STANDARDS OF PROFESSIONAL PRACTICE DIET GUIDE

BluePrint Menu Management System Diet GuideSection One General Nutrition RecommendationsDietary Guidelines for Americans 2015-2020The 2015-2020 Dietary Guidelines for Americans is the federal government’s evidencebased nutritional guidance. These guidelines are intended to help promote health,reduce the risk of chronic diseases, and reduce the prevalence of obesity throughimproved nutrition and physical activity. The recommendations are to be used asguidance and advice in order to achieve an overall healthy eating pattern.The guidelines focus on the following recommendations intended for Americans ages 2 andolder: Follow a healthy eating pattern across the lifespan.Focus on variety, nutrient density, and amount.Limit calories from added sugars and saturated fats and reduce sodium intake.Shift to healthier food and beverage choices.Support healthy eating patterns for all.Recommendations for individuals 50 years and older include: Consume foods fortified with Vitamin B12 – such as fortified cereals or dietarysupplementsAdditional resources and detailed information on the 2015-2020 DietaryGuidelines for Americans is available at www.dietaryguidelines.govReferences1. Academy of Nutrition and Dietetics. Nutrition Care Manual . http://www.nutritioncaremanual.org.Content Release Date November 2019.2. Dietary Guidelines for Americans, 2015-2020, www.dietaryguidelines.govThis Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.12

BluePrint Menu Management System Diet GuideSection One General Nutrition RecommendationsDietary Reference Intakes (DRIs)Dietary Reference Intakes (DRIs) provide reference values for nutrients that may be used whenplanning and evaluating diets for a healthy population. The DRIs are developed by the NationalAcademy of Sciences, Institute of Medicine, Food and Nutrition Board. The DRIs are divided into thefollowing nutrient guidelines: Estimated Average Requirements (EAR): average daily nutrient intake level estimated to meet therequirements of half of the healthy individuals in a groupRecommended Dietary Allowances (RDA): average daily dietary intake level sufficient to meet the nutrientrequirements of nearly all healthy individuals in a group - RDAs are calculated using the Estimated AverageRequirements (EARs)Adequate Intakes (AI): if no RDA is available, an AI is developed. An AI is believed to cover the needs ofall healthy individuals in a group, but data is not clear enough to specify a RDAAcceptable Macronutrient Distribution Ranges (AMDR): the range of intake for a particular energysource that is associated with reduced risk of chronic disease while providing intakes of essentialnutrientsA complete list of Dietary Reference Intake Tables developed by the Institute of Medicine's Foodand Nutrition Board can be accessed ry-reference-intakes/dri-tablesFood and Nutrition Information CenterNational Agricultural Library10301 Baltimore Avenue, Room 108Beltsville, MD 20705(301) 504-5414The Department of Health & Human Service (DHHS) along with the Centers for Medicare & MedicaidService (CMS) require that menus must “Meet the nutritional needs of residents in accordance withthe recommended dietary allowances of the Food and Nutrition Board of the National ResearchCouncil, National Academy of Sciences”(F363 §483.35(c))The intent of this regulation is to assure that the meals served meet the nutritional needs of theresident in accordance with the recommended dietary allowances (RDAs) of the Food and NutritionBoard of the National Research Council, of the National Academy of Sciences. This regulation alsoassures that there is a prepared menu by which nutritionally adequate meals have been planned forthe resident and followed §483.35(c)(1)(2)(3).References1.2.The Institute of Medicine, National Academy of Sciences. ation-reports Retrieved November 2019.Department of Health & Human Services, Center for Medicare & Medicaid Services. CMS Manual System.Dietary Services. https://www.nal.usda.gov/sites/default/files/fnic uploads//SummaryTables.pdf.This Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.13

