1. family and parenting
2. children

Nutritional Guidelines for Food
Served in Public Institutions
Report prepared for The Food Standards Agency
by The Caroline Walker Trust
FINAL REPORT
Acknowledgements
This report was written by Dr Helen Crawley on behalf of the Caroline Walker Trust.
Thanks are due to Lesley Stark and Gemma Hoffman, research associates at
Caroline Walker Trust, Joe Harvey, Professor Martin Wiseman and other CWT
trustees for useful conversations, Sheila Walker for providing some recipes suitable
for ethnic minority groups and Rosie Leyden of Wordworks for her editing of the text
and tables.
Disclaimer
This report was put together by The Caroline Walker Trust in good faith and we have
done our best to check that this information is clear and correct. If any changes are
subsequently made to the data in this report by anyone other than ourselves,
however, then we cannot take responsibility for this. This report does not reflect the
views of the Food Standards Agency.
The Caroline Walker Trust
PO Box 61
St Austell PL7 6YL
ii
www.cwt.org.uk
Contents
Background
1.0
Nutritional guidelines for food served in child care and schools
2.0
Nutritional guidelines for food served in residential premises for
children and young people
3.0
Nutritional guidelines for food served on NHS premises
4.0
Nutritional guidelines for food served in residential premises for
adults
5.0
Nutritional guidelines for food served in the prison service
6.0
Nutritional guidelines for food served in residential care for older
Adults
7.0
Nutritional guidelines for food served as community meals
Appendix 1:
Rationale for the calculation of derived reference nutrient values used
in this report
Appendix 2:
Good sources of nutrients
Appendix 3:
Food customs of ethnic and minority groups
Appendix 4:
Resources
iii
Background
The Food Standards Agency commissioned the Caroline Walker Trust to develop
nutrient-based and food-based guidelines for food served to population groups in
public institutions in the UK, and to design example menus that show how these
nutritional guidelines could be met. The aim of the guidelines is to help caterers with
menu planning and to ensure that those who work for, visit or who are cared for in
public institutions have access to a healthy, balanced diet.
The public sector in England spends around £2 billion a year on providing food and
drink to service users, staff, the general public, clients and visitors. 1 The four biggest
public sector food service areas are schools, the NHS, the Armed Forces and the
Prison Service, with an approximate joint annual spend of around £1.7 billion. In
public sector settings where all food (i.e. three meals a day) is served within that
setting, the average amount spent per day on providing food varies from £1.87 for
prisoners to £2.60 for hospital patients. The average cost of food ingredients in a
school lunch varies from 37p to 85p. There is considerable scope to increase the
nutritional quality of food in the public sector. In addition to providing menus that
meet the nutritional guidelines in this report, caterers should consider other measures
to encourage healthy choices – such as promoting specific menu choices and
providing sufficient information for people to make informed decisions. Some of the
other suggestions to encourage healthy eating, made in a recent report by the
National Audit Office,2 include:
•
increasing the price of less healthy food and reducing the price of healthier
options
•
reducing the number of fried options used
•
working with catering contractors to introduce healthier options
•
offering promotions such as free gifts in return for purchases of fruit and
vegetables
•
introducing a traffic light system to highlight the nutritional value of each
option on the menu
•
providing a nutritional breakdown of all menu items, to help people make
informed decisions.
1
National Audit Office 2006. Smarter food procurement in the public sector. The Stationery Office.
London
iv
Additional information on ways that caterers can promote healthy eating can be
found in The Food Standards Agency publication Catering for Health. 2
Setting nutrient-based guidelines
In the UK, dietary reference values 3 provide population-wide guidance on intakes of
energy (calories) and various nutrients (vitamins and minerals). If a population group
achieves these dietary reference values, it is likely that all members of the group
receive adequate nutrients for their needs. These dietary reference values, as well as
new guidance on salt intakes, 4 have been used as the basis for the nutrient-based
guidelines in this report.
In setting guidelines for different institutions (publicly funded premises) it is also
appropriate to consider and report on whether individual population groups served by
that institution are getting too little, or too much, of particular nutrients, and whether
these problems can be addressed through food provision in these settings. For
example, if a population group is not getting enough of a particular nutrient, the
guidelines could recommend that the food served by the institution should provide an
increased amount of that nutrient relative to the energy content of meals to protect
individuals at risk of insufficiency.
In order for menu planners to assess whether their menus meet the nutritional
guidelines, they will need specialist help from a Registered Public Health Nutritionist
or Registered Dietitian, or they will need to use a computer program which contains a
breakdown of the nutrients of individual foods and cooked dishes. In Scotland
nutrient-based guidelines for school meals have been in use since 2004 and all those
involved in catering provision for schools in Scotland have been provided with a
computer program to help them plan and monitor the food served against the
nutrient-based standards. A similar program is now being planned for school meal
providers in Wales.
Nutrient-based guidelines provide a framework around which caterers can design a
range of menus to meet a variety of needs – including variations in appetite, cultural
2
Food Standards Agency 2001. Catering for Health. London. FSA.
Department of Health 1991. Food Energy and Nutrients for the United Kingdom. Report on Health
and Social Subjects No. 43. London. HMSO
4
Scientific Advisory Committee on Nutrition 2003. Salt and Health. London. The Stationery Office.
3
v
or religious choices, requirements to avoid certain food products (e.g. meat or fish),
local customs and traditions and the cost of food. Nutrient based guidelines ensure
that food is served that can provide the amounts of nutrients that are needed by
different population groups, and these type of standards are therefore considered to
be the most robust method of ensuring nutritional needs are met.
Setting food-based guidelines
In addition to nutrient-based guidelines, it is useful to provide caterers with practical
advice on how to choose foods which will contribute to healthy meal provision. The
Balance of Good Health provides guidance on the proportion of food and drinks from
the different food groups that should make up daily eating patterns to ensure a range
of nutrients are consumed. Food-based approaches, which reflect the nutritional
guidelines, assist caterers in achieving them.
The Balance of Good Health is based on five food groups:
•
fruit and vegetables
•
bread, other cereals and potatoes
•
meat, fish and meat alternatives
•
milk and dairy foods, and
•
foods containing fat and foods and drinks containing sugar.
The Balance of Good Health
.
vi
Choosing a variety of foods from the first four groups every day will provide the body
with the wide range of nutrients which it needs. Foods in the fifth group – foods
containing fat and foods and drinks containing sugar – are not essential to a healthy
diet but add variety, choice and palatability to meals. This group of foods should form
the smallest part of the diet.
This report therefore includes, for each public institution, food-based guidelines in
terms of the food groups that should be offered at meals and the types of foods
within those groups that are most likely to help caterers meet the nutrient-based
guidelines.
vii
Public sector settings and population groups
The nutritional guidance provided here provides guidance for public sector settings
and population groups where individuals receive all their food and drinks over a 24
hour period as well as guidance for under 5s in child care at meals and snacks.
1.0 : Schools and nurseries
•
Children aged 1-4 years in child care settings
•
Children aged 5-18 years at school (caterers should seek appropriate
guidance for their area of the UK and links are given here)
2.0 : Children and young people aged 5-18 years in residential
accommodation
•
Children and young people aged 5-18 years in residential accommodation
3.0: The NHS
•
Children and young people aged 1-18 years (without special dietary needs)
who are looked after 24 hours a day
•
Adults aged 19-74 years (without special dietary needs) who are looked after
24 hours a day
•
Older people aged 75 years or more (without special dietary needs) who are
looked after 24 hours a day
4.0 : Residential care for adults
•
Adults aged 19-74 years in residential accommodation
5.0: The Prison Service
•
Male prisoners aged 18-74 years
viii
•
Female prisoners aged 18-74 years
6.0 : Residential care for older people
•
Adults 75 years and over in residential accommodation
7.0 : Community meals
•
Adults aged 75 years and over having individual meals
The nutritional guidelines for all these groups are based on normal nutritional
requirements and do not include information on diets for medical conditions.
This report outlines, for each group:
•
the rationale for the guidelines given
•
some of the evidence for current nutritional status in these population groups
•
nutrient-based and food-based guidelines.
•
an example menu which shows how caterers can meet the nutrient based
guidelines
ix
Acknowledgements
This report was written by Dr Helen Crawley on behalf of the Caroline Walker Trust.
Thanks are due to Lesley Stark and Gemma Hoffman, research associates at
Caroline Walker Trust; Professor Martin Wiseman and other CWT trustees for useful
conversations; Sheila Walker for providing some recipes suitable for ethnic minority
groups.
Particular thanks are due to Rosie Leyden of Wordworks for her careful editing of the
text and tables
The Caroline Walker Trust
PO Box 61
St Austell PL7 6YL
www.cwt.org.uk
T 020 8542 3469
Contents
1.0 Introduction
2.0 Nutritional guidelines for food served in child care and schools
3.0 Nutritional guidelines for food served in residential premises for
children and young people
4.0 Nutritional guidelines for food served on NHS premises
5.0 Nutritional guidelines for food served in residential premises for
adults
6.0 Nutritional guidelines for food served in the prison service
7.0 Nutritional guidelines for food served in residential premises for
adults
8.0 Nutritional guidelines for food served in residential care for older
Adults
9.0 Nutritional guidelines for food served as community meals
Appendix 1:
Rationale for the calculation of derived reference nutrient values used
in this report
Appendix 2:
Good sources of nutrients
Appendix 3:
Food customs of ethnic and minority groups
Appendix 4:
1.0
Nutritional guidelines for food served in child care
and schools
1.1 Children aged 1-4 years in child care
The number of children under the age of 5 spending some time being cared for
outside the family home has risen substantially as an increasing number of mothers
of young children return to the workforce. There are about 3 million children in the UK
below compulsory school age and many of these children are cared for in a number
of childcare settings including day nurseries, nursery schools, playgroups, with
childminders, and in crèches, with au pairs, private nannies, relatives and friends. In
addition some under-5s are in early education in both nursery classes and reception
classes. The mix of provision of child care has changed substantially in recent years
with providers in the public, private and voluntary sectors responding to government
initiatives to increase the number of childcare places available through the National
Childcare Strategy.
Data from Ofsted on registered childcare providers and places showed that over 1.5
million places were available in England in 2005 1 . The largest childcare providers are
those offering full-day care and sessional day care (periods of less than 4 hours of
continuous care). In Scotland in 2005 there were 263,000 pre-school age children
served by 6,100 childminders and 4,717 childcare and pre-school education centres
of which 711 were private nurseries. 2 In Wales in 2005 it was reported that there
were 72,856 registered childcare places for under-8s 3 and in Northern Ireland, 9,197
places for under-5s were registered with day nurseries and 18,065 places with
childminders in 2005. 4
1.2 Food provision in child care
Although parents or guardians have the main responsibility for providing adequate
and appropriate food for their children, day care providers supply an increasing
proportion of the total food eaten by children in their care. In 2006 Ofsted carried out
a survey into food served in 110 childcare settings: 64 childminders and 46 day-care
providers. 5 The inspectors judged that the majority of providers offered a healthy and
1
Ofsted 2005. Quarterly Childcare Statistics 30 December 2005. www.ofsted.gov.uk
2
Scottish Executive. 2005. Pre-school and Childcare Statistics 2005. Accessed from
www.scotland.gov.uk
3
Care Standards Inspectorate for Wales. 2005. CSIW Annual Report 2004-2005. Accessed from
www.csiw.wales.gov.uk
4
Information on childcare places in Northern Ireland for the year ending 31st March 2005,
accessed from www.publications.parliament.uk/pa/cm200506/cmhansrd/cm060306/text/60306w14.htm
5
Oftsted. 2006. Food for Thought: A Survey of Healthy Eating in Registered Childcare.
1
balanced diet for children but some weaker providers were also identified. Particular
concerns in some settings were infrequent serving of fruit and vegetables, lack of
variety in snacks served, offering sweets as rewards, and the lack of integration of
food served with discussions about healthy eating.
A survey published in 2005 carried out among 168 childcare providers in West
Yorkshire 6 found that only half of nurseries and a quarter of childminders offered fruit
and vegetables at main meals every day. In this study only 14% of nurseries and
21% of childminders offered calcium-rich foods at main meals, and about half
provided meat every day.
New national standards have been introduced for children in full-day child care,
sessional child care, crèches, out-of-school care, and with childminders. These
standards are used by those inspecting childcare facilities through the appropriate
regional agencies of the UK. The standards for England 7 , Scotland
8
and for Wales 9
provide some guidance for inspectors on food and drink in child care standards but
further guidance is required to help them interpret what ‘healthy and nutritious’ meals
and snacks means in practice. Nutritional guidance for the early years in Scotland 10
was published in 2006 and this provides practical support to all those working in the
sector to meet the Scottish National Care Standards. The Caroline Walker Trust
published Eating Well for Under 5s in Child Care in July 2006 11 which provides
detailed practical and nutritional guidance for all those in the early years sector.
1.3 Nutrient based guidelines for food served to 1-4 year olds in child
care
Children have different needs depending on their age and gender, and the
requirements of every child will be different. The recommendations therefore
represent average intakes. If the food offered to a group of children provides the
amount of nutrients recommended, and the children receive the balance of their
Accessed from www.ofsted.gov.uk
6
Moore H, Nelson P, Marshall J, Cooper M, Zambas H, et al. 2005. Laying foundations for
health: food provision for under 5’s in day care. Appetite; 44: 207-213.
7
www.ofsted.gov.uk
8
www.scotland.gov.uk/library5/education/ncsee.pdf.
9
www.csiw.wales.gov.uk
10
Scottish Executive. 2006. Nutritional Guidance for Early Years. Edinburgh: Scottish
Executive.
11
Crawley 2006. Eating Well for Under 5s in Child Care. The Caroline Walker Trust.
www.cwt.org.uk
2
requirements at home, then the nutritional needs of most members of that group are
likely to be met.
The recommendations are based on percentages of the total daily intake of nutrients
that fulfil the needs of a group of children, on average, aged 1-4 years. It is assumed
that older children in the group will eat larger portions of the food offered, and
younger children smaller portions so that the needs of children of different appetites
will be met.
The nutrient based guidelines have been calculated for different periods of child care
as shown below.
-
1-4 year olds in child care for a full day (8 hours or more)
-
1-4 year olds in half-day care which includes lunch
-
1-4 year olds in half-day care which includes tea
-
1-4 year olds those who attend for lunch only and
-
1-4 year olds that receive a snack during a morning or afternoon session
These recommendations apply to children who attend all forms of child care including
playgroups, nursery units and reception classes and are based on average dietary
reference values for boys and girls.
1.4 Rationale for nutrient based guidelines for specific periods of child care
Full day care
Children in child care for a full day will receive the majority of their food whilst in child
care and therefore it is recommended that the food provided gives the children at
least 70% of their daily requirement for energy and nutrients. The remaining 30% will
come from breakfast and from any drinks, snacks or light meals the child receives at
home. It is recommended that for these children there is provision for two meals
(called here 'lunch' and 'tea') and two snacks (mid-morning snack and mid-afternoon
snack).
3
Children in half-day care with lunch and snack
Half-day care which includes one meal and a snack should provide 40% of a child’s
daily energy needs.
Children in half-day care with tea and snack or in half-day care having lunch
only
Children may be in child care for lunch only or for tea and a snack and these meals
should provide 30% of the days energy
Children having a snack only
Children in child care for a morning or afternoon period which does not include a
meal should receive a snack during this period if the period of care exceeds two
hours, and two snacks if this period is five hours or more but does not include a meal
(for example 12.30pm - 5.30pm care, missing lunch and leaving before tea). Snacks
should provide about 10% of the day’s energy and nutrient requirements. The
amount of non-milk extrinsic sugars is a maximum. It should be noted that there is no
necessity to have sugars of this type in snacks or meals.
1.5 Rationale for distribution of nutrients between meals and snacks
When setting nutritional guidance for population groups it is normal practice to
ensure that the needs of individuals in the group with the highest needs are met – so
that where there are discrepancies by age and gender for a specific nutrient for which
there is a minimum, the higher value is selected.
For children aged 1-4 years however, there is already an expectation that the diet will
be nutrient dense and in practice it becomes difficult to enhance the micronutrient
intakes relatively higher than the energy value when energy intakes are small. In this
group therefore, micronutrient recommendations remain proportional to energy
intake: the assumption is that the bigger and hungrier children will eat more and if
they eat the types of food as suggested in the sample menus, they will obtain
proportionally higher amounts of micronutrients to meet their needs.
The exceptions to this are the minerals iron and zinc which are enhanced in main
meals for the reasons outlined here.
4
Iron
The iron intake of children under 5 is lower than currently recommended and there is
evidence to suggest that low iron status is common in this age group. Iron is found in
foods that are typically served as part of meals rather than snacks and it is therefore
sensible to provide greater amounts of iron at meal times. In addition having vitamin
C at the same meal as iron may enhance iron absorption and therefore meals
containing food sources of iron with fruits and vegetables present are likely to be
beneficial. Drinks (including milk) and many snacks are also likely to be low in iron,
so this also suggests that it is important that children receive the bulk of their iron
from their meals For this reason it is recommended that the intakes of iron in the diet
of 1-4 year olds in child care should be enhanced to provide 80% of the derived
reference nutrient intake in full day care, and proportionately more for half-day care
as described in the tables that follow. Iron will be particularly provided by main meals.
Care needs to be taken when menu planning for children receiving a vegetarian diet
to ensure they obtain sufficient iron.
Zinc
Low intakes of zinc have been reported among a large proportion of Under 5’s
particularly when milk intakes start to decline and it is important that good sources of
zinc such as meat and meat dishes, cereals, milk and milk products and eggs are
included in the diet regularly). Since the majority of zinc is likely to come from foods
served at meals it is recommended that the intakes of zinc for children in all day care
be enhanced to provide 80% of the reference nutrient intake as for iron above.
Vitamin D
There is a UK reference value for vitamin D for children aged 6 months -3 years of
7.0ug/day. For children 4 years and above there is an assumption that they will make
enough vitamin D through the action of sunlight on their skin. There is increasing
concern that many pre-school children have low vitamin D status and parents are
recommended to continue giving vitamin D supplementation (though vitamin drops)
until their child’s 5th birthday. It is difficult for children to obtain sufficient vitamin D
from the diet alone since there are few good sources (see Appendix 1) so to achieve
the recommended amounts from food alone is unlikely. The amount of vitamin D that
a child should obtain has been included in the guidelines however to both encourage
the use of good sources of vitamin D in menu planning and to raise awareness of this
as a nutritional issue among under 5’s.
5
1.6 Nutrient based guidelines for children aged 1-4 years
Table 1.1 and 1.2 outline the derived nutrient based guidelines for 1-4 years olds in
child care for meals and snacks throughout the day. The tables summarise the
proportion of nutrients that each eating occasion should achieve for children in child
care. The figures are for the recommended average nutrient content of meals and
snacks provided for children over a one-week period.
The calculation of the derived dietary reference values on which these figures are
based can be found in Appendix 1.
6
Table 1.1 Nutrient-based guidelines for food prepared for 1-4 year olds in child care
Nutrient
Energy
Fat
Total
carbohydrate
Non-milk
extrinsic sugars
Protein
FULL-DAY
CARE *
Morning
session: SNACK
and LUNCH
Afternoon
session: SNACK
and TEA
SNACK
only
LUNCH
only
TEA
Only
% of the Estimated
Average
Requirement (EAR)
% of energy
70%
40%
30%
10%
30%
20%
About 35%
About 35%
About 35%
About 35%
About 35%
About 35%
% of energy
About 50%
About 50%
About 50%
About 50%
About 50%
About 50%
% of energy
MAX
11%
11%
11%
11%
11%
11%
MIN
70%
40%
30%
10%
30%
20%
Vitamin A
% of the Reference
Nutrient Intake (RNI)
% of the RNI
MIN
70%
40%
30%
10%
30%
20%
Vitamin D1
% of the RNI
MIN
70%
40%
30%
10%
30%
20%
Vitamin C
% of the RNI
MIN
70%
40%
30%
10%
30%
20%
Folate
% of the RNI
MIN
70%
40%
30%
10%
30%
10%
Calcium
% of the RNI
MIN
70%
40%
30%
10%
30%
20%
Iron
% of the RNI
MIN
80%
45%
35%
10%
35%
25%
Zinc
% of the RNI
MIN
80%
45%
35%
10%
35%
25%
Sodium
% of the SACN
target average
% of the SACN
target average
MAX
70%
40%
30%
10%
30%
20%
MAX
70%
40%
30%
10%
30%
20%
Salt
* Full-day care includes a morning snack, lunch, afternoon snack and tea. It does not include breakfast
1
For information on Vitamin D please see page 5
% of energy = Percentage of calories consumed
RNI = Reference Nutrient Intake
For an explanation of these terms see Appendix 1.
EAR = Estimated Average Requirement
SACN = Scientific Advisory Committee on Nutrition
Table 1.2 Nutrient-based guidelines for food prepared for 1-4 year olds in child care
FULL-DAY CARE*
Nutrient
Energy
kcals
903
Morning session:
SNACK and
LUNCH
516
Afternoon
session:
SNACK and TEA
387
SNACK
only
129
LUNCH
only
387
TEA
only
258
Fat
About
g
35.0
20.0
15.0
5.0
15.0
10.0
Total
carbohydrate
Non-milk
extrinsic sugars
Protein
About
g
120.4
68.8
51.6
17.2
51.6
34.4
MAX
g
26.6
15.2
11.4
3.8
11.4
7.6
MIN
g
11.0
6.3
4.7
1.6
4.7
3.1
Vitamin A
MIN
µg
300
170
130
40
130
90
Vitamin D1
MIN
µg
5
2.9
2.1
0.7
2.1
1.4
Vitamin C
MIN
mg
21
12
9
3
9
6
Folate
MIN
µg
60
35
25
8
25
17
Calcium
MIN
mg
260
150
110
40
110
70
Iron
MIN
mg
5.5
3.1
2.4
0.7
2.4
1.7
Zinc
MIN
mg
4.3
2.4
1.9
0.5
1.9
1.4
Sodium
MAX
mg
630
360
270
90
270
180
MAX
g
1.6
0.9
0.7
0.2
0.7
0.5
Salt
Numbers have been rounded up or down where necessary, to ensure that figures for different periods of child care add up appropriately.
* Full-day care includes a morning snack, lunch, afternoon snack and tea. It does not include breakfast.
1
For information about Vitamin D see page 5
For an explanation of other terms see Appendix 1.
8
1.6 Food based guidance for menu planners
The following pages contain some information for caterers about food groups and
how to choose foods which will contribute to a healthy balanced diet.
It is also useful for caterers to look at food labels on foods and ingredients they buy
or use and to choose those that are lower in salt, sugar and fat.
The Food Standard’s Agency provides information on what is ‘a lot’ of salt, sugar and
fat in foods and these are outlined below.
Foods high in salt have
1.25 grams or more salt per 100grams or 500
milligrams of sodium per 100 grams of food
Foods high in sugar have
10 grams or more of sugars per 100 grams of
food
Foods high in fat have
20 grams or more of fat per 100 grams of food
Foods high in saturated fat have
5 grams of saturated fat or more per 100 grams
of food
For more information about nutritional information on food labels see
www.eatwell.gov.uk
Additional information about foods which are good sources of some of the nutrients
which appear to be insufficient in the diets of some people in the UK can be found in
Appendix 2.
Liver
Liver, including liver pate is very rich in vitamin A and it is recommended that these
foods are given to children no more than once a week. For more information see
SACN (2005) Review of Dietary Advice on Vitamin A. London: TSO
1.7 Food based guidelines for catering for children aged 1-4 years.
Food group
Guidance
Rationale
What’s included
Bread, other
cereals and
potatoes
Foods from this
group should
be offered at
every meal,
and can be
useful foods to
offer as part of
snacks.
Starchy foods provide
energy, protein, fibre and
vitamins and minerals
such as the B vitamins,
and some calcium, iron
and zinc
All types of bread –
wholemeal, granary,
brown, wheatgerm, white,
multigrain, soda bread,
potato bread, chapattis,
naan bread, rotis, rolls,
bagels, pitta bread, wraps,
tortilla
These foods
should make
up about a
third of the
food served
each day.
Starchy foods are filling
And provide bulk to the
diet
Potatoes or sweet
potatoes – boiled,
mashed, baked or
wedges.
Potato chips should only
be served once a week.
Starchy foods are a good
choice for snacks as they
Yam, plaintain,
cocoyam, cassava and
other starchy root
vegetables
Pasta and noodles –
wholemeal and white
Rice – brown and white
rice
Other grains such as
couscous or bulgur wheat,
maize (polenta) and
cornmeal
Breakfast cereals
Tips
•
•
•
•
•
•
•
Children aged 1-4 may have small appetites and very bulky foods may prevent them
getting all the nutrients they need. High fibre foods should be served in moderation.
Look for lower-salt breads.
Processed potato products like waffles or smiley faces should be avoided.
Avoid dried or canned ready-prepared pasta in sauce as these are very salty.
Avoid fried rice or flavoured dried rice in packets.
Avoid sugary breakfast cereals. (If a food contains more than 10g of sugar per 100g,
it is considered a high-sugar food.)
Choose low-sugar, low-salt cereals such as porridge, puffed wheat, weet bisks,
crisped rice or flaked wheat. Fortified cereals can be a good source of iron.
10
Food group
Guidance
Rationale
What’s included
Fruit and
vegetables
Offer different
fruits and
vegetables at
meals and
snacks.
Fruits and vegetables offer
a range of important
nutrients including fibre,
vitamins A and C and folic
acid
Aim for each
day’s menu for
childcare
settings to offer:
1-2 types of fruit
and
2-3 types of
vegetables.
Evidence suggests that
people who eat more fruits
and vegetables are
protected from a number of
diseases in later life
All types of fresh, frozen
and canned vegetables –
for example, broccoli,
Brussels sprouts,
cabbage, carrots,
cauliflower, mushrooms,
parsnips, peas, peppers,
spinach, swede, sweet
potato, turnip
Children in fullday care should
have the
opportunity to try
4-5 different
fruits and
vegetables each
day.
Encouraging children to try
fruits and vegetables when
they are young will help to
encourage a lifetime
enjoyment of these foods
Fruits and vegetables also
provide colour and texture
to the diet
All types of salad
vegetables – for example,
lettuce, watercress,
cucumber, tomato, raw
carrot, raw pepper, radish
or beetroot
All types of fresh fruit –
such as apples, bananas,
pears, grapes, kiwi fruit,
oranges, plums, berries,
melon or mango
All types of canned fruit in
juice – for example,
peaches, pears,
pineapple, mandarin
oranges, prunes, guava
or lychees
Stewed fruit such as
stewed apple, stewed
dried fruit, stewed plums,
stewed currants or
stewed rhubarb
Dried fruit such as
raisins, dried apricots,
dates, dried figs, prunes
Tips
•
•
•
•
•
•
•
•
•
Avoid vegetables canned with added salt and sugar
Choose fruit canned in fruit juice rather in syrup
Do not overcook fresh vegetables, or cut them up a long time before cooking and leave
them in water, or cook them early and re-heat before serving – these practices all
reduce the vitamin content.
Sugar can be added to sweeten very sour fruit.
Avoid dried fruit with added sugar and vegetable oil.
Serve dried fruit with meals and not as snacks as the sugars in dried fruit can damage
teeth
Add vegetables to dishes such as stews, soups and casseroles
Use fruit in desserts and when making cakes and biscuits
Add dried fruit to milk puddings and yoghurts
11
Food group
Guidance
Rationale
What’s included
Meat, fish and
meat
alternatives
Main meals
should always
contain an item
from this group.
Foods in this group are a
good source of protein and
are often high in iron and
zinc.
Meat. All types including
beef, lamb, pork, chicken,
turkey and offal such as
liver1 and kidney.
Offer a variety of
meat, fish and
alternatives each
week
Lean meat will have greater
proportions of nutrients
than meat products
Meat products such as ham,
bacon, corned beef,
sausages, meat pies, coated
meat products
Include fish in the
menu at least
once a week
Fish is a good source of
protein and is low in fat. Oil
rich fish are a good source
of n-3 (omega 3)
polyunsaturated fats which
are thought to be beneficial
for heart health
Fish includes:
• white fish such as cod,
haddock, coley and white
fish varieties from
sustainable fish stocks such
as pollack, saithe and blue
whiting
• oil-rich fish such as herring
and mackerel, salmon, trout,
sardines, sprats or pilchards.
Canned tuna does not count
as an oil-rich fish but is a
good source of nutrients.
Oil rich fish
should be served
regularly
Make sure meat
alternatives are
varied for
vegetarians
Eggs including boiled,
scrambled or poached, or in
an omelette
Pulses including all sorts of
beans and peas such as
butter beans, kidney beans,
chick peas, lentils,
processed peas or baked
beans
Meat alternatives – such as
soya mince, textured
vegetable protein, quorn or
tofu
Tips
•
Reduce intakes of meat products which are high in fat and salt such as crumb-coated
chicken products, burgers, pies and canned meats. Some meat products such as
sausages are popular with under-5s. Choose good quality versions if you serve these
foods.
• Reduce intakes of processed fish products such as fish fingers or fish cakes
• Make sure all fish dishes are free of bones.
• All eggs should be well cooked.
• Look for canned pulses with no added salt and sugar.
• Dahl and other dishes made from pulses should be made without adding a lot of oil and
salt.
• Choose lower-salt and lower-sugar baked beans.
