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Improving Food Safety,
Nutrition, and Health
The problems have grown all too familiar. Too many Americans are over-
weight or obese. Too many children do not eat healthy meals at school.
Many people consume too much of some foods or nutrients, or too little
of others. Information overload confounds some nutritional claims. The
nation’s food supply, though generally safe, periodically suffers outbreaks
of contamination that cause food-borne illnesses.
All told, the nation has considerable room for improvement in ensur-
ing that the foods available to consumers are safe, that people eat enough of
what they should to be healthy, and that they minimize or eliminate their
intake of potentially harmful foods. To help meet these goals, the Institute
of Medicine (IOM) regularly examines the nation’s nutritional well-being
and offers measures for improvement.
Improving food programs
In February 2010, as part of the launch of Let’s Move!, First Lady Michelle
Obama’s program to reduce childhood obesity, the secretary of the U.S.
Department of Agriculture (USDA), Tom Vilsack, spoke of his depart-
ment’s commitment to have all schools offer nutritious meals to their
students. He said this stand is based in part on the IOM report School
Meals: Building Blocks for Healthy Children (2010), which “sounded an
alarm about the nutritional value of school meals,” and added that his
department “is working as aggressively as possible” to build on the
report’s findings. In 2011, the USDA issued new interim rules for its
21
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22 INFORMING THE FUTURE: Critical Issues in Health
school breakfast and lunch programs that incorporate many of the IOM’s
recommendations.
The report referenced by the secretary was written at the request
of the USDA. The agency asked the IOM to review the food and nutri-
tional needs of school-aged children in the United States and offer guid-
ance on updating the regulations, which had been established in 1995. The
National School Lunch Program and the
School Breakfast Program provide nutri-
In 2011, the USDA issued new
tionally balanced, low-cost or free meals
interim rules for its school
each school day. The lunch program served
breakfast and lunch programs
more than 31 million children in 2009. In its
that incorporate many of the
report, the IOM offers recommendations
IOM’s recommendations.
that focus clearly on providing meals that
are consistent with the Dietary Guidelines for Americans, the foundation of
the government’s nutrition policies. The report calls on the USDA’s Food
and Nutrition Service to adopt standards for menu planning that increase
Key Recommended Changes in School Lunch Requirements
Type of Current
Specification Requirements Recommendations
Fruits Considered together Required daily amount increased
as a fruit and
Vegetables Two servings required daily, amount
vegetable group.
increased. Must include dark green,
No specifications
bright orange, legumes, starchy,
for the type of
and other vegetables each week
vegetable.
Grains/breads No requirement At least half must be whole grain rich
for whole grains
Milk Whole, reduced-fat, Fat-free (plain or flavored)
low-fat, fat-free milks and plain low-fat milk only
(plain or flavored)
Calories Must meet Must be within minimum
minimum level and maximum level
Sodium None (decreased Gradually but markedly decrease
level recommended) sodium to the specified level by 2020
The committee recommends a single approach to menu planning—one that includes a meal pattern
plus specifications for minimum and maximum calorie levels, maximum saturated fat content, and
maximum sodium content.
SOURCE: School Meals: Building Blocks for Healthy Children.
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23
Improving Food Safety, Nutrition, and Health
the amount and variety of fruits, vegetables, and whole grains; set a mini-
mum and maximum level of calories; and place greater focus on reducing
the amounts of saturated fat and sodium provided. Other recommenda-
tions are intended to ensure not only that schools offer nutritious meals
but that students select healthful foods from the menu.
The IOM report generated a response not just by government but
also from the business community. In February 2010, several major food
services companies that provide students with breakfasts and lunches at
schools nationwide announced that they would meet the IOM’s recom-
mended school meal standards for fat, sugar, and whole grains over the
next 5 years, and meet the standards for sodium over the next 10 years. The
companies—ARAMARK, Sodexo, and Chartwells—also agreed to include
more fruit, vegetables, and low-fat and fat-free milk in their school meals.
Specifically, they pledged to work to double the amount of produce offered
over the next 10 years.
