Menu Development and Diets for Special Populations
Candace S. Johnson, RDN, CSG, FAND Consultant Dietitian Nutritionist CS Johnson and Associates, Inc. Email: [email protected] You are What You Eat…but
Common Phrase but with Special Populations: They trust you give them what they need They depend on the food provided to meet their special nutrition needs They want food that tastes good and is healthy Senior populations want variety and choice Seniors are aware of nutrition and news
What is a Special Diet?
A special diet, or therapeutic diet is used to treat a medical condition May be changed with food content Examples: No Added Salt, Consistent Carbohydrate, Low Gluten May be changed with food texture Mechanical soft, puree, thickened liquids Nutrition Focus is Primary
To Prevent Malnutrition
Five meals per week is only partial food intake Meals provided may be more than five meals
Diet Liberalization
Nutrition and Menu Planning
Menus must represent proper and adequate nutrition May be marketable for target populations Gear toward populations served: there may be great differences with groups
Goal is to meet 1/3 of Recommend Daily Allowances for highest need person served What Does This Look Like?
Protein: 30 grams per meal (90 gm) Calcium: 400 mg (1200 mg) Sodium: 430 mg (1300-2300 mg) Fat: No RDA but 35% calories Fiber: 9 gm (25-30 gm) Vitamin C: 30 mg (90 mg)
Nutrition analysis to assure levels
Adequate Nutrition
Protein: 3 ounces high quality protein Calcium: 8 ounces milk or substitute Fiber: Whole grains, fruits and vegetables Sodium: Limited processed foods and high sodium meats, soups and sauces Fat: Less saturated, no added trans fats Vitamin C: Look at juice, fruits and vegetables
Special Diets
Trend for more health?
Brain and Heart Foods?
Are gluten restricted diets increasing?
What to do with requests for special foods
Physician Orders
Special Diets, continued
Therapeutic diets are more restrictive with misinformation and may contribute to malnutrition
Diet liberalization in effect in professional nutrition community since mid 1990s per the Academy of Nutrition and Dietetics position papers Current Special Diets
Move to ADD more nutrition and in effect, decrease culprit nutrients which may overall be more effective for overall health
DASH Diet Mediterranean Diet MIND Diet
DASH Diet
Dietary Approaches to Stop Hypertension
Rich in fruits and vegetables Lower fat or nonfat dairy Whole Grains Lean meats, fish and poultry Includes nuts, seeds, legumes
Rich in potassium, calcium and magnesium DASH Diet
Intended for lowering blood pressure but proven to lower cholesterol and inflammation. Has shown weight loss benefits
Developed by the US National Institutes of Health Consistently rated as the #1 diet
Mediterranean Diet
Introduced in 1993 when low rates of chronic disease were noted in Crete, Greece and southern Italy. Associated with lower LDL cholesterol Mainly fruits, vegetables, nuts, beans, healthy grains, fish, olive oil, small amounts of dairy, red wine Included daily exercise, sharing meals, appreciating pleasure of eating Mediterranean Diet Update
Fish: twice per week Herbs and Spices to replace salt Limits unhealthy fat: more olive or canola oil Focus on plant based diet Other meats, sweets minimized Included water and wine, physical activity and enjoying meals with others
MIND Diet
Mediterranean-DASH Intervention for Neurodegenerative Delay
Proven to benefit heart and may help prevent Alzheimer’s disease
Developed by M. Morris, PhD from Rush University
Combines Mediterranean and DASH diets
What is Brain-Healthy?
Fifteen components for Healthy Foods Green leafy vegetables Other vegetables Nuts Whole grains Berries Poultry Beans Olive Oil Fish Wine
Five Unhealthy Foods
Foods to reduce:
Red meats Butter and stick margarine Cheese Pastries and sweets Fried and fast food MIND Diet Basics
Daily Three servings of whole grains Salad and additional vegetable Glass of wine Snacks most days with nuts Beans every other day Poultry and berries twice a week Fish once per week
Mind Diet Basics
Limit unhealthy foods to less than once per week
Strong evidence for blueberries and emerging for other berries.