BluePrint Menu Management System Diet GuideSection One General Nutrition RecommendationsVitamin A GuidelinesCurrent dietary guidelines indicate a “good source” of Vitamin A is equivalent to at least 20% of theRecommended Dietary Allowance (RDA) for adult men (3,000 IU/day), or 600 IU per serving.PurposeThe purpose of this rationale is to provide a reference for evaluating the Vitamin A content of menus.The BluePrint menu standard is to offer a minimum of three servings of a good source of Vitamin Afrom fruits and vegetables per week.Menu Guidelines A fruit or vegetable is considered a good source of Vitamin A if it provides a minimum of 1,000 IUper serving. A usual serving is ½ cup cooked vegetables, 1 cup raw vegetables or ½ - 1 cup of freshfruit. Three servings of a good Vitamin A source from fruits and vegetables per week are offered.Good Sources of Vitamin ACooked Vegetables (1/2 cup serving):CarrotsSquash (Butternut, Winter)SpinachGreens (Collard, Mustard, Turnip, Seasoned)PumpkinSweet PotatoesYamsBroccoliBrussels SproutsGreen PeasVegetable Blends (1/2 cup serving):Vegetable MedleyVegetable Sticks (Steamed or Fresh)Tuscany BlendSummer BlendSummer BlendStir Fry VegetablesVegetable BlendCalifornia BlendCapri BlendItalian Blend w/ BroccoliMixed VegetablesItalian Blend w/CauliflowerOriental BlendPrince Edward BlendScandinavian BlendRatatouilleRaw Vegetables and Salads (3/4 - 1cupserving):Pico de GalloCaesar SaladSpinach SaladMarinated Vegetable SaladGreen Pea SaladMarinated Garden SaladLayered Pea SaladCreamy Broccoli CauliflowerSalad Carrot Raisin Salad Creamy Vegetable SaladFresh Fruit (1/2 -1 cup serving):ApricotsMelon CubesCantaloupeFruit Cup (Fresh)Mandarin OrangesGrapefruit HalfThis Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.14

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SECTION TWO:GENERAL GUIDELINES FOR MEAL PLANNINGTufts University MyPlate for Older AdultsMyPlate.govThis Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.16

BluePrint Menu Management System Diet GuideSection Two General Guidelines for Meal PlanningTufts University MyPlate for Older AdultsNutrition scientists at Tufts University introduced the updated MyPlate for Older Adultsnutrition guidelines in reference to the 2015-2020 Dietary Guidelines for Americans. Thesenutrition guidelines take into consideration the unique nutritional & physical needs of olderadults1. MyPlate for older adults places focus on the following nutrition recommendations –customized for the needs of older adults: Bright colored vegetables and deep colored fruits high in nutrientsWhole, enriched and fortified grainsLow and non-fat dairy productsDry beans and nuts, fish, poultry, lean meat and eggsUse of spices to help lower sodium intakeOils and spreads low in saturated and trans fatsIncreased fluid intakePhysical activity such as walking, resistance training and light cleaningTufts University nutrition scientists advises older adults who are considering transitioning toa healthier lifestyle to talk with their primary healthcare provider before making majorchanges to diet and physical activity routines1.References1.Tufts University, MyPlate for Older Adults. der-adults. Retrieved November 2019.This Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.17

BluePrint Menu Management System Diet GuideSection Two General Guidelines for Meal PlanningMyPlate.govMyPlate is a tool designed to help remind Americans to eat healthy and incorporate the2015-2020 Dietary Guidelines for Americans when making food choices. This tool includes anillustration outlining 5 food groups in an easy to understand visual icon.At ChooseMyPlate.gov the consumer can access a variety of useful tools to help build ahealthier diet and lifestyle.Also available at MyPlate.gov: Sample Menus for a WeekFood Group Based RecipesHistorical Development of Food GuidanceNutrition Communicators Network for Partners Application FormsAll print-ready contentReferences1.United States Department of Agriculture. Getting Started with MyPlate. http://www.choosemyplate.gov/. Retrieved November 2019This Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.18

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SECTION THREE:DIETSGeneral DietsTexture Modified DietsHeart Healthy DietsRenal DietsGastrointestinal DietsVegetarian DietsBluePrint Menu Management System 20

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GENERAL DIETSRegular/No Added Salt (NAS) DietFinger Foods DietSmall Portion DietHigh Calorie/High Protein DietNo Concentrated Sweets (NCS) DietLow Concentrated Sweets (LCS) DietConsistent Carbohydrate DietThis Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.22