In another study of federal food and nutrition initiatives, the IOM
examined USDA’s Child and Adult Care Food Program (CACFP), which
supports the nutrition and health of the
nation’s most vulnerable individuals—more The IOM examined USDA’s
than 3 million infants and children and Child and Adult Care Food
more than 114,000 impaired or older adults, Program, which supports
primarily from low-income households. the nutrition and health of
To receive federal reimbursement, CACFP the nation’s most vulnerable
meals and snacks must meet regulations individuals—more than 3 million
designed to ensure that participants receive infants and children and more
high-quality, nutritious foods. But the cur- than 114,000 impaired or
rent standards, called Meal Requirements, older adults, primarily from
are based in part on nutrition and health low-income households.
information from 1989. For assistance in
updating the program, the Food and Drug Administration (FDA) asked
the IOM to review and assess the nutritional needs of the populations
served by the CACFP and to provide recommendations to revise its Meal
Requirements.
In Child and Adult Care Food Program: Aligning Dietary Guidance for
All (2010), an IOM committee provided recommendations that cover all
age groups and could be implemented by a variety of providers, including
those in family homes and large centers. The recommendations are based
on current dietary guidance, including the Dietary Guidelines for Ameri
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24 INFORMING THE FUTURE: Critical Issues in Health
cans, and take into account such practical considerations as the need for
appealing menus, the capabilities of the providers, and cost.
The recommendations target three age groups—infants, children,
and adults 19 years and older. (The first two groups are broken down into
several subgroups, based on age.) For each group, the committee recom-
mended new Meal Requirements, including both revised daily and weekly
meal patterns and additional food specifications. The meal patterns are
the types and amounts of foods that are to be offered for breakfast, lunch/
supper, and snacks. The requirements will
promote intakes of healthy foods from five
Today, almost 10 percent of
food groups: fruits, vegetables, milk, grains/
infants and toddlers carry
bread, and lean meats or meat alternates,
excess weight for their
and seek consistency with the Dietary
length, and slightly more than
Guidelines for Americans.
20 percent of children between
The effectiveness of the Meal Require-
the ages of 2 and 5 years are
ments will be determined in large part by the
already overweight or obese.
manner in which they are implemented and
monitored for compliance. Key implementation strategies should include
engaging families, food industry stakeholders, and community members;
providing nutritional education to participants; and training state agency
staff and program providers. To aid in implementation, the committee rec-
ommended that the USDA offer extensive technical assistance to CACFP
providers and work with stakeholders to develop an effective system for
monitoring and reimbursing CACFP meals.
Combating the obesity epidemic
Improving school lunches and meals served by child care providers will be
one tool in reducing obesity among Americans. The hope is that by learning
and practicing good nutritional habits early, children can avoid becoming
overweight or obese later in life. And these behaviors must begin among
even the youngest of children. Because early obesity can track into adult-
hood, efforts to prevent obesity should begin long before a child enters
school. Today, almost 10 percent of infants and toddlers carry excess weight
for their length, and slightly more than 20 percent of children between the
ages of 2 and 5 years are already overweight or obese.
In 2010, the IOM appointed a committee to review factors related to
overweight and obesity from birth to age 5, with a focus on nutrition, physi-
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25
Improving Food Safety, Nutrition, and Health
cal activity, and sedentary behavior. In its report, Early Childhood Obesity
Prevention Policies (2011), the committee recommends actions that health-
care professionals, caregivers, and policy makers can take to prevent obe-
sity in children 5 years old and younger.
Parents see pediatricians, primary care physicians, and other health-
care professionals as child care authorities. Thus, these professionals have
an important opportunity to increase parents’
awareness about healthy weight early on to allow
time for prevention or intervention. The IOM
recommends that healthcare professionals mea-
sure weight and height or length in a standardized
way, as well as pay attention to obesity risk factors,
such as rate of weight gain and parental weight, at
routine pediatric visits. In addition, the IOM rec-
ommends that parents and child care providers
keep children active throughout the day and pro-
vide them with diets rich in fruits, vegetables, and
whole grains, and low in energy-dense, nutrient-
poor foods. Caregivers also should limit young children’s screen time and
ensure that children sleep an adequate amount each day.
Finally, the committee recommends that the USDA and the Depart-
ment of Health and Human Services (HHS) establish dietary guidelines for
children from birth to age 2. Currently, the Dietary Guidelines for Ameri
cans do not include recommendations for children under the age of 2. Such
guidelines are necessary for setting nutrition recommendations for public
and federal programs.
