Nutrition Care for Individuals and Groups: Topic A - screening & assessment Flashcards
what is the nutrition care process
NCP is a standardized, consistent structure and framework used to provide nutrition care. this is different from standardized care, which infers that all patients receive the same cares
ADIME documentation
assess, diagnose, intervene, monitor and evaluate
critical thinking in screening and assessment
critical thinking integrates facts, informed opinions, active listening and observations. it is a reasoning process where ideas are produced and evaluated. it includes the ability to conceptualize, think rationally, think creatively, be inquiring, and think autonomously
Data reviewed during assessment is reviewed when during NCP?
Data reviewed during assessment is reviewed during all steps of NCP.
nutrition screening
A. use of preliminary nutrition assessment techniques to identify people who are
malnourished or who are at risk for malnutrition
B. all health care team members can participate (not a part of the four step
process, but serves a supportive role); brief 5-10 minutes
C. review: client’s history, lab results, weight, physical signs
D. for screening to be effective, the mechanism must be accurate based on:
specificity (can it ID patients without a condition), sensitivity (can it ID those who
have the condition)
what is cultural competence
Cultural competence is the ability to provide care to patients with diverse values,
beliefs and behaviors and tailor delivery to meet their social, cultural and linguistic
needs.
The joint commission and nutrition risk
The Joint Commission requires that nutrition risk is
identified in hospitalized patients, but does not mandate a method of screening
subjective global assessment screening tool
SGA - Subjective Global Assessment (history, intake, GI symptoms, functional
capacity, physical appearance, edema, weight change)
Mini Nutritional Assessment
screening tool
MNA - evaluates independence, medications,
number of full meals consumed each day, protein intake, fruits and
vegetables, fluid, mode of feeding); for people 65 years of age and older
Nutrition Screening Initiative - screening tool
NSI - elderly
Geriatric Nutritional Risk Index - screening tool
GNRI - (serum albumin, weight changes)
Malnutrition Screening Tool
MST - (acute hospitalized adult population) recent
weight loss, recent poor dietary intake
Nutrition Risk Screening
NRS - (medical-surgical hospitalized) % weight loss,
BMI, intake, >70 years
Malnutrition Universal Screening Tool
MUST - (BMI, unintentional weight loss,
effect of acute disease on intake for more than 5 days
Nutrition assessment of individuals - introduction/initiation
- initiated by referral/screening of individuals or groups for nutritional risk factors
- Assessment makes comparisons between data collected and reliable standards.
It is an on-going, dynamic process that involves continual reassessment and
analysis of patient/client/group needs. It provides the basis for the Nutrition
Diagnosis.
critical thinking skills needed for nutrition assessment include
a. Observe verbal/nonverbal cues that can guide effective interviewing methods
b. Determine appropriate data to collect
c. Select tools and procedures and apply in valid, reliable ways
d. Distinguish relevant from irrelevant, and important from unimportant data
e. Validate, organize and categorize the data
components: review, cluster, identify - for nutrition assessment include
a. Review data for factors that affect nutritional and health status
b. Data is clustered for comparison with characteristics of a diagnosis:
food/nutrition related history, lab/medical tests, nutrition-focused physical
findings, anthropometrics, client history
c. These indicators are compared to identified standards and criteria for
interpretation and decision-making. Indicators are clearly defined markers that
can be observed and measured. They are also used to monitor and evaluate
progress towards nutrition outcomes. Nutrition care criteria are what
indicators are compared against.
documentation of nutrition assessment
Documentation: date and time, pertinent data and comparison with standards;
patient’s perceptions, values and motivation related to problem; changes in
patient’s level of understanding, behaviors, outcomes; reason for discharge
Dietary intake assessment, analysis
- diet history - present patterns of eating. Do not ask leading questions.
- food record - food diary, record of everything eaten in a specific period of time
- 24 hour recall - mental recall of everything eaten in previous 24 hours.
Quick tool to estimate a sample daily intake. Clinical setting.
