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7
Recommendations for Nutrient Targets and Meal Requirements for School Meals

PRÉCIS

This chapter presents recommendations for Nutrient Targets and Meal Requirements for school meals, including explanatory information. The recommended Nutrient Targets are not intended to be used for menu planning, but they provided a basis for the development of the Meal Requirements. The Nutrient Targets differ from the existing Nutrition Standards in that they include a maximum as well as a minimum amount of calories; encompass 16 more nutrients; are higher than the current requirements for protein, vitamins A and C, calcium, and iron; and are lower than the current recommended amounts of sodium. The Nutrient Target for saturated fat is the same as in the current Nutrition Standards. To achieve agreement with Dietary Guidelines recommendations, however, the upper limit on total fat as a percentage of total calories was increased from 30 percent to 35 percent. Although a quantitative Nutrient Target was not set for trans fat, the recommended Meal Requirements include a method to keep the amount of trans fat in the meals as low as possible, as recommended in the Dietary Guidelines.

As a part of the Meal Requirements, the recommended standards for menu planning use a food-based approach that includes quantitative control of calories, saturated fat, and sodium. That is, a single set of standards is recommended for menu planning, which encompasses both food-based and nutrient-based elements. Following the standards for menu planning ensures that most of the Nutrient Targets will be met through the meals offered to the students. Exceptions are vitamin E, sometimes potassium, fats



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7 Recommendations for Nutrient Targets and Meal Requirements for School Meals PRÉCIS This chapter presents recommendations for Nutrient Targets and Meal Requirements for school meals, including explanatory information. The recommended Nutrient Targets are not intended to be used for menu plan- ning, but they provided a basis for the development of the Meal Require- ments. The Nutrient Targets differ from the existing Nutrition Standards in that they include a maximum as well as a minimum amount of calories; encompass 16 more nutrients; are higher than the current requirements for protein, vitamins A and C, calcium, and iron; and are lower than the cur- rent recommended amounts of sodium. The Nutrient Target for saturated fat is the same as in the current Nutrition Standards. To achieve agreement with Dietary Guidelines recommendations, however, the upper limit on total fat as a percentage of total calories was increased from 30 percent to 35 percent. Although a quantitative Nutrient Target was not set for trans fat, the recommended Meal Requirements include a method to keep the amount of trans fat in the meals as low as possible, as recommended in the Dietary Guidelines. As a part of the Meal Requirements, the recommended standards for menu planning use a food-based approach that includes quantitative con- trol of calories, saturated fat, and sodium. That is, a single set of standards is recommended for menu planning, which encompasses both food-based and nutrient-based elements. Following the standards for menu planning ensures that most of the Nutrient Targets will be met through the meals of- fered to the students. Exceptions are vitamin E, sometimes potassium, fats 

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 SCHOOL MEALS at breakfast, iron at lunch (for middle and high school levels), and sodium (because of the high sodium content of many foods). Options for standards for meals as selected by students are presented along with strengths and lim- itations of each. Options are provided because P.L. 94-105, Sec. 6(a) states that state and local educational agencies and students are to participate in the establishment of administrative procedures for reducing plate waste. RECOMMENDED NUTRIENT TARGETS FOR THE SCHOOL BREAKFAST Recommendation 1. The Food and Nutrition Service of the U.S. De- partment of Agriculture (USDA) should adopt the Nutrient Targets shown in Table 7-1 as the scientific basis for setting standards for menu planning for school meals but should not adopt a nutrient-based standard for school meal planning and monitoring. The Nutrient Targets in Table 7-1 were developed using methods rec- ommended by the Institute of Medicine for planning diets for groups us- ing the Dietary Reference Intakes (IOM, 2003) and the application of the criteria in Box 2-2 of Chapter 2. Although a Nutrient Target was not set for vitamin D or trans fat, the standards for menu planning cover these dietary components (see later section “Recommended Meal Requirements for School Meals”). Uses of the Nutrient Targets The main purpose for the recommended Nutrient Targets is to provide a firm scientific basis for setting standards for menu planning—that is, stan- dards that will lead to menus that meet or nearly meet the recommended Nutrient Targets. The Nutrient Targets are not intended to be used directly for menu planning (that is, they are not intended to be used for nutrient- based menu planning). Moreover, they are not intended to be used for the monitoring of school meals (see Chapter 10). Such activities would be un- realistic in that the recommended Nutrient Targets include many nutrients for which nutrient composition data are not readily available from nutrition labels, manufacturer’s specifications, or software approved by USDA for the nutrient analysis of school menus. The Nutrient Targets may be useful in evaluation and research, however. Comparison of Recommended Targets with the Preliminary Nutrient Targets Based on its decision regarding appropriate uses of the Nutrient Tar- gets, the committee made no changes in the values of the preliminary nu-