• Reduce intakes of processed products made from meat alternatives (e.g. vegetarian
sausages, burgers and pies) as these can be high in fat or salt
1
Liver and liver pate are high in vitamin A and should be served to children no more than once a
week
12
Food Group
Guidance
Rationale
What’s included
Milk and milk
priducts
Foods from
this group
should be
offered at 2-3
meals and
snacks each
day.
Milk and dairy products
are excellent sources of
calcium which is needed
for optimal bone strength
protein, vitamin A,
riboflavin and vitamin D.
Milk – Whole milk should be
served for under-2s. Over-2s
can have semi-skimmed milk
if they are good eaters.
Cheese e.g. Cheddar,
cottage cheese, cheese
spreads, feta, Edam,
parmesan, pasteurised soft
cheeses
Yoghurt and fromage frais
Tips
•
•
•
•
•
•
•
•
•
Offer plain milk drinks between meals
Avoid unpasteurised milk and milk drinks with added sugar.
Avoid unpasteurised cheese and mould-ripened (blue-vein) cheeses.
Vegetarian cheese should be used where appropriate.
Avoid yoghurts and fromage frais that have a high sugar content. It is preferable to
add fresh fruit to natural yoghurt or natural fromage frais.
Frozen yoghurts can be offered as an alternative to ice cream.
Milk can be used in sweet and savoury sauces, custards and milk puddings.
It is worth highlighting that some dairy products can contain high salt levels. Strong
cheese can impart flavour in smaller amounts and cheese dishes may not need the
addition of extra salt
For dairy-free diets: serve soya drinks fortified with calcium as an alternative.
13
Food group
Guidance
Rationale
What’s included
Foods containing fat
and foods and drinks
containing sugar
These foods add
palatability to the diet
and can increase the
energy density of the
diet for those with a
small appetite
The main nutrients
provided by such foods
are fat, including some
essential fatty acids,
and also some fatsoluble vitamins.
These foods can be
high in calories and
offer few other
nutrients. If appetites
are poor it is important
that these foods do not
displace more nutrientrich foods.
Carbohydrate (in the
form of sugars) is also
provided.
Foods containing fat
include butter,
margarine, other
spreading fats and
low-fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
and gravies.
Sweet foods eaten
between meals can
damage teeth. Keep
sugary foods and drink
to mealtimes only
Some foods in this
groups can also be
high in salt.
Foods containing
sugar include soft
drinks, sweets, jams
and sugar, as well as
foods such as cakes,
puddings, biscuits,
pastries and ice
cream.
Tips
•
•
•
•
•
Use mono- and polyunsaturated fat (such as sunflower, soya, olive, safflower, rapeseed, corn
oil) based spreading fats and in salad dressings
For cooking use fats high in monounsaturates such as soya, rapeseed and olive oils
When making cakes and puddings include dried fruit or fresh fruit,
Avoid sugary drinks between meals and always serve any drink other than milk or water in a
cup
Dilute 100% fruit juice with water for 1-4 year olds
To increase the
amount of dietary
VITAMIN D in
menus served in
child care
•
•
•
•
•
Use margarine fortified with vitamin D for baking and as a fat spread.
Include an oil rich fish that is rich in vitamin D in the menu at least once
a week – for example, herring, mackerel, pilchards, salmon, sardines,
trout or roe. These fish contain between 5-14µg of vitamin D per 100g.
Canned tuna fish can also make a significant contribution to vitamin D
intake as it contains about 3.6µg of vitamin D per 100g.
Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin
D per 100g.
Meat and poultry contribute small but significant amounts of vitamin D.
14
1.8 Example menus for food served to 1-4 year olds in child care
The example menus given here show the sorts, and amounts of foods and drinks that
could be offered to a group of 1-4 year olds which meet the nutritional and foodbased guidance.
A nutritional analysis is provided to show how these menus compare with the
nutritional guidelines suggested for this group across the whole day.
For further practical advice on helping children aged 1-4 years eat well see The
Caroline Walker Trust report Eating Well for Under 5s in Child Care 12
12
Crawley 2006. Eating Well for under 5s in Child Care. The Caroline Walker Trust. www.cwt.org.uk
15
1.9 An example menu for 1-4 year olds in child care (menu 1)
Mid
morning
snack
Water
available
Lunch
Water and
diluted fruit
juice
available
Monday
Tuesday
Wednesday Thursday
Friday
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Canned
peaches in
juice (100g)
with whole
milk yoghurt
(60g)
Tabbouleh
(65g) with
breadsticks
(14g) and
cherry
tomatoes
(40g)
Vanilla yoghurt
(60g) with
banana (40g)
Sliced
grapes (40g),
celery(20g)
and red
pepper slices
(20g)
Wholemeal
savoury
pancakes
(40g) with
butter (4g)
and apple
chunks (40g)
Chicken
korma (180g)
Brown rice
(80g)
Naan bread
(20g)
Lamb
burgers
(45g)
Bubble and
squeak
(100g)
Sardines (40g)
on toast (27g)
Sliced tomato
(40g)
Vegetable
and lentil
lasagne
(180g)
Mixed salad
(45g)
Cottage pie
(180g)
Peas (40g)
Broccoli
(40g)
Stewed
apples (70g)
with custard
(60g)
Rhubarb
crumble
(60g)
Fresh fruit
salad (80g)
Rice pudding
with sultanas
(180g)
Midafternoon
snack
Water
available
Tea
Water and
diluted fruit
juice
available
Milk jelly
(120g) with
mandarins
(80g)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Cucumber
and carrot
sticks (40g),
pitta fingers
(50g), mint
and
cucumber
dip (25g)
Plain
popcorn
(20g)
Sliced pear
(40g)
Wholemeal
toast fingers
(20g) with
margarine (4g)
and apple
slices (40g)
Paprika
potato
wedges
(65g),
cheese
chunks (15g)
Orange
segments
(40g)
Fromage
frais (60g)
with
pineapple
(100g)
Egg and
cress
sandwiches
(90g)
Lettuce (40g)
Cherry
tomatoes
(40g)
Tuna and
sweetcorn
pasta (140g)
Cucumber
(20g)
Red pepper
(20g)
Spanish
omelette (80g)
Baby jacket
potatoes (90g)
Baked beans
(60g) with
toast squares
(30g)
Chicken and
vegetable
couscous
(145g)
Salad (25g)
Banana
custard
(100g)
Fromage
frais (60g)
and Satsuma
(40g)
Semolina
(100g) with
pears (40g)
Yoghurt with
dates (145g)
Fresh fruit
jelly (60g)
16
1.10 An example vegetarian menu for 1-4 year olds in child care (menu 2)
Mid
morning
snack
Water
available
Lunch
Water and
diluted fruit
juice
available
Midafternoon
snack
Water
available
Tea
Water and
diluted fruit
juice
available
Monday
Tuesday
Wednesday Thursday
Friday
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Breadsticks
(14g) with
houmous
(20g), cherry
tomatoes
(40g)
Wholemeal
savoury
pancakes
(40g) with
butter (4g),
celery sticks
(40g)
Apple chunks
(40g) and
sliced grapes
(40g)
Yoghurt
(60g) with
sliced
banana (40g)
Wholemeal
toast fingers
(20g) with
margarine
(4g) and
carrot sticks
(40g)
Vegetarian
Bolognese
(120g) with
wholemeal
spaghetti
(80g)
Stuffed
peppers
(110g)
Potato salad
(45g),
Beansprout
and tomato
salad (40g)
Broccoli
quiche (100g)
Mashed potato
(80g)
Baked beans
(55g)
Chickpea
fritters (90g)
Sweet potato
(80g)
Sweetcorn
(40g)
Green beans
(40g)
Mixed bean
casserole
(160g)
Mashed
potato (80g)
Petits pois
(40g)
Swede (40g)
Semolina
pudding with
dates (140g)
Banana
custard
(100g)
Stewed fruit
(70g) with
Greek yoghurt
(30g)
Milk jelly
(120g) with
mandarins
(80g)
Fresh fruit
salad (80g)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Cucumber
and carrot
sticks (40g),
cream
crackers
(12g), soft
cheese (20g)
Fromage
frais (60g)
with canned
peaches
(100g)
Breadsticks
(14g) with mint
and cucumber
dip (30g) and
kiwi slices
(40g)
Plain
popcorn
(20g)
Apple chunks
(40g)
Curried rice
salad (45g),
yellow and
orange
pepper
slices (40g)
Egg and
cress
sandwiches
(90g)
Lettuce (40g)
Wholemeal
pasta twirls
(80g)
Chickpea
salad (50g)
Cucumber
and carrot
sticks (40g)
Vegetable
couscous
(100g)
Mixed salad
with butter
beans (80g)
Coleslaw (35g)
Baby jacket
potatoes
(90g) with
ratatouille
and tofu
sauce (140g)
Quorn
burger (45g)
and bun
(50g)
Salad (40g)
Fruit flan
(100g)
Greek
yoghurt with
orange (70g)
Rice pudding
with sultana
(180g)
Oaty fruit
crumble
(80g) with
custard (60g)
Orange and
lemon rice
(120g)
17
1.11 An example menu for 1-4 year olds in child care including
multicultural choices (menu 3)
Mid
morning
snack
Water
available
Lunch
Water and
diluted fruit
juice
available
Midafternoon
snack
Water
available
Tea
Water and
diluted fruit
juice
available
Monday
Tuesday
Wednesday Thursday
Friday
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Wholemeal
toast (23g)
with soft
cheese (20g)
and grape
slices (40g)
Natural
yoghurt
(60g) with
sliced
banana
(40g)
Wholemeal
savoury
pancakes
(40g) with
butter (4g) and
canned
peaches in
juice (100g)
White bread
fingers (23g)
with tuna
pate (15g)
and apple
chunks (40g)
Fromage
frais (60g)
with canned
pineapple
chunks in
juice (100g)
Coconut fish
curry (100g)
Basmati rice
(80g)
Sliced
tomato (40g)
Chicken
fajitas (120g)
Sweetcorn
salsa (30g)
Mixed salad
(40g)
Sweet and
sour pork
(120g)
Egg noodles
(70g)
Stir-fried
vegetables
(100g)
Channa aloo
(80g)
Masur dahl
(40g)
Mixed
vegetable
pilau (80g)
Chilli con
carne (100g)
Jacket
potato (90g)
and crème
fraiche (20g)
Watercress
salad (40g)
Stewed fruit
(70g) and
whole milk
yoghurt (50g)
Lemon
sorbet (40g)
with wafers.
Chinese fruit
salad (115g)
Neapolitan
ice cream
(50g)
Banana
custard
(100g)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Milk (100ml)
Pitta bread
fingers (55g)
with
houmous
(20g), carrot
and cumber
sticks (40g)
Sliced celery
(20g),
grapes (40g)
and red
pepper (20g)
Plain popcorn
(20g)
Lychees (40g)
Breadsticks
(14g) with
raita (30g)
Clementine
(40g)
Paprika
potato
wedges
(60g)
Tomato and
sweetcorn
salsa (32g)
Spicy
ratatouille
with tofu
(100g)
Flat bread
(50g)
Spanish
omelette
(90g)
Potato dice
(60g)
Cucumber,
red pepper
and spring
onion (50g)
Fruity
couscous with
kidney
beans(105g)
Mixed salad
(45g)
Chapati
(45g)
Chickpea
salad (55g)
Cucumber
and carrot
sticks (40g)
Chicken
tikka filling
(60g)
Wrap (20g)
Mexican
salad (45g)
Watermelon
(40g)
Fruit
smoothies
(100ml)
Chewy
cereal bar
(20g)
Rice pudding
with
mandarins
(100g)
Spiced
banana
crumble
(75g)
Fromage
frais with
dates (100g)
18
1.12 Nutritional analysis of example menus for 1-4 year olds
Average nutrient values from
sample menus
Nutrient
based
Guideline
(full-day)
Menu 1
Menu 2
Menu 3
941
4.0
27
970
4.1
22
956
4.0
30
Kcals
MJ
g
Max
903
3.8
35.0
Total
carbohydrate
g
Min
120
137
155
140
Non milk
extrinsic sugars
g
Max
27
17
21
19
Protein
g
Min
11
46
39
41
Vitamin A
µg
Min
300
553
1084
721
Vitamin C
mg
Min
21
76
90
87
Folate
µg
Min
60
160
180
140
Calcium
mg
Min
260
770
684
650
Iron
mg
Min
5.5
5.8
7.5
6.2
Zinc
mg
Min
4.3
5.1
4.9
4.5
Sodium
mg
Max
630
704
785
630
g
Max
1.6
1.7
1.9
1.6
Energy
Fat
Salt
19
1.13 Nutritional guidelines for school children aged 5-18 years
Nutritional guidance for school meals was published as part of the Hungry for
Success initiative in Scotland in 2002
13
and has recently been published for
England 14 . Nutritional standards for school meals in Wales 15 are currently under
consideration through their document Appetite for Life and in Northern Ireland
standards produced for use in England are likely to be adopted.
These standards involve both food based and nutrient based guidance. Some foods
will no longer be made available to children in schools. In addition The Food
Standards Agency’s voluntary target nutrient specifications set maximum levels for
total fat, saturated fat, sodium/salt and sugar in a range of manufactured foods used
in school meals, including bread, poultry products, soups, sausages and burgers. In
addition, target minimum values for protein have been set for certain products to help
ensure an adequate protein intake when pupils select vegetarian options. These can
be found at www.food.gov.uk
Caterers should ensure that they have copies of the nutritional guidance for
schools for the area in which they live and that they are aware of the regulatory
aspects relating to school food in their area.
The Caroline Walker Trust report Eating Well at School 16 provides details of the
rationale for standards for school food and nutrient based guidelines for schools by
age and gender type, and this data formed the basis of the standards for England.
Similar information is contained within the Hungry for Success and Appetite for Life
documentation. Example menus and practical advice on how to achieve these
guidelines are included in these documents. Additional practical advice and guidance
can be obtained from The School Food Trust (www.schoolfoodtrust.org.uk) the Food
in Schools Toolkit (www.foodinschools.org) and from the Food Standards Agency
(www.eatwell.gov.uk).
13 Scottish Executive 2002. Hungry for Success; A whole school approach to school meals in
Scotland. Scottish Executive. Edinburgh
14 DfES 2006. Turning the Tables: Transforming School Food - Recommendations for the
Development and Implementation of Revised School Lunch Standards.
http://www.teachernet.gov.uk/wholeschool/healthyliving/
15
Welsh Assembly 2006. Appetite for Life. http://new.wales.gov.uk/consultations/
currentconsultation/2656718/486602/;jsessionid=37D364111E8032F26883F058FFE4F3C9.www2?lan
g=en
16 Crawley 2005. Eating Well at School. The Caroline Walker Trust. www.cwt.org.uk
20
2.0
Nutritional guidelines for food served in residential
accommodation for children and young people aged
5 -18 years
0
2.1 Background
Children and young people may spend periods of time in residential care for a
number of reasons. This may be because they have a health or social need specific
need, it may be that their parents, extended family or other carers are unable to look
after them and they are in the care of the state or it may be that they are required to
spend time in secure accommodation.
Whilst it is possible for children younger than 5 years to be in residential
accommodation, in practice it is unlikely that younger children will live in residential
units and therefore the nutritional guidelines in this chapter are aimed at children
aged 5-18 years.
In 2005 there were 60,900 children looked after in England, 3,300 of whom were in
residential settings. There were also 12,185 looked after children in Scotland, 1,539
of whom were in residential care. In Wales in 2005 there were 4,668 looked after
children, 234 of whom were in residential accommodation and in Northern Ireland
there were 2,531 looked after children, 317 of whom were living in residential
accommodation 1 . Whilst the numbers of children and young people living in
residential accommodation is therefore relatively small, these children and young
people may be particularly vulnerable and many of them are likely to have had poor
nutrition in their early years and poor experiences of food in their early lives. The
Caroline Walker Trust reviewed the need for guidance on eating well in their 2001
report Eating well for looked after children 2 and this book summarised the limited
evidence available that suggests that there is a particular need for good nutrition in
this population group.
Healthy eating and physical activity are fundamental for proper growth and
development in childhood and essential for good health and well-being in later life. To
help children and young people develop patterns of healthy eating from an early age,
it is important that the food and eating patterns to which they are exposed are those
which promote positive attitudes to good nutrition.
1
2
https://www.baaf.org.uk/info/stats/
The Caroline Walker Trust 2001. Eating Well for Looked After Children. www.cwt.org.uk
1
There is evidence that the diets of children and young people in Britain are too low in
vitamins A and C, iron, zinc and calcium and are too high in salt and the types of
sugars that can damage teeth. The diets of many children and young people are also
very low in fruits and vegetables. 3 It is therefore important that the food served to
children and young people in residential accommodation provides enough of those
vitamins and minerals that may typically be in short supply and that they have the
opportunity to try, and hopefully eat, at least five different fruits and vegetables every
day
2.2 Rationale for nutrient-based guidelines for children and young
people in residential care
The derived dietary reference values calculated for the age groups 5-10 year and 1118 years are explained in Appendix 1. Using these derived reference values it is
assumed that menus offered in residential care for children and young people will
provide all of the nutrients needed in the meals served. The values for 11-18 year
olds for energy, fat, carbohydrate and protein are given as ranges. These reflect the
fact that young people will be growing at very different rates and that some will have
much greater needs for energy and nutrients since they may be growing rapidly, be
physically bigger, be more active or all three. If the menus offered provide nutrients in
the right balance then hungrier young people will eat bigger portions to satisfy their
appetites.
The current standards for school meals across the UK suggest that whilst a main
meal should provide about 30% of energy it is prudent that it provides a greater
proportion of vitamins and minerals to ensure adequacy, since these nutrients are
more commonly found in meals compared to snack foods. The nutrient-based
guidelines here assume that the total nutrients are met from an average intake of all
the food served over a period of one week, but the proportions of energy and
nutrients at meals and snacks should mirror the current recommendations made for
school meals. Whilst there are differences between the school meal guidance in
England, Scotland and Wales these differences are relatively small, and in practical
terms menus which achieve the guidance for England and Wales will also meet the
guidance for Scotland. For this reason the values adopted here for the distribution of
3
Gregory J, Lowe S, Bates C,J, Prentice A, Jackson L, Smithers G, Wenlock R, Farron M. 2000. The
National Diet and Nutrition Survey: Young people aged 4-18 years, The Stationery Office. London
2
macro and micronutrients at meals for children and young people in residential
accommodation are based on those for school aged children in England and Wales.
The distribution of energy and other nutrients at meals and snacks will be as
described in table 2.1. These figures will ensure that intakes of fat, saturated fat, salt
and sugars are not too high and that sufficient amounts of all nutrients are provided.
2.3 Rationale for increasing intakes of some micronutrients at main
meals for children and young people in residential accommodation
The rationale for the setting of the guidance for children in residential accommodation
across the UK is based on evidence that the diets of many school aged children
contain insufficient amounts of some important micronutrients, as well as some foods
such as fruit and vegetables and oil rich fish. Data from the National Diet and
Nutrition Survey of young people aged 4-18 years published in 2000 4 showed that
many children and young people do not get enough of certain important nutrients –
for example iron, calcium, zinc, vitamin A, vitamin C and folate. For this reason the
proportion of these micronutrients has been enhanced in main meals for school aged
children in relation to their energy intake, to protect children and young people from
insufficiencies. So, for example, although the amount of energy provided by a main
meal is 30%, the amount of iron it provides should be 40%. The reason for this is that
the majority of some nutrients are likely to be consumed at mealtimes rather than
between meals as snacks, and therefore meals should provide a greater proportion
of some important nutrients.
It is also recommended that in a group of children or young people, the nutrient
based guidance should meet the requirements of those children with the greatest
needs. So, among mixed gender groups of children, the guidance for iron will meet
the needs of the girls in the group who have higher requirements, and the standards
for calcium, zinc and vitamin A will meet the greater needs of the boys in the group.
Guidance given here assumes that groups will be of mixed gender.
For children and young people in residential accommodation, the guidance presented
here allows for two main meals of the same nutritional quality as is currently
4
Gregory J, Lowe S, Bates CJ, Prentice A et al 2000. National Diet and Nutrition Survey: Young
People aged 4-18 years. London. The Stationery Office.
3
proposed for school meals since some children and young people in residential
accommodation may not have their main meal as a school meal each day.
Table 2.1 The proportion (%) of daily energy and nutrients to be supplied by
meals and snacks
Energy
Protein, carbohydrate,
non-milk extrinsic
sugars, fat, saturated
fat, fibre and salt
Vitamin A, Vitamin C,
Folate, Calcium, Iron
and Zinc
Breakfast
20%
20%
20%
Lunch
30%
30%
40%
Evening meal
30%
30%
40%
Snacks
20%
20%
+
Total
100%
100%
100%+
For this population group it is recommended that 100% of micronutrient intakes are
met at the three main meals each day. Additional micronutrients are likely to be
provided by nutritious snacks, but since there is some evidence that children and
young people in residential accommodation may be a particularly vulnerable group
with some children having early experience of poor diet and poor health care 5 , this
would appear prudent. Children and young people will not be exposed to excessive
micronutrient intakes if they eat and drink the sorts of foods and drinks at meals and
snacks recommended here.
Vitamin D
Young people who spend little time outside (e.g. less than half an hour a day during
the summer months April to September) may not make enough vitamin D in their
skin. It is difficult to get enough vitamin D from the diet alone, since there are few
good food sources of vitamin D. If young people spend most of their time indoors for
whatever reason, they may need vitamin D supplements. If young people rarely go
outside and when they do wear clothing which covers most of their skin they may
also be at risk of low vitamin D status. Young women who may become pregnant
should consult their GP about their need for vitamin D during pregnancy.
5
The Caroline Walker Trust 2001. Eating Well for Looked After Children. www.cwt.org.uk
4
Folic acid
Folic acid is another name for folate. It is important that all women who may become
pregnant have sufficient folic acid. Young women who live in residential
accommodation and who may become pregnant should consult their GP about the
need for folic acid before and during pregnancy.
Fluid intakes
It is important that everyone has access to adequate fluid intakes throughout the day.
In climates such as the UK, we should drink approximately 1.2 litres (6 to 8 glasses)
of fluid every day to stop us getting dehydrated. In hotter climates the body needs
more than this. We get some fluid from the food we eat but it is important that fluids
are not restricted since dehydration can lead to headaches, confusion and irritability
and lack of concentration as well as constipation and potentially urinary tract
infections. Clean, chilled water should always be available with meals and between
meals.
5
Table 2.2 Nutrient based guidelines for food served to children and
young people in residential accommodation
kcals
MJ
Energy
Dietary reference
value (DRV)
Children 5-10
years
Young people
11-18 years
EAR
1780
7.5
1845 – 2755
7.7 – 11.6
Fat
g
No more than 35%
of energy
MAX
70
72 -107
Saturated fat
g
No more than 11%
of energy
MAX
22
23 -34
Total
carbohydrate
g
At least 50% of
energy
MIN
237
246 - 367
Non-milk
extrinsic sugars
g
No more than 11%
of energy
MAX
52
54 - 81
Fibre
g
DRV
MIN
14
18
Protein
g
RNI
MIN
25
41-55
Vitamin A
µg
RNI
MIN
500
700
µg
RNI
MIN
-
-
Vitamin C
mg
RNI
MIN
30
40
Folate
μg
RNI
MIN
150
200
Calcium
mg
RNI
MIN
550
1000
Iron
mg
RNI
MIN
9
15
Zinc
mg
RNI
MIN
7
9.5
Sodium
mg
1800
2400
4.5
6
Vitamin D1
Salt
g
SACN
recommendation
SACN
recommendation
MAX
MAX
EAR = Estimated Average Requirement
DRV = Dietary Reference Value
RNI = Reference Nutrient Intake
For explanation of terms see glossary
1
Although there is not an RNI for Vitamin D for this age group it is assumed that all young
people will spend at least half an hour outside each day during the summer months to ensure
they make enough vitamin D. Young people who are housebound or do not regularly go
outside or who go outside infrequently and wear clothing which means their skin is not
exposed to the sun are likely to require vitamin D supplements.
6
2.4 Food based guidance for menu planners
The following pages contain some information for caterers about food groups and
how to choose foods which will contribute to a healthy balanced diet.
It is also useful for caterers to look at food labels on foods and ingredients they buy
or use and to choose those that are lower in salt, sugar and fat.
The Food Standard’s Agency provides information on what is ‘a lot’ of salt, sugar and
fat in foods and these are outlined below.
Foods high in salt have
1.25 grams or more salt per 100grams or 500
milligrams of sodium per 100 grams of food
Foods high in sugar have
10 grams or more of sugars per 100 grams of
food
Foods high in fat have
20 grams or more of fat per 100 grams of food
Foods high in saturated fat have
5 grams of saturated fat or more per 100 grams
of food
For more information about nutritional information on food labels see
www.eatwell.gov.uk
Additional information about foods which are good sources of some of the nutrients
which appear to be insufficient in the diets of some people in the UK can be found in
Appendix 2.
Liver
Liver, including liver pate is very rich in vitamin A and it is recommended that these
foods are given to children no more than once a week. For more information see
SACN (2005) Review of Dietary Advice on Vitamin A. London: TSO
7
2.5 Food-based guidelines for food served to children and young people
in residential accommodation
Food Group
Guidance
Rationale
What’s Included
Bread, other cereals
and potatoes
Starchy foods should
make up a third of the
daily diet.
Starchy foods are a
good source of energy
and the main source
of a range of nutrients
in the diet. As well as
starch, these foods
supply fibre, calcium
iron and B vitamins.
All varieties of bread
including wholemeal,
granary, seeded,
chapattis, bagels, roti,
tortillas, pitta bread
A variety of breads
should be available
daily at every meal
Different starchy foods
should be offered in
main meals throughout
the week so that a
variety of starchy foods
are included. Aim to
include pasta and rice
on the menu once a
week
Potatoes, yam, sweet
potato, plantain,
cocoyam, dasheen,
breadfruit, cassava
Breakfast cereals
Rice, couscous, bulgar
wheat, maize (polenta),
cornmeal
Noodles, spaghetti and
other pastas
Wholegrain and
wholemeal cereal
foods are a good
source of fibre and
other nutrients
Tips
•
•
•
•
•
•
•
•
•
Serve more pasta and rice and use less sauce. Opt for tomato based sauces instead of
cheese-based to reduce fat content
When serving rice and pasta, try to use wholemeal, wholegrain, brown or high fibre versions.
Some breakfast cereals are nutrient fortified (have added iron, folic acid and other vitamins and
minerals). Choose wholegrain cereals or mix some in with other cereals.
Offer a variety of breads, such as seeded, wholegrain and granary and use thicker slices with
low-fat options for fillings
Large pieces of potato and thick or straight cut chips absorb less fat
Boil potatoes in the minimum amount of water and for the shortest amount of time to retain
vitamins.
Use herbs or other shredded vegetables to add colour and flavour to baked potatoes, rather
than butter or margarine.
If you look after young people who have allergies to wheat, oats, barley and rye: good
alternatives to offer are foods made from maize (e.g. polenta), rice, rice flour, potatoes, potato
flour, buckwheat, sago, tapioca, soya and soya flour.
Cereal foods which are good sources of iron and zinc include fortified cereals, whole grain
cereals, wholemeal bread and flour, couscous and wholemeal pasta.
8
Food Group
Guidance
Rationale
What’s Included
Fruit and Vegetables
Fruit and vegetables
should make up about
a third of the daily diet.
Fruit and vegetables
are good sources of
many vitamins and
minerals.
All types of fresh,
frozen and tinned
vegetables i.e.
broccoli, Brussels
sprouts, cabbage,
carrots, frozen peas,
peppers, swede,
sweetcorn
It’s important to offer a
variety. Five-a-day is
an achievable target.
Aim for one or two
portions with each
meal and offer fruit and
vegetables as snacks.
One portion s about
80g fresh fruit and
vegetables and 40g of
dried fruit
Beans and pulses are
included but only count
as a maximum of 1
portion per day
A glass of 100% fruit
juice can count as one
portion of fruit each
day
There is evidence that
consuming 400g a day
or more of fruit and
vegetables reduces
the risk of developing
chronic diseases such
as coronary heart
disease and some
cancers.
Including fruits and
vegetables in the diet
will help to increase
the intake of fibre and
can help to reduce the
total amount of
calories consumed
among those who may
wish to lose weight
All types of salad
vegetables including
lettuce, cucumber,
tomato, raw carrots,
peppers, beetroot
All types of fresh fruit
e.g apples, bananas,
kiwi fruit, oranges,
pears, mango, plums
All types of tinned fruit
in fruit juice e.g.
pineapple, peaches,
mandarin oranges
Stewed fruit
Dried Fruit
Fruit juice (100% juice)
Tips
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Avoid adding fat or rich sauces to vegetables or sugar or syrupy dressings to fruit
Steaming or cooking vegetables with minimum amounts of water and serving as soon as
possible will help retain vitamins.
Use fresh fruit and vegetables as soon as possible, rather than storing, to avoid vitamin loss
Incorporate fruit and vegetables in snack options. Offer a variety of healthy snack alternatives
Add vegetable and pulses to curry, casserole or stir-fry and serve at least two types of
vegetables with fish, chicken or meat.
