food choices and balanced eating for participants, as well as demonstrate to federal policy makers the best that the OANPs offer;
• The availability of water-soluble nutrients, such as vitamin C, in foods may be reduced over long cooking or transporting times. Thus, participants may not be consuming the level of these nutrients that is planned; and
• The needs of congregate and home-delivered meal participants may not be equally met. Individuals who receive home-delivered meals five days per week may have better nutrient intakes over time than congregate participants that do not receive meals daily. Data indicate that only 60% of congregate participants attend a dining center 5 days a week. It is possible that participants might come on days when the meal contains less than requirements (16).

The Center plans to hold another Issue Panel (2003) regarding implementation of the DRIs. It is expected that the Panel will develop more specificity for energy (calories), the percentage of carbohydrate, protein, and fat to total calories, and key nutrients that should be included in computer-assisted menu analyses. The Issue Panel recommendations will be included in future modifications of the above table and other sections of this chapter.

C. MENU PLANNING

In order to ensure nutrient quality for the health of older Americans and to comply with the requirements of the OAA, SUAs establish written standards and guidelines detailing the specific requirements for menu planning and approval. Planning menus that includes input from participants is a best practice. Information may be obtained through focus groups, advisory councils, suggestion boxes, or surveys. Suggestions may also come from food production staff, site managers, home-delivered meal drivers, and food purveyors. SUAs, AAAs, and local providers should rely on professionals, preferably registered dietitians or nutritionists, to assist in the development, implementation, and approval of menus for OANPs. (Chapter 2 provides a description of a registered dietitian). Ideally, the menu will reflect local food preferences, provide variety in shape, color, temperature, texture, and flavor, consider food availability (foods in season), and costs. Well planned menus improve meal quality and increase client satisfaction (17).

The Issue Panel recommended that OANPs plan and evaluate meals for meeting nutritional requirements using computer-assisted nutrient analysis and that Registered Dietitians (or individuals with comparable expertise) be available at the state, area, and local provider levels to assure nutrient adequacy of meals (16).

A variety of nutrient analysis and meal production software products are available and used by SUAs, AAAs, and providers. Some simply provide analysis of foods, recipes, and menus. Others offer food production, inventory, and costing capabilities. The National Policy and Resource Center on Nutrition and Aging surveyed SUAs (12/02) concerning their use and requirements to use nutrient analysis software. (Click here for complete survey). Below is a summary of some of the responses. Additional responses are included in the "Menu Review and Approval" section of this chapter.

State Unit on Aging Respondents (N = 33)

• 10 SUAs use computer software to analyze the nutrient content of meals. These include Food Processor (6 SUAs), Nutritionist Pro (2 SUAs), FoodWorks (1), Computrition (1), and Nutritionist V (1).
• Factors influencing the selection of Food Processor software were cost, ease of use, ability to add to the data base, completeness of the database, and technical support. Nutritionist Pro and Foodworks were selected for similar reasons. Nutritionist V was selected because it provided quantity recipes. Computrition was used by a large vendor to do forecasting, inventory control, etc.
• 6 SUAs recommended a particular brand of nutrient analysis software for AAA and provider use: Food Processor (4 SUAs), NutritionistPro (1), and Nutritionist IV or more (1). Several SUAs indicated they provide no specific recommendations.
• SUAs identified nutrient analysis software commonly used by AAAs and providers: Food Processor (9 SUAs ), Nutritionist IV or V (5), Nutritionist Pro (4), Computrition (4), and Master cook (2).
  