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 NUTRIENT TARGETS AND MEAL REQUIREMENTS FOR SCHOOL MEALS TABLE 7-1 Recommended Nutrient Targets for the School Breakfast Program and the National School Lunch Program, by Meal and Age- Grade Group (Amounts per Meal Are Averages for a 5-Day School Week) Breakfasta Lunchb Nutrient, unit 5–10 y 11–13 y 14–18 y 5–10 y 11–13 y 14–18 y Calories (kcal) 350–500 400–550 450–600 550–650 600–700 750–850 < 65 < 65 < 65 < 96 < 96 < 96 Cholesterol (mg)* Total Fat (% of kcal)* 25–35 25–35 25–35 25–35 25–35 25–35 <10 <10 <10 <10 <10 <10 Sat. Fat (% of kcal)* Linoleic Acid (g) 2.2 2.5 3 3.3 3.6 4.5 α-Linolenic Acid (g) 0.21 0.25 0.3 0.31 0.36 0.45 Protein (g) 10.2 21.6 21.8 15.2 32.2 32.5 Vitamin A (µg RAE) 129 162 186 192 241 277 Vitamin C (mg) 16 20 26 24 30 39 Vitamin E (mg αT)c 2 2.7 3.7 3 4 5.4 Thiamin (mg) 0.2 0.3 0.4 0.4 0.5 0.6 Riboflavin (mg) 0.31 0.41 0.45 0.46 0.61 0.67 Niacin (mg) 3.2 4 4.9 4.7 6 7.3 Vitamin B6 (mg) 0.3 0.4 0.4 0.4 0.5 0.6 Folate (µg DFE) 91 114 138 136 169 205 Vitamin B12 (µg) 0.8 0.9 1.1 1.2 1.3 1.6 Iron (mg) 2.3 3.5 4.0 3.4 5.2 5.9 Magnesium (mg) 49 66 99 72 98 147 Zinc (mg) 2 2.5 2.9 2.9 3.7 4.3 Calcium (mg) 223 296 323 332 440 481 Phosphorus (mg) 242 362 384 361 538 572 Potassium (mg)c 909 1,023 1,169 1,353 1,523 1,740 ≤ 434 ≤ 473 ≤ 495 ≤ 636 ≤ 704 ≤ 736 Sodium (mg)d Fiber (g) 5.7 6.3 7.2 8.5 9.4 10.7 NOTES: αT = α-tocopherol; DFE = dietary folate equivalents; g = gram; kcal = calories; kg = kilogram; mg = milligrams; RAE = retinol activity equivalents; Sat. = saturated; µg = micrograms; y = years. aTargets based on 21.5 percent of the daily School Meal-Target Median Intake for the age- grade group. bTargets based on 32 percent of the daily School Meal-Target Median Intake for the age- grade group. cTargets for vitamin E and potassium are known to be higher than can be expected following meal plans based on MyPyramid. dTargets for sodium, which are based on the Tolerable Upper Intake Level, are for the year 2020. SOURCE: *HHS/USDA, 2005. trient targets other than to increase the maximum calorie level for two of the grade groups at breakfast (see Chapter 6). That is, the recommended Nutrient Targets are essentially the same as the preliminary nutrient targets that are discussed in Chapter 4. In those cases in which it is very difficult to meet the Nutrient Targets, which are based largely on the Dietary Reference Intakes, the values can

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 SCHOOL MEALS serve as goals. For example, school meal programs could be encouraged to incorporate rich sources of vitamin E and potassium in their menus more often, to reduce the amount of sodium in the foods that are offered, and to increase the use of vegetable oils or soft margarine at breakfast (within calorie limits). Comparison of the Recommended Nutrient Targets with Existing Nutrition Standards for the School Meal Programs Comparison with the existing Nutrition Standards is not straightfor- ward because the recommended age-grade ranges differ from the existing ranges. Appendix O presents the data for calories and the nutrients that are common to both the standards and the targets, and it lists the additional nutrients contained in the recommended targets. Notably, compared to the current Nutrition Standards, the recommended Nutrient Targets are higher for protein and the vitamins and minerals, the recommended minimum calorie levels are lower, and maximum calorie levels have been set for the first time. The maximum calorie levels are similar, and in some cases lower, than the existing minimum calorie standards. Comparison of Possible Nutrient Targets Derived Using Different Methods Because the recommendations for Nutrient Targets were developed using methods that differ from those set out in P.L. 104-193 (1)(B), it is essential to compare the recommended Nutrient Targets with values that would have been developed using the previously accepted method, which was based on using specified fractions of the Recommended Dietary Allow- ances (RDAs) of the Food and Nutrition Board. The committee compared all the recommended Nutrient Targets for protein, vitamins, and minerals with the values it calculated for the same nutrients using the most recent RDAs or Adequate Intakes (AIs) as the reference standard.1 Table 7-2 shows the comparisons for the high school age-grade group (ages 14–18 years, grades 9–11). Tables for elementary school and middle school may be found in Appendix O. All the recommended Nutrient Targets are higher than those that would have been set using the current RDAs or AIs, with one or two exceptions. The recommended standard for α-linolenic acid is very slightly lower than that based on the AI for ages 5–10 years, and the recommended standard for linoleic acid for the children ages 5–10 years is the same as the AI. The Nutrient Targets have higher values as a result of the committee’s 1 Thecomparison excludes sodium. For sodium, the objective is to reduce the amount rather than to be sure to provide enough.