Underreporting and overreporting are concerns. - food frequency lists - how often an item is consumed. Community setting.
Quick way to determine intakes on large numbers of people
Hamwi formula estimates desirable body weight
Frame
medium -
Women:
100 lbs for first 5’
add 5 lbs for each additional inch
subtract 5 lbs for each inch under 5’
Men
106 lbs for first 5’
add 6 lbs. for each additional inch
subtract 6 lbs or each inch under 5’
Hamwi formula estimates desirable body weight - small or large frame
small & large for women and men -
subtract 10%
add 10%
hamwi Amputations:
entire leg 16% of body weight, lower leg with foot 6%, entire arm 5%,
forearm with hand 2.3%.
Adjusted IBW = (100 - % amputation)/100 X IBW for original height
hamwi Spinal cord injury
quadriplegic reduce by 10-15% of table weight
paraplegic reduce by 5-10% table weight
% weight change -
stresses significance of weight change; assess nutritional risk
(1) usual weight - actual (current) weight / usual weight
X 100
significant weight loss
10% loss within 6 months
triceps skinfold thickness - TSF
(1) measures body fat reserves; measures calorie reserves
(2) standard: male 12.5mm; female 16.5 mm
arm muscle area AMA
(1) measures skeletal muscle mass (somatic protein)
(2) to determine: use TSF and MAC (midarm circumference)
(3) standard: male 25.3cm; female 23.2 cm
(4) important to measure in growing children
e. BMI body mass index - Quetelet index - compares weight to height
(1) weight in KG divided by height squared in meters; or weight in pounds
divided by height in inches squared X 703
(2) healthy adult 18.5 - 24.9 (healthy for most elderly 24-29), 25-29 overweight,
30 and above obese
(3) BMI for age charts starting at age two when accurate stature can be obtained
waist circumference
> 40 M, >35 F is independent risk factor for disease when
out of proportion to total body fat (with BMI of 25-34.9)
Waist circumference best for assessing risk. It predicts central adiposity
(lower torso around abdominal area)
EAL recommends at annual visit calculate
adult BMI and waist circumference to
determine risk of CVD, Type 2 diabetes.
waist/ hip ratio (WHR)
(1) differentiates between android and gynoid obesity
(2) WHR of 1.0 or greater in men, 0.8 or greater in women is indicative of
android obesity and an increased risk for obesity-related diseases
(diabetes, hypertension)
BIA bioelectrical impedance analysis
used at bedside to evaluate fat free mass
and total body water (usefulness in critical illness may be limited)
(1) must be well hydrated, no caffeine, alcohol or diuretics in the past 24 hours, no
exercise in the past 4-6 hours
(2) fever, electrolyte imbalance and extreme obesity may affect reliability
NFPE Nutrition - focused physical exam - inspection
a. Inspection: visual assessment using sight, sense of smell and hearing to observe
textures, sizes, colors, shapes and sounds
(1) information obtained: obesity, cachexia, fluid status, skin integrity, wound
healing, feeding devices, jaundice, ascites
assessment - hair -
thin, sparse, dull dry brittle
easily pluckable
vitamin C, protein deficiency, protein deficiency
assessment - eyes - pale, dry, poor vision
vitamin A, zinc or riboflavin deficiencies
assessment - lips - swollen, red, dry, cracked
riboflavin, pyridoxine, niacin deficiencies
assessment - Tongue - smooth, slick, purple, white coating
vitamin or iron deficiencies
assessment - Gums - sore, red, swollen, bleeding
vitamin C deficiency
assessment - Teeth -missing, loose, loss of enamel
calcium deficiency, poor intake
assessment - Skin - pale, dry, scaly
iron, folic acid, zinc deficiency
assessment - Nails - brittle, thin, spoon-shaped
iron or protein deficiency
Palpation
gathering data via touch using palms and fingertips
information obtained: areas of tenderness, muscle rigidity, fluid retention or
pitting edema, skin integrity and moisture, body temperature
Auscultation
listening to bowel using stethoscope on the RLQ (right lower
quadrant which is the location of the ileocecal valve))
(1) normal bowel sounds are gurgling high-pitched sounds every 5-15 seconds.
