Section 340.1920 Meal Planning

Section 340

Section 340.1920  Meal

Planning

Each resident shall be served

food to meet the resident's needs and to meet the physician's orders. The

facility shall use this Section to plan menus and purchase food in accordance

with the following Recommended Dietary Allowances of the Food and Nutrition

Board of the National Research Council, National Academy of Sciences.

a)         Milk and Milk Products Group: 16 ounces or more of Grade A

whole or low fat pasteurized milk where milk is used for fluid consumption.

Calcium equivalents for eight ounces of milk:

1)         1½ ounces natural cheese,

2)         Two ounces processed cheese,

3)         One cup yogurt, or one cup frozen yogurt,

4)         One cup cottage cheese, or

5)         1½ cups ice cream or ice milk.

b)         Meat Group:  A total of 6 ounces (by weight) of good quality

protein to provide 38 to 42 grams of protein daily.  To ensure variety, food

items repeated within the same day shall not be counted as meeting a required

serving. The following are examples of one serving:

1)         Three ounces (excluding bone, fat and breading) of any cooked

meat such as whole or ground beef, veal, pork or lamb; poultry; organ meats

such as liver, heart, kidney; prepared luncheon meats.

2)         Three ounces (excluding skin and breading) of cooked fish or

shell fish or 1/2 cup canned fish.

3)         Three ounces of natural or processed cheese or ¾ cup cottage

cheese.

4)         Three eggs (minimum weight of 21 ounces per dozen, considered

a medium egg).  Note:  If one egg is served at a meal, a protein food of good

quality may be reduced from six to five ounces for the remaining meals.  If two

eggs are served at a meal, a minimum of two ounces of good quality protein

shall be served at each of the remaining meals.

5)         1½ cups cooked dried peas or beans, six tablespoons of peanut

butter, one cup nuts, not more than twice a week and provided that eggs,

cheese, milk or lean meat is served at the same meal

ty may be reduced from six to five ounces for the remaining meals.  If two

eggs are served at a meal, a minimum of two ounces of good quality protein

shall be served at each of the remaining meals.

5)         1½ cups cooked dried peas or beans, six tablespoons of peanut

butter, one cup nuts, not more than twice a week and provided that eggs,

cheese, milk or lean meat is served at the same meal.

6)         Three ounces of soy protein containing not less than 21 grams

of protein, or in combination with other sources of quality protein to equal 21

grams of protein, provided that it is acceptable to the resident population.

7)         Combinations of all above examples are acceptable, provided

the minimum of six ounces of a good quality protein is served daily and

provided that the combinations do not conflict with eye appeal or palatability.

8)         The content of meat alternative products shall be listed on

the menu.

c)         Vegetable and Fruit Group:  Five or more servings of

vegetables or fruits.

1)         A serving consists of:

A)        ½ cup chopped raw, cooked, canned or frozen fruit or

vegetables;

B)        ¾ cup fruit or vegetable juice; or

C)        One cup raw leafy vegetable.

2)         The five or more servings shall consist of:

A)        Sources of vitamin C

i)          One serving of a good source of vitamin C (containing at

least 60 mg of vitamin C); or

ii)         Two servings of a fair source of vitamin C.  This may be more

than one food item and shall contain a total of at least 65 mg of vitamin C.

B)        One serving of a good source of vitamin A at least three times

a week supplying at least 1000 micrograms retinol equivalent (RE) of vitamin A.

C)        Other fruits and vegetables, including potatoes, that may be

served in ⅓ cup or larger portions.

3)         To ensure variety, food items repeated within the same day

shall not be counted as meeting a required serving

mg of vitamin C.

B)        One serving of a good source of vitamin A at least three times

a week supplying at least 1000 micrograms retinol equivalent (RE) of vitamin A.

C)        Other fruits and vegetables, including potatoes, that may be

served in ⅓ cup or larger portions.

3)         To ensure variety, food items repeated within the same day

shall not be counted as meeting a required serving.

d)         Bread, Cereal, Rice and Pasta Group: Six or more servings of

whole grain, enriched or restored products.  One serving equals:

1)         One slice of bread,

2)         ½ cup of cooked cereal, rice, pasta, noodles or grain product,

3)         ¾ cup of dry, ready-to-eat cereal,

4)         ½ hamburger or hotdog bun, bagel or English muffin,

5)         One 4-inch diameter pancake,

6)         One tortilla,

7)         Three to four plain crackers (small),

8)         ½ croissant (large), doughnut or danish (medium),

9)         1/16 cake,

10)       Two cookies,

11)       1/12 pie (2-crust, 8").

e)         Butter or Margarine: To be used as a spread and in cooking.

f)         Other foods shall be served to round out meals, satisfy

individual appetites, improve flavor, and meet the individual's nutritional and

caloric needs.

g)         Meals for the day shall be planned to provide a variety of

foods, variety in texture and good color balance.  The following meal patterns

shall be used.

1)         Three meals a day plan

A)        Breakfast:  Fruit or juice, cereal, meat (optional, but three

to four times per week preferable), bread, butter or margarine, milk, and

choice of additional beverage.

B)        Main Meal (may be served noon or evening):  Soup or juice

(optional), entree (quality protein), potato or potato substitute, vegetable or

salad, dessert (preferably fruit unless fruit is served as a salad or will be

served at other meal), bread, butter or margarine, milk and choice of beverage

per week preferable), bread, butter or margarine, milk, and

choice of additional beverage.

B)        Main Meal (may be served noon or evening):  Soup or juice

(optional), entree (quality protein), potato or potato substitute, vegetable or

salad, dessert (preferably fruit unless fruit is served as a salad or will be

served at other meal), bread, butter or margarine, milk and choice of beverage.

C)        Lunch or Supper:  Soup or juice (optional), entree (quality

protein), potato or potato substitute (optional if served at main meal),

vegetable or salad, dessert, bread, butter or margarine, milk, and choice of

additional beverage.

2)         Other meal patterns may be used if facilities are able to meet

residents' needs using such plans.

i)          No more than 14 hours shall occur between the usual beginning

of the evening meal and the usual beginning of the morning meal.

j)          Snacks of nourishing quality shall be offered at bedtime when

there are four or more hours between the ending of the last meal and bedtime,

or as otherwise indicated in the resident's plan of care.

k)         If a resident refuses food served, reasonable and

nutritionally appropriate substitutes shall be served.