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 NUTRIENT TARGETS AND MEAL REQUIREMENTS FOR SCHOOL MEALS TABLE 7-2 Comparison of the Recommended Nutrient Targets for the School Breakfast Program and the National School Lunch Program with Values Based on the Recommended Dietary Allowances or Adequate Intake, High School (Ages 14 Through 18 Years) Breakfast Targetsa Lunch Targetsb Current Nutrient RDA/AI Nutrient RDA/AI Nutrient SM-TMI RDA/AI Targets Method Targets Method Protein (g) 101.6 49 21.8 12.3 32.5 16.3 Vitamin A (µg RAE)c 867 800 186 200 277 266 Vitamin C (mg)c 121 70 26 18 39 23 Vitamin E (mg αT) 17 15 3.7 3.8 5.4 5.0 Thiamin (mg)c 1.74 1.1 0.37 0.28 0.56 0.37 Riboflavin (mg)c 2.08 1.2 0.45 0.29 0.67 0.38 Niacin (mg)c 22.7 15 4.9 3.8 7.3 5.0 Vitamin B6 (mg) 1.97 1.3 0.42 0.33 0.63 0.43 Folate (µg DFE) 640 400 138 100 205 133 Vitamin B12 (µg) 5.1 2.4 1.1 0.6 1.6 0.8 Iron (mg)c 18.4 13.0 4.0 3.3 5.9 4.3 Magnesium (mg)c 459 385 99 96 147 128 Zinc (mg)c 13.5 10.0 2.9 2.5 4.3 3.2 Calcium (mg) 1,504 323 325 481 416 ,00 Phosphorus (mg) 1,787 1,250 384 313 572 400 Potassium (mg) 5,438 1,169 1,175 1,740 1,504 ,00 ≤ 495d ≤ 736d 2,300d 375e 480e Sodium (mg) ,00 Linoleic Acid (g) 14.1 3.0 3.4 4.5 4.3 . α-Linolenic Acid (g) 1.41 0.30 0.34 0.45 0.43 . Fiber (g)c 33.5 7.2 8.0 10.7 10.7 .0 NOTES: AIs are presented in italics. AI = Adequate Intake; αT = α-tocopherol; d = day; DFE = dietary folate equivalent; g = gram; kg = kilogram; mg = milligram; RAE = retinol activity equivalents; RDA = Recommended Dietary Allowance; SM-TMI = School Meal-Target Median Intake; µg = microgram; y = years. aNutrient Targets based on 21.5 percent of the School Meal-TMI; RDA/AI Method values are based on 25 percent of the RDA or AI. bNutrient Targets based on 32 percent of the School Meal-TMI; RDA/AI Method values are based on 33.3 percent of the RDA or AI. cRDA/AI expressed as mean for males and females. dTargets for sodium, which are based on the Tolerable Upper Intake Level, are for the year 2020. eValues for sodium are based on the AI for sodium SOURCE: *IOM, 2006. intent to reduce the prevalence of inadequate intakes of nutrients2 among schoolchildren (Criterion 1 in Box 2-2) rather than simply ensure that the mean intake equals the RDA.3 In choosing Nutrient Targets that are high 2 Thatis, a low prevalence of intakes below the Estimated Average Requirement. 3 Although intake at the RDA should result in a low probability of inadequacy for a given individual, mean intake at the RDA for a group of people does not usually result in a low