The following list of nutrition software products was compiled by the Center:

• CALCMENU www.calcmenu.com/
• Computrition www.computrition.com/
• Dave Johnson Nutrition www.djsoft.com/
• DietAid www.shannonsoft.com/
• DietMaster www.lifestylestech.com/
• Dine Healthy www.dinesystems.com/
• Food Processor, Esha Research www.esha.com
• Food Smart www.food-smart.com/
• FoodWorks, Nutrition Company www.nutritionco.com
• Fuel Nutrition Software www.logiform.ca/fuel/pro_an.htm
• Mealformation Software www.mealformation.com/
• Nutribase 2001 Clinical, CyberSoft, Inc. www.nutribase.com
• Nutritionist Pro, First Databank www.firstdatabank.com
• SureQuest Software www.surequest.com/products.htm

A meal pattern is best used as a menu-planning tool (ensuring food plate coverage, and as a component of a catering contract) rather than as a standard for nutritional adequacy or as a compliance tool. Use of computerized nutrient analysis rather than a meal pattern helps ensure nutritional adequacy of meals and increases menu planning flexibility. Many SUAs require documentation that menus meet nutrient requirements using computer-assisted nutrient analysis. Some SUAs specify that meals must follow a meal pattern with no deviation.

Additional guidance is often provided for accompaniments such as desserts, condiments including margarine, salad dressings, and relishes, and beverages other than milk. Specific guidance is frequently included to ensure that foods high in key nutrients are provided. Recommendations for inclusion of foods high in vitamins A and C and fiber are common. In addition, information is typically provided in SUA guidelines to ensure that menus incorporate foods that are lower in sodium, fat, saturated fat, and cholesterol.

The 1972 meal pattern (still used by many OANPs today) first appeared in the Guide to Effective Project Operations, The Nutrition Program for the Elderly (the Oregon Guide, 1973). It was assumed that if a variety of foods were provided daily in the amounts indicated and proper food preparation and handling was practiced, the meal would provide at least 1/3 of the 1968 RDAs. The pattern became the quick checklist for determining the nutritional adequacy of a meal. Some SUAs added requirements that meals provide foods high in specific nutrients, such as vitamins A and C, as well as some others. This pattern does not ensure that the new DRI requirements are met for calories, carbohydrates, magnesium, folate, vitamin E, and fiber as noted in the Issue Panel Report: Table 4.1 Nutrient Composition of the 1972 Meal Pattern [page 53 of 62] (16). These variations in menu planning may be addressed in state guidelines.

The updated sample meal pattern below is based on the newer DRIs for energy as calculated for the table above, "Dietary Reference Intakes for Meal Planning and Evaluation." It provides approximately 685 calories per meal. The number of servings for each food group are based on USDA's Food Guide: Background and Development, Table 5 Nutrient profiles for food groups and subgroup composites. These profiles represent the quantities of nutrients and other components that one would expect to obtain on average from a serving of food in each group (18). Information from Table 5 Nutrient profiles... and from USDA's Agricultural Research Service, Home and Garden Bulletin No.72 (Revised October 2002) was used to determine the appropriate number of food group servings to best meet the new DRIs. See table, "Nutrient Composition of a Sample Meal Pattern."

The updated sample meal pattern includes 1 additional serving of bread or bread alternate and another serving of vegetable or fruit compared to the 1972 meal pattern. Serving sizes are based on the Food Guide Pyramid. The number of servings reflects an appropriate distribution of foods for the day, particularly for lunch or supper. Servings from a food group may be combined as one larger serving. For example, 2 servings from the bread or bread alternate food group may include 2 slices of bread for a sandwich or 1 cup of pasta or rice or it may include 1/2 cup pasta and 1 slice of bread. Likewise, 2 servings of vegetable may be 1/2 cup mashed potato and 1/2 cup green beans or 1 cup of either vegetable. The pattern provides the option for substituting 1 fruit serving for a vegetable serving and vice versa.