(2) hypoactive bowel sounds, every 15-20 seconds, may indicate paralytic ileus
or peritonitis.
(3) hyperactive, continuous, high-pitched, tinkling sounds may indicate diarrhea or intestinal obstruction.
Percussion
(not done by RD, but findings recorded in medical record).
Intake and output (I and O)
used to assess hydration status, measure fluid balance
serum albumin
3.5-5.0 g/dl visceral protein (blood and organs)
a. maintains colloidal osmotic pressure
b. hypoalbuminemia associated with edema, surgery
c. levels above normal range likely due to dehydration
d. long half-life, does not reflect current protein intake
serum transferrin
> 200 mg/di visceral protein (transports iron to bone marrow)
a. serum level controlled by iron storage pool; rises with iron deficiency
b. can be determined from TIBC - total iron binding capacity
c. not useful as measure of protein status
TTHY transthyretin, PAB prealbumin
16 - 40mg/dl
a. short half-life; picks up changes in protein status quickly
b. during inflammation, liver synthesizes CRP at expense of PAB
c. limited usefulness in screening or assessment
RBP retinol-binding protein
3-6mg/dl
a. circulates with prealbumin; shortest half-life (12 hours)
b. binds and transports retinal
Hct hematocrit
men 42-52%, women 36-48%, pregnant women 33%,
newborn 44-64 %
a. volume of packed cells in whole blood
Hgb hemoglobin
men 14-18 gm/di, women 12-16 gm/di; pregnant ~11
a. iron-containing pigment of red blood cells
b. erythrocytes are produced in bone marrow
serum ferritin
10-150ng/ml F 12-300ng/ml M
a. indicates size of iron storage pool
serum creatinine
0.6-1.2 mg/di M, 0.5-1.1 F
a. related to muscle mass; measures somatic protein
b. may indicate renal disease, muscle wastage
CHI creatinine height index
80% normal
a. ratio of creatinine excreted/ 24 hours to height
b. estimates lean body mass - somatic protein
c. 60-80% mild muscle depletion
BUN blood urea nitrogen
10-20 mg/di
a. related to protein intake
b. indicator of renal disease
c. BUN: creatinine ratio normal 10-15:1
urinary creatinine clearance
115 ± 20ml/minute
a. measures GFR - glomerular filtration, renal function
b. estimate includes body surface area (height and weight)
TLC total lymphocyte count
> 2700 cells/cu mm
a. measures immunocompetency
b. moderate depletion 900-1800, severe depletion <900
c. decreased in protein-calorie malnutrition
CRP C-reactive protein
marker of acute inflammatory stress
a. as it declines, indicates when nutritional therapy would be beneficial
b. when elevated CRP decreases, PAB increases
FEP Free erythrocyte protoporphyrin
direct measure of toxic effects of lead
on heme synthesis (leading to anemia). Increased in lead poisoning. Lead and
calcium compete at plasma membrane for transport
PT prothrombin time
11.0 - 12.5 seconds; 85-100% of normal
a. anticoagulants prolong PT
b. evaluates clotting adequacy; change in vitamin K intake will alter rate
Hair analysis
not for nutritional assessment; useful in measuring intake of
toxic metals
Assessment of energy requirements
1. based on activity factors and BEE
a. BEE X 1.2 sedentary
b. BEE X 1.3 active
c. BEE X 1.5 stressed
Medication management - megestrol acetate
appetite stimulant
Medication management - marinol
appetite stimulant
Medication management - dextroamphetamine (Adderall)
appetite suppressant, anorexia, nausea, weight loss
Medication management - orlistat
decreased fat absorption by binding lipase; vitamin/mineral supp.