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0 SCHOOL MEALS enough to result in a low predicted prevalence of nutrient inadequacy, the committee recognizes that the nutrient density (nutrients per 100 calories) of the school meals will need to increase. School meals with an increased nutrient density will hopefully serve as a model for meals and snacks that children consume outside the school setting and will result in improvements of their total day’s diet. Thus, with the above-noted minor exceptions, the recommended Nutri- ent Targets are consistent with P.L. 104-193, which states that the school meals must provide at least one-third of the RDA for lunch and at least one-fourth of the RDA for breakfast. With respect to calories, the recom- mended Nutrient Targets are consistent with P.L. 104-193 in that they “are consistent with the goals of the most recent Dietary Guidelines for Americans” (namely, adequate nutrients within energy needs [HHS/USDA, 2005]), and the RDAs do not apply to calories. Importantly, however, to be consistent with Dietary Guidelines, the recommended standards for menu planning are primarily derived from the MyPyramid food patterns, rather than from the Nutrient Targets. As noted in Chapters 4 and 5, the nutrient values of the MyPyramid food patterns are almost always higher than the School Meal-Target Median Intake values that were the basis of the Nutri- ent Targets for school meals. Sodium is a special case in that (1) the Dietary Guidelines calls for re- duced intake and (2) the recommended Nutrient Targets are based on the Tolerable Upper Intake Levels (ULs) for the age-grade groups rather than on the AI. The recommended Nutrient Targets for sodium are slightly lower than the values that would correspond to the Dietary Guidelines recom- mendation because the ULs are lower for children and adolescents. RECOMMENDED MEAL REQUIREMENTS FOR SCHOOL MEALS Meal Requirements encompass (1) the standards for menu planning, which apply to the foods that are prepared and set out for the students and (2) the standards for meals as selected by the student, which apply to the foods the student has on his or her tray, as checked by the cashier. The recommended Meal Requirements are intended for all school food service prevalence of inadequacy for the group. Because the person-to-person variation in intake is very high within a group, it is almost always necessary to aim for a group mean intake above the RDA to ensure a low prevalence of inadequacy. For this reason, the method the commit- tee used to set the School Meal-Target Median Intakes results in values that are uniformly above the RDA, and the breakfast and lunch Nutrient Targets are correspondingly higher than targets that would result from an approach that was based on having the group mean equal to the RDA. For nutrients with either an AI or an RDA, the use of the nutrient density approach rather than the use of the average Target Median Intake (as described in Chapter 4) also resulted in higher Nutrient Targets for some nutrients.

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 NUTRIENT TARGETS AND MEAL REQUIREMENTS FOR SCHOOL MEALS operations, regardless of the approach to menu planning that is currently in use. Recommended Standards for Menu Planning Based on the results of the committee’s analysis of test meal patterns and menus, the information presented in Chapter 6 on challenges, and consideration of the committee’s four criteria set out in Chapter 2, the com- mittee developed a single set of standards for menu planning. Recommendation 2. To align school meals with the Dietary Guidelines for Americans and improve the healthfulness of school meals, the Food and Nutrition Service should adopt standards for menu planning that increase the amounts of fruits, vegetables and whole grains; increase the focus on reducing the amounts of saturated fat and sodium provided; and set a minimum and maximum level of calories—as presented in Table 7-3. The standards depicted in Table 7-3 include elements from three exist- ing USDA meal planning approaches—namely, the traditional food-based, enhanced food-based, and nutrient-based menu planning approaches. In particular, the standards for menu planning include • food-based meal patterns that cover the types and amounts of food groups and subgroups to be offered by age-grade group; • specifications for minimum and maximum calorie levels and for the maximum level of saturated fat; • specifications for sodium that are to be attained by the year 2020, with suggestions for intermediate targets (see Chapter 10); and • specifications for trans fat that limit the amount of trans fat that any commercial food product may contain. As explained in the section “Consideration of Meal Planning Ap- proaches” in Chapter 5, the committee did not develop standards for a nutrient-based menu planning approach. The committee’s recommended standards for menu planning do not preclude the use of a comprehensive nutrient analysis in menu planning if an operator wants to compare the nutrient content of the menus with the Nutrient Targets, but nutrient analysis software to accomplish this task for all the Nutrient Targets is not currently available. Nonetheless, existing USDA-approved nutrient analysis software can simplify the process of implementing the committee’s recom- mended standards for menu planning. In particular, the software can help in choosing items from food groups that will keep the calorie and saturated