Baked beans (as a vegetable) should be served a maximum of twice a week
Encourage a daily glass of fruit juice (100% juice, unsweetened) with meals
Choose tinned fruit in fruit juice not in syrup
Add a handful of dried fruit to cereal options and porridge
Supply a good combination of traditional salads and raw vegetables, fruits and nuts to increase
colour, taste and texture at meal times
Add additional vegetables to savoury dishes
Vegetable soups are a useful way of increasing vegetable intake
Avoid dried fruit with added sugar or vegetable oil
Fruit and vegetables which are useful sources of iron include spinach, broccoli, spring greens,
dried apricots, raisins, baked beans, broad beans and blackcurrants
Fruit and vegetables which are useful sources of folate include spinach, broccoli, peas,
oranges, melon, green leafy salads and tomatoes.
Fruit and vegetables which are useful non-dairy sources of calcium include green leafy
vegetables, dried fruit and oranges.
9
Food Group
Guidance
Rationale
Milk and Dairy
Products
Offer dairy foods
such as milk, yoghurt
and cheese as part
of meals and snacks
Milk and dairy
products are
excellent sources of
calcium, protein,
vitamin A and vitamin
D. Calcium helps to
contribute to good
bone health
Offer low fat options
such as semiskimmed milk, low fat
yoghurt and skimmed
milk cheeses
The fat content of
different dairy
products varies and
much of this is
saturated fat.
Skimmed, semi-skimmed,
whole milk
Dried milk, goats and
sheep’s milk
All types of cheeses e.g.
Cheddar cheese, cottage
cheese, cheese spreads,
brie, feta, Edam, goats
cheese, stilton, parmesan
Yoghurt
Fromage frais
Do not rely on
cheese as the main
protein item for
vegetarians.
Where no other
option is available,
cheese served as a
sandwich filler should
be offered no more
than twice per week.
Tips
•
•
•
•
•
•
•
•
•
•
Try using very strong-tasting cheese (mature cheddar, blue cheese) if using to flavour dishes or
sauces, because less will be required.
Choose reduced-fat hard cheeses, cottage cheese and skimmed milk soft cheese
Offer semi-skimmed or skimmed milk and low-fat yoghurts and fromage frais.
Use plain yoghurt and fromage frais instead of cream, soured cream or crème fraiche in recipes
Try serving frozen yoghurts as an alternative to ice cream.
It is worth highlighting that some dairy product can contain high salt levels. Look for lower salt
cheeses and use smaller amounts of stronger cheese
Dairy foods are very important during pregnancy, but unpasteurised dairy produce and softmould-ripened cheese (e.g. camembert, Brie and all blue-veined cheese) should be avoided
For those on dairy free diets serve soya drinks fortified with calcium as an alternative.
Fresh fruit milkshakes and chilled milk drinks can be offered as snacks
Restrict sweetened milk drinks to mealtimes as the sugars in these drinks can damage teeth
10
Food Group
Guidance
Rationale
What’s Included
Meat, fish and meat
alternatives
Offer a meat or
alternative at all main
meals
Meat and meat
alternatives are a good
source of protein,
vitamins and minerals
such as iron and zinc
Use lean meat (which
has a fat content of
about 10%)
Some meat and meat
products can have a
high fat and saturated
fat content
Meat includes all cuts
of beef, pork, lamb,
poultry, offal1 and meat
products such as
bacon, sausages, beef
burgers, pies and cold
meats
Fish should be
offered at least twice
per week.
White fish is low in fat
It is strongly
recommended that
oily fish such as
salmon, trout,
mackerel, herring,
pilchards, sardines
should be served
once a week
Oil-rich fish provides a
good source of omega-3
fatty acids, which may
help to protect against
heart disease. Oil-rich
fish are also a source of
vitamins A and D.
Eggs can be served
at breakfast and as
part of main meals
Eggs are a good source
of protein, vitamin
A,vitamin D and some
minerals
Beans, pulses, eggs,
meat alternatives and
nuts all provide good
sources of nutrients.
Ensure meat
alternatives for
vegetarians are
varied
Fish includes fresh,
frozen and tinned fish,
such as tuna and
sardines, Fish
products such as fish
cakes and fish fingers
may have a low fish
content
Boiled, poached,
scrambled eggs,
omelettes
Beans and pulses
such as chick peas,
lentils, kidney beans,
butter beans, textured
vegetable protein,
nuts, soya products
such as tofu, quorn
Tips
•
•
•
•
•
•
•
•
1
Always select the leanest cuts of meat and remove visible fat and poultry skin
Roast meat on a rack in order to let the fat run off.
Grill, poach or bake meat rather than frying. If you do fry, use clean oil and at the correct
temperature to minimise absorption. Note that larger pieces of fish and meat absorb less fat.
Do not add extra fat or oil when cooking meat
Use more vegetables, pulses and starchy food to extend dishes further, as well as add more
texture and flavour. Less meat is also required, reducing the fat content and the cost of the
meal.
Offer unsalted nuts and seeds as snacks
Reduce the amount of processed meat products served such as meat pies and pasties, coated,
canned and composite meat products such as sausages, burgers, coated chicken products
Reduce the amount of processed fish products on offer, particularly those that are fried or
coated such as fish fingers or fish cakes
Liver and liver pate are very high in vitamin A and should not be erved more than once a week
11
Food Group
Guidance
Rationale
What’s Included
Foods containing fat
and foods and drinks
containing sugar
These foods can add
palatability to the diet
but should be eaten
in small amounts
each day
Foods containing fat
and foods containing
sugar often provide a lot
of calories and a lower
proportion of other
nutrients.
Foods containing fat
include:
Reduce the amount
of foods containing
visible fat for
example, margarine
and butter, cooking
oils and mayonnaise.
Other foods
containing fat such as
cakes and biscuits
should be eaten
occasionally
Foods and drinks
containing sugar
often contain few
other nutrients and
frequent consumption
between meals can
contribute to tooth
decay
Some foods in this
group are also high in
sodium/salt
Butter, margarine,
other spreading fats
and low fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
gravies.
Foods and drinks
containing sugar
include:
Soft drinks, sweets,
chocolate, jams, sugar,
cakes, puddings,
biscuits, pastries and
ice cream
Tips
•
•
•
•
•
•
•
•
•
•
•
Use mono- or poly-unsaturated fat spreads
Use cooking oils high in monounsaturates such as soya, rapeseed or olive oils
Avoid serving pastry dishes frequently
Measure oil for cooking carefully and reduce oil used in the preparation of soups, stews and
casseroles. Vegetables can often be dry fried, steamed or stewed to form the basis of sauces
and other dishes
Use low-fat yoghurt or non-dairy ice cream to compliment puddings or pies.
Produce puddings lower in fat and sugar and incorporate fresh, tinned fruit in juice or dried fruit.
Offer water, unsweetened fruit juices and chilled milk drinks
Serve wholegrain or plain cereals rather than sugar coated cereals
Provide currant buns, fruit bread, melon slices, malt loaf and other lower fat bread based foods
as alternatives to cakes and biscuits.
When preparing sandwiches, try and avoid using butter or spreads if the filling is already moist.
Consider using reduced-fat spreads and opt for types that are soft straight from the fridge, so it
is easier to spread thinly.
To increase the
amount of dietary
VITAMIN D in
menus
•
•
•
•
•
Use margarine fortified with vitamin D for baking and as a fat spread.
Include an oily fish that is rich in vitamin D in the menu at least once a
week – for example, herring, mackerel, pilchards, salmon, sardines,
trout or roe. These fish contain between 5-14µg of vitamin D per 100g.
Canned tuna fish can also make a significant contribution to vitamin D
intake as it contains about 3.6µg of vitamin D per 100g.
Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin
D per 100g.
Meat and poultry contribute small but significant amounts of vitamin D.
12
2.6 Example menu for children and young people in residential
accommodation
An example menu is given here which show the sorts of foods that could be served
to meet the nutritional and food-based guidance for children and young people. The
menu is shown twice: firstly with portion sizes suitable for children aged 5-10 years
(2.7) and secondly with portion sizes suitable for those aged 11-18 years (2.87. The
analysis of both menus is included on pages 18 and 19.
The example menus shown here include a sandwich style meal, however this is just
an example. Caterers may wish to offer a variety of hot and cold meals at lunch and
tea and may choose to offer one, two or more choices depending on the client
groups that they serve.
13
2.7 Menu for children and young people in residential accommodation aged 5-10 years
Monday
Breakfast
Midmorning
Lunch
Water or
100%
fruit juice
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Raw carrots/cucumber/pepper slices (40g)
Pizza with choice of
toppings (120g)
Coleslaw (80g)
Jacket potatoes (180g)
Roast turkey (80g)
Stuffing (30g)
Roast potato (150g)
Carrots (80g)
Broccoli (80g)
Fromage frais or yoghurt (60-125g)
or
Breakfast cereal (37g) (average of bran flakes/puffed wheat/wheat bisks)
Semi-skimmed milk (100ml)
Orange juice (150ml)
Wholemeal toast (63g) with polyunsaturated margarine (7g) and marmalade/jam/honey (8g)
Apple/banana/Satsuma/pear or other fresh fruit snack (80g)
Water (200ml) or milk (200ml)
Choice of sandwiches (75-110g) made with brown or white bread or wraps filled with cheese/tuna
fish/corned beef/ham/egg mayonnaise/chicken tikka/sweetcorn/tomato/cress
or
Dried fruit snack (40g)
Vegetable lasagne (v)
(200g)
Peas (80g)
Lentil roast (v) (150g)
New potatoes (160g)
Green beans (80g)
Banana custard (100g)
Fresh fruit salad and
ice cream (150g)
or
or
Ice cream and topping
sauce (60g)
Lemon meringue pie
(100g)
Midafternoon
/ after
school
Tea
Water or
100%
fruit juice
Banana bread
(50g)
Water or milk
(200ml)
Jacket potato
(180g)
with savoury
mince filling
(150g)
Green beans
(80g)
Date bars (75g)
Water or milk
(200ml)
or
Lentil and
mushroom
crumble (240g)
Tomato salad
(80g)
Crusty brown roll
(48g)
or
Vegetarian
burgers (v) (50g)
Pasta Roma
(160g)
Carrot cake (80g)
or
Rhubarb fool
(200g)
or
Fruit yoghurt with
crunchy topping
(130g)
Summer
pudding (150g)
Chicken and
vegetable stir-fry
(230g)
Egg noodles
(200g)
Swiss roll
(25g)
Water or milk
(200ml)
Lamb and
potato hotpot
(250g)
Peas (80g)
or
Broccoli
quiche (v)
(120g)
Crunchy
coleslaw
(80g)
Rice salad
(150g)
Flapjack (50g)
Water or milk
(200ml)
Banana and raisin
bake (50g)
Water or milk (200ml)
Oat bars (40g)
Water or milk (200ml)
Chocolate yoghurt
cake (60g)
Water or milk (200ml)
Sardine pasta
(200g)
Crunchy salad
(90g)
Baked cod (90g)
Oven chips
(100110g)
Baked beans (90g)
Chicken risotto (225g)
Sweetcorn (80g)
Cherry tomatoes (80g)
Crusty bread (60/40g)
Hot dogs with pork,
beef or vegetarian
sausages (115g)
Carrot and apple
salad (100g)
Mixed bean salad
(100g)
or
Chickpea rissoles (v)
(100g)
Spinach (80g)
New potatoes (130g)
or
Sweetcorn and
pasta bake (v)
(200g)
Carrots (80g)
Oven chips (110g)
Or
Couscous with sweet
and sour vegetables
(v) (250g)
Baked apples
with yoghurt
(210g)
or
Meringue baskets
with fruit (100g)
or
Pineapple crunch
(150g)
or
Fruit mousse (80g)
or
Apple crumble with
custard (200g)
or
Rice and
sultana
pudding
(150g)
Mandarin oranges
and ice cream
(200g)
Lemon sorbet (100g)
Poached pear and
custard (200g)
Fresh fruit (80g)
1
2.8 Menu for children and young people in residential accommodation aged 11-18 years
Monday
Breakfast
Midmorning
Lunch
Water or
100%
fruit juice
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Raw carrots/cucumber/pepper slices (40g)
Pizza with choice of
toppings (240g)
Coleslaw (80g)
Jacket potatoes (220g)
Roast turkey (80g)
Stuffing (30g)
Roast potato (200g)
Carrots (80g)
Broccoli (80g)
Currant bun/fruit bread/malt loaf/fortified cereal bar/crunchy muesli bar (20-75g)
or
Fromage frais or yoghurt (60-125g)
Vegetable lasagne (v)
(300g)
Peas (80g)
Breakfast cereal (37g) (average of bran flakes/puffed wheat/wheat bisks)
Semi-skimmed milk (100ml)
Orange juice (150ml)
Wholemeal toast (63g) with polyunsaturated margarine (7g) and marmalade/jam/honey (8g)
Apple/banana/Satsuma/pear or other fresh fruit snack (100g)
Water (200ml) or milk (200ml)
Choice of sandwiches (75-110g) made with brown or white bread or wraps filled with cheese/tuna
fish/corned beef/ham/egg mayonnaise/chicken tikka/sweetcorn/tomato/cress
or
Dried fruit snack (40g)
Banana custard (150g)
Lentil roast (v) (170g)
New potatoes (200g)
Green beans (80g)
Fresh fruit salad and
ice cream (150g)
or
or
Ice cream and topping
sauce (60g)
2
Lemon meringue pie
(100g)
Midafternoon
/ after
school
Tea
Water or
100%
fruit juice
Supper
Banana bread
(70g)
Water or milk
(200ml)
Jacket potato
(220g)
with savoury
mince filling
(200g)
Green beans
(80g)
Date bars (75g)
Water or milk
(200ml)
or
Lentil and
mushroom
crumble (250g)
Tomato salad
(80g)
Crusty brown roll
(48g)
Polyunsaturated
margarine (7g)
or
Vegetarian
burgers (v) (50g)
Pasta Roma
(250g)
Carrot cake (80g)
or
Rhubarb fool
(200g)
or
Fruit yoghurt with
crunchy topping
(150g)
Summer
pudding (150g)
Chicken and
vegetable stir-fry
(270g)
Egg noodles
(200g)
Swiss roll
(40g)
Water or milk
(200ml)
Lamb and
potato hotpot
(300g)
Peas (80g)
Flapjack (50g)
Water or milk
(200ml)
Banana and raisin
bake (70g)
Water or milk (200ml)
Oat bars (40g)
Water or milk (200ml)
Chocolate yoghurt
cake (60g)
Water or milk (200ml)
Sardine pasta
(300g)
Crunchy salad
(90g)
Baked cod (90g)
Oven chips (150g)
Baked beans (90g)
Chicken risotto (250g)
Sweetcorn (80g)
Cherry tomatoes (80g)
Crusty bread (50g)
Polyunsaturated
margarine (7g)
Hot dogs with pork,
beef or vegetarian
sausages (115g)
Carrot and apple
salad (100g)
Mixed bean salad
(100g)
or
Sweetcorn and
pasta bake (v)
(300g)
Carrots (80g)
Oven chips (150g)
Or
Couscous with sweet
and sour vegetables
(v) (250280g)
Baked apples
with yoghurt
(210g)
or
Meringue baskets
with fruit (150g)
or
Pineapple crunch
(170g)
or
Fruit mousse (80g)
or
Apple crumble with
custard (250g)
or
Rice and
sultana
pudding
(220g)
Mandarin oranges
and ice cream
(200g)
Lemon sorbet (100g)
Poached pear and
custard (270g)
Fresh fruit (80g)
or
Broccoli
quiche (v)
(120g)
Crunchy
coleslaw
(80g)
Rice salad
(200g)
Milky drink (made with semi-skimmed milk) (200ml)
Wholemeal biscuits (26g) or fresh fruit (100g)
3
or
Chickpea rissoles (v)
(100g)
Spinach (80g)
New potatoes
(130200g)
2.9 Nutritional analysis of example menu for 5-10 year olds in residential
accommodation
Energy
Kcals
MJ
g
Max
Saturated fat
g
Max
Total
carbohydrate
Non milk
extrinsic sugars
Fibre
g
Min
Fat
g
Max
g
Min
Protein
g
Min
Vitamin A
µg
Min
Vitamin C
mg
Min
Folate
µg
Min
Calcium
mg
Min
Iron
mg
Min
Zinc
mg
Min
Sodium
mg
Max
Salt
g
Nutrient
based
Guideline
(5-10 year
olds)
1780
7.5
Average nutrient values
from sample menu
70
52
22
18
237
280
52
47
14
22
25
68
500
1273
30
148
150
451
550
1032
9
16
7
9
1800
1796
4.5
4.5
1780
7.5
Max
2.10 Nutritional analysis of example menu for 11-18 year olds in
residential accommodation
Energy
Kcals
MJ
Nutrient
based
Guideline
(11-18 year
olds)
Average nutrient values
from sample menus
2301
9.7
71.4
Fat
g
Max
1845 – 2755
7.7 – 11.6
72 -107
Saturated fat
g
Max
23 -34
26
Total
carbohydrate
Non milk
extrinsic sugars
Fibre
g
Min
246 - 367
351
g
Max
54 - 81
55
g
Min
18
26
Protein
g
Min
41-55
87
Vitamin A
µg
Min
700
1444
Vitamin C
mg
Min
40
167
Folate
µg
Min
200
507
Calcium
mg
Min
1000
1521
Iron
mg
Min
15
18
Zinc
mg
Min
9.5
11
Sodium
mg
Max
2400
2247
g
Max
6
5.7
Salt
1
The salt content of menus will go down as the amount of salt in common commodities such
as bread is reduced
1
3.0
Nutritional Guidelines for food served on NHS
premises
40
3.1 Background
There have a been a number of initiatives around hospital food in recent years
across all four countries of the UK and local NHS food and beverage systems are
influenced by an increasingly broad range of legislation and guidance, both national
and international. In 2003 the Council of Europe produced a report Food and
Nutritional Care in Hospital: How to prevent under nutrition 1 with over 100
recommendations aiming to improve food service in hospital settings. New nutritional
screening guidance from NICE 2 in 2006 has also contributed to increased awareness
of the need for better nutritional support of older adults in hospital and this can be
added to earlier initiatives such as the Department of Health’s 2001 initiative Essence
of Care. 3
In England the NHS plan (2000) had a goal of enhanced food and beverage services
in hospitals and England’s Better Hospital Food Programme was launched in 2001 4 .
The Department of Health core standards which are assessed by the Healthcare
Commission include a commitment to ‘provide choice and a safely prepared and
balanced diet’.
In Scotland Food, Fluid and Nutritional Care 5 was published in 2003 by Quality
Improvement Scotland as part of their commitment to improving food in hospitals and
in Wales there is an integrated framework for nutrition and catering as part of client
care across all NHS organisations in Wales. There are currently no formal standards
for hospital food in Northern Ireland.
The Better Hospital Food programme recommended a standard menu plan
containing 3 meals and 2 snacks, but with 24 hour access to food for those patients
who have missed a meal. The guidance in this report makes recommendations for
standards for meals and snacks only but it would seem prudent that snack boxes and
light meals provided to patients who have missed meals should also provide the
nutrients outlined here.
1
Council of Europe 2003. Food and Nutritional Care in Hospital: How to prevent under nutrition.
Council of Europe. Strasbourg.
2
See www.nice.org.uk/page.aspx?o=cg032niceguideline
3
See
www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsP
olicyAndGuidanceArticle/fs/en?CONTENT_ID=4005475&chk=A0A4iz
4
Better Hospital Food 2001. www.betterhospitalfood.com
5
See www.nhshealthquality.org/nhsqis/files/Food,%20Fluid%20Nutrition.pdf
1
Previous nutritional targets for hospital catering produced by The Department of
Health in 1995 6 stated that meals for adults should provide between 300-500kcals
and 18g protein for omnivores, 12g protein for vegetarians. Sandwich meals were
expected to offer 300kcals/12g protein and breakfast, snacks and milk in drinks a
further 900kcals and 30g protein a day. It is suggested that menus should provide
between 1200-2500kcals a day and 60-66g of protein but a broader range of
nutrients are not included in these standards.
3.2 Who are these nutritional guidelines designed for?
This report provides nutrient based guidelines for those eating in NHS settings who
do not have special dietary requirements. It is acknowledged that many people in
NHS settings will have special dietary requirements: this may be a particular special
diet caused by ill health such as a low protein diet, it may be due to the need for
additional energy and nutrients following illness, accident or surgery or it may be due
to an underlying condition such as coeliac disease. In addition, many older people on
NHS premises are known to have specific nutritional needs since undernutrition has
been frequently documented 7 and the information in this report does not apply to inpatients for whom particularly energy and nutrient rich diets are required.
This guidance is designed for those who eat all their meals and snacks on NHS
premises but who require a diet in line with current healthy eating guidelines. For
example, this may apply to those who are receiving treatment for mental health
disorders, to those who have a physical condition which does not require special
dietary consideration or to those who have recently given birth and do not require a
therapeutic diet. It also applies to staff who, for whatever reason, may eat all their
meals and snacks on NHS premises.
Those groups for whom nutrient based standards are included here are:
•
Children aged 1-4 years
6
Nutrition Task Force (1995), Nutritional Guidelines for Hospital Catering, Department of Health,
London
7
BAPEN 1999. Hospital Food as Treatment: A report by the British Association of Parenteral and
Enteral Nutrition. (Allison SP. Ed). Maidenhead. BAPEN.
2
•
Children aged 5-18 years
•
Adults aged 19-74 years
•
Adults aged over 75 years
3.3 Rationale for nutrient based guidance for food served to children
aged 1-4 years catered in NHS settings
Children under the age of 5 years have specific nutrient needs since they are in a
period of rapid growth and development. There is evidence from the National Diet
and Nutrition Survey for children aged 1½ to 4½ years 8 that the diets of children
under 5 in the UK are too low in some essential nutrients such as vitamin A, vitamin
C, iron and zinc and too high in the types of sugars that can damage teeth and salt.
In addition some children have low vitamin D status. Intakes of meat, fish, fruits and
vegetables are generally low. The food and nutrient intake of children under 5 has
been recently reviewed by The Caroline Walker Trust. 9 This report provides guidance
on the general principles of eating well for this population group.
The average daily nutrient requirements for menu planners for a group of children of
mixed gender aged 1-4 years (i.e. from 12 months of age up to their fifth birthday)
has been derived for this report and this is outlined in Appendix 1. These values are
also shown in table 3.1.
In order that children under 5 receive sufficient nutrients for their needs, particularly
when their appetites are small, they will require both nutritious meals and snacks.
The example menu outlines the sorts of meals and snacks that could be served over
a period of one week to ensure that these average values are met. It is also
important that children under 5 are offered at least 5 different types of fruit and
vegetables every day. Food based guidance for caterers providing food for those
aged under 5 years are outlined in sections 3.4 and 3.5.
8
Gregory JR, Collins DL, Davies PSW, Hughes JM, Clarke PC. 1995. National Diet and Nutrition
Survey: Children aged 1½ to 4½ years. Volume 1: Report of the Diet and Nutrition Survey. London.
HMSO
9
Crawley 2006. Eating well for under 5s in child care. The Caroline Walker Trust. www.cwt.org.uk
3
Table 3.1 Nutrient based guidelines for food served to children aged 1-4 years
on NHS premises
Energy
Dietary reference
value (DRV)
Children
1-4 years
EAR
1290
5.4
kcals
MJ
Fat
g
No more than 35%
of energy
MAX
501
Saturated fat
g
No more than 11%
of energy
MAX
*
Total carbohydrate
g
MIN
1721
Non-milk extrinsic
sugars
Fibre
g
g
DRV
MIN
Protein
g
RNI
MIN
Vitamin A
µg
RNI
MIN
µg
RNI
MIN
Vitamin C
mg
RNI
MIN
Folate
μg
RNI
MIN
Calcium
mg
RNI
MIN
Iron
mg
RNI
MIN
Zinc
mg
RNI
MIN
Sodium
mg
Vitamin D2
Salt
g
At least 50% of
energy
No more than 11%
of energy
SACN
recommendation
SACN
recommendation
EAR = Estimated Average Requirement
RNI = Reference Nutrient Intake
For explanation of terms see glossary
MAX
MAX
MAX
38
*
16
425
7
30
85
375
7
5.5
900
2.3
DRV = Dietary Reference Value
SACN = Scientific Advisory Committee on Nutrition
* There is currently no dietary reference value for fibre for children under the age of 5 years
1
For children aged 1-4 years the amounts of fat and carbohydrate should be about the figures
shown but some flexibility is essential to ensure that young children have diets which are nutrient
dense
2
It is difficult to obtain the vitamin D required from the diet. Children will make vitamin D from
exposure of their skin to the sunlight in summer, but in the UK it is recommended that all children
aged 1-4 years receive vitamin drops containing vitamins A, C and D daily. For older children who
rarely go outside it is particularly important that they receive vitamin D supplements.
4
3.4 Food based guidance for menu planners
The following pages contain some information for caterers about food groups and
how to choose foods which will contribute to a healthy balanced diet.
It is also useful for caterers to look at food labels on foods and ingredients they buy
or use and to choose those that are lower in salt, sugar and fat.
The Food Standard’s Agency provides information on what is ‘a lot’ of salt, sugar and
fat in foods and these are outlined below.
Foods high in salt have
1.25 grams or more salt per 100grams or 500
milligrams of sodium per 100 grams of food
Foods high in sugar have
10 grams or more of sugars per 100 grams of
food
Foods high in fat have
20 grams or more of fat per 100 grams of food
Foods high in saturated fat have
5 grams of saturated fat or more per 100 grams
of food
For more information about nutritional information on food labels see
www.eatwell.gov.uk
Additional information about foods which are good sources of some of the nutrients
which appear to be insufficient in the diets of some people in the UK can be found in
Appendix 2.
Liver
Liver, including liver pâté is very rich in vitamin A and it is recommended that these
foods are given to children no more than once a week. For more information see
SACN (2005) Review of Dietary Advice on Vitamin A. London: TSO
5
3.5 Food based guidelines for catering for children aged 1-4 years
Food group
Guidance
Rationale
What’s included
Bread, other
cereals and
potatoes
Foods from this
group should
be offered at
every meal,
and can be
useful foods to
offer as part of
snacks.
Starchy foods provide
energy, protein, fibre and
vitamins and minerals
such as the B vitamins,
and some calcium, iron
and zinc
All types of bread –
wholemeal, granary,
brown, wheatgerm, white,
multigrain, soda bread,
potato bread, chapattis,
naan bread, roti, rolls,
bagels, pitta bread, wraps,
tortilla
These foods
should make
up about a
third of the
food served
each day.
Starchy foods are filling
And provide bulk to the
diet
Potatoes or sweet
potatoes – boiled,
mashed, baked or
wedges.
Potato chips should only
be served once a week.
Starchy foods are a good
choice for snacks as they
Yam, plaintain,
cocoyam, cassava and
other starchy root
vegetables
Pasta and noodles –
wholemeal and white
Rice – brown and white
rice
Other grains such as
couscous or bulgur wheat,
maize (polenta) and
cornmeal
Breakfast cereals
Tips
•
•
•
•
•
•
•
Children aged 1-4 may have small appetites and very bulky foods may prevent them
getting all the nutrients they need. High fibre foods should be served in moderation.
Look for lower-salt breads.
Processed potato products like waffles or smiley faces should be avoided.
Avoid dried or canned ready-prepared pasta in sauce as these are very salty.
Avoid fried rice or flavoured dried rice in packets.
Avoid sugary breakfast cereals. (If a food contains more than 10g of sugar per 100g,
it is considered a high-sugar food.)
Choose low-sugar, low-salt cereals such as porridge, puffed wheat, weet bisks,
crisped rice or flaked wheat. Fortified cereals can be a good source of iron.
6
Food group
Guidance
Rationale
What’s included
Fruit and
vegetables
Offer different
fruits and
vegetables at
meals and
snacks.
Fruits and vegetables offer
a range of important
nutrients including fibre,
vitamins A and C and folic
acid
Aim for each
day’s menu for
childcare
settings to offer:
1-2 types of fruit
and
2-3 types of
vegetables.
Evidence suggests that
people who eat more fruits
and vegetables are
protected from a number of
diseases in later life
All types of fresh, frozen
and canned vegetables –
for example, broccoli,
Brussels sprouts,
cabbage, carrots,
cauliflower, mushrooms,
parsnips, peas, peppers,
spinach, swede, sweet
potato, turnip
Children in fullday care should
have the
opportunity to try
4-5 different
fruits and
vegetables each
day.
Encouraging children to try
fruits and vegetables when
they are young will help to
encourage a lifetime
enjoyment of these foods
Fruits and vegetables also
provide colour and texture
to the diet
All types of salad
vegetables – for example,
lettuce, watercress,
cucumber, tomato, raw
carrot, raw pepper, radish
or beetroot
All types of fresh fruit –
such as apples, bananas,
pears, grapes, kiwi fruit,
oranges, plums, berries,
melon or mango
All types of canned fruit in
juice – for example,
peaches, pears,
pineapple, mandarin
oranges, prunes, guava
or lychees
Stewed fruit such as
stewed apple, stewed
dried fruit, stewed plums,
stewed currants or
stewed rhubarb
Dried fruit such as
raisins, dried apricots,
dates, dried figs, prunes
Tips
•
•
•
•
•
•
•
•
•
Avoid vegetables canned with added salt and sugar
Choose fruit canned in fruit juice rather in syrup
Do not overcook fresh vegetables, or cut them up a long time before cooking and leave
them in water, or cook them early and re-heat before serving – these practices all
reduce the vitamin content.
Sugar can be added to sweeten very sour fruit.
Avoid dried fruit with added sugar and vegetable oil.