Another IOM study committee looked at options outside of school for
helping children and adolescents avoid weight problems. In Local Govern
ment Actions to Prevent Childhood Obesity (2009), the committee identi-
fied numerous actions that show potential for use by local governments. Of
course, parents and other adult caregivers play a fundamental role in teach-
ing children about healthy behaviors, in modeling those behaviors, and in
making decisions for children when needed. But those positive efforts can
be undermined by local environments that are poorly suited to supporting
healthy behaviors—and may even promote unhealthy behaviors.
Local governments have many opportunities to promote children’s
health. Given their jurisdiction over aspects of land use, food marketing,
community planning, transportation, health and nutrition programs, and
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26 INFORMING THE FUTURE: Critical Issues in Health
other community concerns, local governments also are ideally positioned
to promote behaviors that will help children and adolescents reach and
maintain healthy weights.
As a blueprint for action, the IOM committee
recommended nine healthy eating strategies and
six physical activity strategies for local government
officials to consider in planning, implementing, and
refining childhood obesity prevention efforts. The
committee also recommended a number of spe-
cific action steps for each strategy and highlighted
12 steps overall judged to have the most promise.
One general message is clear: Promoting children’s
healthy eating and activity will require the involve-
ment of an array of government officials, includ-
ing mayors and commissioners or other leaders of
counties, cities, or townships. Many departments,
including those responsible for public health, education, public works,
transportation, parks and recreation, public safety, planning, economic
development, and housing, also need to be involved.
In addition, community involvement and evaluation are vital to
childhood obesity prevention efforts. It is critical for local government offi-
cials and staff to involve constituents in determining local needs and identi-
fying top priorities. Engaging community members in the process will help
identify local assets, focus resources, and
improve implementation plans. And, as obe-
Promoting children’s healthy
sity prevention actions are implemented,
eating and activity will require
such actions need to be evaluated in order
the involvement of an array of
to provide important information on what
government officials, including
does and does not work.
mayors and commissioners
The IOM also has dealt with the
or other leaders of counties,
obesity epidemic across broader society.
cities, or townships.
Approximately 68 percent of adults in the
United States aged 20 years or older are either overweight or obese. Among
children and adolescents aged 2 through 19 the rate is nearly 32 percent.
To respond most effectively, policy makers, public health professionals,
and other decision makers need relevant and useful evidence on promising
obesity prevention actions for the populations they serve.
In 2008, Kaiser Permanente asked the IOM to develop a practical,
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27
Improving Food Safety, Nutrition, and Health
action-oriented framework to guide the use of evidence in decision making
about obesity prevention policies and programs and to guide the genera-
tion of new and relevant evidence. The IOM convened a committee that
sought the answers to two fundamental questions:
• How can evidence that is currently available and potentially relevant
to decisions about obesity prevention be identified, evaluated, and
compiled in ways that will best inform decisions?
• How can more evidence be developed that is of high quality and framed
to be directly relevant to decision making on obesity prevention?
The committee developed the L.E.A.D. framework process—short
for Locate evidence, Evaluate it, Assemble it, and inform Decisions—to
help in answering these questions. Presented in the committee’s report,
Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform
Decision Making (2010), the framework encourages decision makers and
researchers to look at obesity from a systems perspective in order to under-
O
Specify
pp
Questions
or
tu
e
ni
tiv
tie
ec
s
sp
to
Identify and gather the
r
Pe
G
Locate
en
types of evidence that are
s
er
em
Evidence potentially relevant to the
at
st
questions
e
Sy
Ev
i
de
nc
Apply standards of quality
e
Evaluate as relevant to different
Evidence types of evidence
Select and summarize the
Assemble
O
relevant evidence according
pp
Evidence to considerations for its use
or
tu
e
ni
tiv
tie
ec
s
sp
to
r
Pe
G
en
Inform Use evidence in the
s
er
em
decision-making process
Decisions
at
st
e
Sy
Ev
i
de
nc
e
The L.E.A.D. framework.
SOURCE: Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision
Figures S-1, 3-1, 10-1.eps
Making, p. 5.
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28 INFORMING THE FUTURE: Critical Issues in Health
stand it as a complex, population-based health problem. The framework
provides guidelines for assembling and compiling evidence in an open and
transparent way, placing it in a real context in order to inform decisions. It
offers opportunities to generate useful, high-quality evidence for decision
making at every step, and encourages learning from a variety of sources,
including ongoing policies and practices and alternatives to randomized
experiments. It also provides a way for
assessing how well research results can be
The (L.E.A.D.) framework
applied to other individuals, settings, con-
provides guidelines for
texts, and time frames.
assembling and compiling
The IOM continues to tackle the
evidence in an open and
obesity epidemic through many different
transparent way, placing it
avenues. Its Standing Committee on Child-
in a real context in order
hood Obesity Prevention, sponsored by the
to inform decisions.