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 SCHOOL MEALS TABLE 7-3 Recommended as Offered Meal Standards Breakfast Lunch Grades Grades Grades Grades Grades Grades K–5 6–8 9–12 K–5 6–8 9–12 Amount of Foodsa Per Week Meal Pattern Fruits (cups)b 5 5 5 2.5 2.5 5 Vegetables (cups)b 0 0 0 3.75 3.75 5 0.5c 0.5c 0.5c Dark green 0 0 0 0.5c 0.5c 0.5c Orange 0 0 0 0.5c 0.5c 0.5c Legumes 0 0 0 Starchy 0 0 0 1 1 1 1.25c 1.25c 2.5c Other 0 0 0 Grains, at least half of which 7–10 8–10 9–10 9–10 9–10 12–13 must be whole grain-richd (oz eq) Meats, beans, cheese, yogurt 5 5 7–10 8–10 9–10 10–12 (oz eq) Fat-free milk (plain or 5 5 5 5 5 5 flavored) or low-fat milk (1% milk fat or less) (cups) Other Specifications: Daily Amount Based on the Average for a 5-Day Week Other Specifications Min-max calories (kcal)e,f 350–500 400–550 450–600 550–650 600–700 750–850 < 10 < 10 < 10 < 10 < 10 < 10 Saturated fat (% of total calories)g [≤ 430] [≤ 470] [≤ 500] [≤ 640] [≤ 710] [≤ 740] Sodium (mg) Sodium targets are to be reached by the year 00.h Nutrition label must specify zero grams of trans fat per serving.i trans fat NOTES: K = kindergarten; kcal = calories; max = maximum; mg = milligrams; min = minimum; oz eq = ounce equivalent. Although the recommended weekly meal intake patterns do not specify amounts of unsaturated oils, their use is to be encouraged within calorie limits. aFood items included in each group and subgroup and amount equivalents. Appendix Table H-1 gives a listing of foods by food group and subgroup. Minimum daily requirements apply: 1⁄5 of the weekly re- quirement for fruits, total vegetables, and milk and at least 1oz equivalent each of grains and meat or meat alternate (2 oz of each for grades 9–12 lunch). bOne cup of fruits and vegetables usually provides two servings; ¼ cup of dried fruit counts as ½ cup of fruit; 1 cup of leafy greens counts as ½ cup of vegetables. No more than half of the fruit offerings may be in the form of juice. cLarger amounts of these vegetables may be served. dBased on at least half of the grain content as whole grain. Aiming for a higher proportion of whole grain-rich foods is encouraged. See Box 7-1 for Temporary Criterion for Whole-Grain Rich Foods. Also note that in Chapter 10 the committee recommends that the Food Buying Guide serving sizes be updated to be consistent with MyPyramid Equivalent serving sizes. eThe average daily amount for a 5-day school week is not to be less than the minimum or exceed the maximum. fDiscretionary sources of calories (for example, solid fats and added sugars) may be added to the meal pattern if within the specifications for calories, saturated fat, trans fat, and sodium. gThe average daily amount for a 5-day school week is not to exceed the maximum. hTo ensure that action is taken to reduce the sodium content of school meals over the 10-year period in a manner that maintains student participation rates, the committee suggests the setting of intermediate targets for each 2-year interval. (See the section “Achieving Long-Term Goals” in Chapter 10.) iBecause the nutrition facts panel is not required for foods with Child Nutrition labeling, the commit- tee suggests that only products with 0 grams of trans fat per serving be eligible for consideration for such labeling.

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 NUTRIENT TARGETS AND MEAL REQUIREMENTS FOR SCHOOL MEALS fat levels within the calorie and saturated fat specifications in Table 7-3 and help monitor progress on reducing the sodium content of meals. Moreover, computerized nutrient analysis may be helpful to parents of schoolchildren with special dietary needs. Computerized nutrient analysis is not essential, however, as long as operators use an accepted method to control the calorie, saturated fat, and sodium content of school meals. Food-based Meal Patterns Dietary Guidelines for Americans (HHS/USDA, 2005) emphasizes the use of foods to meet nutrient needs: A basic premise of the Dietary Guidelines is that nutrient needs should be met primarily through consuming foods. Foods provide an array of nutri- ents (as well as phytochemicals, antioxidants, etc.) and other compounds that may have beneficial effects on health. HHS/USDA, 2005, p. 3 The food-based meal patterns shown in Table 7-3 were designed to be consistent with Dietary Guidelines and to be consistent with the recom- mended Nutrient Targets by age-grade group. Menus written to correspond with the meal patterns shown in Table 7-3 were demonstrated, through the use of nutrient analysis, to meet or nearly meet the standards for protein, vitamins, minerals, and other dietary components like fatty acids, with a few exceptions. The fluid milk that is specified in the standards for menu planning provides one-half of the AI for vitamin D at each school meal. Specifications for Calories, Saturated Fat, and Sodium The use of meal patterns alone cannot ensure that calories, saturated fat, and sodium are consistent with Dietary Guidelines. Because of this, the recommended standards for menu planning include specifications for calories, saturated fat, and sodium, with the understanding that the sodium specification is to be achieved by the year 2020 (see Chapter 10). Operators will need to use some quantitative method to ensure that, on average for the 5-day school week, the menus provide calories within the specified limits and less than 10 percent of the calories from saturated fat (a possible approach is given in Chapter 10); and they will need to monitor their progress in reducing the average daily sodium content of the school meals. Forms of Food for School Meals The meal patterns were designed assuming that the following forms of food would be used in planning menus:

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 SCHOOL MEALS • Fruits will be fresh, frozen without sugar, dried, or canned in fruit juice, water, or light syrup. • If canned vegetables are purchased, they will contain no added salt or will be reduced in sodium content. • To be classified as a whole grain-rich food as part of the meal standards, the food will meet the whole grain-rich food criterion shown in Box 7-1. BOX 7-1 Temporary Criterion for Whole Grain-Rich Foods Both elements of the criterion must be met for a food to qualify as a whole grain- rich food: Element #1. A serving of the food item must be at least the portion size of one Grains/Breads serving as defined in the USDA Food Buying Guide for Child Nutri- tion Programs (USDA/FNS, 2009c). AND Element #2. The food must meet at least one of the following: a. The whole grains* per serving (based on minimum serving sizes specified for grains/breads in the USDA Food Buying Guide for Child Nutrition Pro- grams) (USDA/FNS, 2009c) must be ≥ 8 grams. This may be determined from information provided on the product packaging or by the manufacturer, if available. b. The product includes the following Food and Drug Administration (FDA)- approved whole grain health claim on its packaging. “Diets rich in whole grain foods and other plant foods, and low in saturated fat and cholesterol may help reduce the risk of heart disease.” c. Product ingredient listing lists whole grain first, specifically, I. Non-mixed dishes (e.g., breads, cereals): Whole grains must be the pri- mary ingredient by weight (a whole grain is the first ingredient in the list) II. Mixed dishes (e.g., pizza, corn dogs): Whole grains must be the primary grain ingredient by weight (a whole grain is the first grain ingredient in the list) For foods prepared by the school food service, the recipe is used as the basis for a calculation to determine whether the total weight of whole grain ingredients exceeds the total weight of non-whole grain ingredients. Detailed instructions for this method appear in the HealthierUS School Challenge Whole Grains Resource guide (USDA/FNS, 2009b). *Whole grain ingredients are those specified in the HealthierUS School Challenge Whole Grain Resource guide (www.fns.usda.gov/TN/HealthierUS/wholegrainresource.pdf).

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 NUTRIENT TARGETS AND MEAL REQUIREMENTS FOR SCHOOL MEALS • Meats will be lean. Soy extenders are acceptable. Although meats that are preserved by smoking, curing, or salting, or by the addition of pre- servatives are sometimes lean, they usually are very high in sodium. Because of their sodium content and because the consumption of such processed meats, especially processed red meats, has been linked with an increased risk of colorectal cancer in adults (WCRF/AICR, 2007), less frequent use of even low-fat versions of these meats may be advisable. • Cheese and yogurt will be low fat. • Milk offerings will be fat-free (plain or flavored) or low-fat (1 per- cent milk fat or less, plain only). • Foods (such as salad dressing, dips, muffins, some entrées, and some vegetable dishes) that contain added “fat” will be made with unsatu- rated oils. The use of some unsaturated oils is encouraged because they provide vitamin E and essential fatty acids. • If purchased commercially, the nutrition labeling or manufacturer’s specification will indicate that the product contains 0 g of trans fat per serving. Guidance for reducing sodium in school meals may be obtained from sev- eral resources, including http://teamnutrition.usda.gov/Resources/DGfact sheet_sodium.pdf and the SMI Road to Success booklet (USDA/FNS, 2007b). The recommended temporary criterion for whole grain-rich foods (Box 7-1) merits special attention. It is based in large part on what is cur- rently possible considering that current labeling regulations and practices limit the school food service purchaser’s ability to know the actual whole grain content of many grain products. Although the goal of the criterion is to ensure that foods qualify as whole grain-rich if they contain at least 8 g of whole grains, some foods with lower amounts of whole grains may be classified as whole grain rich if the product ingredient listing (item c under element #2 of the criterion) is used as one of the indicators of whole grain content. At this time, product ingredient listing is an essential element of the temporary criterion for two reasons: (1) manufacturers are not required to provide information about the grams of whole grains in their products, and many do not provide that information; and (2) the FDA whole grain health claim is not mandatory. Rather, manufacturers are allowed to place this claim on product packaging if whole grain, fat, fatty acid, and cholesterol content requirements for this health claim are met. It is important to note that whole grain foods (such as brown rice) and some other foods that contain substantially more than 8 g of whole grain per grain serving may be classified as whole grain rich using the tempo- rary criterion. Consequently, although some foods with less than 8 grams