Medication management - methylphenidate (Ritalin)
anorexia, weight loss, nausea
Medication management - statins
avoid grapefruit juice; decreased LDL, TG; increase HDL
Medication management - chemotherapy
malabsorption
Medication management - mineral oil, cholestyramine
decrease absorption of fat, fat-soluble vitamins
Medication management - glucocorticoids, antibiotics
protein deficits
Medication management - oral contraceptives
decrease folate, Bs, C
Medication management - loop diuretics
deplete thiamin, potassium, magnesium, calcium, sodium
Medication management - thiazide diuretics
decrease potassium and magnesium, absorb calcium
Medication management - antibiotics
decrease vitamin K
Medication management - corticosteroids
hyperglycemia, thin skin, hypertension, bone fracture
Medication management - methotrexate
decrease folate
Medication management - lithium carbonate
(antidepressant)
increased appetite, weight gain; Maintain consistent sodium and caffeine intake to stabilize levels. If sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity
Medication management - anticoagulant
(warfarin sodium)
antagonizes vitamin K (consistent intake essential); avoid
Ginkgo biloba extract (GBE), garlic, ginger (may increase
bleeding); avoid high dose vitamin A, E
Medication management - propofol
administered in oil, consider fat calories, 1.1 cals/cc, check TG
Medication management - phenobarbital
decreased folic acid, vitamins B12, B6, D, K
Medication management - cyclosporine (immunosuppresant)
hyperlipidemia, hyperglycemia, hyperkalemia, hypertension
Medication management - lsoniazid (treats TB)
(INH)
depletes pyridoxine, peripheral neuropathy, don’t take with
food, interferes with vitamin D, calcium, phosphorus
Medication management - Elavil (antidepressant)
sedative effect, weight gain, increased appetite
Medication management - vitamin B6 and protein
decrease effectiveness of L-dopa (levodopa) which controls
symptoms of Parkinson’s disease. Take drug in morning with
limited protein (competes with drug for absorption sites)
Medication management - calcium
binds tetracycline
Medication management - tyramine
hypertension if taken with MAOI (monoamine oxidase inhibitor)
1. Eliminate dopamine and restrict tyramine (monoamines). MAO inhibitors
interact releasing norepinephrine which elevates blood pressure. Restrict aged,
fermented, dried, pickled, smoked, spoiled foods.
2. Avoid hard, aged cheese (cheddar, Swiss), sauerkraut, some sausages, luncheon
meats, tofu, miso, Chianti wine, tomatoes. Limit sour cream, yogurt, buttermilk.
3. OK: cottage cheese, cream cheese. Good advice: buy, cook, eat fresh foods
curcumin (turmeric) may reduce inflammation, antioxidant, in curry powder
Economic/social factors
Factors that influence food choices: income, price of food, time spent on food activities
How easily can they get foods from stores nearby?
Do their cultural practices support the kind of changes they need to make?
Are food sources near their workplace supportive of healthy eating?
What media do they watch or use? What are their sources of nutrition and food
information?
Nutrition assessment of populations and community needs assessment
A. Determine purpose and goals of assessment. Obtain and assess community and
group nutrition status indicators.
1. Obtain overview to determine whether nutritional resources are adequate,
what groups are potentially at high nutritional risk, how well health needs are
being met by existing programs.
2. Identify target population and nutritional problem of concern.
3. Set parameters of the assessment, collect data, analyze and interpret data,
share findings and set priorities.
4. Define goals and objectives, develop plans, define management system
(personnel, staff, record-keeping).
5. HRA Health Risk Appraisal - survey categorizing a populations’ general health
status (used in worksites, government agencies as a health education or
screening tool)
a. consists of questionnaire, calculations that predict risk of disease,
educational message to the participant
sources of assessment information
a. demographic - population by age, ethnic groups, sex, birth rates, deaths,
socioeconomic stratification (census data, housing statistics)
morbidity (disease) rates, mortality (death) rates
a. Infant mortality rate: infant deaths under 1 year of age, expressed as the
number of deaths per 1000 live births
incidence
number of NEW cases of a disease over a period of time /
total number of people at risk
X 100,000
prevalence
total number of people with a disease during a period of time /
average number of people
X 100,000
Food security
is the access by all people at all times to sufficient food for an
active and healthy life. It is the ready availability of nutritionally adequate and
safe foods and an assured ability to acquire them in a socially acceptable
manner (without resorting to emergency food programs, stealing, scavenging).