Robert Wood Johnson Foundation, serves
as a focal point for national and state-level
policy discussions about obesity prevention, and it has guided the devel-
opment of previous and upcoming studies on various aspects of obesity
prevention, among them the legal strategies that have an effect on obe-
sity. The standing committee hosted a workshop to highlight current and
potential legal strategies and other public health initiatives in October
2010.
In addition, the IOM recently partnered with HBO Documentary
Films on The Weight of the Nation, a project that will incorporate multiple
documentary films, publications, and a web component. More about this
project can be found in the chapter on collaboration.
Strengthening food safety
Approximately 76 million food-borne illnesses—caused by a variety of
bacteria, viruses, parasites, or chemical residues—occur each year in the
United States, resulting in more than 300,000 hospitalizations and 5,000
deaths. While food safety is regulated by several agencies, the FDA over-
sees approximately 80 percent of the nation’s food supply, including all
produce, seafood, and cheeses. But experts and the public have criticized
the FDA’s food safety system and questioned whether it properly safe-
guards the public from food-borne diseases. In response, Congress asked
the IOM to examine the gaps in the current food safety system under the
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29
Improving Food Safety, Nutrition, and Health
purview of the FDA and to identify the tools needed to improve food safety.
In Enhancing Food Safety: The Role of the Food and Drug Adminis
tration (2010), the IOM study committee concludes that the FDA lacks a
comprehensive vision for food safety and should change its approach in
order to properly protect the nation’s food. The agency should use a risk-
based approach to evaluate food safety problems rather than its current
reactive approach, which addresses prob-
lems only on a case-by-case basis and may Approximately 76 million
fail to account for all the factors involved food-borne illnesses—
in making a decision. Adopting a risk- caused by a variety of
based approach will enable decision mak- bacteria, viruses, parasites,
ers to evaluate the food safety system in a or chemical residues—occur
comprehensive way and follow a system- each year in the United
atic process for addressing and preventing States, resulting in more than
problems. Components of a risk-based food 300,000 hospitalizations
safety system include conducting strategic and 5,000 deaths.
planning; ranking public health risks; tar-
geting information gathering efforts, such as surveillance, on identified
risks; analyzing and selecting interventions; designing an intervention
plan; and monitoring and reviewing implementation efforts.
The committee outlines a set of actions that are needed to implement
a risk-based food safety system. For example, the FDA should hire or train
additional staff with expertise in risk management and analysis; develop a
comprehensive strategic plan that identifies public health goals and met-
rics to measure success; and define the roles of all parties in the food sys-
tem, including suppliers, farmers, retailers, consumers, and government
agencies, among others. The agency also should lead efforts to integrate
federal, state, and local safety programs so they work in a seamless manner;
improve food safety inspections; and expand and sharpen communications
programs to inform the public of risks in a timely and useful manner.
Finally, the committee called on Congress to help, by considering
legislative action to provide the FDA with the authority it needs to fulfill
its food safety mission. In November 2010, the Senate passed legislation
that aligned with many of the IOM’s recommendations, and in January
2011, President Obama signed into law the FDA Food Safety Moderniza-
tion Act, which is aimed at ensuring the U.S. food supply is safe by shift-
ing the focus of federal regulators from responding to contamination to
preventing it.
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30 INFORMING THE FUTURE: Critical Issues in Health
Fostering good nutrition
Consumers need sound information about food and nutrition in order
to make choices that promote and protect their health and well-being.
The IOM has helped by developing and disseminating Dietary Reference
Intakes (DRIs) that specify how much of a given nutrient should be con-
sumed for good nutrition and how much is unsafe or unwarranted, with
the levels specified according to an individual’s age, gender, and life stage.
Now available for more than 40 nutrient sources, the DRIs are intended to
serve as a guide for good nutrition and provide the basis for the develop-
ment of nutrient guidelines in both the United States and Canada.