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 SCHOOL MEALS of whole grain may count as whole grain-rich, so too will some foods with substantially more than 8 g of whole grain per 1 ounce equivalent serving. The committee views the criterion for whole grain-rich foods included in this report as temporary. Recommendations to improve the criterion in coming years appear in Chapter 10. Standards for Menu Planning for Different Grade Configurations The standards in Table 7-3 make allowance for a number of possible grade configurations in schools. For example, the same general meal pat- tern could be used for students from kindergarten through grade 8. In those instances where the grade configuration differs, as in schools that serve elementary through high school students on the same line, the com- mittee suggests that the school food authority work with the state agency to find a solution that ensures that the basic elements of the standards for menu planning will be maintained: inclusion of the specified food groups and food subgroups, moderate calorie values, and an emphasis on reducing saturated fat and sodium. Recommended Standards for Menu Planning and the Current Law The Healthy Meals for Children Act of  (P.L. 104-149, Sec. 2) increased the flexibility of schools to meet the Dietary Guidelines for Americans under the National School Lunch Act. In particular, it amends that act to allow the use of any reasonable approach, within guidelines established by the Secretary of Agriculture, but “The Secretary may not require a school to conduct or use a nutrient analysis to meet the require- ments of this paragraph.” The recommended standards for menu planning could be implemented under this law. The committee’s recommendation calls for only one approach to menu planning—an approach that is based primarily on foods and entails that quantitative attention be given only to the calorie, saturated fat, and so- dium content of the meal. A food-based approach is the only depend- able approach to meeting most of the Dietary Guidelines. However, the committee’s experience in developing an approach to menu planning (and the evidence presented in the third School Nutrition Dietary Assessment study [SNDA-III] report) has shown that it is difficult to control the calo- rie, saturated fat, and sodium content of menus without using quantitative methods that ordinarily come under the category of “nutrient analysis.” Notably, the sponsor requested that the committee “examine the adequacy of the current menu planning approaches in meeting the applicable [Dietary Reference Intakes] and [Dietary Guidelines for Americans]” and expressed

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 NUTRIENT TARGETS AND MEAL REQUIREMENTS FOR SCHOOL MEALS concern that the current menu planning approaches . . . may no longer be adequate to provide school meals that reflect the 2005 [Dietary Guidelines for Americans]” (see Appendix C). The recommended standards for menu planning provide an approach that removes that concern. Compared with the recommended standards for menu planning, a somewhat less specific set of standards (one without the quantitative com- ponent) could help move school meal programs in the direction of meeting the recommended Nutrient Targets and the Dietary Guidelines, but only partway. The recommended standards are presented as the most nutrition- ally sound yet practical approach to planning menus that will appeal to schoolchildren. Options for Standards for Meals as Selected by Students Under the offer ersus sere (OVS) provision of P.L. 94-105, all high schools must allow students to select a smaller number of food items than are offered at lunch. OVS is optional at breakfast for all the grades, and it is optional for lunch in elementary and middle schools. The current standards specify the number of food components and sometimes a type of food com- ponent that must be on a student’s tray if the meal is to be reimbursable. Recommendation 3. To achieve a reasonable balance between the goals of reducing waste and preserving the nutritional integrity of school meals, the Food and Nutrition Service, in conjunction with state and local educational agencies and students, should weigh the strengths and limitations of the committee’s two options (see Table 7-4) when setting standards for the meals as selected by students. Based on its reading of the OVS provision of P.L. 94-105 and the committee’s consideration of nutrition, practicality, and cost, the commit- tee decided that the most useful course of action would be to put forth two options for standards for meals as selected by the student (Table 7-4). Op- tion 1, the committee’s preferred option, is similar to the current standard, but it offers the advantage of encouraging the consumption of fruits and vegetables, in line with the Dietary Guidelines for Americans. The student would be able to select from at least two fruit or vegetable items. Option 2 allows the student to decline an additional food item and thus may decrease waste, but the nutritional integrity of the meal would be lower (see Tables H-4 through H-7 in Appendix H). The committee notes that option 2 for breakfast is inconsistent with Amendments to the National School Lunch Act and Child Nutrition Act (1986), Sec. 331 Extension of Offer Versus Serve Provision to the School Breakfast Program, Section 4(e) of the Child Nutrition Act of  (42 U.S.C. 1773(e)), which states that students may