Strong adherence lowered risk by 53%, moderate adherence lowered by 35%
MIND Diet Science
What is good for the heart is good for the brain
Antioxidants in berry fruits may protect from harmful free radical damage
Resveratrol found in red wine and grape skins may also help neuron signaling
Polyphenols and anthocyanins
Gluten Restriction
Gluten free for celiac disease
Low gluten maybe for other digestive disorders
Requests for gluten restriction changing
Gluten sensitivity and intolerance Low Gluten Diets
Celiac disease need gluten free for treatment
Few programs can claim a sterile environment so diet cannot be gluten free
Traces make a difference but benefit can be offered
Gluten Free Diets
Requires firm diagnosis of celiac and label reading for proper foods to avoid Undiagnosed can cause other complications such as osteoporosis and other immune disorders Estimated 18 million have non-celiac gluten sensitivity and require a low gluten diet
Some may react to wheat proteins and need to avoid wheat but not other grains Gluten Free Grains
Amaranth Millet Rice: brown, white, wild Pea flour Buckwheat Potato flour Almond meal flour Potatoes Coconut flour Quinoa Corn and cornstarch Sorghum Guar gum Soy flour Teff
All need watch due to contamination
Nutrient Focus Diets
Low Sodium: Varying opinions for level of sodium for an older person. 1500-2300mg
Consistent Carbohydrate Terms: Avoid low sugar, reduced sugar, low/no concentrated sweets, no added sugar
Calcium Rich: for bone health with vitamin D
Low Lactose: Does not mean no dairy, use of low lactose milk products
Menu Planning
Goals to have acceptable menus, great flavor and socialization with budget adherence
Adequate menus assumed with all food groups represented
Amounts are standard for nutrition and also for marketing
Trends with Menus
Fresh, local and healthy
Healthy may stated but not eaten
Desire for choice
Assume what is offered is good to eat Educating our Clients
Provide education for nutrition
Focus on healthy and eating more health vs limiting culprits
Culprits: Sugar, fat – Can you include them?
Note portions of culprits
Menu Strategies
Cost concerns: use seasonal, effective purchasing and proper portions
Waste Not! Means to reduce waste
Food preferences for clientele Can Any Diet Fit?
MIND diet can fit with number of salads, vegetables, fish, whole grains and poultry
Wine most likely will not fit
Snacks: could have added nuts in dishes
Can Any Diet Fit?
Low Gluten: May have low gluten products for some items, substitutes with lower gluten foods
May have cost affect and more food production with time
Education for adequacy and other meals Can Any Diet Fit?
Consistent Carbohydrate: Smaller portions of high carbohydrate foods or reduced portions of CHO foods Example: Fruit for dessert, half portion of dessert, no roll or bread. Do not have to purchase low sugar desserts
Can Any Diet Fit?
Low Sodium: Avoid cured meats, bacon excess cheese. Homemade casseroles vs. prepared product “Au Gratin” for special occasions Encourage use of herbs, spices Herb mixtures at the table
Educate for not adding salt at table and lower sodium strategies at home
Foods Avoided
Client are becoming more educated
No milk – try shelf stable milk or volume once a week for home delivered meals
Fresh fruits and vegetables for chewing/swallowing disorders: Can we make this work? YES
Summary
Yes: We are what we eat and nutrition is changing
Diets for heart and brain health are in the news and can be provided with strong evidence of effect
You taste it and eat it – the importance of good food Questions and Answers
Nutrition is a science and changing. Diets are what we eat to provide the body with nutrition.
Menus are the delivery of diets
As a science, changes, recommendations, and findings are expected to evolve. More to come for our exciting times for food and health
Thank You
For coming to Denver!
Travel safe, wear your seatbelt, and eat lots of FRUITS and VEGETABLES!!
Candace S. Johnson, RDN, CSG, FAND [email protected]