Serve dried fruit with meals and not as snacks as the sugars in dried fruit can damage
teeth
Add vegetables to dishes such as stews, soups and casseroles
Use fruit in desserts and when making cakes and biscuits
Add dried fruit to milk puddings and yoghurts
7
Food group
Guidance
Rationale
What’s included
Meat, fish and
meat
alternatives
Main meals
should always
contain an item
from this group.
Foods in this group are a
good source of protein and
are often high in iron and
zinc.
Meat. All types including
beef, lamb, pork, chicken,
turkey and offal such as
liver1 and kidney.
Offer a variety of
meat, fish and
alternatives each
week
Lean meat will have greater
proportions of nutrients
than meat products
Meat products such as ham,
bacon, corned beef,
sausages, meat pies, coated
meat products
Include fish in the
menu at least
once a week
Fish is a good source of
protein and is low in fat. Oil
rich fish are a good source
of n-3 (omega 3)
polyunsaturated fats which
are thought to be beneficial
for heart health
Fish includes:
• white fish such as cod,
haddock, coley and white
fish varieties from
sustainable fish stocks such
as pollack, saithe and blue
whiting
• oil-rich fish such as herring
and mackerel, salmon, trout,
sardines, sprats or pilchards.
Canned tuna does not count
as an oil-rich fish but is a
good source of nutrients.
Oil rich fish
should be served
regularly
Make sure meat
alternatives are
varied for
vegetarians
Eggs including boiled,
scrambled or poached, or in
an omelette
Pulses including all sorts of
beans and peas such as
butter beans, kidney beans,
chick peas, lentils,
processed peas or baked
beans
Meat alternatives – such as
soya mince, textured
vegetable protein, quorn or
tofu
Tips
•
Reduce intakes of meat products which are high in fat and salt such as crumb-coated
chicken products, burgers, pies and canned meats. Some meat products such as
sausages are popular with under-5s. Choose good quality versions if you serve these
foods, and serve them no more than once a week.
• Reduce intakes of processed fish products such as fish fingers or fish cakes
• Make sure all fish dishes are free of bones.
• All eggs should be well cooked.
• Look for canned pulses with no added salt and sugar.
• Dahl and other dishes made from pulses should be made without adding a lot of oil and
salt.
• Choose lower-salt and lower-sugar baked beans.
• Reduce intakes of processed products made from meat alternatives (e.g. vegetarian
sausages, burgers and pies) as these can be high in fat or salt
1
Liver and liver pâté are very high in vitamin A and children should consume these foods no more
than once per week.
8
Food Group
Guidance
Rationale
What’s included
Milk and milk
priducts
Foods from
this group
should be
offered at 2-3
meals and
snacks each
day.
Milk and dairy products
are excellent sources of
calcium which is needed
for optimal bone strength
protein, vitamin A,
riboflavin and vitamin D.
Milk – Whole milk should be
served for under-2s. Over-2s
can have semi-skimmed milk
if they are good eaters.
Cheese e.g. Cheddar,
cottage cheese, cheese
spreads, feta, Edam,
parmesan, pasteurised soft
cheeses
Yoghurt and fromage frais
Tips
•
•
•
•
•
•
•
•
•
Offer plain milk drinks between meals
Avoid unpasteurised milk and milk drinks with added sugar.
Avoid unpasteurised cheese and mould-ripened (blue-vein) cheeses.
Vegetarian cheese should be used where appropriate.
Avoid yoghurts and fromage frais that have a high sugar content. It is preferable to
add fresh fruit to natural yoghurt or natural fromage frais.
Frozen yoghurts can be offered as an alternative to ice cream.
Milk can be used in sweet and savoury sauces, custards and milk puddings.
It is worth highlighting that some dairy products can contain high salt levels. Strong
cheese can impart flavour in smaller amounts and cheese dishes may not need the
addition of extra salt
For dairy-free diets: serve soya drinks fortified with calcium as an alternative.
9
Food group
Guidance
Rationale
What’s included
Foods containing fat
and foods and drinks
containing sugar
These foods add
palatability to the diet
and can increase the
energy density of the
diet for those with a
small appetite
The main nutrients
provided by such foods
are fat, including some
essential fatty acids,
and also some fatsoluble vitamins.
These foods can be
high in calories and
offer few other
nutrients. If appetites
are poor it is important
that these foods do not
displace more nutrientrich foods.
Carbohydrate (in the
form of sugars) is also
provided.
Foods containing fat
include butter,
margarine, other
spreading fats and
low-fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
and gravies.
Sweet foods eaten
between meals can
damage teeth. Keep
sugary foods and drink
to mealtimes only
Some foods in this
groups can also be
high in salt.
Foods containing
sugar include soft
drinks, sweets, jams
and sugar, as well as
foods such as cakes,
puddings, biscuits,
pastries and ice
cream.
Tips
•
•
•
•
•
Use mono- and polyunsaturated fat (such as sunflower, soya, olive, safflower, rapeseed, corn
oil) based spreading fats and in salad dressings
For cooking use fats high in monounsaturates such as soya, rapeseed and olive oils
When making cakes and puddings include dried fruit or fresh fruit,
Avoid sugary drinks between meals and always serve any drink other than milk or water in a
cup
Dilute 100% fruit juice with water for 1-4 year olds
To increase the
amount of dietary
VITAMIN D in
menus served in
child care
•
•
•
•
•
Use margarine fortified with vitamin D for baking and as a fat spread.
Include an oil rich fish that is rich in vitamin D in the menu at least once
a week – for example, herring, mackerel, pilchards, salmon, sardines,
trout or roe. These fish contain between 5-14µg of vitamin D per 100g.
Canned tuna fish can also make a significant contribution to vitamin D
intake as it contains about 3.6µg of vitamin D per 100g.
Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin
D per 100g.
Meat and poultry contribute small but significant amounts of vitamin D.
10
3.6 Example menu for children aged 1-4 years catered for on NHS
premises
The menu shown in 3.7 is an example of the types of foods, and the amounts that
would meet nutrient based guidance for those aged 1-4 years who eat all their meals
and snacks on NHS premises over one week.
The menu offers some main meal and dessert choices, but this is an example, and
many caterers would offer more choices as well as special dietary options not
covered in this report.
11
3.7 Example menu for children aged 1-4 years catered for on NHS
premises
Monday
Tuesday
Wednesday Thursday Friday
Saturday Sunday
BREAKFAST
Weet bisks or puffed wheat (24g) with 100ml whole milk
Diluted 100% fruit juice (50ml)
Soft brown or white toast (20g) with polyunsaturated margarine (5g) and jam, honey or marmalade (5g)
MID MORNING SNACK
Choice of fresh fruit slices : (40g): pear, banana, pineapple, grapes
Choice of vegetable slices: (40g): Cucumber, cherry tomatoes, celery sticks
Choice of dips: Whole milk yoghurt (60g), natural yoghurt (60g), fromage frais (60g) or tabbouleh (65g), mint and
cucumber (35g), houmous (30g)
LUNCH
Main
choice
1
Chicken
korma
(120g)
brown rice
(80g)
naan bread
(20g)
Lamb
burgers
(45g)
bubble and
squeak
(100g)
Sardines (40g)
on toast (27g)
sliced tomato
(40g)
Vegetable
and lentil
lasagne
(150g)
mixed salad
(35g)
Cottage
pie (150g)
peas (40g)
broccoli
(40g)
Lamb pilaf
(130g)
Mixed bean
salad (40g)
Main
choice
2
(v)
Vegetarian
bolognese
(100g) with
wholemeal
spaghetti
(90g)
Stuffed
peppers
(100g)
potato salad
(40g)
Broccoli quiche
(100g)
mashed potato
(80g)
baked beans
(55g)
Chickpea
burgers
(90g)
Mixed
bean
casserole
(160g)
Jacket
potato
(115g)
sweet
potato (80g)
sweetcorn
(40g)
green
beans (40g)
mashed
potato
(75g)
baked
beans
(55g)
mixed
salad (35g)
Main
choice
3
Coconut
fish curry
(100g)
basmati rice
(80g)
beansprouts
(40g)
and cherry
tomato
(40g) salad
Chicken
fajitas
(120g)
sweetcorn
salsa (35g)
mixed salad
(35g)
Kedgeree
(150g)
Peas (40g)
carrots (40g)
Channa
aloo (80g)
masoor dahl
(60g)
mixed
vegetable
pilau (80g)
Dessert
choice
1
Tropical
fruit salad
(80g)
Apricot
conde
(110g)
Milk jelly (90g)
with mandarins
(70g)
Dessert
choice
2
Chocolate
semolina
(110g)
Trifle (110g)
Melon and
grape salad
(85g) with
Stewed
apples
(75g) with
custard
(60g)
Banana
yogurt flan
(90g)
Dessert
Fruit
Lemon
Cinnamon fruit
Neapolitan
12
petits pois
(40g)
swede
(40g)
Chilli con
carne
(100g)
Roast
chicken and
gravy (110g)
roast
potatoes
(80g)
mixed
vegetables
(40g)
Lentil pasta
(180g)
grated
cheese
(10g)
Caribbean
chicken
(100g)
sweet
potato
(80g)
rice and
peas (50g)
Sweet and
sour pork
(120g)
egg noodles
(70g)
stir-fried
vegetables
(70g)
Crème
caramel
(100g)
Apple pie
(70g)
custard
(60g)
Banana
custard
(100g)
Fresh fruit
salad (85g)
Rhubarb
fool (90g)
Lemon
meringue
pie (60g)
Pineapple
Fruit jelly
Milk jelly
jacket
potato
(90g)
tomato
salad (40g)
choice
3
compote
(50g)
Whole milk
yoghurt
(50g)
sorbet (40g)
with wafers
(2g)
fool (90g)
ice cream
(50g)
crush (85g)
(90g)
(90g)
pears (60g)
100% orange juice (50ml) diluted with water
MID-AFTERNOON SNACK
Choice of fruit and vegetable slices : kiwi, peaches, clementine, apple, grapes, pepper, carrot, celery, cucumber
(40g)
Natural yoghurt (60g), fromage frais (60g), whole milk yoghurt (60g)
Wholemeal pancake with butter (40g), rice cakes (20g), plain popcorn (20g), crackers with soft cheese (19g)
100% orange juice (50ml) diluted with water
TEA
Main
choice
1
Main
choice
2
(v)
Main
choice
3
Egg and
cress
sandwiches
(90g)
lettuce
(20g)
cherry
tomatoes
(40g)
Vegetable
couscous
(100g)
mixed
salad(30g)
with butter
beans (20g)
homemade
coleslaw
(35g)
Spicy
ratatouille
(130g) with
tofu (30g)
flat bread
(30g)
Tuna (30g)
and
sweetcorn
(30g) pasta
(80g)
cucumber
(20g)
red pepper
(20g)
Egg
sandwiches
(90g)
green salad
(40g)
Spanish
omelette (70g)
baby jacket
potatoes (90g)
Cherry
tomatoes (40g)
Baked
beans (60g)
with white
toast
squares
(30g)
Chicken
and
vegetable
couscous
(145g)
salad (35g)
Curried
bean and
rice salad
(100g)
yellow and
orange
peppers
(40g)
Sardines
(50g)
white toast
(20g)
tomato
(40g)
Wholemeal
pasta twirls
(80g)
Chickpea
salad (50g)
cucumber
(20g) and
carrot (20g)
sticks
Baby jacket
potatoes
(90g) with
ratatouille
sauce
(130g)
Quorn
burger
(45g) and
bun (50g)
Cheese
and Onion
sandwich
(60g)
salad (35g)
Vegetable
rice (110g)
kidney
beans (40g)
Egg tortilla
(70g) potato
dice (60g)
Vegetable
sticks (40g)
Fruity
couscous
(80g)
Chicken
tikka wrap
(75g)
mixed Salad
(40g)
Chapati
(45g)
Tuna and
sweetcorn
pasta
(160g)
Houmous
(35g) and
roasted red
onion (35g)
wrap (40g)
Fromage
frais (60g)
satsuma
(40g)
Cool rice
sundae
(100g)
mixed salad
(35g) and
kidney beans
(40g)
chickpea
salad (55g)
cucumber
(20g) and
carrot
(20g)
Fresh fruit
jelly (60g)
Dessert
choice
1
Banana
custard
(100g)
Canned
peaches (in
juice)
(100g)
Semolina (90g)
with pears
(40g)
Yoghurt
with
raisins
(145g)
Dessert
choice
2
Fruit
mousse
(80g)
Greek
yoghurt
(30g) with
orange
(40g)
Fruit flan
(100g)
Tropical
granola (75g)
Oaty fruit
crumble
(75g) with
custard
(60g)
Orange
and lemon
rice (100g)
Fruit trifle
(120g)
Clementine
(40g) with
natural
yoghurt
(60g)
Dessert
choice
3
Watermelon
(40g)
Fruit
smoothies
(100g)
chewy
cereal bar
(20g)
Rice pudding
with mandarins
(100g)
Peach
melba
(100g)
Fromage
frais (60g)
with dates
(40g)
Apple
crumble
(80g)
Lemon jelly
fluff (90g)
EVENING
Whole milk (200ml)
13
3.8 Analysis of NHS menu for children aged 1-4 years
Nutrient
based
Guideline
Average analysis
about
1290
5.4
50
1290
5.4
44
g
about
172
177
Non milk
extrinsic sugars
g
MAX
38
29
Protein
g
Min
16
50
Vitamin A
µg
Min
425
928
Vitamin C
mg
Min
30
128
Folate
µg
Min
85
210
Calcium
mg
Min
375
928
Iron
mg
Min
7
8
Zinc
mg
Min
5.5
6
Sodium
mg
Max
900
925
g
Max
2.3
2.3
Energy
Kcals
MJ
g
Total
carbohydrate
Fat
Salt1
1
The salt content of menus will go down as the amount of salt in common commodities such
as bread is reduced
14
3.9 Rationale for nutrient based standards for food served to those over
5 years of age on NHS premises
3.9.1 Children and young people 5-18 years
The rationale for the setting of the guidance for children and young people in NHS
settings for all their meals, snacks and drinks is based on evidence that the diets of
many school aged children contain insufficient amounts of some important
micronutrients, as well as some foods such as fruit and vegetables and oil rich fish.
Data from the National Diet and Nutrition Survey of young people aged 4-18 years
published in 2000 10 showed that many children and young people do not get enough
of certain important nutrients – for example iron, calcium, zinc, vitamin A, vitamin C
and folate. For this reason it is important that the food served throughout the day
provides enough of these essential nutrients to protect children and young people
from insufficiencies. Since many of the important nutrients which may be insufficient
in the diets of children and young people are more likely to be found at meals than in
snacks, it is likely that meals will provide a greater proportion of these nutrients.
It is also recommended that in a group of children or young people, the nutrient
based guidance should meet the requirements of those children with the greatest
needs. So, among mixed gender groups of children, the guidance for iron will meet
the needs of the girls in the group who have higher requirements, and the standards
for calcium, zinc and vitamin A will meet the greater needs of the boys in the group.
Guidance given here assumes that groups will be of mixed gender.
The derived dietary reference values calculated for the age groups 5-10 year and 1118 years are explained in Appendix 1 and are also shown in table 3.2. Using these
derived reference values it is assumed that menus offered to children and young
people on NHS premises will provide all of the nutrients needed in the meals, snacks
and drinks served. The values for 11-18 year olds for energy, fat, carbohydrate and
protein are given as ranges. This reflects the fact that young people will be growing
at very different rates and that some will have much greater needs for energy and
nutrients since they may be growing rapidly, be physically bigger, be more active or
10
Gregory J, Lowe S, Bates CJ, Prentice A et al 2000. National Diet and Nutrition Survey: Young
People aged 4-18 years. London. The Stationery Office.
15
all three. If the menus offered provide nutrients in the right balance then hungrier
young people will eat bigger portions to satisfy their appetites.
16
Table 3.2 Nutrient based guidelines for food served to children aged 5-18 years
on NHS premises
Energy
kcals
MJ
Dietary
reference
value (DRV)
Children
5-10 years
Young people
11-18 years
EAR
1780
7.5
1845 – 2755
7.7 – 11.6
Fat
g
No more than
35% of energy
MAX
70
72 -107
Saturated fat
g
No more than
11% of energy
MAX
22
23 -34
Total
carbohydrate
Non-milk
extrinsic sugars
Fibre
g
237
246 - 367
g
DRV
MIN
52
14
54 - 81
18
Protein
g
RNI
MIN
25
41-55
Vitamin A
µg
RNI
MIN
500
700
µg
RNI
MIN
-
-
Vitamin C
mg
RNI
MIN
30
40
Folate
μg
RNI
MIN
150
200
Calcium
mg
RNI
MIN
550
1000
Iron
mg
RNI
MIN
9
15
Zinc
mg
RNI
MIN
7
9.5
Sodium
mg
1800
2400
4.5
6
Vitamin D2
Salt
g
g
At least 50% of
energy
No more than
11% of energy
MIN
MAX
SACN
recommendation
SACN
recommendation
EAR = Estimated Average Requirement
RNI = Reference Nutrient Intake
For explanation of terms see glossary
MAX
MAX
DRV = Dietary Reference Value
SACN = Scientific Advisory Committee on Nutrition
1
For children aged 1-4 years the amounts of fat and carbohydrate should be about the figures
shown but some flexibility is essential to ensure that young children have diets which are nutrient
dense
2
It is very difficult to obtain enough vitamin D from the diet alone. Children will make vitamin D
from exposure of their skin to the sunlight in summer. Older children who rarely go outside or who
wear very restrictive clothing are likely to require vitamin D supplements.
17
3.9.2 Rationale for nutrient based guidance for food served to adults
aged 19-74 years on NHS premises
The National Diet and Nutrition Survey 11 (NDNS) of adults aged 19-64, carried out in
2002, has raised several key concerns with regards to nutrient intake and the
nutritional status of this population group.
Energy (calories) and fat intake
Adults’ total carbohydrate intake is close to the dietary reference value (DRV) 12 of
50% of food energy for both men and women and since the last adult survey carried
out in 1986/87 13 total fat intake has decreased. However, the proportion of energy
derived from saturated fat still exceeds the dietary reference value of 11% of food
energy. Also, in the 2002 survey the percentage of food energy derived from nonmilk extrinsic sugars was 13.6% for men and 11.9% for women – exceeding the DRV
of 11% of food energy. Intakes were higher in the younger age groups (19-24 years).
Non-starch polysaccharides (NSP, or fibre)
In the survey of 19-64 year olds, the mean daily intake of non-starch polysaccharides
(NSP) was below the recommended average intake of 18g per day for all sex and
age groups, and a third of adults had intakes of less than 12g a day. Intakes were
particularly low among those in the younger age group (19-24 years) where average
intakes were 12.3g for men and 10.6 for women.
Vitamins
In the 2002 survey, adults’ average intakes of all vitamins were close to the
Reference Nutrient Intake (RNI) for all sex and age groups, except for vitamin A in
the youngest groups, where results were below the RNI. Assessments of nutritional
status indicated issues regarding low vitamin D status as well as inadequate vitamin
C and folate concentrations among some individuals. Adults who rarely go outside, or
who wear very restrictive clothing will not get sufficient Vitamin D from their diet alone
and are likely to need vitamin D supplements.
11
Henderson L et al 2002 and 2003. The National Diet and Nutrition Survey: Adults Aged 19-64 Years,
Volumes 1-4. TSO. London
12
Department of Health 1991. Dietary Reference Values for Food Energy and Nutrients for the United
Kingdom. Report on Health and Social Subjects No. 43. HMSO. London
13
Gregory J et al 1990. The National Dietary and Nutritional Survey of British Adults. HMSO.
London.
18
Minerals
Iron intakes in women were well below the RNI in all but the oldest age group. Over
40% of those women in the two youngest age groups had iron intakes below the
LRNI (Lower Reference Nutrient Intake). Assessments of nutritional status indicated
issues regarding low iron status, with 8% of women and 3% of men having signs of
anaemia and 11% of women and 4% men having low serum ferritin levels (another
measure of low iron status).
The average intakes of some other minerals were below the RNI for a number of sex
and age groups. Results indicated low intakes of potassium and magnesium, which
were well below the RNI for the youngest male group and below the RNI for all
female age groups. Issues regarding low intakes of iodine and zinc were also
apparent in the younger female groups, and concerns with intakes of calcium and
copper were also highlighted.
Sodium/salt
In the 2002 survey, the average salt intake for adults was estimated at 9.5g per day
overall (based on mean urinary sodium excretion levels per 24 hours of 187.4mmol
per day for men and 138.5mmol per day for women.) This result represents a slight
increase from the 1986/87 adult survey and average intakes in all sex and age
groups were well above the recommended maximum daily intake of 6g per day 14 .
Fruit and vegetables
The National Diet and Nutrition Survey reported that few adults achieved the 5
portions of fruit and vegetables recommended each day – with men and women
having on average less than 3 portions a day.
Overweight and obesity
Data on overweight and obesity levels among adults in the UK from the 2004 Health
Survey for England 15 and The Scottish Health Survey 2003
16
suggest that a
significant proportion of adult men and women are now obese (with a body mass
index of more than 30kg/m2). Nearly a quarter (23.6%) of men and 16% of women in
England and 22.4% men and 26% of women in Scotland are reported to be obese
14
Scientific Advisory Committee on Nutrition 2003. Salt and Health. TSO. London
Data from Healthy Survey for England 2004 accessed from:
http://www.ic.nhs.uk/pubs/hlthsvyeng2004upd
16
Scottish Executive 2005. The Scottish Health Survey. Scottish Executive. Edinburgh.
15
19
and approximately two-thirds of all adults are overweight (with a body mass index
greater than 25 kg/m2). Similar levels of overweight and obesity are found in Wales 17
and Northern Ireland 18 .
Given the rising levels of obesity in the UK, it is important not to exceed average
energy (calorie) requirements. It is therefore suggested that main meals should
provide nutrient-dense food – that is, food which contains high levels of nutrients –
but that these foods should not be correspondingly higher in calories. Those
individuals who are in the normal range for bodyweight (BMI 20-25 kg/m2) but who
have higher energy needs because they use up more calories (because they either
have a larger body size, or do more activity, or both) should have the opportunity to
eat more carbohydrate-based foods at meals to meet their higher energy
requirements without disproportionately increasing their intake of fat, saturated fat,
sugar or salt.
Based on the most recent assessments of nutritional status for the UK population, it
appears that it may also be prudent to ensure that food served in public institutions at
breakfast and at main meals provides enhanced amounts of fibre, iron, folate, vitamin
C and zinc. In order to ensure that population maximum intakes of fat, saturated fat,
sugars and salt are within current recommendations, it is important that these
nutrients are not exceeded in the guidance suggested. Another priority is to ensure
that meals offer the opportunity to increase fruit and vegetable intakes.
Table 3.3 outlines the nutrient based guidance for adults aged 19-74 years and the
derivation of this is explained in Appendix 1.
17
Welsh Health Survey October 2003 - March 2004. Accessed from:
wales.gov.uk/keypubstatisticsforwales/content/publication/health/2004/sdr82-2004/sdr82-2004.pdf
18
Northern Ireland Health and Social Wellbeing Survey 2001. Accessed from:
www.csu.nisra.gov.uk/archive/Surveys/HWB/publications/1997/Health%20&%20lifestyle%20report%
201997.pdf
20
Table 3.3 Nutrient based guidelines for food served to adults aged 19-74
years on NHS premises
Energy
Dietary reference
value (DRV)
Adults
19-74 years
EAR
2225
9.4
kcals
MJ
Fat
g
No more than 35%
of energy
MAX
87
Saturated fat
g
No more than 11%
of energy
MAX
27
Total
carbohydrate
g
At least 50% of
energy
MIN
297
Non-milk
extrinsic sugars
g
No more than 11%
of energy
MAX
65
Fibre
g
DRV
MIN
Protein
g
RNI
MIN
Vitamin A
µg
RNI
MIN
Vitamin D
µg
RNI
MIN
Vitamin C
mg
RNI
MIN
Folate
μg
RNI
MIN
Calcium
mg
RNI
MIN
Iron
mg
RNI
MIN
Zinc
mg
RNI
MIN
Sodium
mg
Salt
g
SACN
recommendation
SACN
recommendation
EAR = Estimated Average Requirement
RNI = Reference Nutrient Intake
For explanation of terms see glossary
MAX
MAX
18
50
700
-*
40
200
700
15
9.5
2400
6
DRV = Dietary Reference Value
* Vitamin D
It is difficult for adults to get all the vitamin D they require through the diet and most adults will
also make Vitamin D on exposure of the skin to sunlight during the summer months. Adults
who rarely go outside or who go outside infrequently and who wear clothing which means
their skin is not exposed to the sun are likely to require vitamin D supplements.
21
3.9.3 Rationale for nutrient based guidance for food served to adults
aged over 75 years on NHS premises
The food provided for older people on NHS premises should as a minimum provide
the average dietary reference values for energy and nutrients specified for people
aged 75 years and over 19 . It should be stressed however that many older people
may have higher requirements for energy and nutrients as well as specific
requirements for help with eating and drinking. The nutrient-based guidelines in this
report provide guidance for menu planners on the amounts of energy and nutrients
that they should aim to provide for a group of older people in their care, while
remembering that this is a vulnerable population group who are frequently found to
eat and drink too little. The needs of each older person should be assessed as part of
his or her care plan and meals and snacks organised to ensure that each individual is
able to access sufficient nutrients each day. Monitoring nutritional status (e.g.
whether a person loses weight) is an important part of the care of older people and
this will indicate when specialist help may be needed to help someone eat and drink
appropriately. Registered Dietitians are able to provide advice on how nutritional
status should be measured in NHS settings.
The foods and drinks offered each day should meet the total nutritional guidance
outlined. The sample menus in section 6.0 show the sorts of foods and drinks that
would be required across the day to do this. Where there are eating difficulties or the
texture of food needs to be altered, it is important that appropriate advice is taken
from a Registered Dietitian or a Speech and Language Therapist to ensure that
residents receive adequate nutrition at both meals and snacks.
Vitamin D
It is impossible for most older adults to obtain the full daily requirement of 10
micrograms of vitamin D from the diet alone. It is likely that older adults in NHS
accommodation who rarely go outside will need vitamin D supplements.4 They
should seek medical advice about this. Good dietary sources of vitamin D are
outlined in the food-based guidelines for older people in section 3.10.
19
Department of Health 1991. Dietary Reference Values for Food Energy and Nutrients for the United
Kingdom. Report on Health and Social Subjects 41. HMSO. London
22
Folate and vitamin C
The low intakes of folate and vitamin C among older people 20 may be due in part to
reduced intakes of fruit and vegetables, since some older people may find it difficult
to peel, cut up or chew these foods. Caterers should be aware of the importance of
increasing fruits and vegetables in menus for older people and offer a variety of raw
and cooked fruits and vegetables in accessible forms.
Iron and zinc
Low iron intakes and low iron status have been reported among older people 21 and
this may be due both to poorer iron absorption, greater iron losses and lower iron
intakes 22 . Meat is a good source of iron but as people get older they may find it more
difficult to chew and therefore it is important that foods high in iron are included in the
menu in forms that are easy for older people to access.
Zinc intakes are also often low in the diets of older people and many good sources of
iron are also good sources of zinc.
Salt/sodium
The current recommendation for salt intakes for all adults is 6g a day3 and the current
daily intake by adults is approximately 9g. Older people may be used to adding salt
to food out of habit, or they may have a reduced sense of taste and smell and
therefore add salt to food to give it taste, or they may prefer highly salted foods and
condiments that they typically ate when younger. NHS caterers should respect the
food choices of those they cater for but attempt to reduce the use of highly salted
foods and salt in cooking, while ensuring that food remains tasty. Advice on reducing
salt in cooking can be found on the website www.salt.gov.uk
Fluid Intakes
A regular and adequate intake of fluids is extremely important for older people. It
helps to prevent dehydration which can lead to confused states; helps to prevent and
alleviate the symptoms of constipation and fluids can also provide important nutrients
when appetites are small. It is recommended that older people drink at least 1.5 litres
or 8 cups of non-alcoholic fluid a day11. Many older people may find they are less
20
Finch S, Doyle W, Lowe C, Bates CJ et al. 1998. National Diet and Nutrition Survey: People Aged
65 Years and Over. Volume 1: Report of the Diet and Nutrition Survey. TSO. London.
21
Finch S, Doyle W, Lowe C, Bates CJ et al. 1998. National Diet and Nutrition Survey: People Aged
65 Years and Over. Volume 1: Report of the Diet and Nutrition Survey. TSO. London.
22
Caroline Walker Trust 2003. Eating Well for Older People. CWT. www.cwt.org.uk
23
likely to recognise that they are thirsty or may be afraid of drinking because of fears
of incontinence. It is important to explain to older people the importance of drinking
and that more fluid, rather than less, can help with incontinence. The fluid older
people require can be consumed in a number of ways, and some fluids may offer
additional nutritional or psychological benefits to older people. Tea and coffee are
sociable drinks which many older people habitually drink and enjoy. These should be
offered regularly, and served in the style that the older person prefers. Some older
people may enjoy milky coffee or tea or another hot beverage such as a malted or
chocolate milk drink particularly at bedtime. Fruit juice should be offered at meals as
the vitamin C it contains may help the absorption of iron from some foods. Fresh,
chilled water should be freely available and offered regularly as an additional option.
Some foods can also provide fluid: older people may enjoy frozen drinks if the
weather is warm and nutritious soup can be offered.