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 SCHOOL MEALS TABLE 7-4 Options for Standards for Meals as Selected by the Student under the Offer Versus Sere Provision of P.L. 94-105a Number of Items the Student May Decline and Required Items Breakfast Lunch itemb 1. Preferred One may be declined, must Two items may be declined, must take at least one fruit or juice take at least one fruit or vegetable 2. Alternative Two items may be declined, must Three items may be declined, must take at least one fruit or juice take at least one fruit or vegetable NOTE: Options are provided for consideration by the U.S. Department of Agriculture, work- ing cooperatively with state educational agencies and with participation by local educational agencies and student to develop new regulations. The committee recommends Option 1. aUnder current traditional food-based menu planning standards, high school students are required to take three out of four (or five) food items at breakfast and three out of five food items at lunch. Offer ersus sere is optional for elementary and middle schools. bA specific food offered in the specified portion sizes that will meet the recommended as offered Meal Requirements. decline no more than one item at breakfast. Because the number of items has been increased in the recommended standards for menu planning, how- ever, allowing students to decline two items could be a reasonable approach for breakfast. At either breakfast or lunch, option 2 (which would allow the student to select fewer food items) may be more appropriate for high school females who have low energy needs. These options provide those involved in establishing administrative procedures (USDA, with input from state and local educational agencies and students) with information that may guide their decision-making process. The committee’s considerations in developing options are summarized briefly below. Nutritional Considerations There is concern that OVS will result in lower nutrient intake at school breakfast and lunch because children are allowed to decline items, espe- cially if they decline the most nutrient-rich food components (e.g., fruits, vegetables, whole grain-rich foods, milk). Appendix H gives examples of how declining specific food components affect the average nutrient content of the meal. The omission of milk, in particular, substantially reduces the content of calcium, magnesium, potassium, and many vitamins and other nutrients. However, this concern about OVS would be valid only if chil- dren would indeed eat all of the food components included in the standard meal plan if served. Because child taste and food preferences and state of hunger and satiety play strong roles in regulating food consumption, for

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 NUTRIENT TARGETS AND MEAL REQUIREMENTS FOR SCHOOL MEALS some children the food and nutrient content of a school meal as offered by the school will exceed the child’s food and nutrient intake from that meal, regardless of the OVS regulations that are in place. Assuming wise food choices by the student, the least amount of restric- tion of choice might provide a nutritional advantage for children whose en- ergy needs are lower than the levels targeted by the standard meal pattern. Theoretically, the second option, which is less restrictive, would provide children the opportunity to better match their meal selection with indi- vidual energy needs. Although option 1 (which allows the student to decline fewer items) would result in more food on the student’s tray, it would not necessarily result in the consumption of more foods. Practical Considerations The options presented by the committee were influenced by practical considerations relating to the cafeteria setting. The typical cafeteria moves 7 to 10 students through the line per minute, and the flow in some cafeterias may exceed 14 students per minute through the line. The student is making quick food selections, often with little prior contemplation other than on the entrée selection (if a choice is offered and was publicized), while little thought is given to the other choices. The cashier is responsible for record- ing the meal sale (which may involve ticket collection, roster checklist, ac- cepting the meal identification card, or key pad entry into the point-of-sale software system), often taking cash and checks and making change, and verifying whether the meal on the tray meets the requirements for meals as selected by the student. If the meal does not meet the requirements, the meal will not be reimbursable unless the student takes something additional from the line. Although there may be creative ways of facilitating that, the line is likely to be slowed somewhat. Thus, to ensure that the OVS provisions will be followed, the standard for meals as selected by the student must be easy for students and staff to follow. The committee’s two options were selected with that objective in mind. Cost Considerations Giving choices helps to reduce waste and thus cost for the overall pro- gram. For this reason, although options 1 and 2 both list a specific food requirement, the requirement allows choice among two or more foods. If an option required a vegetable, a vegetable would be selected but might not be eaten. An option to require a serving of fluid milk was ruled out because milk intolerance or avoidance is relatively common among some racial, ethnic, and religious groups, and some children will not drink the lower fat varieties of milk until they are more familiar with them. If the child does

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0 SCHOOL MEALS not consume the food, requiring a vegetable or milk leads to waste rather than improved nutrient intake. SUMMARY The recommended Nutrient Targets provide a scientific underpinning for the Meal Requirements, but the targets are not meant for menu plan- ning. The Nutrient Targets differ from the existing Nutrition Standards in that they include a maximum as well as a minimum level of calories; encompass 16 additional nutrients; are higher for the 8 nutrients that are common to both; and, for most nutrients, are based on a Target Median Intake rather than the Recommended Dietary Allowances. Under the Meal Requirements, the recommended standards for menu planning provide a food-based approach that encompasses five major food groups and seven food subgroups; it also provides specifications for calories, saturated fat, and sodium; a method to minimize trans fat content, and a temporary crite- rion to identify whole grain-rich foods. The options presented for standards for meals as selected by the student are accompanied by information on nutrition-related strengths and concerns of each option.