This updated sample meal pattern, although based on the food servings recommended in the Food Guide Pyramid, does not assure that meals meet 1/3 the DRIs and the 2000 Dietary Guidelines. Meals are likely to require specific types of fruits and vegetables, whole grains, and high fiber foods. Based on the information used from USDA's Food Guide: Background and Development, Table 5 Nutrient profiles for food groups and subgroup composites, the updated meal pattern may be deficient in vitamin E, requiring extra care in the selection of foods that are good sources of this nutrient (see "Sources of Key Nutrients" section of this chapter). Because of the increased nutrient requirements, it may be difficult for some participants to eat the amount of food for 1 meal at 1 sitting. The use of nutrient dense foods as well as fortified and enriched products should be a priority. In addition, calories from carbohydrates, fats, and/or proteins will require adjustment for underweight or overweight individuals. As appropriate for the weight status of participants, the provision of food supplements and modifications in serving sizes of particular food groups may be needed.

(1) The number of servings per meal provides for 1/3 of the DRIs as calculated in Table "Nutrient Composition of a Suggested Meal Pattern for Older Americans Nutrition Program Meals. This table is based on USDA's Food Guide Background and Development, Table 5, Nutrient Profiles for Food Group and Subgroup Composites. This meal pattern also relates to Table "Dietary Reference Intakes for Meal Planning and Evaluation" in this chapter.
(2) Caloric value (685 Kcal) based on a 75 year old male, height of 5'7", " low active" physical activity level (PAL). Using Table 5-22 Estimated Energy Requirements (EER) for Men and Women 30 Years of Age, calculated the median BMI and calorie level for men and substracted 10 kcal/day (from 2504 kcal) for each year of age above 30.
(3) The caloric requirement in the 2000 Dietary Guidelines is 1600-2200 calories.

The food group information below generally follows the 2000 Dietary Guidelines and Food Guide Pyramid. Although some foods are classified in more than 1 food group, a serving of a food can only be counted in 1 food group within the same meal. For example, dried beans may be counted as either a meat alternate serving or as a vegetable serving but not both in the same meal. Likewise, cottage cheese may be counted as either meat alternate serving or milk alternate serving but not both.

The Issue Panel recommended that OANPs emphasize foods that are high in fiber, calcium, and protein, and continue to target vitamins A and C, with vitamin A provided from vegetable-derived (carotenoid) sources. Targeting specific nutrients mentioned in this recommendation should not be misinterpreted as permission to ignore other nutrients (16). A number of studies found specific nutrients to be deficient in diets of older adults (8,19,20). While the National Evaluation revealed that OANP meals supplied over 33% of the 1989 RDAs for key nutrients. When compared to the newer DRIs, meals were inadequate in vitamins D and E, folate, calcium, and magnesium (8). The Continuing Survey of Food Intakes by Individuals 1994-1996 found older adults' dietary intake to be low in calories, total fat, fiber, carbohydrate, vitamin E, folate, calcium, and magnesium (19). The Third National Health and Nutrition Examination Survey (NHANES III) found older adults' dietary intake to be low in calories, total fat, fiber, calcium, magnesium, zinc, copper, folate, and vitamins B6, C and E (20). Therefore, the following require special attention: vitamins A, B-6, C, D, E, and folate; calcium, copper, magnesium, zinc; and calories, carbohydrates, total fat, protein, and fiber. More definitive guidance concerning targeting key nutrients will be developed as part of the next Issue Panel on the implementation of the DRIs.

Foods considered good sources of specific nutrients are shown in the following table prepared by the Center. Information provides "good" and "high" food sources of specific nutrients. A "high source" is defined as providing 20% or more of the Daily Value for a given nutrient per serving. A "good source" is federally defined as providing 10-19% of the Daily Value for a given nutrient per serving. See summary of the use and meaning of Daily Values that follows the table. Foods selected for the table meet the above parameters using typical serving sizes.

The USDA's National Nutrient Database for Standard Reference, Release 15 Nutrient List was used to develop the table (21). The database contains reports of selected food items and nutrients sorted by food description or in descending order by nutrient content in terms of common household measures. The food items and weights are adapted from Home and Garden Bulletin No. 72, Nutritive Value of Foods.