It is important that all those who care for older people work with the older person to
ensure that they have access to 1.5 litres or 8 cups of fluid during the day, of the type
that the older person enjoys. As older people may not recognise that they are thirsty
it is important that drinks are offered, served and encouraged: provision of fluid alone
e.g. water coolers in community areas or jugs of water by the side of the bed will not
necessarily ensure adequate fluid intake.
Table 3.3 outlines the nutrient based guidance for people over the age of 75 years
and the derivation of this is explained in Appendix 1.
Specific food based guidance for those aged over 75 years is shown in section 3.12
24
Table 3.3 Nutrient based guidelines for food served to adults aged over
75 years on NHS premises
Energy
Dietary reference
value (DRV)
Adults
75 years +
EAR
1955
8.2
kcals
MJ
Fat
g
No more than 35% of
energy
MAX
76
Saturated fat
g
No more than 11% of
energy
MAX
24
Total
carbohydrate
g
At least 50% of energy
MIN
260
Non-milk
extrinsic sugars
g
No more than 11% of
energy
MAX
57
Fibre
g
DRV
MIN
Protein
g
RNI
MIN
Vitamin A
µg
RNI
MIN
µg
RNI
MIN
Vitamin C
mg
RNI
MIN
Folate
μg
RNI
MIN
Calcium
mg
RNI
MIN
Iron
mg
RNI
MIN
Zinc
mg
RNI
MIN
Sodium
mg
SACN recommendation
MAX
g
SACN recommendation
MAX
Vitamin D1
Salt
EAR = Estimated Average Requirement
RNI = Reference Nutrient Intake
For explanation of terms see glossary
18
50
700
10
40
200
700
9
9.5
2400
6
DRV = Dietary Reference Value
1
Vitamin D
The RNI for Vitamin D for adults over 65 years is 10µg a day. It is very unlikely that older
adults can get all the vitamin D they require through the diet and most adults will also make
Vitamin D on exposure of the skin to sunlight during the summer months. Older adults who
rarely go outside or who go outside infrequently and who wear clothing which means their
skin is not exposed to the sun are likely to require vitamin D supplements.
25
3.10 Food based guidance for menu planners
The following pages contain some information for caterers about food groups and
how to choose foods which will contribute to a healthy balanced diet. It is also useful
for caterers to look at food labels on foods and ingredients they buy or use and to
choose those that are lower in salt, sugar and fat.
The Food Standard’s Agency provides information on what is ‘a lot’ of salt, sugar and
fat in foods and these are outlined below.
Foods high in salt have
1.25 grams or more salt per 100grams or 500
milligrams of sodium per 100 grams of food
Foods high in sugar have
10 grams or more of sugars per 100 grams of
food
Foods high in fat have
20 grams or more of fat per 100 grams of food
Foods high in saturated fat have
5 grams of saturated fat or more per 100 grams
of food
For more information about nutritional information on food labels see
www.eatwell.gov.uk
Additional information about foods which are good sources of some of the nutrients
which appear to be insufficient in the diets of some people in the UK can be found in
Appendix 2.
Fluid intakes
It is important that everyone has access to adequate fluid intakes throughout the day.
In climates such as the UK, we should drink approximately 1.2 litres (6 to 8 glasses)
of fluid every day to stop us getting dehydrated. In hotter climates the body needs
more than this. We get some fluid from the food we eat but it is important that fluids
are not restricted since dehydration can lead to headaches, confusion and irritability
and lack of concentration as well as constipation and potentially urinary tract
infections. Clean, chilled water should always be available with meals and between
meals.
26
3.11 Food-based guidelines for food served to all those over the age of
five years on NHS premises
Food Group
Guidance
Rationale
What’s Included
Bread, other cereals
and potatoes
Starchy foods should
make up a third of the
daily diet.
Starchy foods are a
good source of energy
and the main source
of a range of nutrients
in the diet. As well as
starch, these foods
supply fibre, calcium
iron and B vitamins.
All varieties of bread
including wholemeal,
granary, seeded,
chapattis, bagels, roti,
tortillas, pitta bread
A variety of breads
should be available
daily at every meal
Different starchy foods
should be offered in
main meals throughout
the week so that a
variety of starchy foods
are included. Aim to
include pasta and rice
on the menu once a
week
Potatoes, yam, sweet
potato, plantain,
cocoyam, dasheen,
breadfruit, cassava
Breakfast cereals
Rice, couscous, bulgar
wheat, maize (polenta),
cornmeal
Noodles, spaghetti and
other pastas
Wholegrain and
wholemeal cereal
foods are a good
source of fibre and
other nutrients
Tips
•
•
•
•
•
•
•
•
•
Serve more pasta and rice and use less sauce. Opt for tomato based sauces instead of
cheese-based to reduce fat content
When serving rice and pasta, try to use wholemeal, wholegrain, brown or high fibre versions.
Some breakfast cereals are nutrient fortified (have added iron, folic acid and other vitamins and
minerals). Choose wholegrain cereals or mix some in with other cereals.
Offer a variety of breads, such as seeded, wholegrain and granary and use thicker slices with
low-fat options for fillings
Large pieces of potato and thick or straight cut chips absorb less fat
Boil potatoes in the minimum amount of water and for the shortest amount of time to retain
vitamins.
Use herbs or other shredded vegetables to add colour and flavour to baked potatoes, rather
than butter or margarine.
If you look after young people who have allergies to wheat, oats, barley and rye: good
alternatives to offer are foods made from maize (e.g. polenta), rice, rice flour, potatoes, potato
flour, buckwheat, sago, tapioca, soya and soya flour.
Cereal foods which are good sources of iron and zinc include fortified cereals, whole grain
cereals, wholemeal bread and flour, couscous and wholemeal pasta.
27
Food Group
Guidance
Rationale
What’s Included
Fruit and Vegetables
Fruit and vegetables
should make up about
a third of the daily diet.
Fruit and vegetables
are good sources of
many vitamins and
minerals.
All types of fresh,
frozen and tinned
vegetables i.e.
broccoli, Brussels
sprouts, cabbage,
carrots, frozen peas,
peppers, swede,
sweetcorn
It’s important to offer a
variety. Five-a-day is
an achievable target.
Aim for one or two
portions with each
meal and offer fruit and
vegetables as snacks.
One portion is about
80g fresh fruit and
vegetables and 40g of
dried fruit
Beans and pulses are
included but only count
as a maximum of 1
portion per day
A glass of 100% fruit
juice can count as one
portion of fruit each
day
There is evidence that
consuming 400g a day
or more of fruit and
vegetables reduces
the risk of developing
chronic diseases such
as coronary heart
disease and some
cancers.
Including fruits and
vegetables in the diet
will help to increase
the intake of fibre and
can help to reduce the
total amount of
calories consumed
among those who may
wish to lose weight
All types of salad
vegetables including
lettuce, cucumber,
tomato, raw carrots,
peppers, beetroot
All types of fresh fruit
e.g apples, bananas,
kiwi fruit, oranges,
pears, mango, plums
All types of tinned fruit
in fruit juice e.g.
pineapple, peaches,
mandarin oranges
Stewed fruit
Dried Fruit
Fruit juice (100% juice)
Tips
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Avoid adding fat or rich sauces to vegetables or sugar or syrupy dressings to fruit
Steaming or cooking vegetables with minimum amounts of water and serving as soon as
possible will help retain vitamins.
Use fresh fruit and vegetables as soon as possible, rather than storing, to avoid vitamin loss
Incorporate fruit and vegetables in snack options. Offer a variety of healthy snack alternatives
Add vegetable and pulses to curry, casserole or stir-fry and serve at least two types of
vegetables with fish, chicken or meat.
Baked beans (as a vegetable) should be served a maximum of twice a week
Encourage a daily glass of fruit juice (100% juice, unsweetened) with meals
Choose tinned fruit in fruit juice not in syrup
Add a handful of dried fruit to cereal options and porridge
Supply a good combination of traditional salads and raw vegetables, fruits and nuts to increase
colour, taste and texture at meal times
Add additional vegetables to savoury dishes
Vegetable soups are a useful way of increasing vegetable intake
Avoid dried fruit with added sugar or vegetable oil
Fruit and vegetables which are useful sources of iron include spinach, broccoli, spring greens,
dried apricots, raisins, baked beans, broad beans and blackcurrants
Fruit and vegetables which are useful sources of folate include spinach, broccoli, peas,
oranges, melon, green leafy salads and tomatoes.
Fruit and vegetables which are useful non-dairy sources of calcium include green leafy
vegetables, dried fruit and oranges.
28
Food Group
Guidance
Rationale
What’s Included
Milk and Dairy
Products
Offer dairy foods
such as milk, yoghurt
and cheese as part
of meals and snacks
Milk and dairy
products are
excellent sources of
calcium, protein,
vitamin A and vitamin
D. Calcium helps to
contribute to good
bone health
Skimmed, semi-skimmed,
whole milk
Offer low fat options
such as semiskimmed milk, low fat
yoghurt and skimmed
milk cheeses
The fat content of
different dairy
products varies and
much of this is
saturated fat.
Dried milk, goats and
sheep’s milk
All types of cheeses e.g.
Cheddar cheese, cottage
cheese, cheese spreads,
brie, feta, Edam, goats
cheese, stilton, Parmesan
Yoghurt
Fromage frais
Do not rely on
cheese as the main
protein item for
vegetarians.
Where no other
option is available,
cheese served as a
sandwich filler should
be offered no more
than twice per week.
Tips
•
•
•
•
•
•
•
•
•
•
Try using very strong-tasting cheese (mature Cheddar, blue cheese) if using to flavour dishes
or sauces, because less will be required.
Choose reduced-fat hard cheeses, cottage cheese and skimmed milk soft cheese
Offer semi-skimmed or skimmed milk and low-fat yoghurts and fromage frais.
Use plain yoghurt and fromage frais instead of cream, soured cream or crème fraiche in recipes
Try serving frozen yoghurts as an alternative to ice cream.
It is worth highlighting that some dairy products can contain high salt levels. Look for lower salt
cheeses and use smaller amounts of stronger cheese
Dairy foods are very important during pregnancy, but unpasteurised dairy produce and softmould-ripened cheese (e.g. Camembert, Brie and all blue-veined cheese) should be avoided
For those on dairy free diets serve soya drinks fortified with calcium as an alternative.
Fresh fruit milkshakes and chilled milk drinks can be offered as snacks
Restrict sweetened milk drinks to mealtimes as the sugars in these drinks can damage teeth
29
Food Group
Guidance
Rationale
What’s Included
Meat, fish and meat
alternatives
Offer a meat or
alternative at all main
meals
Meat and meat
alternatives are a good
source of protein,
vitamins and minerals
such as iron and zinc
Use lean meat (which
has a fat content of
about 10%)
Some meat and meat
products can have a
high fat and saturated
fat content
Meat includes all cuts
of beef, pork, lamb,
poultry, offal1 and meat
products such as
bacon, sausages, beef
burgers, pies and cold
meats
Fish should be
offered at least twice
per week.
White fish is low in fat
It is strongly
recommended that
oily fish such as
salmon, trout,
mackerel, herring,
pilchards, sardines
should be served
once a week
Oil-rich fish provides a
good source of omega-3
fatty acids, which may
help to protect against
heart disease. Oil-rich
fish are also a source of
vitamins A and D.
Eggs can be served
at breakfast and as
part of main meals
Eggs are a good source
of protein, vitamin A,
vitamin D and some
minerals
Beans, pulses, eggs,
meat alternatives and
nuts all provide good
sources of nutrients.
Ensure meat
alternatives for
vegetarians are
varied
Fish includes fresh,
frozen and tinned fish,
such as tuna and
sardines, Fish
products such as fish
cakes and fish fingers
may have a low fish
content
Boiled, poached,
scrambled eggs,
omelettes
Beans and pulses
such as chick peas,
lentils, kidney beans,
butter beans, textured
vegetable protein,
nuts, soya products
such as tofu, quorn
Tips
•
•
•
•
•
•
•
•
•
•
•
Always select the leanest cuts of meat and remove visible fat and poultry skin
Roast meat on a rack in order to let the fat run off.
Grill, poach or bake meat rather than frying. If you do fry, use clean oil and at the correct
temperature to minimise absorption. Note that larger pieces of fish and meat absorb less fat.
Do not add extra fat or oil when cooking meat.
Use more vegetables, pulses and starchy food to extend dishes further, as well as add more
texture and flavour. Less meat is also required, reducing the fat content and the cost of the
meal.
Buy good quality meat and use smaller amounts.
Use fish from sustainable fish stocks.
Offer unsalted nuts and seeds as snacks.
Reduce the amount of processed meat products served such as meat pies and pasties, coated,
canned and composite meat products such as sausages, burgers, coated chicken products
Reduce the amount of processed fish products on offer, particularly those that are fried or
coated such as fish fingers or fish cakes.
1
Liver and liver pate is very rich in vitamin A and it is recommended that these foods are given
to children no more than once a week.
30
Food Group
Guidance
Rationale
What’s Included
Foods containing fat
and foods and drinks
containing sugar
These foods can add
palatability to the diet
but should be eaten
in small amounts
each day
Foods containing fat
and foods containing
sugar often provide a lot
of calories and a lower
proportion of other
nutrients.
Foods containing fat
include:
Reduce the amount
of foods containing
visible fat for
example, margarine
and butter, cooking
oils and mayonnaise.
Other foods
containing fat such as
cakes and biscuits
should be eaten
occasionally
Foods and drinks
containing sugar
often contain few
other nutrients and
frequent consumption
between meals can
contribute to tooth
decay
Some foods in this
group are also high in
sodium/salt
Butter, margarine,
other spreading fats
and low fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
gravies.
Foods and drinks
containing sugar
include:
Soft drinks, sweets,
chocolate, jams, sugar,
cakes, puddings,
biscuits, pastries and
ice cream
Tips
•
•
•
•
•
•
•
•
•
•
•
Use mono- or poly-unsaturated fat spreads.
Use cooking oils high in monounsaturates such as soya, rapeseed or olive oils
Avoid serving pastry dishes frequently.
Measure oil for cooking carefully and reduce oil used in the preparation of soups, stews and
casseroles. Vegetables can often be dry fried, steamed or stewed to form the basis of sauces
and other dishes.
Use low-fat yoghurt or non-dairy ice cream to complement puddings or pies.
Produce puddings lower in fat and sugar and incorporate fresh, tinned fruit in juice or dried fruit.
Offer water, unsweetened fruit juices and chilled milk drinks.
Serve wholegrain or plain cereals rather than sugar coated cereals.
Provide currant buns, fruit bread, melon slices, malt loaf and other lower fat bread based foods
as alternatives to cakes and biscuits.
When preparing sandwiches, try and avoid using butter or spreads if the filling is already moist.
Consider using reduced-fat spreads and opt for types that are soft straight from the fridge, so it
is easier to spread thinly.
To increase the
amount of dietary
VITAMIN D in
menus
•
•
•
•
•
Use margarine fortified with vitamin D for baking and as a fat spread.
Include an oily fish that is rich in vitamin D in the menu at least once a
week – for example, herring, mackerel, pilchards, salmon, sardines,
trout or roe. These fish contain between 5-14µg of vitamin D per 100g.
Canned tuna fish can also make a significant contribution to vitamin D
intake as it contains about 3.6µg of vitamin D per 100g.
Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin
D per 100g.
Meat and poultry contribute small but significant amounts of vitamin D.
31
3.12 Food-based guidance for food served to adults aged 75 years + on
NHS premises
Food group
Guidance
Rationale
What’s included
Bread, other cereals
and potatoes
Starchy foods should
make up a third of the
daily diet.
Foods from this group
are a good source of
energy and the main
source of a range of
nutrients in the diet.
As well as starch,
these foods supply
fibre, calcium iron and
B vitamins.
All varieties of bread
including wholemeal
and granary bread,
chappati and bagels.
Older people may
prefer white bread, and
higher fibre white bread
may also be
acceptable,
A variety of breads
should be available
daily as starters or
meal accompaniments.
Offer a variety of
starchy foods with
main meals including
potatoes, rice, pasta,
noodles and other
grains.
Potatoes, plantain, yam
and sweet potato
Breakfast cereals
Rice, couscous, bulgar
wheat, maize, cornmeal
Wholegrain cereals
provide fibre
Noodles, pasta
Tips
•
•
•
•
•
•
Older people with small appetites need nutrient-dense meals and, if there is concern about how
much someone is eating, starchy foods should be offered in moderate amounts. Avoid very
high-fibre cereals unless an older person has a very good appetite.
Some white bread has added nutrients and fibre and can be useful for older people who do not
like brown or wholemeal bread.
Some older people find it easier to chew brown or wholemeal bread if it is lightly toasted.
Some breakfast cereals are nutrient-fortified (e.g. they may have added iron, folic acid, vitamin
D and other nutrients). These can be good choices for breakfast but look for those with a lower
salt content.
Boil potatoes in the minimum amount of water and for the shortest amount of time to retain
vitamins, but ensure they are cooked until soft. Roast potatoes in small amounts of vegetable
oil and use milk to mash potatoes to smoothness.
If you have customers who are allergic to wheat, oats, barley or rye, good alternatives are foods
made from maize (i.e. polenta), rice, rice flour, potatoes, potato flour, buckwheat, sago, tapioca,
soya and soya flour. Seek expert advice from a dietitian where necessary.
32
Food group
Guidance
Rationale
What’s included
Fruit and vegetables
Fruit and vegetables
should make up about
a third of the daily diet.
Fruit and vegetables
are good sources of
many vitamins and
minerals.
All types of fresh,
frozen and tinned
vegetables – e.g.
broccoli, Brussels
sprouts, cabbage,
carrots, frozen peas,
swede, green beans.
It’s important to offer at
least 5 different fruits
and vegetables every
day.
Aim for 1 or 2 portions
with each meal and
offer fruit as a snack.
A portion of fresh or
cooked fruit or
vegetables should be
about 80g.
1 portion of dried fruit
can be about 40g.
(Dried fruit only counts
once per day.)
1 glass of fruit juice = 1
portion (however much
is consumed in a day)
There is increasing
evidence that
consuming more than
400g of fruit and
vegetables every day
reduces the risk of
developing chronic
diseases such as
coronary heart disease
and some cancers.
All types of salad
vegetables including
lettuce, cucumber,
tomato, raw carrots,
peppers and beetroot.
All types of fresh fruit –
e.g. apples, bananas,
kiwi fruit, oranges,
pears, mango and
plums.
All types of tinned fruit
in juice – e.g.
pineapple or peaches
Stewed fruit
Dried fruit
Beans and pulses only
count as a maximum
of 1 portion per day.
Fruit juice (100% juice)
Tips
•
•
•
•
•
•
•
•
•
Steaming or cooking vegetables with minimum amounts of water and serving as soon as
possible will help retain vitamins.
Use fresh fruit and vegetables as soon as possible, rather than storing them, to avoid vitamin
loss.
Offer fruit as a snack. Older people may find it difficult to peel or cut whole fruit, so a plate of
sliced ready prepared fruits may be more acceptable.
Add vegetables and pulses to stews, casseroles or other dishes and offer a variety of
vegetables at main meals.
Baked beans (as a vegetable) should be served a maximum of twice a week.
Encourage a daily glass of 100% fruit juice with breakfast or with a main meal.
Buy tinned fruit in natural juice rather than in syrup.
Offer a variety of dried fruits to add to cereal options and porridge and include dried fruit in
cakes and desserts.
Pureed stewed fruit can be offered with custard or yoghurt or ice cream as dessert
33
Food group
Guidance
Rationale
What’s included
Milk and dairy
products
Milk and dairy foods
should be served
every day.
Milk and dairy
products are
excellent sources of
calcium which is
needed for optimal
bone strength
protein, vitamin A,
riboflavin and vitamin
D.
All types of milk.
Moderate amounts
should be offered 2-3
times a day as milk in
drinks, cheese,
yoghurt or milkbased puddings and
sauces.
Dried milk, goat’s and
sheep’s milk.
Cheeses – e.g. Cheddar,
cottage cheese, cheese
spreads, brie, feta, Edam,
goat’s cheese, Stilton,
Parmesan.
Yoghurt (fruit or plain,
whole milk or low-fat), or
fromage frais.
Older people with
small appetites who
may need to gain
weight or who are of
low weight should be
encouraged to have
full-fat milk and
yoghurt.
Milk-based sauces, custard
and milk puddings.
Semi-skimmed milk
is suitable for older
people with good
appetites.
Tips
•
•
•
•
•
•
•
•
To add extra calories, protein and nutrients to dishes, extra milk, cheese or dried milk powder
can be added in cooking.
Whole milk can be fortified further by the addition of extra dried skimmed milk powder for those
older people who are of low weight or who have small appetites.
Offer milky drinks at snacks and before bed. Milkshakes may be an acceptable alternative,
particularly in hot weather.
Frozen yoghurts can be offered as an alternative to ice cream.
Milk can be used in sweet and savoury sauces, custards and puddings.
Smooth yoghurt and fromage frais can be offered as a snack and is useful if older people have
eating difficulties.
It is worth highlighting that some dairy products can contain high salt levels. Strong cheese can
impart flavour in smaller amounts.
For dairy-free diets, serve soya drinks (fortified with calcium) as an alternative.
34
Food group
Guidance
Rationale
What’s included
Meat, fish and meat
alternatives
A meat or alternative
should be offered at all
main meals.
Meat is a good source
of protein and of
vitamins and minerals
such as iron and zinc
Meat, poultry, offal1,
fish, eggs, nuts, beans,
pulses and meat
alternatives.
Red meat should be
offered a minimum of
twice a week.
Fish is an excellent
protein source and
contains selenium and
iodine.
Meat includes all cuts
of beef, lamb and pork
and meat and meat
products such as ham,
corned beef and
sausages. Look for
meat products with a
high meat content.
Use lean meat (with a
fat content of about
10%).
Fish should be offered
at least twice a week.
It is strongly
recommended that oily
fish should be served
once a week.
Meat alternatives for
vegetarians should be
varied and use a
variety of foods from
this group (e.g. eggs,
peas, beans and
pulses, soy-based
meat alternatives,
nuts, quorn or tofu).
Oil-rich fish provides
omega-3 fatty acids
which may help to
prevent heart disease.
Such foods are also a
source of vitamins A
and D, and iron.
Beans and pulses are
sources of protein, iron
and zinc.
Eggs are a good
source of protein,
vitamins A and D
Nuts provide a source
of protein, iron, fibre,
zinc and calcium.
Fish includes fresh,
frozen and tinned fish,
such as tuna, sardines,
pilchards and
mackerel, and fish
products such as fish
cakes and fish fingers.
Oily fish, such as
salmon and sardines.
Beans – e.g baked
beans, butter beans,
kidney beans and
lentils are in this group
and provide a good
source of protein for
vegetarians.
Tips
•
•
•
•
•
•
•
•
Always select the leanest cuts of meat and remove visible fat and poultry skin.
Reduce the amount of processed meat and fish products which are high in fat and salt, such as
crumb-coated chicken products, burgers, pies and canned meats. These are often high in salt
and low in meat content.
Customers need to be made aware of nuts and nut products incorporated into dishes.
Eggs are a useful source of nutrients but they should always be well cooked for older people.
Oil-rich fish can be used in pâtés and spreads on bread and toast.
Liver pâté is a useful source of nutrients for older people but liver and liver products should not
be served more than once a week.
For older people who have difficulty chewing, offer soft lean meat and fish or meat and fish
dishes where the meat has been minced or served in a sauce.
1
Liver and liver pâté are very rich in vitamin A and it is recommended that these foods are
consumed no more than once a week
35
Food group
Guidance
Rationale
What’s included
Foods
containing fat
and foods
and drinks
containing
sugar
These foods add palatability to
the diet and can be useful in
the diets of older people for
encouraging eating and
stimulating the appetite.
The main nutrients
provided by such foods
are fat, including some
essential fatty acids,
and also some fatsoluble vitamins.
Foods containing fat
include: butter,
margarine, other
spreading fats and
low-fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
and gravies.
These foods can be high in
calories and offer few other
nutrients. If appetites are poor,
it is important that these foods
do not displace more nutrientrich foods.
As for the rest of the
population, foods from this
group can contribute to excess
energy intakes if they are
eaten in large amounts.
Snacking on sugary foods and
drinks throughout the day is
discouraged as this can cause
tooth decay. Older people may
enjoy some sweet foods as
snacks, and moderate
amounts of these foods are
acceptable.
Carbohydrate (in the
form of sugars) is also
provided.
Some foods in this
group also contain salt.
Foods containing
sugar include: soft
drinks, sweets, jams
and sugar, as well as
foods such as cakes,
puddings, biscuits,
pastries and ice
cream.
Tips
Use mono- and poly- unsaturated fats wherever possible for cooking, spreading and in dressings.
Good choices of cooking and salad dressing fats include soya, rapeseed and olive oils and good
choices of fat spread are those made from sunflower oil, soya oil or olive oil.
Vitamin D
To increase the amount of dietary vitamin D in menus served to older people:
• Use margarine fortified with vitamin D for baking and as a fat spread.
• Include an oily fish that is rich in vitamin D in the menu at least once a week – for example,
herring, mackerel, pilchards, salmon, sardines, trout or roe. These fish contain between 514µg of vitamin D per 100g.
• Canned tuna fish can also make a significant contribution to vitamin D intake as it contains
about 3.6µg of vitamin D per 100g.
• Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin D per 100g.
• Meat and poultry contribute small but significant amounts of vitamin D.
36
3.13 Example menu for those eating all their meals and snacks on NHS
premises
An example menu which shows the types and amounts of foods and drinks that would
meet the nutrient based guidance for adults aged 19-74 years is shown in section 3.12.
This is an example only: many NHS setting may offer more choices at meals and
snacks and may also offer a range of special diet options which are not covered by this
report.
This menu is based on the portion sizes that would be needed by those aged 19-74
years to meet the nutrient guidance. For those aged 5-18 years and those aged 75
years +, smaller, or larger, portion sizes of these foods are likely to provide appropriate
amounts of nutrients.
Further information about how to encourage eating well for young people and older
people can be found in the sections:
4.0 Nutritional guidelines for children and young people aged 5-18 years in
residential accommodation and
6.0 Nutritional guidelines for older people in residential care.
40
3.14 Example menu for those eating all their meals and snacks on NHS premises
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
BREAKFAST
Fruit choice
Cereal
choice
Cooked
choice 1
Cooked
choice 2
Cooked
choice 3
Bread
choice
Drinks
Orange juice (200ml), grapefruit juice (200ml), grapefruit segments (105g), prunes (50g), or fruit
compote (105g)
Weet bisks (20g), Shredded wheat (22g), or Bran flakes (21g) with semi-skimmed milk (100g),
or porridge (110g)
Bacon – reduced salt (25g) or sausage – lean (35g)
with baked beans – lower salt and sugar (80g) or grilled tomato (80g)
Scrambled egg (60g) or poached egg (50g)
Kedgeree – reduced salt (200g)
Slice white toast (27g), wholemeal toast (31g), white bread (31g) or wholemeal bread (35g), with
low fat spread (7g) and jam (15g) or marmalade (15g)
Water, tea or coffee with semi-skimmed milk (30ml)
MID MORNING SNACK
Tea or coffee with Semi-skimmed milk (30ml), with
Digestive biscuit (13g) or Oat based biscuit (15g)
LUNCH
Tomato
and lentil
soup
(180g)
Beef
Olives
(150g)
Gravy
(50g)
Courgette
and
watercress
soup (180g)
Irish Stew
(190g)
Tomato soup
(180g)
Scotch
broth
(180g)
Mushroom
soup
(180g)
Onion soup
(180g)
Spicy lentil
soup (180g)
Chicken and
mushroom
pasta (340g)
Pork and
potato
bake
(260g)
Braised
Steak
(120g)
Gravy (50g)
Lamb Curry
(200g)
Main choice
2
Vegetable
shepherd
s pie
200g
Vegetable
bake (90g)
(110g)
Mixed bean
casserole
(250g)
Mixed
vegetable
crumble
(160g)
Mushroom
stroganoff
(150g)
Vegetable
chilli (150g)
Roast Beef
(70g) and
Yorkshire
Pudding
(35g)
Gravy 50g)
Vegetable
lasagne
(240g)
Main choice
3
Goujons
of fish
(80g) with
tartare
sauce
(10g)
Chips
(100g)
Chicken
chasseur
(200g)
Prawn curry
(140g)
Tuna (45g)
Salad (50g)
Option of
Coleslaw
(40g) and/or
Potato salad
(85g)
Chicken
and
vegetable
casserole
(225g)
Salmon in
spicy
tomato
sauce
(230g)
Seafood
pasta (230g)
Tuna and
tomato
pasta (260g)
Beef stew
(150g)
Beef curry
(180g)
Oriental
beef stir fry
(135g)
Egg fried
rice (140g)
Roast
chicken
(60g)
Calypso
turkey
(165g)
Pork with
apricots
(140g)
Soup
Main choice
1
Main choice
4
40
Starchy
choice 1
Boiled new potatoes (120g), Jacket potato (120g) or Mashed potato (120g)
Starchy
choice 2
Rice (150g) or Pasta (200g)
Vegetable
choice 1
Leeks
(80g)
Cauliflower
Gratin (90g)
Aubergine in
Tomato
Sauce (90g)
Carrots
(80g)
Spinach
(80g)
Vegetable
choice 2
Broccoli
(80g)
Peas (80g)
Brussels
sprouts (80g)
Parsnips
(80g)
Mixed
diced
vegetables
(80g).