Community Food Security Initiative
a. development of sustainable, community-based strategies to ensure that all
have access to culturally acceptable, nutritionally adequate food at all times.
b. strategies that strengthen local food systems:
(1) farmer’s markets - increased access to fresh produce
(2) food recovery and gleaning programs - collect excess wholesome foods
that would otherwise be thrown away (from farms, packing houses,
caterers, cafeterias, restaurants) for delivery to hungry people
(3) PPFPs - Prepared and Perishable Food Programs - nonprofit programs
that link sources of unused, cooked and fresh foods with social service
agencies that serve the hungry
Food insecurity
is prevalent among emergency food recipients. It affects all
ages, ethnicities and locations. It Impacts the working poor. It extends to
government food assistance recipients, and those with poor health status
Nutrition survey
- nutrition survey - examination of a population group at a particular point of time
a. considered a cross-sectional exam; pin-points problems
b. determines prevalence of condition or characteristic at a specific time
c. WIG PC and NCCOR National Collaborative on Childhood Obesity Research
nutritional surveillance - continuous collection of data
a. identifies problem, sets baseline, sets priorities, detects changes in trends
b. use height, weight, hematocrit, hemoglobin, serum cholesterol
c. on-going system linked to active health program: WIC, CDC (Center for
Disease Control) EPSDT - Early Periodic Screening, Diagnosis, Treatment
d. data identifies needs and kind of intervention needed
NSI Nutrition Screening Initiative
- promote nutrition and improve nutritional
care for the elderly to identify nutritional problems early
NSI Nutrition Screening Initiative - DETERMINE checklist
identifies factors placing people at nutritional risk
- increases awareness of factors that influence nutritional health
- disease, tooth loss, economic hardship, reduced social contact, multiple
medications, involuntary weight loss/gain, needs assistance in self-care,
elder years above age 80
NSI Nutrition Screening Initiative - LEVEL I screen
identifies those who need more comprehensive assessments
NSI Nutrition Screening Initiative - LEVEL II screen
provides more specific diagnostic info on nutritional status
focus group
a. 5 - 12 people brought together to talk about concerns, beliefs, problems
b. obtain advice, insights and information; contributes attitudinal data
NNMRRP National Nutrition Monitoring and Related Research Program
a. includes all data collection and analysis activities of the federal government
related to measuring the health and nutritional status, food consumption,
attitudes about diet and health
b. jointly run by USDHHS and USDA
PedNSS Pediatric Nutrition Surveillance System
USDHHS
a. low income, high risk children, birth - 17 years, emphasis on birth-5 years
b. height, weight, birth-weight, hematocrit, hemoglobin, cholesterol, breast-feeding
c. monitors growth and nutritional status, infant-feeding practices
PNSS Pregnancy Nutrition Surveillance System
USDHHS
a. low income, high risk pregnant women
b. maternal weight gain, anemia, pregnancy behavioral risk-factors (smoking,
alcohol), birth-weight, counts # of women who breast-feed
c. identify and reduce pregnancy-related health risks
NHANES - National Health and Nutrition Examination Survey
CDC
a. ongoing (repeated)survey to obtain info on health of American people
b. evaluates clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometric,
nutritional data (24 hour recall, food frequency lists)
c. NHANES Ill - oversampling of adults >=65 with NO upper age limit
d. WWEIA What We Eat in America - dietary intake component of NHANES
(also known as National Food and Nutrition Survey NFNS)
(1) two days of 24 hour dietary recall data with times of eating occasions and
sources of foods eaten way from home
(2) USDA conducts over-sampling of adults >=60, African Americans, Hispanics
USDA Nationwide Food Consumption Surveys (NFCS)
a. to obtain info on food intake of individuals and total households from entire US
b. evaluates 7 nutrients - protein, calcium, iron, thiamin, riboflavin, vitamins C, A