The IOM has compiled these DRIs into a single listing for easy view-
ing. A summary guide to the DRIs also is available, along with a number of
focused, in-depth publications to help users understand the important con-
siderations in applying the values for planning and assessing diets. Through
these and other avenues, the DRIs are used by a range of health profes-
sionals and policy makers, including federal nutrition officials who develop
policies and programs, dietitians and health practitioners who counsel
individuals and groups, and researchers who are working to advance the
state of nutrition knowledge.
Dietary Reference Intakes for Calcium and Vitamin D (2010) is the
most recent report in the IOM series. These two nutrients have long been
known for their role in bone health. Over the past 10 years, however, the
public has heard conflicting messages about other
benefits of these nutrients—especially vitamin D—
and about how much of the nutrients must be con-
sumed for good health. The new DRIs are based on
much more information and higher-quality stud-
ies than were available when the reference values
were first set in 1997.
The report’s authoring committee concluded
that a strong body of evidence from rigorous test-
ing substantiates the importance of vitamin D and
calcium in promoting bone health. The evidence
for other health benefits, however, is mixed and
inconclusive, and targeted research is needed to
assess these possible health benefits. The commit-
tee also found that consuming vitamin D and calcium at levels higher than
recommended does not confer greater benefits. In fact, elevated consump-
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31
Improving Food Safety, Nutrition, and Health
Dietary Reference Intakes for Calcium and Vitamin D
Calcium Vitamin D
Recom- Estimated Recom-
Estimated
mended Average mended
Average Upper Upper
Dietary Require- Dietary
Require- Level Level
Allowance ment Allowance
Life Stage ment Intake Intake
Group (mg/day) (mg/day) (mg/day) (IU/day) (IU/day) (IU/day)
Infants * * 1,000 ** ** 1,000
0 to 6
months
Infants * * 1,500 ** ** 1,500
6 to 12
months
1–3 500 700 2,500 400 600 2,500
years old
4–8 800 1,000 2,500 400 600 3,000
years old
9–13 1,100 1,300 3,000 400 600 4,000
years old
14–18 1,100 1,300 3,000 400 600 4,000
years old
19–30 800 1,000 2,500 400 600 4,000
years old
31–50 800 1,000 2,500 400 600 4,000
years old
51–70 800 1,000 2,000 400 600 4,000
year old
males
51–70 1,000 1,200 2,000 400 600 4,000
year old
females
>70 1,000 1,200 2,000 400 600 4,000
years old
14–18 1,100 1,300 3,000 400 600 4,000
years old,
pregnant/
lactating
19–50 800 1,000 2,500 400 600 4,000
years old,
pregnant/
lactating
*For infants, Adequate Intake is 200 mg/day for 0 to 6 months of age and 260 mg/day for 6 to 12
months of age.
**For infants, Adequate Intake is 400 IU/day for 0 to 6 months of age and 400 IU/day for 6 to 12
months of age.
SOURCE: Dietary Reference Intakes for Calcium and Vitamin D.
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32 INFORMING THE FUTURE: Critical Issues in Health
tion has been linked to various health problems, such as kidney stones
caused by excessive calcium intake—challenging the concept that “more is
better.” These findings may raise important concerns as North Americans
take more supplements and eat more foods that have been fortified with
vitamin D and calcium, increasing their risk of consuming far too much of
these otherwise important nutrients.
In another study, the IOM looked at a common food ingredient
that can cause health problems: sodium. Americans consume unhealthy
amounts of sodium in their food, increasing
their risk for high blood pressure, a serious
Consuming vitamin D and
health condition that can lead to a variety of
calcium at levels higher than
diseases. While numerous stakeholders have
recommended does not
initiated voluntary efforts to reduce sodium
confer greater benefits.
consumption during the past 40 years, they
have not succeeded. Challenges arise because salt—the primary source of
sodium in the diet—and other sodium-containing compounds are widely
used in the food industry, including restaurants, to enhance the flavor of
foods.
To help in meeting this concern, Congress asked the IOM to rec-
ommend strategies for reducing sodium intake to levels recommended in
the Dietary Guidelines for Americans—currently no more than 2,300 milli-
grams per day for persons 2 or more years of age.
This amounts to about a teaspoon of salt per day,
while the average person consumes about 50 per-
cent more than that. In Strategies to Reduce Sodium
Intake in the United States (2010), the authoring
study committee concluded that a new, coordi-
nated approach is needed to reduce sodium con-
tent in food, requiring new government standards
for the acceptable level of sodium.