Vegetable
choice 3
Side salad (80g)
Dessert
choice 1
Fresh fruit slices (100g) or Low fat fruit yoghurt (125g)
Dessert
choice 2
Rhubarb
crumble
(100g)
with
Custard
(150g)
Chocolate
fudge
pudding
(100g)
Dessert
choice 3
Drinks
Apple Pie
(100g) with
Cream (40g)
Fruit compote
(160g) with
Custard
(150g)
Bread &
Butter
Pudding
(115g) with
Custard
(150g)
Sweet oat
cake (45g)
Apple
crumble
(100g) with
Custard
(150g)
French
beans (80g)
with tomato
sauce (10g)
Ratatouille
(90g)
Cabbage
(80g)
Apricot and
pear layer
(100g) with
Custard
(150g)
Dutch apple
tart (100g)
with Custard
(150g)
Apricots
Trifle (150g)
Bakewell
Lemon
canned in
tart (100g)
Meringue
juice (125g)
pie (100g)
with Custard
(150g)
Water, tea, coffee (with semi-skimmed milk 30ml), 100% fruit juice (150ml)
Curly kale
(80g)
Chocolate
mousse
(100g)
MID AFTERNOON SNACK
Tea or coffee with semi-skimmed milk (30ml)
Fruit loaf (45g), Madeira cake (45g), banana bread (45g)
EVENING MEAL
Bread
Bread roll selection – granary, wholemeal, crusty white and soft white rolls with soft margarine (60g)
Main choice
1
Fish Pie
(220g)
Baked cod
(70g)
Main choice
2
Chicken
and
broccoli
lasagne
(300g)
Macaroni
cheese
(250g)
Main choice
3
Cheese
salad
(90g)
Oriental
chicken
curried rice
Steamed fish
with Ginger
and Spring
Onion (70g)
Vegetable
curry (225g)
Breaded
cod (95g)
Chicken
dansak
(230g)
Kedgeree –
reduced salt
(200g)
Plaice
Veronique
(100g)
Vegetable
pie (250g)
Vegetable
crumble
(160g)
Cheese and
onion
turnovers
(120g)
Mushroom
and pepper
bake (120g)
Chicken salad
(100g)
Option of
Cottage
cheese &
pineapple
Salmon
(salad
(95g)
Corned beef
salad (100g)
Turkey
salad (100g)
1
Coleslaw
(40g)
and/or
Potato
salad
(85g)
Starchy
choice 1
(300g)
Mixed salad
(50g)
Coleslaw
(40g) and/or
Potato salad
(85g)
salad
Option of
Option of
(100g)
Coleslaw
Coleslaw
Option of
(40g)
(40g) and/or
Coleslaw
and/or
Potato salad
(40g)
Potato
(85g)
and/or
salad (85g)
Potato
salad (85g)
Boiled new potatoes (120g), Jacket potato (120g) or Mashed potato (120g)
Starchy
choice 2
Rice (150g) or Pasta (200g)
Vegetable
choice 1
Spinach
(80g)
Vegetable
choice 2
Ratatouill
e (90g)
Vegetable
choice 3
Coleslaw
(40g) and/or
Potato salad
(85g)
Leeks (80g)
Cabbage
(80g)
French
beans (80g)
with tomato
sauce (10g)
Side salad (80g)
Parsnips
(80g)
Aubergine
in Tomato
Sauce
(90g)
Peas (80g)
Curly kale
(80g)
Brussels
sprouts
(80g)
Cauliflower
gratin (90g)
Carrots
(80g)
Mixed diced
vegetables
(80g).
Broccoli
(80g)
Dessert
choice 1
Fresh fruit (100g) or low fat fruit yoghurt (125g)
Dessert
choice 2
Muesli
Chocolate
Flapjack (55g) Spiced
Fruit tea
Sultana
slice
brownie
apple slice
bake (50g)
sponge
(50g)
(60g)
(50g)
(50g)
Melon
Fruit jelly
Fresh fruit
Poached
Fruit flan
Rhubarb
and grape (160g)
salad (120g)
pear (140g) (150g)
fool (120g)
salad
(120g)
Water, tea or coffee with semi-skimmed milk (30ml), 100% fruit juice (150ml)
Dessert
choice 3
Drinks
Option of
Coleslaw
(40g) and/or
Potato salad
(85g)
Flapjack
(60g)
Tropical fruit
salad (120g)
EVENING DRINK
Tea or coffee with semi-skimmed milk (30ml), hot chocolate (218g), Horlicks (218g) or Ovaltine (218g)
Water and 100% fruit juice should be available with main meals
Water should be freely available throughout the day
Please Note
1
The portion sizes outlined here are for adults aged 19-74 years. The analysis of this menu is
compared with the guidance for an adult of this age below.
For those aged 5-18 years and those aged 75 years +, smaller, or larger, portion sizes of these
foods are likely to provide appropriate amounts of nutrients for those who do not have specific
nutritional needs.
.
2
3.15 Analysis of NHS menu compared with the guidance for adults aged
19-74 years
Energy
kcals
MJ
Dietary reference
value (DRV)
Adults
19-74
years
Menu
analysis
EAR
2225
9.4
2225
9.4
Fat
g
No more than 35%
of energy
MAX
87
64
Saturated fat
g
No more than 11%
of energy
MAX
27
23
Total
carbohydrate
g
At least 50% of
energy
MIN
297
343
Non-milk
extrinsic
sugars
g
No more than 11%
of energy
MAX
65
65
Fibre
g
DRV
MIN
18
22.5
Protein
g
RNI
MIN
50
92.9
Vitamin A
µg
RNI
MIN
700
1497
Vitamin C
mg
RNI
MIN
40
197
Folate
μg
RNI
MIN
200
427
Calcium
mg
RNI
MIN
700
1333
Iron
mg
RNI
MIN
15
17
Zinc
mg
RNI
MIN
9.5
11.3
Sodium
mg
MAX
2400
2393
MAX
6
6
Salt
1
g
SACN
recommendation
SACN
recommendation
The salt content of menus will go down as the amount of salt in common commodities such
as bread is reduced
40
4.0
Nutritional guidelines for food served to adults in
residential accommodation
4.1 Background
There are a number of reasons why adults might be in residential accommodation.
The majority of adults living in residential accommodation however are likely to have
some form of physical or learning disability. It is estimated that there are about 1.5
million people with learning disabilities in the UK, and approximately 40% of this
population group live in some form of residential accommodation. 1
There is considerable evidence that the nutritional status of people with learning
disabilities is frequently poor. Studies have shown that people with learning
disabilities are frequently both underweight and overweight 2 and that their diets are
frequently inadequate 3 . Poor intakes of fruits and vegetables, low fibre, high fat diets
have been reported. There is currently a lack of good data reviewing the diets of
people with learning disabilities in the UK.
4.2 Who are these nutritional guidelines for?
These guidelines apply to all adults aged 19-74 years in residential accommodation
who do not have special dietary requirements. Nutrient guidelines for adults aged
over 75 years can be found in section 6.0. This guidance is therefore not appropriate
for those catering for adults with any medical condition which requires a therapeutic
diet or any disability which requires dietary manipulation. Advice on special diets
should be sought from a Registered Dietitian.
4.3 Rationale for nutrient based guidance for food served to adults aged
19-74 years in residential accommodation
The majority of adults in residential care have the same needs for a healthy balanced
diet as all other adults in the population. The rationale here is based on the current
evidence available for all adults in the population.
1
http://www.mencap.org.uk/html/press_office/fact_figures.asp
Emerson E 2005. Underweight, obesity and exercise among adults with intellectual disabilities in
supported accommodation in Northern England. Journal of Intellectual Disability Research, 49, 134143
3
Robertson J, Emerson E, Gregory N, Hatton C et al. Lifestyle related risk factors for poor health in
residential settings for people with intellectual disabilities. Research in Developmental Disabilities, 21,
469-486
2
The National Diet and Nutrition Survey 4 (NDNS) of adults aged 19-64, carried out in
2002, has raised several key concerns with regards to nutrient intake and the
nutritional status of this population group.
Energy (calories) and fat intake
Adults’ total carbohydrate intake is close to the dietary reference value (DRV) 5 of
50% of food energy for both men and women and since the last adult survey carried
out in 1986/87 6 total fat intake has decreased. However, the proportion of energy
derived from saturated fat still exceeds the dietary reference value of 11% of food
energy. Also, in the 2002 survey the percentage of food energy derived from nonmilk extrinsic sugars was 13.6% for men and 11.9% for women – exceeding the DRV
of 11% of food energy. Intakes were higher in the younger age groups (19-24 years).
Non-starch polysaccharides (NSP, or fibre)
In the survey of 19-64 year olds, the mean daily intake of non-starch polysaccharides
(NSP) was below the recommended average intake of 18g per day for all sex and
age groups, and a third of adults had intakes of less than 12g a day. Intakes were
particularly low among those in the younger age group (19-24 years) where average
intakes were 12.3g for men and 10.6 for women.
Vitamins
In the 2002 survey, adults’ average intakes of all vitamins were close to the
Reference Nutrient Intake (RNI) for all sex and age groups, except for vitamin A in
the youngest groups, where results were below the RNI. Assessments of nutritional
status indicated issues regarding low vitamin D status as well as inadequate vitamin
C and folate concentrations among some individuals. Adults who rarely go outside, or
who wear very restrictive clothing will not get sufficient Vitamin D from their diet alone
and are likely to need vitamin D supplements.
Minerals
Iron intakes in women were well below the RNI in all but the oldest age group. Over
40% of those women in the two youngest age groups had iron intakes below the
LRNI (Lower Reference Nutrient Intake). Assessments of nutritional status indicated
issues regarding low iron status, with 8% of women and 3% of men having signs of
4
Henderson L et al 2002 and 2003. The National Diet and Nutrition Survey: Adults Aged 19-64 Years,
Volumes 1-4. TSO. London
5
Department of Health 1991. Dietary Reference Values for Food Energy and Nutrients for the United
Kingdom. Report on Health and Social Subjects No. 43. HMSO. London
6
Gregory J et al 1990. The National Dietary and Nutritional Survey of British Adults. HMSO. London.
anaemia and 11% of women and 4% men having low serum ferritin levels (another
measure of low iron status).
The average intakes of some other minerals were below the RNI for a number of sex
and age groups. Results indicated low intakes of potassium and magnesium, which
were well below the RNI for the youngest male group and below the RNI for all
female age groups. Issues regarding low intakes of iodine and zinc were also
apparent in the younger female groups, and concerns with intakes of calcium and
copper were also highlighted.
Sodium/salt
In the 2002 survey, the average salt intake for adults was estimated at 9.5g per day
overall (based on mean urinary sodium excretion levels per 24 hours of 187.4mmol
per day for men and 138.5mmol per day for women.) This result represents a slight
increase from the 1986/87 adult survey and average intakes in all sex and age
groups were well above the recommended maximum daily intake of 6g per day 7 .
Fruit and vegetables
The National Diet and Nutrition Survey reported that few adults achieved the 5
portions of fruit and vegetables recommended each day – with men and women
having on average less than 3 portions a day.
Overweight and obesity
Data on overweight and obesity levels among adults in the UK from the 2004 Health
Survey for England 8 and The Scottish Health Survey 2003
9
suggest that a
significant proportion of adult men and women are now obese (with a body mass
index of more than 30kg/m2). Nearly a quarter (23.6%) of men and 16% of women in
England and 22.4% men and 26% of women in Scotland are reported to be obese
and approximately two-thirds of all adults are overweight (with a body mass index
7
Scientific Advisory Committee on Nutrition 2003. Salt and Health. TSO. London
Data from Healthy Survey for England 2004 accessed from:
http://www.ic.nhs.uk/pubs/hlthsvyeng2004upd
9
Scottish Executive 2005. The Scottish Health Survey. Scottish Executive. Edinburgh.
8
greater than 25 kg/m2). Similar levels of overweight and obesity are found in Wales 10
and Northern Ireland 11 .
Given the rising levels of obesity in the UK, it is important not to exceed average
energy (calorie) requirements. It is therefore suggested that main meals should
provide nutrient-dense food – that is, food which contains high levels of nutrients –
but that these foods should not be correspondingly higher in calories. Those
individuals who are in the normal range for bodyweight (BMI 20-25 kg/m2) but who
have higher energy needs because they use up more calories (because they either
have a larger body size, or do more activity, or both) should have the opportunity to
eat more carbohydrate-based foods at meals to meet their higher energy
requirements without disproportionately increasing their intake of fat, saturated fat,
sugar or salt.
Based on the most recent assessments of nutritional status for the UK population, it
appears that it may also be prudent to ensure that food served in public institutions at
breakfast and at main meals provides enhanced amounts of fibre, iron, folate, vitamin
C and zinc. In order to ensure that population maximum intakes of fat, saturated fat,
sugars and salt are within current recommendations, it is important that these
nutrients are not exceeded in the guidance suggested. Another priority is to ensure
that meals offer the opportunity to increase fruit and vegetable intakes.
The example menu provided here for adults aged 19-74 years outlines the sorts of
foods and drinks that could be offered to ensure that adults have the opportunity to
consume a healthy, balanced diet that corrects current insufficiencies and provides
amounts of fat, saturated fat, salt and sugar in line with current recommendations.
The food based guidance on pages 7-12 provides caterers with practical guidance on
how to prepare menus for adults who receive all their meals and snacks on NHS
premises.
10
Welsh Health Survey October 2003 - March 2004. Accessed from:
wales.gov.uk/keypubstatisticsforwales/content/publication/health/2004/sdr82-2004/sdr82-2004.pdf
11
Northern Ireland Health and Social Wellbeing Survey 2001. Accessed from:
www.csu.nisra.gov.uk/archive/Surveys/HWB/publications/1997/Health%20&%20lifestyle%20report%
201997.pdf
Table 4.1 Nutrient based guidelines for food served to adults aged 19-74
years in residential accommodation
Energy
Dietary reference
value (DRV)
Adults
19-74 years
EAR
2225
9.4
kcals
MJ
Fat
g
No more than 35%
of energy
MAX
87
Saturated fat
g
No more than 11%
of energy
MAX
27
Total
carbohydrate
g
At least 50% of
energy
MIN
297
Non-milk
extrinsic sugars
g
No more than 11%
of energy
MAX
65
Fibre
g
DRV
MIN
Protein
g
RNI
MIN
Vitamin A
µg
RNI
MIN
Vitamin D
µg
RNI
MIN
Vitamin C
mg
RNI
MIN
Folate
μg
RNI
MIN
Calcium
mg
RNI
MIN
Iron
mg
RNI
MIN
Zinc
mg
RNI
MIN
Sodium
mg
Salt
g
SACN
recommendation
SACN
recommendation
EAR = Estimated Average Requirement
RNI = Reference Nutrient Intake
For explanation of terms see glossary
MAX
MAX
18
50
700
-*
40
200
700
15
9.5
2400
6
DRV = Dietary Reference Value
* Vitamin D
It is difficult for adults to get all the vitamin D they require through the diet and most adults will
also make Vitamin D on exposure of the skin to sunlight during the summer months. Adults
who rarely go outside or who go outside infrequently and who wear clothing which means
their skin is not exposed to the sun are likely to require vitamin D supplements.
4.3 Food based guidance for menu planners
The following pages contain some information for caterers about food groups and
how to choose foods which will contribute to a healthy balanced diet. It is also useful
for caterers to look at food labels on foods and ingredients they buy or use and to
choose those that are lower in salt, sugar and fat.
The Food Standard’s Agency provides information on what is ‘a lot’ of salt, sugar and
fat in foods and these are outlined below.
Foods high in salt have
1.25 grams or more salt per 100grams or 500
milligrams of sodium per 100 grams of food
Foods high in sugar have
10 grams or more of sugars per 100 grams of
food
Foods high in fat have
20 grams or more of fat per 100 grams of food
Foods high in saturated fat have
5 grams of saturated fat or more per 100 grams
of food
For more information about nutritional information on food labels see
www.eatwell.gov.uk
Additional information about foods which are good sources of some of the nutrients
which appear to be insufficient in the diets of some people in the UK can be found in
Appendix 2.
Fluid intakes
It is important that everyone has access to adequate fluid intakes throughout the day.
In climates such as the UK, we should drink approximately 1.2 litres (6 to 8 glasses)
of fluid every day to stop us getting dehydrated. In hotter climates the body needs
more than this. We get some fluid from the food we eat but it is important that fluids
are not restricted since dehydration can lead to headaches, confusion and irritability
and lack of concentration as well as constipation and potentially urinary tract
infections. Clean, chilled water should always be available with meals and between
meals.
4.4 Food-based guidelines for food served to adults aged 19-74 years in
residential accommodation
Food Group
Guidance
Rationale
What’s Included
Bread, other cereals
and potatoes
Starchy foods should
make up a third of the
daily diet.
Starchy foods are a
good source of energy
and the main source
of a range of nutrients
in the diet. As well as
starch, these foods
supply fibre, calcium
iron and B vitamins.
All varieties of bread
including wholemeal,
granary, seeded,
chapattis, bagels, roti,
tortillas, pitta bread
A variety of breads
should be available
daily at every meal
Different starchy foods
should be offered in
main meals throughout
the week so that a
variety of starchy foods
are included. Aim to
include pasta and rice
on the menu once a
week
Potatoes, yam, sweet
potato, plantain,
cocoyam, dasheen,
breadfruit, cassava
Breakfast cereals
Rice, couscous, bulgar
wheat, maize (polenta),
cornmeal
Noodles, spaghetti and
other pastas
Wholegrain and
wholemeal cereal
foods are a good
source of fibre and
other nutrients
Tips
•
•
•
•
•
•
•
•
•
Serve more pasta and rice and use less sauce. Opt for tomato based sauces instead of
cheese-based to reduce fat content
When serving rice and pasta, try to use wholemeal, wholegrain, brown or high fibre versions.
Some breakfast cereals are nutrient fortified (have added iron, folic acid and other vitamins and
minerals). Choose wholegrain cereals or mix some in with other cereals.
Offer a variety of breads, such as seeded, wholegrain and granary and use thicker slices with
low-fat options for fillings
Large pieces of potato and thick or straight cut chips absorb less fat
Boil potatoes in the minimum amount of water and for the shortest amount of time to retain
vitamins.
Use herbs or other shredded vegetables to add colour and flavour to baked potatoes, rather
than butter or margarine.
If you look after young people who have allergies to wheat, oats, barley and rye: good
alternatives to offer are foods made from maize (e.g. polenta), rice, rice flour, potatoes, potato
flour, buckwheat, sago, tapioca, soya and soya flour.
Cereal foods which are good sources of iron and zinc include fortified cereals, whole grain
cereals, wholemeal bread and flour, couscous and wholemeal pasta.
Food Group
Guidance
Rationale
What’s Included
Fruit and Vegetables
Fruit and vegetables
should make up about
a third of the daily diet.
Fruit and vegetables
are good sources of
many vitamins and
minerals.
All types of fresh,
frozen and tinned
vegetables i.e.
broccoli, Brussels
sprouts, cabbage,
carrots, frozen peas,
peppers, swede,
sweetcorn
It’s important to offer a
variety. Five-a-day is
an achievable target.
Aim for one or two
portions with each
meal and offer fruit and
vegetables as snacks.
One portion s about
80g fresh fruit and
vegetables and 40g of
dried fruit
Beans and pulses are
included but only count
as a maximum of 1
portion per day
A glass of 100% fruit
juice can count as one
portion of fruit each
day
There is evidence that
consuming 400g a day
or more of fruit and
vegetables reduces
the risk of developing
chronic diseases such
as coronary heart
disease and some
cancers.
Including fruits and
vegetables in the diet
will help to increase
the intake of fibre and
can help to reduce the
total amount of
calories consumed
among those who may
wish to lose weight
All types of salad
vegetables including
lettuce, cucumber,
tomato, raw carrots,
peppers, beetroot
All types of fresh fruit
e.g. apples, bananas,
kiwi fruit, oranges,
pears, mango, plums
All types of tinned fruit
in fruit juice e.g.
pineapple, peaches,
mandarin oranges
Stewed fruit
Dried Fruit
Fruit juice (100% juice)
Tips
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Avoid adding fat or rich sauces to vegetables or sugar or syrupy dressings to fruit
Steaming or cooking vegetables with minimum amounts of water and serving as soon as
possible will help retain vitamins.
Use fresh fruit and vegetables as soon as possible, rather than storing, to avoid vitamin loss
Incorporate fruit and vegetables in snack options. Offer a variety of healthy snack alternatives
Add vegetable and pulses to curry, casserole or stir-fry and serve at least two types of
vegetables with fish, chicken or meat.
Baked beans (as a vegetable) should be served a maximum of twice a week.
Encourage a daily glass of fruit juice (100% juice, unsweetened) with meals.
Choose tinned fruit in fruit juice not in syrup.
Add a handful of dried fruit to cereal options and porridge.
Supply a good combination of traditional salads and raw vegetables, fruits and nuts to increase
colour, taste and texture at meal times.
Add additional vegetables to savoury dishes.
Vegetable soups are a useful way of increasing vegetable intake.
Avoid dried fruit with added sugar or vegetable oil.
Fruit and vegetables which are useful sources of iron include spinach, broccoli, spring greens,
dried apricots, raisins, baked beans, broad beans and blackcurrants.
Fruit and vegetables which are useful sources of folate include spinach, broccoli, peas,
oranges, melon, green leafy salads and tomatoes.
Fruit and vegetables which are useful non-dairy sources of calcium include green leafy
vegetables, dried fruit and oranges.
Food Group
Guidance
Rationale
What’s Included
Milk and Dairy
Products
Offer dairy foods
such as milk, yoghurt
and cheese as part
of meals and snacks
Milk and dairy
products are
excellent sources of
calcium, protein,
vitamin A and vitamin
D. Calcium helps to
contribute to good
bone health
Skimmed, semi-skimmed,
whole milk
Offer low fat options
such as semiskimmed milk, low fat
yoghurt and skimmed
milk cheeses
The fat content of
different dairy
products varies and
much of this is
saturated fat.
Dried milk, goats and
sheep’s milk
All types of cheeses e.g.
Cheddar cheese, cottage
cheese, cheese spreads,
Brie, Feta, Edam, goats
cheese, Stilton, Parmesan
Yoghurt
Fromage frais
Do not rely on
cheese as the main
protein item for
vegetarians.
Where no other
option is available,
cheese served as a
sandwich filler should
be offered no more
than twice per week.
Tips
•
•
•
•
•
•
•
•
•
•
Try using very strong-tasting cheese (mature cheddar, blue cheese) if using to flavour dishes or
sauces, because less will be required.
Choose reduced-fat hard cheeses, cottage cheese and skimmed milk soft cheese.
Offer semi-skimmed or skimmed milk and low-fat yoghurts and fromage frais.
Use plain yoghurt and fromage frais instead of cream, soured cream or crème fraiche in recipes
Try serving frozen yoghurts as an alternative to ice cream.
It is worth highlighting that some dairy product can contain high salt levels. Look for lower salt
cheeses and use smaller amounts of stronger cheese.
Dairy foods are very important during pregnancy, but unpasteurised dairy produce and softmould-ripened cheese (e.g. Camembert, Brie and all blue-veined cheese) should be avoided.
For those on dairy free diets serve soya drinks fortified with calcium as an alternative.
Fresh fruit milkshakes and chilled milk drinks can be offered as snacks.
Restrict sweetened milk drinks to mealtimes as the sugars in these drinks can damage teeth.
Food Group
Guidance
Rationale
What’s Included
Meat, fish and meat
alternatives
Offer a meat or
alternative at all main
meals
Meat and meat
alternatives are a good
source of protein,
vitamins and minerals
such as iron and zinc
Use lean meat (which
has a fat content of
about 10%)
Some meat and meat
products can have a
high fat and saturated
fat content
Meat includes all cuts
of beef, pork, lamb,
poultry, offal1 and meat
products such as
bacon, sausages, beef
burgers, pies and cold
meats
Fish should be
offered at least twice
per week.
White fish is low in fat
It is strongly
recommended that
oily fish such as
salmon, trout,
mackerel, herring,
pilchards, sardines
should be served
once a week
Oil-rich fish provides a
good source of omega-3
fatty acids, which may
help to protect against
heart disease. Oil-rich
fish are also a source of
vitamins A and D.
Eggs can be served
at breakfast and as
part of main meals
Eggs are a good source
of protein, vitamin A,
vitamin D and some
minerals
Ensure meat
alternatives for
vegetarians are
varied
Beans, pulses, eggs,
meat alternatives and
nuts all provide good
sources of nutrients.
Fish includes fresh,
frozen and tinned fish,
such as tuna and
sardines, Fish
products such as fish
cakes and fish fingers
may have a low fish
content
Boiled, poached,
scrambled eggs,
omelettes
Beans and pulses
such as chick peas,
lentils, kidney beans,
butter beans, textured
vegetable protein,
nuts, soya products
such as tofu, quorn
Tips
•
•
•
•
•
•
•
•
•
•
1
Always select the leanest cuts of meat and remove visible fat and poultry skin.
Roast meat on a rack in order to let the fat run off.
Grill, poach or bake meat rather than frying. If you do fry, use clean oil and at the correct.
temperature to minimise absorption. Note that larger pieces of fish and meat absorb less fat.
Do not add extra fat or oil when cooking meat.
Use more vegetables, pulses and starchy food to extend dishes further, as well as add more
texture and flavour. Less meat is also required, reducing the fat content and the cost of the
meal.
Buy good quality meat and use smaller amounts.
Use fish from sustainable fish stocks.
Offer unsalted nuts and seeds as snacks.
Reduce the amount of processed meat products served such as meat pies and pasties, coated,
canned and composite meat products such as sausages, burgers, coated chicken products.
Reduce the amount of processed fish products on offer, particularly those that are fried or
coated such as fish fingers or fish cakes.
Liver and liver pâté are very rich in vitamin A and it is recommended that these foods are
consumed no more than once a week.
Food Group
Guidance
Rationale
What’s Included
Foods containing fat
and foods and drinks
containing sugar
These foods can add
palatability to the diet
but should be eaten
in small amounts
each day
Foods containing fat
and foods containing
sugar often provide a lot
of calories and a lower
proportion of other
nutrients.
Foods containing fat
include:
Reduce the amount
of foods containing
visible fat for
example, margarine
and butter, cooking
oils and mayonnaise.
Other foods
containing fat such as
cakes and biscuits
should be eaten
occasionally
Foods and drinks
containing sugar
often contain few
other nutrients and
frequent consumption
between meals can
contribute to tooth
decay
Some foods in this
group are also high in
sodium/salt
Butter, margarine,
other spreading fats
and low fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
gravies.
Foods and drinks
containing sugar
include:
Soft drinks, sweets,
chocolate, jams, sugar,
cakes, puddings,
biscuits, pastries and
ice cream
Tips
•
•
•
•
•
•
•
•
•
•
•
Use mono- or poly-unsaturated fat spreads
Use cooking oils high in monounsaturates such as soya, rapeseed or olive oils
Avoid serving pastry dishes frequently
Measure oil for cooking carefully and reduce oil used in the preparation of soups, stews and
casseroles. Vegetables can often be dry fried, steamed or stewed to form the basis of sauces
and other dishes
Use low-fat yoghurt or non-dairy ice cream to complement puddings or pies.
Produce puddings lower in fat and sugar and incorporate fresh, tinned fruit in juice or dried fruit.
Offer water, unsweetened fruit juices and chilled milk drinks
Serve wholegrain or plain cereals rather than sugar coated cereals
Provide currant buns, fruit bread, melon slices, malt loaf and other lower fat bread based foods
as alternatives to cakes and biscuits.
When preparing sandwiches, try and avoid using butter or spreads if the filling is already moist.
Consider using reduced-fat spreads and opt for types that are soft straight from the fridge, so it
is easier to spread thinly.
To increase the
amount of dietary
VITAMIN D in
menus
•
•
•
•
•
Use margarine fortified with vitamin D for baking and as a fat spread.
Include an oily fish that is rich in vitamin D in the menu at least once a
week – for example, herring, mackerel, pilchards, salmon, sardines,
trout or roe. These fish contain between 5-14µg of vitamin D per 100g.
Canned tuna fish can also make a significant contribution to vitamin D
intake as it contains about 3.6µg of vitamin D per 100g.
Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin
D per 100g.
Meat and poultry contribute small but significant amounts of vitamin D.
4.5 Example menu for adults aged 19-74 years in residential
accommodation
An example menu is given here which show the sorts of foods, and the amounts of
these foods, that could be served to meet the nutritional and food-based guidance for
adults in residential accommodation. The analysis of the menu is included on page
16.
The example menu shown here includes a sandwich style lunch, however this is just
an example. Caterers may wish to offer a variety of hot and cold meals at lunch and
tea and may choose to offer one, two or more choices depending on the client
groups that they serve.