c. diets rated good if intakes equaled or surpassed RDA; rated poor if less than
2/3 of RDA for 1 or more nutrients
BRFSS Behavioral Risk Factor Surveillance System
USDHHS
a. adults 18 years and older residing in households with telephones
b. telephone interviews collect info on height, weight, smoking, alcohol use,
food frequency for fat, fruits and vegetables
YRBSS Youth Risk Behavior Surveillance System
USDHHS
a. Grades 9-12. Smoking, alcohol use, weight control, exercise, eating habits
b. prevalence of health risk behaviors among young people
FSANS Food Safety and Nutrition Survey
FDA
a. assess consumers’ awareness, knowledge, understanding and reported behaviors
related to food safety and nutrition-related topics
b. help to make better informed regulatory, policy, education decisions to promote
and protect public health
Temporary Assistance for Needy Families
TANF - a. states determine the eligibility and the benefits and services provided
b. helps needy families achieve self-sufficiency, time-limited, helps foster
economic security and stability
c. grants funds to states
USDA Commodity Food Donation/ Distribution Program
a. provides foods to help meet nutritional needs of children and adults and strengthens agricultural market for products produced by American farmers
b. food given to School Lunch, elderly feeding, supplemental food programs
CSFP Commodity Supplemental Food Program
(1) administered by state health agencies
(2) monthly commodity canned or packaged foods
(3) improve health of low-income elderly at least 60 years of age
(4) states may require that participants be at nutritional risk
The Emergency Food Assistance Program
TEFAP
(1) quarterly distributions of commodity foods by local, public or private
nonprofit agencies, food banks, soup kitchens, homeless shelters
(2) supplements diets of low-income households, short term hunger relief
National School Lunch Program USDA Food and Nutrition Service (FNS)
NSLP
a. entitlement program to improve nutrition of children, especially from low
income families; utilize surplus production of foods
b. cash grants and food donations; dollars reimburse schools on basis of
numbers of meals served
c. implements the Dietary Guidelines into the Lunch and Breakfast Programs
d. lunch must provide on average over each school week: 1 /3 of the
recommended intake for protein, vitamins A and C, iron, calcium
e. grades 9-12: 2 ounces meat serving; nuts must be combined and only used
for half the requirement.
f. graham flour is considered whole grain
g. K through 5: ¾ cup vegetables is one serving
h. 100% full-strength fruit juice may be used as ½ of weekly servings of fruit
i. Team Nutrition implements School Meals Initiatives for Healthy Children
(1) motivate child to make healthy choices; helps schools meet Guidelines
(2) provides recipes, training, support to child nutrition professionals
NSBP National School Breakfast Program - USDA
NSBP
a. entitlement program, meals must meet federal Dietary Guidelines
b. breakfast must provide on average over each school week: 1/4 daily
recommended levels for protein, calcium, iron, vitamin A, vitamin C
Afterschool Snack Programs - USDA;
ASP
provides healthy snacks
a. cash subsidies for each snack served, same eligibility bases as NSLP
Special Milk Program USDA
SMP
a. provides milk to children in schools and childcare institutions who do not
participate in other Federal meal service programs
b. reimburses schools for milk served
Summer Food Service Program USDA School Lunch
SFSP
a. entitlement program; purpose is to initiate, maintain or expand foodservice
programs to children and teens in low-income areas when school is out
b. reimburses providers for meals served at a central site, 18 and younger
c. administered by FNS, state educational agencies, public or private nonprofit
residential summer camps
Child and Adult Care Food Program USDA
CACFP
a. supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless shelters, nonresidential adult daycare centers
b. reimburses operators for meal costs, provides commodity foods and nutrition education materials
c. meals must meet guidelines; must offer free or reduced-price to eligible
d. eligibility standards same as NSLP (1/3)
Fresh Fruit and Vegetable Program USDA
FFVP
