Planning Nutritionally Adequate Diets for Groups: Methods Used to Develop Recommendations for a Child and Adult Care Food Program.

Planning nutritionally adequate intakes for large groups of people presents many challenges. Because of between-person variations in both food choices and nutrient requirements, it is necessary to examine nutrient intake distributions and select a Target Median Intake (TMI) that will lead to a low prevalence of inadequate nutrient intakes. The TMI may then be used to guide a feeding or education program. A comprehensive report from the Institute of Medicine evaluated nutrient intakes from the NHANES and recommended new meal patterns for all age groups (other than infants) served by the Child and Adult Day Care Food Program, which provides meals and snacks to children and adults in a variety of care settings. The Estimated Average Requirement, a DRI value, for each nutrient of interest was used to estimate both the prevalence of inadequate intakes as well as the changes in the intake distribution that are needed to reduce unacceptably high levels of inadequacy. For nutrients with an Adequate Intake (AI), the prevalence of inadequacy could not be estimated, but the AI could be used as the TMI. Simultaneously, it was important to ensure that the new intake distributions did not result in intakes that exceeded the Tolerable Upper Intake Level for any nutrient. Data for 2- to 4-y-old children are presented in detail to illustrate this process. Of 18 nutrients examined, analyses showed that intakes of vitamin E, potassium, and fiber should be increased, while intakes of sodium should be decreased. If more recent nutrient standards are used, revised assessments show that calcium intake should also be increased, while potassium intake is adequate. These methods and results should be useful when designing feeding programs for other population groups within the United States, as well as in other countries.