4.6 Example menu for adults in residential accommodation
Monday
Breakfast
Midmorning
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Raw carrots/cucumber/pepper slices (40g)
Pizza with choice of
toppings (240g)
Coleslaw (80g)
Jacket potatoes (220g)
Roast turkey (80g)
Stuffing (30g)
Roast potato (200g)
Carrots (80g)
Broccoli (80g)
Currant bun/fruit bread/malt loaf/fortified cereal bar/crunchy muesli bar (20-75g)
or
Fromage frais or yoghurt (60-125g)
Vegetable lasagne (v)
(300g)
Peas (80g)
Breakfast cereal (37g) (average of bran flakes/puffed wheat/wheat bisks)
Semi-skimmed milk (100ml)
Orange juice (150ml)
Wholemeal toast (63g) with polyunsaturated margarine (7g) and marmalade/jam/honey (8g)
Tea, coffee with semi-skimmed milk (30ml)
Apple/banana/Satsuma/pear or other fresh fruit snack (100g)
Tea, coffee, water
Lunch
Water or
100% fruit
juice
Choice of sandwiches (75-110g) made with brown or white bread or wraps filled with cheese/tuna
fish/corned beef/ham/egg mayonnaise/chicken tikka/sweetcorn/tomato/cress
or
Dried fruit snack (40g)
Banana custard (150g)
or
Ice cream and topping
sauce (60g)
Lentil roast (v) (170g)
New potatoes (200g)
Green beans (80g)
Fresh fruit salad and
ice cream (150g)
or
Lemon meringue pie
(100g)
Midafternoon
Tea,
coffee,
water
Water or
100% fruit
juice
available
Banana bread
(70g)
Date bars (75g)
Swiss roll
(40g)
Flapjack (50g)
Banana and raisin
bake (70g)
Oat bars (40g)
Chocolate yoghurt
cake (60g)
Jacket potato
(220g)
with savoury
mince filling
(200g)
Green beans
(80g)
Chicken and
vegetable stir-fry
(270g)
Egg noodles
(200g)
Lamb and
potato hotpot
(300g)
Peas (80g)
Sardine pasta
(300g)
Crunchy salad
(90g)
Baked cod (90g)
Oven chips (150g)
Baked beans (90g)
Chicken risotto (250g)
Sweetcorn (80g)
Cherry tomatoes (80g)
Crusty bread (50g)
Polyunsaturated
margarine (7g)
Hot dogs with pork,
beef or vegetarian
sausages (115g)
Carrot and apple
salad (100g)
Mixed bean salad
(100g)
or
Lentil and
mushroom
crumble (250g)
Tomato salad
(80g)
Crusty brown roll
(48g)
Polyunsaturated
margarine (7g)
or
Vegetarian
burgers (v) (50g)
Pasta Roma
(250g)
or
Broccoli
quiche (v)
(120g)
Crunchy
coleslaw
(80g)
Rice salad
(200g)
or
Sweetcorn and
pasta bake (v)
(300g)
Carrots (80g)
Oven chips (150g)
Or
Couscous with sweet
and sour vegetables
(v) (280g)
or
Chickpea rissoles (v)
(100g)
Spinach (80g)
New potatoes (200g)
Carrot cake
(80g)
or
Rhubarb fool
(200g)
or
Meringue baskets
with fruit (150g)
or
Mandarin oranges
and ice cream
(200g)
Pineapple crunch
(170g)
or
Lemon sorbet (100g)
Fruit mousse (80g)
or
Poached pear and custard
(270g)
Rice and
sultana
pudding
(220g)
Warm milky drink (option of Milk, Hot chocolate, Ovaltine or Horlicks -made with semi-skimmed milk) (218ml)
Wholemeal biscuits (26g) or fresh fruit (100g)
Fruit yoghurt
with crunchy
topping (150g)
Supper
Baked apples
with yoghurt
(210g)
or
Summer
pudding (150g)
Apple crumble with
custard (250g)
or
Fresh fruit (100g)
4.7 Nutritional analysis of example menu for adults in residential
accommodation
Energy
Kcals
MJ
Nutrient
based
Guideline
Average nutrient values
from sample menu
2225
9.4
2227
9.2
Fat
g
Max
87
68
Saturated fat
g
Max
27
24
Total
carbohydrate
Non milk
extrinsic sugars
Fibre
g
Min
297
346
g
Max
65
59
g
Min
18
26
Protein
g
Min
50
80
Vitamin A
µg
Min
700
1417
Vitamin C
mg
Min
40
1 73
Folate
µg
Min
200
5 11
Calcium
mg
Min
700
1300
Iron
mg
Min
15
19
Zinc
mg
Min
9.5
10
Sodium
mg
Max
2400
2212
g
Max
6
5.5
Salt1
1
The salt content of menus will go down as the amount of salt in common commodities such
as bread is reduced
5.0
Nutritional guidelines for food served in prisons
5.1 Background
In England and Wales there are 128 prisons: 91 for male prisoners and 17 for
females, 16 are Young Offender Institutions and 4 are juvenile establishments. The
prison population, at 31st March 2005 was 68,306 and consisted of 54,982 adult male
prisoners and 3,517 adult female prisoners 1 . There were 9,386 male and 421 female
prisoners under the age of 21. The Home Office Prison Population Projections
anticipates the number of prisoners to increase over the next four years from
between 76,060 – 79,490 in 2006, to between 77,380 and 91,500 in 2010.
At the end of September 2002 there were 2633 children between the ages of 15 to
17 in prison in England and Wales, just 4% of those were girls. In England and
Wales, young black people represent just 2% of the population, but inside prison,
they represent 20% of the population. Young people held in prison are particularly
vulnerable as about half of them have been looked after children and may have had
poor nutritional intakes in childhood.
The fastest growing population of prisoners is the ‘older’ prisoner: between 1992 and
2002 the population of male prisoners over 60 had more than trebled from 442 to
1359, comprising 2.6% of the male adult prison population over the age of 18. Only
5.2% of the female prison population was over the age of 50 in 2002.
A recent report by the National Audit Office has found that the overall quality of
prison catering has improved since 1998 but suggests that further improvements are
needed 2 . Prison Service catering in 2004-2005 cost £94 million, £43million of which
was spent on food and £32 million on catering staff. In each prison the governor sets
the daily food budget and this averages at £1.87 per prisoner per day, but ranges
from £1.20 to £3.41. The Scottish Prison Service spends an average of £1.57 daily.
This can be compared with the amount typically spent on a hospital in-patient of
about £2.50 per person per day
The National Audit Office highlighted a number of issues around prison food
summarised on page 2.
1
2
HM Prisons Service: Sustainable Development Report 2004-2005
National Audit Office 2006 Serving Time: Prisoner diet and exercise. The Stationery Office London
1
•
In some Scottish prisons that there has been insufficient food provided for
young men, in addition to an insufficient supply of fresh fruit and vegetables.
•
The nutritional content of food may be reduced due to long standing time after
preparation.
•
Food is often served cool or cold and is therefore less palatable.
•
The main lunch meal (often the only hot meal in the day) has been served as
early as 11.15 am and an evening meal at 4pm, leaving an interval of well
over the recommended 14 hours between meals overnight. Because of this
sometimes a snack such as biscuits or fruit may have been provided for
consumption in the evenings.
•
Whilst prisons met the standard requirements for a choice of religious and
ethnic food prisoners were not always convinced that this was the case.
Equipment for Muslim food production, such as knives and cutting boards,
pots and pans had been found with other equipment, unlabelled.
•
Prisoners are unlikely to be offered a hot meal for breakfast. It is apparent
that the majority of prisoners are provided with ‘breakfast packs’ during the
evening service. These are cold meals costing around 27p and although are
intended to be eaten for breakfast, are often consumed during the preceding
evening.
•
Salt content of meals was high with some meals containing up to 93% more
than salt than is currently recommended.
•
Fibre was found to be low in many meals owing to the low level of fresh fruit
and vegetables and wholegrain products such as bread and cereals. Most
prison meals did not appear to contain sufficient dietary fibre. Instead of the
recommended 18g dietary fibre daily, the levels ranged from 5.7g for women
prisoners’ meals to 12.7g in vegan meals for male prisoners.
•
A major concern for prisoners is that they are likely to have limited exposure
to sunlight and consequently have a greater dietary requirement for vitamin D
than the population at large. Vitamin D was not sufficiently provided by any
meals investigated by the National Audit Office.
•
Many of the meals examined were high in calories, and these exceeded
government recommendations, and were also high in saturated fatty acids.
Many of these meals relied heavily on convenience foods such as pies and
burgers and tinned food, with little use of seasonal produce.
•
Most meals offered to women prisoners provided similar energy levels as
those offered to the male prisoners.
2
One of the main findings of the report was that even though some prisons offered as
many as six options for an evening meal, meeting the recommendations for fruit and
vegetables was difficult as many meals relied on convenience foods, such as pies,
burgers, soups and noodles. These foods are often poor sources of some important
nutrients and most contain high levels of salt. Many prisons do not offer oil rich fish
every week.
5.2 Rationale for nutrient based guidelines for food served to male and
female prisoners
The amounts of energy and nutrients that are recommended for populations of males
and females aged 19-74 years have been calculated for this report and these are
given in Appendix 1 and are outlined in table 5.1.
The nutrient based guidelines are outlined for the whole day. Since not all prisoners
may have access to snacks and are therefore reliant on the food provided at
breakfast, lunch and tea for all their nutrient requirements, it is recommended here
that 100% of requirements are spread across the day. The proportions of energy and
other nutrients offered at these meals are recommended as follows:
Breakfast
20%
Lunch
40%
Evening meal
40%
Many prisoners may have access to a prison shop and will therefore be able to buy
foods to supplement their daily rations. This could mean that some prisoners
routinely eat more calories each day than they burn up and this could lead to weight
gain. It is difficult to ensure that the needs of both those individuals who have higher
energy and nutrient requirements are met whilst others do not receive more food
energy than they need. Prisoners are more likely to have excessive calories if they
frequently snack on high fat, high sugar foods between meals. It is important
however that the three meals provided to prisoners contain all the vitamins and
minerals that are needed for good health as snack foods cannot be relied on to be
good sources of these nutrients.
3
The menus suggested here are nutritionally balanced and prisoners who eat from
menus similar to these, to appetite, are likely to eat appropriate quantities of energy
and nutrients.
It is strongly suggested that there needs to be further debate about the energy
needs of prisoners who may be less active than the general population. In
addition some prisoners may have increased needs for some micronutrients.
There currently remains insufficient evidence on the requirements of prison
populations to recommend intakes that differ from current reference nutrient
intakes.
5.3 Breakfast
It is recommended here that prisoners should receive 20% of their energy and
nutrient needs at breakfast. This may be difficult to achieve if the current system of
breakfast packs used in some establishments continues since this means that the
choice of food and drink items available is severely limited. Example breakfasts
which provide 20% of daily energy and nutrient needs are included on page 13 and
prison caterers, prison staff, Governors and prisoners themselves may wish to
discuss the practical implications of supplying prisoners with more energy and
nutrients at breakfast.
5.4 Ethnic and cultural food choices
It is likely that the prison catering service will be required to offer food suitable for a
number of different ethnic and minority groups. The food customs typically observed
by different groups are shown in Appendix 3, but caterers should be aware that
individuals may have requirements different to these. It is important that prison
caterers respect the food habits and choices of different groups and understand the
importance of keeping cooking pans and utensils separate and using appropriate
ingredients in mixed meals. For example, care should be taken when using stock
products that they do not contain animal ingredients that cannot be eaten by some
groups or that animal fats or gelatine are not present in purchased foods when these
are unacceptable.
5.5 Fluid intakes
It is important that everyone has access to adequate fluid intakes throughout the day.
In climates such as the UK, we should drink approximately 1.2 litres (6 to 8 glasses)
4
of fluid every day to stop us getting dehydrated. In hotter climates the body needs
more than this. We get some fluid from the food we eat but it is important that fluids
are not restricted since dehydration can lead to headaches, confusion and irritability
and lack of concentration as well as constipation and potentially urinary tract
infections. Clean, chilled water should always be available with meals and between
meals.
5
Table 5.1 Nutrient based guidelines for food served to male and female
prisoners
Dietary reference
value (DRV)
Men
19-74 years
Women
19-74 years
kcals
MJ
EAR
2515
10.6
1930
8.1
Fat
g
No more than 35%
of energy
MAX
98
75
Saturated fat
g
No more than 11%
of energy
MAX
31
24
Total
carbohydrate
g
At least 50% of
energy
MIN
335
257
g
No more than 11%
of energy
MAX
74
57
g
DRV
MIN
18
18
Protein
g
RNI
MIN
55
45
Vitamin A
µg
RNI
MIN
700
600
Vitamin D
µg
RNI
MIN
-1
-1
Vitamin C
mg
RNI
MIN
40
40
Folate
μg
RNI
MIN
200
200
Calcium
mg
RNI
MIN
700
700
Iron
mg
RNI
MIN
9
15
Zinc
mg
RNI
MIN
9.5
7
Sodium
mg
2400
2400
6
6
Energy
Non-milk
extrinsic
sugars
Fibre
Salt
g
SACN
recommendation
SACN
recommendation
MAX
MAX
EAR = Estimated Average Requirement
For explanation of terms see Appendix 1
RNI = Reference Nutrient Intake
1
Vitamin D
It is difficult for adults to get the vitamin D they require through the diet and most adults will
also make Vitamin D on exposure of the skin to sunlight during the summer months. Adults
who rarely go outside or who go outside infrequently and who wear clothing which means
their skin is not exposed to the sun are likely to require vitamin D supplements.
6
5.6 Food based guidance for menu planners
The following pages contain some information for caterers about food groups and
how to choose foods which will contribute to a healthy balanced diet.
It is also useful for caterers to look at food labels on foods and ingredients they buy
or use and to choose those that are lower in salt, sugar and fat.
The Food Standard’s Agency provides information on what is ‘a lot’ of salt, sugar and
fat in foods and these are outlined below.
Foods high in salt have
1.25 grams or more salt per 100grams or 500
milligrams of sodium per 100 grams of food
Foods high in sugar have
10 grams or more of sugars per 100 grams of
food
Foods high in fat have
20 grams or more of fat per 100 grams of food
Foods high in saturated fat have
5 grams of saturated fat or more per 100 grams
of food
For more information about nutritional information on food labels see
www.eatwell.gov.uk
Additional information about foods which are good sources of some of the nutrients
which appear to be insufficient in the diets of some people in the UK can be found in
Appendix 2.
7
5.7 Food-based guidelines for caterers preparing food for prisons
Food Group
Guidance
Rationale
What’s Included
Bread, other cereals
and potatoes
Starchy foods should
make up a third of the
daily diet.
Starchy foods are a
good source of energy
and the main source
of a range of nutrients
in the diet. As well as
starch, these foods
supply fibre, calcium
iron and B vitamins.
All varieties of bread
including wholemeal,
granary, seeded,
chapattis, bagels, roti,
tortillas, pitta bread
A variety of breads
should be available
daily at every meal
Different starchy foods
should be offered in
main meals throughout
the week so that a
variety of starchy foods
are included. Aim to
include pasta and rice
on the menu once a
week
Potatoes, yam, sweet
potato, plantain,
cocoyam, dasheen,
breadfruit, cassava
Breakfast cereals
Rice, couscous, bulgar
wheat, maize (polenta),
cornmeal
Noodles, spaghetti and
other pastas
Wholegrain and
wholemeal cereal
foods are a good
source of fibre and
other nutrients
Tips
•
•
•
•
•
•
•
•
•
Serve more pasta and rice and use less sauce. Opt for tomato based sauces instead of
cheese-based to reduce fat content.
When serving rice and pasta, try to use wholemeal, wholegrain, brown or high fibre versions.
Some breakfast cereals are nutrient fortified (have added iron, folic acid and other vitamins and
minerals). Choose wholegrain cereals or mix some in with other cereals.
Offer a variety of breads, such as seeded, wholegrain and granary and use thicker slices with
low-fat options for fillings.
Large pieces of potato and thick or straight cut chips absorb less fat.
Boil potatoes in the minimum amount of water and for the shortest amount of time to retain
vitamins.
Use herbs or other shredded vegetables to add colour and flavour to baked potatoes, rather
than butter or margarine.
If you look after young people who have allergies to wheat, oats, barley and rye: good
alternatives to offer are foods made from maize (e.g. polenta), rice, rice flour, potatoes, potato
flour, buckwheat, sago, tapioca, soya and soya flour.
Cereal foods which are good sources of iron and zinc include fortified cereals, whole grain
cereals, wholemeal bread and flour, couscous and wholemeal pasta.
8
Food Group
Guidance
Rationale
What’s Included
Fruit and Vegetables
Fruit and vegetables
should make up about
a third of the daily diet.
Fruit and vegetables
are good sources of
many vitamins and
minerals.
All types of fresh,
frozen and tinned
vegetables i.e.
broccoli, Brussels
sprouts, cabbage,
carrots, frozen peas,
peppers, swede,
sweetcorn
It’s important to offer a
variety. Five-a-day is
an achievable target.
Aim for one or two
portions with each
meal and offer fruit and
vegetables as snacks.
One portion s about
80g fresh fruit and
vegetables and 40g of
dried fruit
Beans and pulses are
included but only count
as a maximum of 1
portion per day
A glass of 100% fruit
juice can count as one
portion of fruit each
day
There is evidence that
consuming 400g a day
or more of fruit and
vegetables reduces
the risk of developing
chronic diseases such
as coronary heart
disease and some
cancers.
Including fruits and
vegetables in the diet
will help to increase
the intake of fibre and
can help to reduce the
total amount of
calories consumed
among those who may
wish to lose weight
All types of salad
vegetables including
lettuce, cucumber,
tomato, raw carrots,
peppers, beetroot
All types of fresh fruit
e.g. apples, bananas,
kiwi fruit, oranges,
pears, mango, plums
All types of tinned fruit
in fruit juice e.g.
pineapple, peaches,
mandarin oranges
Stewed fruit
Dried Fruit
Fruit juice (100% juice)
Tips
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Avoid adding fat or rich sauces to vegetables or sugar or syrupy dressings to fruit.
Steaming or cooking vegetables with minimum amounts of water and serving as soon as
possible will help retain vitamins.
Use fresh fruit and vegetables as soon as possible, rather than storing, to avoid vitamin loss.
Incorporate fruit and vegetables in snack options. Offer a variety of healthy snack alternatives.
Add vegetable and pulses to curry, casserole or stir-fry and serve at least two types of
vegetables with fish, chicken or meat.
Baked beans (as a vegetable) should be served a maximum of twice a week.
Encourage a daily glass of fruit juice (100% juice, unsweetened) with meals.
Choose tinned fruit in fruit juice not in syrup.
Add a handful of dried fruit to cereal options and porridge.
Supply a good combination of traditional salads and raw vegetables, fruits and nuts to increase
colour, taste and texture at meal times.
Add additional vegetables to savoury dishes.
Vegetable soups are a useful way of increasing vegetable intake.
Avoid dried fruit with added sugar or vegetable oil.
Fruit and vegetables which are useful sources of iron include spinach, broccoli, spring greens,
dried apricots, raisins, baked beans, broad beans and blackcurrants.
Fruit and vegetables which are useful sources of folate include spinach, broccoli, peas,
oranges, melon, green leafy salads and tomatoes.
Fruit and vegetables which are useful non-dairy sources of calcium include green leafy
vegetables, dried fruit and oranges.
9
Food Group
Guidance
Rationale
What’s Included
Milk and Dairy
Products
Offer dairy foods
such as milk, yoghurt
and cheese as part
of meals and snacks
Milk and dairy
products are
excellent sources of
calcium, protein,
vitamin A and vitamin
D. Calcium helps to
contribute to good
bone health
Skimmed, semi-skimmed,
whole milk
Offer low fat options
such as semiskimmed milk, low fat
yoghurt and skimmed
milk cheeses
The fat content of
different dairy
products varies and
much of this is
saturated fat.
Dried milk, goats and
sheep’s milk
All types of cheeses e.g.
Cheddar cheese, cottage
cheese, cheese spreads,
Brie, feta, Edam, goats
cheese, stilton, parmesan
Yoghurt
Fromage frais
Do not rely on
cheese as the main
protein item for
vegetarians.
Where no other
option is available,
cheese served as a
sandwich filler should
be offered no more
than twice per week.
Tips
•
•
•
•
•
•
•
•
•
•
Try using very strong-tasting cheese (mature cheddar, blue cheese) if using to flavour dishes or
sauces, because less will be required.
Choose reduced-fat hard cheeses, cottage cheese and skimmed milk soft cheese.
Offer semi-skimmed or skimmed milk and low-fat yoghurts and fromage frais.
Use plain yoghurt and fromage frais instead of cream, soured cream or crème fraiche in recipes
Try serving frozen yoghurts as an alternative to ice cream.
It is worth highlighting that some dairy product can contain high salt levels. Look for lower salt
cheeses and use smaller amounts of stronger cheese.
Dairy foods are very important during pregnancy, but unpasteurised dairy produce and softmould-ripened cheese (e.g. Camembert, Brie and all blue-veined cheese) should be avoided
For those on dairy free diets serve soya drinks fortified with calcium as an alternative.
Fresh fruit milkshakes and chilled milk drinks can be offered as snacks
Restrict sweetened milk drinks to mealtimes as the sugars in these drinks can damage teeth
10
Food Group
Guidance
Rationale
What’s Included
Meat, fish and meat
alternatives
Offer a meat or
alternative at all main
meals
Meat and meat
alternatives are a good
source of protein,
vitamins and minerals
such as iron and zinc
Use lean meat (which
has a fat content of
about 10%)
Some meat and meat
products can have a
high fat and saturated
fat content
Meat includes all cuts
of beef, pork, lamb,
poultry, offal1 and meat
products such as
bacon, sausages, beef
burgers, pies and cold
meats
Fish should be
offered at least twice
per week.
White fish is low in fat
It is strongly
recommended that
oily fish such as
salmon, trout,
mackerel, herring,
pilchards, sardines
should be served
once a week
Oil-rich fish provides a
good source of omega-3
fatty acids, which may
help to protect against
heart disease. Oil-rich
fish are also a source of
vitamins A and D.
Eggs can be served
at breakfast and as
part of main meals
Eggs are a good source
of protein, vitamin A,
vitamin D and some
minerals
Beans, pulses, eggs,
meat alternatives and
nuts all provide good
sources of nutrients.
Ensure meat
alternatives for
vegetarians are
varied
Fish includes fresh,
frozen and tinned fish,
such as tuna and
sardines, Fish
products such as fish
cakes and fish fingers
may have a low fish
content
Boiled, poached,
scrambled eggs,
omelettes
Beans and pulses
such as chick peas,
lentils, kidney beans,
butter beans, textured
vegetable protein,
nuts, soya products
such as tofu, quorn
Tips
Always select the leanest cuts of meat and remove visible fat and poultry skin.
Roast meat on a rack in order to let the fat run off.
Grill, poach or bake meat rather than frying. If you do fry, use clean oil and at the correct
temperature to minimise absorption. Note that larger pieces of fish and meat absorb less fat.
•
Do not add extra fat or oil when cooking meat.
•
Use more vegetables, pulses and starchy food to extend dishes further, as well as add more
texture and flavour. Less meat is also required, reducing the fat content and the cost of the
meal.
•
Buy good quality meat and use smaller amounts.
•
Use fish from sustainable fish stocks.
•
Offer unsalted nuts and seeds as snacks.
•
Reduce the amount of processed meat products served such as meat pies and pasties, coated,
canned and composite meat products such as sausages, burgers, coated chicken products.
•
Reduce the amount of processed fish products on offer, particularly those that are fried or
coated such as fish fingers or fish cakes.
1
Liver and liver pâté are very rich in vitamin A and it is recommended that these foods are
consumed no more than once a week.
•
•
•
11
Food Group
Guidance
Rationale
What’s Included
Foods containing fat
and foods and drinks
containing sugar
These foods can add
palatability to the diet
but should be eaten
in small amounts
each day
Foods containing fat
and foods containing
sugar often provide a lot
of calories and a lower
proportion of other
nutrients.
Foods containing fat
include:
Reduce the amount
of foods containing
visible fat for
example, margarine
and butter, cooking
oils and mayonnaise.
Other foods
containing fat such as
cakes and biscuits
should be eaten
occasionally
Foods and drinks
containing sugar
often contain few
other nutrients and
frequent consumption
between meals can
contribute to tooth
decay
Some foods in this
group are also high in
sodium/salt
Butter, margarine,
other spreading fats
and low fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
gravies.
Foods and drinks
containing sugar
include:
Soft drinks, sweets,
chocolate, jams, sugar,
cakes, puddings,
biscuits, pastries and
ice cream
Tips
•
•
•
•
•
•
•
•
•
•
•
Use mono- or poly-unsaturated fat spreads.
Use cooking oils high in monounsaturates such as soya, rapeseed or olive oils.
Avoid serving pastry dishes frequently.
Measure oil for cooking carefully and reduce oil used in the preparation of soups, stews and
casseroles. Vegetables can often be dry fried, steamed or stewed to form the basis of sauces
and other dishes.
Use low-fat yoghurt or non-dairy ice cream to compliment puddings or pies.
Produce puddings lower in fat and sugar and incorporate fresh, tinned fruit in juice or dried fruit.
Offer water, unsweetened fruit juices and chilled milk drinks.
Serve wholegrain or plain cereals rather than sugar coated cereals.
Provide currant buns, fruit bread, melon slices, malt loaf and other lower fat bread based foods
as alternatives to cakes and biscuits.
When preparing sandwiches, try and avoid using butter or spreads if the filling is already moist.
Consider using reduced-fat spreads and opt for types that are soft straight from the fridge, so it
is easier to spread thinly.
To increase the
amount of dietary
VITAMIN D in
menus
•
•
•
•
•
Use margarine fortified with vitamin D for baking and as a fat spread.
Include an oily fish that is rich in vitamin D in the menu at least once a
week – for example, herring, mackerel, pilchards, salmon, sardines,
trout or roe. These fish contain between 5-14µg of vitamin D per 100g.
Canned tuna fish can also make a significant contribution to vitamin D
intake as it contains about 3.6µg of vitamin D per 100g.
Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin
D per 100g.
Meat and poultry contribute small but significant amounts of vitamin D.
12
5.8 Example breakfast menus for male and female prisoners
Example male breakfast
Example female breakfast
Carton of semi-skimmed milk (200ml)
1 piece fresh fruit (banana, apple or
orange) (108g)
1 low fat fruit yoghurt (125g)
1 brown bread roll (65g) with
polyunsaturated spread (7g)
43g dried fruit mix (apricots, dates,
raisins)
Drinking water
Semi-skimmed milk (100ml)
1 piece fresh fruit (banana, apple or
orange) (40g)
1 low fat fruit yoghurt (125g)
1 brown bread roll (48g) with low fat
spread (7g)
40g dried fruit mix (apricots, raisins,
prunes)
Drinking water
Nutrient
Males
Females
Guidance
(20%
energy and
nutrients)
Menu
analysis
Guidance
(20%
energy and
nutrients)
Menu
analysis
503
2.1
8
386
1.6
15
386
1.6
8
Energy kcals
MJ
Fat g
MAX
503
2.1
20
Saturated fat g
MAX
6
3
5
3
Carbohydrate g
MIN
67
91
51
68
Non milk extrinsic
sugars g
MAX
15
8
11
8
Fibre g
MIN
4
8
4
5
Protein g
MIN
11
21
9
15
Vitamin A μg
MIN
140
92
120
88
Vitamin C mg
MIN
8
31
8
12
Folate ug
MIN
40
98
40
66
Calcium mg
MIN
140
597
140
423
Iron mg
MIN
2
3
3
3
Zinc mg
MIN
2
2.9
1
2
Sodium mg
MAX
480
427
480
430
Salt g
MAX
1.2
1.1
1.2
1.1
13
5.9 Example weekly menu for male prisoners
(v) Suitable for Vegetarians
Lunch
1 v) Chickpea curry (100g) with spiced
vegetable pilau (320g), Punjabi
M .
courgette (80g), naan bread (80g)
O
N
D 2 Shepherd’s pie (300g) with gravy
(70g)*
A .
Y
3 Cottage pie (300g) with gravy (70g)*
.
4 (v) Butter bean and vegetable pie
.
(250g)*
Tea
1 Oriental chicken curried rice (280g) with
. egg noodles (150g)
2 (v) Cauliflower gratin* (250g)
.
3 (v) Macaroni cheese* (250g)
.
4 Corned beef hash* (245g)
.
*options served with potato dice (200g)
- all options served with broccoli florets
(80g), and wholemeal roll (48g) or
French bread ( 60g) with low fat
margarine (7g)
* options served with extra mashed
potatoes (80g) , broccoli florets (80g)
and choice of bread roll with soft
vegetable margarine (60g)
Oat biscuits (60g) or, banana and
chocolate brownie (60g)
Low fat fruit yoghurt (125g) or choice of
fresh fruit - apple (100g), banana (100g)
or orange(120g)
Spotted dick (170g) with custard
(150g) or choice of fresh fruit - apple
(100g), banana (100g) or orange(120g)
T
U
E
S
D
A
Y
1
.
Tanzanian coconut fish curry (250g),
with rice (180g), plantain (100g) and
flat bread (50g)
2
.
Fish Pie (250g) with extra mashed
potatoes (80g)* French beans (80g)
3
.
(v) Courgette and cheese bake (250g),
couscous (150g) and tomatoes stuffed
with rice(120g)*
4
.
(v) Potato & broccoli bake (280g)*
French beans (80g)
*options with choice of bread roll with
soft vegetable margarine (60g)
Chocolate fudge pudding (170g)
custard (150g), or choice of fresh fruit apple (100g), banana (100g) or
orange(120g)
14
1
.
2
.
3
.
4
.
(v) Chickpea rissoles (250g)
(v) Pasta Provencal (300g)
Chicken and broccoli lasagne (280g)
Salmon quiche (130g)
-all options served with green salad
(50g) or ratatouille (100g), and baby
jacket potatoes (200g) or mashed
potatoes (200g)
Wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
Banana tea bread (60g) or Bakewell tart
(55g)
low fat fruit yoghurt (125g) or choice of
fresh fruit - apple (100g), banana (100g)
or orange(120g)
W
E
D
N
E
S
D
A
Y
1
.