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Diet Guide Section Three General DietsRegular/No Added Salt (NAS) DietRegular/No Added Salt (NAS) DietDescriptionThe Regular/NAS diet is for healthy adults and is planned in accordance with theRecommended Dietary Allowances (RDAs) for adults 70 years old. The RDAs are part of theDietary Reference Intakes (DRIs) developed by the National Academy of Sciences, Institute ofMedicine, Food and Nutrition Board1. The RDAs are intended to provide reference values fornutrients that may be used when planning or analyzing diets for a healthy population. TheRegular/NAS diet is suitable for use in a wide variety of facilities. Although not intended tomeet the nutritional needs of all residents in a facility, it is appropriate when adjusted to meeteach individual’s needs.PurposeThe Regular/NAS diet macronutrient distribution is approximately 15% protein, 50%carbohydrate and 35% fat.Diet OrderThis diet should be ordered as:Facility NotesDocument facility specific diet modificationsApproved byDateTitleThis Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.24

Diet Guide Section Three General DietsRegular/No Added Salt (NAS) DietMenu GuidelinesA. Number of meals: Three meals daily with an evening snack.B. The daily meal pattern isasfollows2:3 – Fruit servings3 – Vegetable servings3 – Cups low- or nonfat milk6 – Ounces of good quality protein6 – Grain servingsBeverages: At least eight cups of fluid is recommended daily.C. No Added Salt: In order to reduce sodium intake, table salt is not provided on theRegular/NAS diet and salt is not included in the preparation of vegetables. TheRegular/NAS diet on average provides less than 4,000mg of sodium a day overeach week of the menu cycle.D. Each week the menu provides three sources of Vitamin A-rich fruits or vegetables. A food isconsidered a good source of Vitamin A if it provides 1000 IU or more per serving2. Forfurther information refer to guidelines for Vitamin A in Section 1: General NutritionRecommendations.E. Each day the menu provides one good fruit or vegetable source of vitamin C or two fruit orvegetable servings of a fair source of vitamin C. A good source of vitamin C contains at least60 mg of vitamin C. Two or more servings of a fair fruit or vegetable source must contain atotal of at least 65mg of vitaminC2.F. Since older adults have special nutrient needs1, each day the menu provides at least 1,200mg calcium and 2.4 mcg of Vitamin B12. Food manufacturers do not currently provideadequate information on the following nutrients: Vitamin D, Vitamin E, Molybdenum andIodine3. Consequently, these nutrients are not consistently reported as part of our menuguidelines.G. Protein distribution per meal:Breakfast -1 ounce (7 grams good quality protein)Noon meal - 3 ounces (21 grams good quality protein)*Evening meal – 3 ounces (21 grams good quality protein)**Protein amount may be swapped between meals, but will total at least sixounces daily.H. One cup of low- or nonfat milk is included at breakfast, lunch, and dinner.I.Blueprint Nutrition Goals are an average of 16 nutrients from the highest male andfemale DRI Values.This Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or other health professional. The accuracy of the information provided is based on informationUS Foods, Inc. obtains from third parties. This Standards of Professional Practice document is not meant to be a substitute for the individualizednutrition intervention provided by a registered dietitian. US Foods, Inc. neither assumes any legal liability nor makes any warranty or guarantee,either express or implied, regarding the completeness, accuracy, or usefulness of this information.25

Diet Guide Section Three General DietsRegular/No Added Salt (NAS) DietReferences1.2.3.The Institute of Medicine, National Academy of Sciences. https://www.nal.usda.gov/fnic/dietary- reference-intakesAdministrative Code. Joint Committee on Administrative Rules, Illinois Department of Public Health. Available 7/077003000J20500R.html. Accessed on November 2017.Dietary Supplement Health Professional Fact Sheets. Office of Dietary Supplements. National Institutes of Health.Available at http://ods.od.nih.gov/factsheets/list-all/. Accessed on November 2017.This Standards of Professional Practice document is provided for informational purposes, is not tailored to your specific situation, and is notmeant to substitute for the advice of a physician or

National Dysphagia Diet: NDD Level 1 Pureed 7 4 National Dysphagia Diet: NDD Level 2 Mechanically Altered 78 National Dysphagia Diet: NDD Level 3 Dysphagia Advanced 82 Soft Diet 86 Heart Healthy Diets 90 Low-Sodium 92 C