a. introduces children to fresh fruits and vegetables; help develop eating habits
that improve health, prevent obesity and subsequent chronic disease
b. free to children at eligible elementary schools who operate the NSLP
WIC Special Supplemental Nutrition Program for Women, Infants, and Children
USDA
a. for pregnant, postpartum, breast-feeding women; infants and children up to 5
b. provides food for low income mothers at nutritional risk (abnormal weight gain,
history of high risk, LBW, underweight, overweight, anemia)
c. risk: weight, height, head circumference in infants, hemoglobin, hematocrit
d. provides food, nutrition education, referrals to other agencies
e. health exam is REQUIRED
f. must meet income standards, be at nutritional risk, and in need of foods offered
g. foods provided included: iron-fortified formula, cereal, milk, cheese, fruit juice
h. not an entitlement program: cap on the amount of federal dollars allocated
i. priorities: pregnant and breast-feeding women, infants up to 1 year
j. WIC FMNP Farmers’ Market Nutrition Program: coupons to purchase fresh,
locally grown foods at farmers’ markets
k. EBT electronic benefits transfer card
EFNEP Expanded Food and Nutrition Education Program USDA
EFNEP
a. provides grants to universities that assist in community development
b. trains nutrition aides to educate the public
c. works with small groups; teaches skills needed to obtain a healthy diet (how to
budget, meal planning, shop, cook)
d. does not provide food
Maternal and Child Health Block Grant USDHHS
a. under Title V of the Social Security Act
b. fosters public health nutrition programs at the state and local levels
c. provides training, consultation, funding
d. women of child-bearing age, infants, children; state eligibility requirements
Healthy Start USDHHS
a. reduce infant mortality, improve health of low-income women, infants,
children, families
Nutrition Services Incentive Program AoA Administration on Aging
NSIP
developed services to foster independent living; cash and commodities to state agencies
Older Americans Act Nutrition Program (formerly ENP Elderly Nutrition
Program) USDHHS Title Ill
OAA
(1) one hot meal each day, 5 days/week, provide 1/3 recommended intake
(2) eligibility: all aged 60 and older plus spouse, regardless of income
(3) Congregate Meals - ambulatory; transportation essential for rural elderly
(4) Home delivered meals - Meals on Wheels - must be homebound
(5) counseling, nutrition education, referrals, social interaction
SNAP Supplemental Nutrition Assistance Program USDA
a. largest food assistance program: entitlement
b. assist low income with monthly benefits; net income must be at or below
certain % of poverty level; income limits vary by household size and are
adjusted to the cost of living. Nutritional risk NOT a consideration.
c. designed to increase their purchasing power; not for non-food items
d. figures are adjusted to reflect cost of food in Thrifty Food Plan for June of
preceding year - least costly of USDA four food plans
e. SNAP nutrition education program: provided to program participants
f. EBT electronic benefits transfer card
Headstart USDHHS
a. helps low income children; ages 3 through 5
b. introduces new foods, teaches good food habits
c. child’s participation in food activities is important
NETP Nutrition Education and Training Program USDA
NETP
a. amendment to School Lunch Act
b. provides nutrition education training to teachers and school foodservice personnel
Senior Farmers’ Market Nutrition Program USDA
SFMNP
a. cash grants to states to provide low-income seniors(~ 60 years) with coupons to
be exchanged for eligible foods at farmers’ markets, roadside stands, community
supported agriculture programs (CSA)
b. fresh, nutritious, unprepared fruits, vegetables, herbs and honey
c. may be limited to specific and locally grown foods
d. nutrition education and information are provided (how to select, store, prepare)
Non-governmental agencies
a. Feeding America is the largest
domestic hunger relief organization in the US
(food banks, shelters, soup kitchens)
International agencies
a. FAO - Food and Agricultural Organization
raising world- wide levels of
nutrition by increasing efficiency of production and distribution of foods