Manufacturers, restaurants, and other food-
service operators should be required to meet these
standards so all sources in the food supply are
involved and so consumers’ taste preferences can
be changed over time to the lower amounts of salt
in food. The goal is to slowly, over time, reduce the
sodium content of the food supply in a way that goes unnoticed by most
consumers as individuals’ taste sensors adjust to the lower levels of sodium.
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33
Improving Food Safety, Nutrition, and Health
A range of stakeholders will need to cooperate in this effort. HHS
should act in cooperation with other government and private groups to
design and implement a nationwide campaign to reduce sodium intake
and should set a timeline for achieving recommended sodium intake levels.
Consumers have an important role to play by making healthy food choices
and selecting lower-sodium foods. In addition, government agencies, public
health and consumer organizations, health professionals, the health insur-
ance industry, the food industry, and public-private partnerships should
support the implementation of the sodium standards for foods and also
support consumers in reducing their sodium intake. Finally, better monitor-
ing of sodium intake and of the progress toward changing salt taste prefer-
ence are essential so the reduction efforts can be tracked and evaluated, and
improvements can be made as needed.
In response to the IOM report, some companies in the food indus-
try have begun to act. And Walmart, which sells more food than any other
grocery store chain in the nation, announced in January 2011 that it would
work with its suppliers to provide healthier food choices and make those
foods more affordable to consumers. The company referred to the IOM in
making its announcement. Walmart plans to reformulate many of its pack-
aged foods to reduce sodium—as well as added sugars and trans fats—by
5,000
Sodium Intake (mg/d)
4,000 1971–1974
1976–1980
3,000
1988–1994
2,000
1999–2000
1,000 2003–2006
0
Children Men Women
6–11 20–74 20–74
Gender/Age Groups
Trends in mean sodium intake from food for three gender/age groups, 1971–1974 to 2003–2006.
NOTES: Analyzed using 1-day mean intake data for the National Health and Nutrition Examina-
tion Survey (NHANES) 2003–2006 to be consistent with earlier analyses and age-adjusted to the
Figure S-2 & 2-13.eps
2000 Census; includes salt used in cooking and food preparation, but not salt added to food at
the table. d = day; mg = milligram.
SOURCE: Briefel and Johnson (2004) for 1971–2000 data; NHANES for 2003–2006 data.
SOURCE: Strategies to Reduce Sodium Intake in the United States, p. 5.
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34 INFORMING THE FUTURE: Critical Issues in Health
2015. The company said it also intends to ask its suppliers to reduce sodium
by 25 percent in some foods and to report on their progress.
Meeting the needs of an aging population
The nation’s population is increasingly an older population, and IOM’s Food
Forum held a workshop in October 2009 to discuss food safety and nutri-
tion in older adults. One general concept that emerged was that there is no
single “elder” population. Rather, there are many different aging popula-
tions defined by age range as well as by such factors as race, socioeconomic
status, level of family support, disability, and
chronic health conditions. Meeting the dif-
There is no single “elder”
fering needs of these groups rapidly becomes
population. Rather, there
a complex task. Workshop participants from
are many different aging
government, academia, industry, and other
populations defined by age
sectors discussed the variety of ways that dif-
range as well as by such
ferent stakeholders are embracing the chal-
factors as race, socioeconomic
lenge of improving food safety and nutrition
status, level of family
in aging populations.
support, disability, and
This challenge is made more difficult
chronic health conditions.
by a lack of information in many key areas.
For example, although high-quality diets and nutrient optimization are
understood to be necessary for maintaining good health in older adults, sev-
eral questions remain about exactly what constitutes a high-quality diet and
what types of obstacles, such as poor oral health and loss of appetite, keep
people from obtaining optimal diets. Another challenge in differentiating
among multiple aging populations is the lack of health-monitoring data and
the consequent inability to generate enough statistical power to make con-
clusions about the health conditions and needs of those varied populations.
Also, although industry has developed new food-processing techniques and
novel packaging that minimize many food safety problems, there are still
important unanswered questions about how food processing, formulation,
and packaging can be improved to better meet the needs of older adults.
In October 2011, the IOM held another workshop to explore nutri-
tional interventions and services for older people staying in community
settings. This workshop outlined the scope of nutrition needs; the impor-
tance, strengths, and weaknesses of nutrition services; and future research
needs related to nutrition and healthy aging in the community.