Chicken biryani (350g) lentil dahl
(175g), mixed vegetable curry (100g),
and chapatti (55g)
2
.
3
.
4
.
Chicken curry with pineapple (320g)*
(v) Caribbean casserole (250g)*,
Pork with apricot sauce (300g)*
*options served with rice (180g), diced
mixed vegetables (80g) and choice of
bread roll with soft vegetable
margarine (60g)
Crème caramel (100g)
or choice of fresh fruit - apple (100g),
banana (100g) or orange (120g)
T
H
U
R
S
D
A
Y
F
R
I
D
A
Y
1
.
African beef and bean stew (250g),
African dumplings (80g), rice (180g) &
sweet potato (100g)
2
.
Steak Hotpot (300g) Boiled potatoes
(150g) *
3
.
(v) Crunchy vegetable crumble (300g),
Jacket wedges (180g)*
4
.
Savoury pork and vegetable pie (250g)
and Gravy (70g) Boiled potatoes
(150g) *
1 Beef curry (280g) with spiced vegetable
. pilau (300g)
2 (v) Sweetcorn & pasta bake (280g)*
.
3 Kedgeree (250g)*
.
4 Scotch egg (120g)*
.
*options served with jacket potato
(200g), green salad (50g), and mixed
bean salad (100g)
Wholemeal roll (48g) or French bread
(60g), with low fat margarine (7g)
Sultana sponge cake (55g) or
gingerbread (60g)
Low fat fruit yoghurt (125g) or choice of
fresh fruit - apple (100g), banana (100g)
or orange(120g)
1 Caribbean chicken (250g) with egg
. noodles (150g)
2 (v) Lentil & tomato quiche (140g)*
.
3 (v) Cheese and tomato quiche (130g)*
.
4 Pilchards in tomato sauce (165g)*
.
*options served with Peas (80g) and
Choice of bread roll with soft vegetable
margarine (60g)
*options served with vegetable rice
salad (170g), mixed salad (50g) and
coleslaw (80g)
Wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
Rice pudding with jam (200g)
or choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
Apple cake (60g), or fruit flapjack (50g)
low fat fruit yoghurt (125g) or choice of
fresh fruit - apple (100g), banana (100g)
or orange(120g)
1
.
Sardine Curry (250g), rice (180g) &
naan bread (80g)
2
.
Mackerel Fishcakes (150g), tartare
Sauce (10g) oven chips (180g)*
3
.
(v) Chickpea burgers (150g) with oven
chips (180g) or rice (180g)*
15
1
.
2
.
3
.
4
.
South African Bobotie (280g)
(v) Broccoli bake (240g)
(v) Cauliflower crunch (250g)
(v) Sweetcorn & pepper quiche (130g)
4
.
(v) Mixed Bean casserole (300g) with
oven chips (180g) or rice (180g)*
*options served with choice of bread
roll with soft vegetable margarine (60g)
all options served with spinach bhaji
(100g) or green beans (80g)
S
A
T
U
R
D
A
Y
1
.
2
.
Bread & butter pudding (170g) and
Custard (150g)
or Choice of fresh fruit - Apple (100g),
Banana (100g) or Orange(120g)
Lamb keema (320g), spinach curry
(80g), brown rice (180g) & chapatti
(55g)
Pasta (300g) with bolognese sauce*
(200g)
3
.
(v) Pasta (300g) with creamy
mushroom Sauce* (150g)
4
.
Pasta shells with tuna and tomato
sauce* (380g)
1
.
Apricot cereal bars (40g) or carrot cake
(60g) or low fat fruit yoghurt (125g) or
choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
1 (v) Vegetable and bean curry (300g
. raita (35g) and basmati rice (200g)
2 (v) Mushroom omelette (140g) with
. oven chips (200g)
3 Salmon fishcakes(150g) with oven
. chips (200g)
Served with mixed salad (50g) & garlic
bread (55g)
S
U
N
D
A
Y
-all options served with mixed salad
(50g) and boiled new potatoes (200 g)
or curried rice salad (180g)
Wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
Queen of puddings (140g)
or choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
Chicken bhuna (320g), okra (80g) &
basmati rice (180g), naan bread (80g)
2
.
Roast chicken and chipolatas with
gravy (190g), stuffing (40g), roast
potatoes (180g) and cabbage (80g)
3
.
4
.
(v) Crispy vegetable bake (300g),*
(v) Sweetcorn and mushroom bake*
(300g)
*options served with jacket wedges
(180g), cabbage (80g) and choice of
bread roll with soft vegetable
margarine (60g)
Apple crumble (170g) with custard
(150g) or choice of fresh fruit - apple
(100g), banana (100g) or orange(120g)
4 Chicken and prawn paella (240g)
.
- all options served with peas (80g)
wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
Fruit loaf (50g) or chocolate cake (50g)
low fat fruit yoghurt (125g) or choice of
fresh fruit - apple (100g), banana (100g)
or orange(120g)
1 Oriental beef stir fry (250g)
.
2 (v) Mushroom stroganoff (200g)
.
3 (v) Spanish omelette (140g)
.
4 (v) Vegetable lasagne (300g)
.
- all options served with rice (200g) or
boiled new potatoes (200g) and green
beans (80g), or carrot apple and
sultana salad (110g)
Wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
Date square (40g) or iced
sponge (60g)
Low fat fruit yoghurt (125g) or choice of
fresh fruit - apple (100g), banana (100g)
or orange(120g)
Choice of bread rolls from wholemeal, soft white, crusty white & granary rolls
16
5.10 Analysis of example menu for male prisoners compared with
nutrient based guidance
Nutrient
based
guideline
40% energy
and other
nutrients
Energy
Kcals
MJ
g
Max
Saturated fat
g
Max
Total
carbohydrate
g
Min
Non milk
extrinsic sugars
g
Fibre
g
Min
Protein
g
Min
Vitamin A
µg
Min
Vitamin C
mg
Min
Folate
µg
Min
Calcium
mg
Min
Iron
mg
Min
Zinc
mg
Min
Sodium
mg
Max
g
Max
Fat
Salt1
Lunch
Tea
1006
4.2
1006
4.2
1006
4.2
39
30
31
12
9
10
134
145
155
30
12
18
7
11
11
22
40
37
280
684
425
16
51
69
80
163
245
280
418
444
4
7
6.5
4
5.2
4.8
960
922
960
2.4
2.4
2.4
Max
1
The salt content of menus will go down as the amount of salt in common commodities such
as bread is reduced
17
5.11 Example weekly menu for female prisoners
(v) Suitable for Vegetarians
Females lunch
1. v) Chickpea curry (100g) with
Vegetable pilau (300g), & Punjabi
M
courgette (80g), naan bread (80g)
O
N
D 2. Shepherd’s pie (300g) with Gravy
(65g)*
A
Y
3. Cottage pie (300g) with Gravy
(70g)*
Females Tea
1. Oriental chicken curried rice (200g) with
egg noodles (120g)
2. (v) Cauliflower gratin* (180g)
3. (v) Macaroni cheese* (180g)
4. Corned beef hash* (220g)
4. (v) Butter bean & vegetable pie
(250g)*
options served with broccoli florets
(80g) and choice of bread roll with
soft vegetable margarine (60g)
Low fat fruit yoghurt (125g) or
choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
T
U
E
S
D
A
Y
1. Tanzanian coconut fish curry
(250g), with rice (100g), plantain
(100g) and flat bread (50g)
*options served with potato dice (100g)
- all options served with broccoli florets
(80g), and wholemeal roll (48g) or French
bread ( 60g) with low fat margarine (7g)
Rock bun (40g)
Mixed dried fruit selection of apricots,
raisins & dates (40g) or choice of fresh
fruit - apple (100g), banana (100g) or
orange(120g)
1. (v) Chickpea fritters (150g)
2. (v) Lentil & mushroom crumble (200g)
2. Fish Pie (250g) French beans
(80g)*
3.
(v) Courgette & cheese bake
(250g), couscous (150g) &
tomatoes stuffed with rice(120g)*
4.
(v) Potato & broccoli bake (250g)
French beans (80g)*
*Options served with choice of
bread roll with soft vegetable
margarine (60g)
Low fat fruit yoghurt (125g) or
choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
18
3. Chicken and broccoli lasagne (180g)
4. Salmon quiche (120g)
-all options served with green salad (50g)
or ratatouille (100g), and baby jacket
potatoes (100g) or mashed potatoes
(100g)
Wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
Sponge cake (40g)
Mixed dried fruit selection of apricots,
raisins & dates (40g) or choice of fresh
fruit - apple (100g), banana (100g) or
orange(120g)
1. Ismaili chicken biryani (280g), lentil
dahl (160g), mixed vegetable curry
W
(100g), and chapatti (55g)
E
D
N 2. Chicken curry with pineapple
(280g)*
E
S
D 3. (v) Caribbean casserole (250g)*
A
Y 4. Pork with apricot sauce (280g)*
1. Beef and banana curry (250g) with spiced
vegetable pilau (150g)
2.
3. Kedgeree (200g)*
4. Scotch egg (120g)*
*options served with jacket potato (100g),
green salad (50g), and mixed bean salad
(100g)
Wholemeal roll (48g) or French bread
(60g), with low fat margarine (7g)
*options served with rice (100g),
diced mixed vegetables (80g) and
choice of bread roll with soft
vegetable margarine (60g)
Low fat fruit yoghurt (125g) or
choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
T
H
U
R
S
D
A
Y
1. African beef and bean stew (250g),
African dumplings (80g), rice
(105g) & sweet potato (100g)
Apricot oat bars (40g)
Mixed dried fruit selection of apricots,
raisins & dates (40g) or choice of fresh
fruit - apple (100g), banana (100g) or
orange(120g)
1. Caribbean chicken (200g) with egg
noodles (120g)
2. (v) Lentil & tomato quiche (120g)*
2. Steak Hotpot (280g)*
3. (v) Broccoli quiche (120g)*
3. (v) Crunchy vegetable crumble
(250g), jacket wedges (150g)*
4. Pilchards in tomato sauce (110g)*
4. Savoury pork and vegetable pie
(250g) and gravy (65g)*
*options served with vegetable rice salad
(100g), mixed salad (50g) and coleslaw
(80g)
Wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
*options served with boiled
potatoes (100g) & peas (80g) and
choice of bread roll with soft
vegetable margarine (60g)
Low fat fruit yoghurt (125g) or
choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
F
R
I
D
A
Y
(v) Sweetcorn & pasta bake(250g)*
1. Sardine Curry (250g), rice (105g) &
naan bread (80g)
Gingerbread (45g)
Mixed dried fruit selection of apricots,
raisins & dates (40g) or choice of fresh
fruit - apple (100g), banana (100g) or
orange(120g)
1. South African Bobotie (230g)
2.
2. Mackerel fishcakes (150g), tartare
Sauce (10g) oven chips (120g)*
3. (v) Cauliflower crunch (200g)
4.
3. (v) Chickpea fritters (150g) with
oven chips (120g) or rice (100g)*
(v) Broccoli bake (200g)
(v) Sweetcorn & pepper quiche (120g)
-all options served with mixed salad (50g)
and boiled new potatoes (100 g) or curried
rice salad (100g)
4. (v) Mixed Bean casserole (280g)
with oven chips (120g) or rice
19
Wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
(100g)*
*options served with choice of
bread roll with soft vegetable
margarine (60g)
- all options served with spinach
bhaji (100g) or green beans (80g)
S
A
T
U
R
D
A
Y
Low fat fruit yoghurt (125g) or
choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
1. Lamb keema (250g), spinach curry
(80g), brown rice (105g) & chapatti
(55g)
Fruit loaf (50g)
Mixed dried fruit selection of apricots,
raisins & dates (40g) or choice of fresh
fruit - apple (100g), banana (100g) or
orange(120g)
1. (v) Vegetable and bean curry (200g) raita
(35g) and basmati rice (100g)
2.
2. Pasta (150g) with bolognese
Sauce* (180g)
(v) Mushroom rice omelette (140g) with
oven chips (100g)
3. Salmon fishcakes(120g) with oven chips
(100g)
3. (v) Pasta (150g) with creamy
mushroom Sauce* (150g)
4. Chicken and prawn paella (200g)
4. Pasta shells with tuna and tomato
sauce* (350g)
-all options served with spinach (80g)
wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
options served with mixed salad
(50g) & garlic bread (55g)
Low fat fruit yoghurt (125g) or
choice of fresh fruit - apple (100g),
banana (100g) or orange(120g)
S
U
N
D
A
Y
1. Chicken bhuna (250g), okra (80g)
& basmati rice (100g), naan bread
(80g)
2. Roast Chicken and chipolatas with
gravy (190g), stuffing (40g), roast
potatoes (100g) and cabbage
(80g)
Fairy cake (30g)
Mixed dried fruit selection of apricots,
raisins & dates (40g) or choice of fresh
fruit - apple (100g), banana (100g) or
orange(120g)
1. Oriental beef stir fry (200g)
2. (v) Moroccan spicy lamb (180g)
3. (v) Spanish omelette (130g)
4.
(v) Vegetable lasagne (180g)
3. (v) Crispy vegetable bake (250g)*
4. (v) Sweetcorn and mushroom bake
(280g)*
*options served with jacket wedges
(100g), cabbage (80g) and choice
of bread roll with soft vegetable
margarine (60g)
Apple crumble (170g) with custard
(145g) or choice of fresh fruit apple (100g), banana (100g) or
orange(120g)
20
- all options served with rice (100g) or
boiled new potatoes (100g) and green
beans (80g), or carrot apple and sultana
salad (100g)
Wholemeal roll (48g) or French bread
(60g) with low fat margarine (7g)
Fruit scone (40g)
Mixed dried fruit selection of apricots,
raisins & dates (40g) or choice of fresh
fruit - apple (100g), banana (100g) or
orange(120g)
5.12 Analysis of example menu for female prisoners compared with
nutrient based guidance
Nutritional
Guideline
40% energy
and other
nutrients
Energy
Lunch
Tea
772
772
772
Kcals
MJ
g
Max
30
23
23.
Saturated fat
g
Max
10
7
7
Total
carbohydrate
g
Min
103
105
120
Non milk
extrinsic sugars
g
Max
23
5
8
Fibre
g
Min
7
9
10
Protein
g
Min
18
34
28
Vitamin A
µg
Min
240
612
483
Vitamin C
mg
Min
16
46
54
Folate
µg
Min
80
142
198
Calcium
mg
Min
280
361
324
Iron
mg
Min
6
6
6
Zinc
mg
Min
3
4.3
3.6
Sodium
mg
Max
960
763
876
g
Max
2.4
2.0
2.2
Fat
Salt1
1
The salt content of menus will go down as the amount of salt in common commodities such
as bread is reduced
21
6.0
Nutritional guidelines for food served to older
people in residential care
6.1 Background
There are approximately 410,000 people living in residential and nursing homes
across the UK 1 . A quarter of people aged over 85 years live in a residential or
nursing home or long-stay hospital environment and the population in these settings
are increasingly old and frail 2 . While this population is increasingly dependent on
care of both a personal and practical nature, there remains evidence that many older
people living in residential accommodation are undernourished2. It has been
estimated that about a half of all older people in residential care may have some form
of dementia2 and it is known that dementia will often impact on a person’s ability to
eat and drink well.
In England, Wales and Northern Ireland, the 2002 National Minimum Standards for
Care Homes for Older People 3 provided new standards for all aspects of care,
including issues around food and drink, and the standards demand that residents
‘should receive a wholesome, appealing, balanced diet in pleasing surroundings at
times convenient to them’. Guidance on how this can be achieved is outlined in nine
individual standards that cover aspects such as nutritional screening, timing of meals
and snacks, having sufficient staff are available to help ensure food standards are
met, and some meal-specific standards. Older people in residential care should be
offered three full meals each day, at least one of which must be cooked, as well as
snack meals as appropriate.
Similar care standards 4 are also available for Scotland as part of the Regulation of
Care Scotland Act (2001).
A recent report by the Care Standards Commission, Highlight of the Day?, 5 outlined
some of the issues about food that older people in care homes still face. This
research, collected in 2005, reported that while 83% of care homes met the
requirements of meals and mealtime standards, a significant proportion did not, with
one in six homes requiring improvement in how food is cooked and served to
residents. The most common themes for complaint about food in care homes were
1 Office of Fair Trading 2005. Care Homes for Older People in the UK. Accessed from:
www.oft.gov.uk
2 Caroline Walker Trust 2003. Eating Well for Older People. CWT. www.cwt.org.uk
3 Department of Health 2002. Care Homes for Older People: National Minimum Standards. London.
TSO.
4 National Care Standards for Scotland. Accessed from: www.scotland.gov.uk/library3/social/chop.pdf
5 Commission for Social Care Inspection 2006. Highlight of the Day? Improving Meals for Older
People in Care Homes. Accessed from: http://www.csci.org.uk/PDF/highlight_of_day.pdf
1
the quality of food, the choice and the availability. It was reported, both in the Care
Standards Commission report and elsewhere, that for older people food remains a
priority among the factors they associate with good personal care and, for people
over 85 years of age food has been ranked as the most important part of the
personal care they receive 6 .
The importance of good food and good nutrition for older people has been well
established and it has been reported that the diets of older people in residential care
are often low in folate, riboflavin, vitamin C, vitamin D, iron, zinc and potassium.2 In
addition the diets of older people are often high in salt, and intakes of fruits and
vegetables are frequently poor.
It is therefore essential that the food provided in residential care accommodation for
older people provides adequate nutrition in food that is accessible and well liked.
Smaller appetites are likely to require nutrient-dense meals which ensure that all the
essential nutrients are included without unnecessary bulk.
6.2 Rationale for nutrient-based guidelines for food prepared for older
people in residential care
The food provided for older people in residential care should as a minimum provide
the average dietary reference values for energy and nutrients specified for people
aged 75 years and over 7 . It should be stressed however that some older people may
have higher requirements for energy and nutrients. The nutrient-based guidelines in
this report provide guidance for menu planners on the amounts of energy and
nutrients that they should aim to provide for a group of older people in their care,
while remembering that this is a vulnerable population group who are frequently
found to eat and drink too little. The needs of each resident should be assessed as
part of his or her care plan and meals and snacks organised to ensure that each
individual is able to access sufficient nutrients each day. Monitoring nutritional status
(e.g. whether a person loses weight) is an important part of the care of older people
and this will indicate when specialist help may be needed to help someone eat and
drink appropriately. Details of a tool for monitoring nutritional status of older people in
6 Personal Services Research Unit 2002. OPUS: A Measure of Social Care Outcome for Older People.
Accessed from: www.ukc.ac.uk/PSSRU
7 Department of Health 1991. Dietary Reference Values for Food Energy and Nutrients for the United
Kingdom. Report on Health and Social Subjects 41. HMSO. London
2
residential care (The Malnutrition Universal Screening Tool – MUST) can be found on
the BAPEN website. 8
The nutrient-based guidelines in section 6.3 assume that older people will receive
three meals and two snacks each day as well as a milky drink in the evening. The
guidelines do not specify the proportion of energy and other nutrients to be provided
by individual meals and snacks, since the eating patterns of older people may vary
considerably depending on appetite and eating ability. The foods and drinks offered
each day should meet the total nutritional guidance outlined. The sample menus on
pages 13-14 show the sorts of foods that would be required across the day to do this.
Where there are eating difficulties or the texture of food needs to be altered, it is
important that appropriate advice is taken to ensure that residents receive adequate
nutrition at both meals and snacks.
Vitamin D
It is impossible for most older adults to obtain the full daily requirement of 10
micrograms of vitamin D from the diet alone. It is likely that older adults in
residential accommodation who rarely go outside will need vitamin D
supplements.4 They should seek medical advice about this. Good dietary sources of
vitamin D are outlined in the food-based guidelines for older people in residential
care in section 6.3
Folate and vitamin C
The low intakes of folate and vitamin C among older people 9 may be due in part to
reduced intakes of fruit and vegetables, since some older people may find it difficult
to peel, cut up or chew these foods. Caterers should be aware of the importance of
increasing fruits and vegetables in menus and offer a variety of raw and cooked fruits
and vegetables in accessible forms.
Iron and zinc
Low iron intakes and low iron status have been reported among older people in
residential care 10 and this may be due both to poorer iron absorption, greater iron
8 http://www.bapen.org.uk/the-must.htm
9 Finch S, Doyle W, Lowe C, Bates CJ et al. 1998. National Diet and Nutrition Survey: People Aged
65 Years and Over. Volume 1: Report of the Diet and Nutrition Survey. TSO. London.
10 Finch S, Doyle W, Lowe C, Bates CJ et al. 1998. National Diet and Nutrition Survey: People Aged
65 Years and Over. Volume 1: Report of the Diet and Nutrition Survey. TSO. London.
3
losses and lower iron intakes 11 . Meat is a good source of iron but as people get older
they may find it more difficult to chew and therefore it is important that foods high in
iron are included in the menu in forms that are easy for older people to access.
Zinc intakes are also often low in the diets of older people and many good sources of
iron are also good sources of zinc. Good sources of nutrients are outlined in
Appendix 2.
Salt/sodium
The current recommendation for salt intakes for all adults is 6g a day3 and the current
daily intake by adults is approximately 9g. Older people may be used to adding salt
to food out of habit, or they may have a reduced sense of taste and smell and
therefore add salt to food to give it taste, or they may prefer highly salted foods and
condiments that they typically ate when younger. Caterers in residential care
accommodation should respect the food choices of those they cater for but attempt to
reduce the use of highly salted foods and salt in cooking, while ensuring that food
remains tasty.
Fluid Intakes
A regular and adequate intake of fluids is extremely important for older people. It
helps to prevent dehydration which can lead to confused states; helps to prevent and
alleviate the symptoms of constipation and fluids can also provide important nutrients
when appetites are small. It is recommended that older people drink at least 1.5 litres
or 8 cups of non-alcoholic fluid a day11. Many older people may find they are less
likely to recognise that they are thirsty or may be afraid of drinking because of fears
of incontinence. It is important to explain to older people the importance of drinking
and that more fluid, rather than less, can help with incontinence. The fluid older
people require can be consumed in a number of ways, and some fluids may offer
additional nutritional or psychological benefits to older people. Tea and coffee are
sociable drinks which many older people habitually drink and enjoy. These should be
offered regularly, and served in the style that the older person prefers. Some older
people may enjoy milky coffee or tea or another hot beverage such as a malted or
chocolate milk drink particularly at bedtime. Fruit juice should be offered at meals as
the vitamin C it contains may help the absorption of iron from some foods. Clean,
11 Caroline Walker Trust 2003. Eating Well for Older People. CWT. www.cwt.org.uk
4
chilled water should be freely available and offered regularly as an additional option.
Some foods can also provide fluid: older people may enjoy frozen drinks if the
weather is warm and nutritious soup can be offered at meals and snacks.
It is important that all those who care for older people in residential care works with
the older person to ensure that they have access to at least 1.5 litres or 8 cups of
fluid during the day, of the type that the older person enjoys. As older people may not
recognise that they are thirsty it is important that drinks are offered, served and
encouraged: provision of fluid alone e.g. water coolers in community areas, will not
necessarily encourage fluid intake.
5
Table 6.1 Nutrient based guidelines for food served to older people in
residential care
Dietary reference
value (DRV)
Men and
women aged 75
years and over
kcals
MJ
EAR
Fat
g
About 35% energy
MAX
76
Saturated fat
g
About 11% of energy
MAX
24
Total
carbohydrate
g
About 50% of energy
MIN
260
Non-milk
extrinsic sugars
g
About 11% of energy
MAX
57
Fibre
g
RNI
MIN
18
Protein
g
RNI
MIN
50
Vitamin A
μg
RNI
MIN
700
μg
RNI
MIN
10
Vitamin C
mg
RNI
MIN
40
Folate
μg
RNI
MIN
200
Calcium
mg
RNI
MIN
700
Iron
mg
RNI
MIN
9
Zinc
mg
RNI
MIN
9.5
Sodium
mg
SACN recommendation
MAX
2,400
g
SACN recommendation
MAX
6
Energy
Vitamin D1
Salt
1955
8.2
EAR = Estimated Average Requirement
DRV = Dietary Reference Value
RNI = Reference Nutrient Intake
For an explanation of these terms see Appendix 1.
1
Vitamin D
It is impossible for most older adults to obtain the full daily requirement of 10
micrograms of vitamin D from the diet alone. It is very likely that older adults who live
in residential accommodation will need vitamin D supplements.
6
6.3 Food-based guidelines for older people in residential care
Below are some food-based guidelines that caterers may find useful in planning
menus for older people in their care.
Food group
Guidance
Rationale
What’s included
Bread, other cereals
and potatoes
Starchy foods should
make up a third of the
daily diet.
Foods from this group
are a good source of
energy and the main
source of a range of
nutrients in the diet.
As well as starch,
these foods supply
fibre, calcium iron and
B vitamins.
All varieties of bread
including wholemeal
and granary bread,
chapattis and bagels.
Older people may
prefer white bread, and
higher fibre white bread
may also be
acceptable,
A variety of breads
should be available
daily as starters or
meal accompaniments.
Offer a variety of
starchy foods with
main meals including
potatoes, rice, pasta,
noodles and other
grains.
Wholegrain cereals are
higher in fibre
Potatoes, plantain, yam
and sweet potato
Breakfast cereals
Rice, couscous, bulgar
wheat, maize, cornmeal
Noodles, pasta
Tips
•
•
•
•
•
•
Older people with small appetites need nutrient-dense meals and, if there is concern about how
much someone is eating, starchy foods should be offered in moderate amounts. Avoid very
high-fibre cereals unless an older person has a very good appetite.
Some white bread has added nutrients and fibre and can be useful for older people who do not
like brown or wholemeal bread.
Some older people find it easier to chew brown or wholemeal bread if it is lightly toasted.
Some breakfast cereals are nutrient-fortified (e.g. they may have added iron, folic acid, vitamin
D and other nutrients). These can be good choices for breakfast but look for those with a lower
salt content.
Boil potatoes in the minimum amount of water and for the shortest amount of time to retain
vitamins, but ensure they are cooked until soft. Roast potatoes in small amounts of vegetable
oil and use milk to mash potatoes to smoothness.
If you have customers who are allergic to wheat, oats, barley or rye, good alternatives are foods
made from maize (i.e. polenta), rice, rice flour, potatoes, potato flour, buckwheat, sago, tapioca,
soya and soya flour. Seek expert advice from a dietitian where necessary.
7
Food group
Guidance
Rationale
What’s included
Fruit and vegetables
Fruit and vegetables
should make up about
a third of the daily diet.
Fruit and vegetables
are good sources of
many vitamins and
minerals.
All types of fresh,
frozen and tinned
vegetables – e.g.
broccoli, Brussels
sprouts, cabbage,
carrots, frozen peas,
swede, green beans.
It’s important to offer at
least 5 different fruits
and vegetables every
day.
Aim for 1 or 2 portions
with each meal and
offer fruit as a snack.
A portion of fresh or
cooked fruit or
vegetables should be
about 80g.
1 portion of dried fruit
can be about 40g.
(Dried fruit only counts
once per day.)
1 glass of fruit juice = 1
portion (however much
is consumed in a day)
There is increasing
evidence that
consuming more than
400g of fruit and
vegetables every day
reduces the risk of
developing chronic
diseases such as
coronary heart disease
and some cancers.
All types of salad
vegetables including
lettuce, cucumber,
tomato, raw carrots,
peppers and beetroot.
All types of fresh fruit –
e.g. apples, bananas,
kiwi fruit, oranges,
pears, mango and
plums.
All types of tinned fruit
in juice – e.g.
pineapple or peaches
Stewed fruit
Dried fruit
Beans and pulses only
count as a maximum
of 1 portion per day.
Fruit juice (100% juice)
Tips
•
•
•
•
•
•
•
•
•
•
•
Steaming or cooking vegetables with minimum amounts of water and serving as soon as
possible will help retain vitamins.
Use fresh fruit and vegetables as soon as possible, rather than storing them, to avoid vitamin
loss.
Offer fruit as a snack. Older people may find it difficult to peel or cut whole fruit, so a plate of
sliced ready prepared fruits may be more acceptable.
Add vegetables and pulses to stews, casseroles or other dishes and offer a variety of
vegetables at main meals.
Baked beans (as a vegetable) should be served a maximum of twice a week.
Encourage a daily glass of 100% fruit juice with breakfast or with a main meal.
Buy tinned fruit in natural juice rather than in syrup.
Offer a variety of dried fruits to add to cereal options and porridge and include dried fruit in
cakes and desserts.
Pureed stewed fruit can be offered with custard or yoghurt or ice cream as dessert.
Fruit and vegetables which are useful sources of folate include spinach, broccoli, peas,
oranges, melons, green leafy salads and tomatoes.
Fruit and vegetables which are useful sources of iron include green leafy vegetables, peas,
broccoli, baked beans, dried apricots and raisins, blackcurrants and broad beans.
8
Food group
Guidance
Rationale
What’s included
Milk and dairy
products
Milk and dairy foods
should be served
every day.
Milk and dairy
products are
excellent sources of
calcium which is
needed for optimal
bone strength
protein, vitamin A,
riboflavin and vitamin
D.
All types of milk.
Moderate amounts
should be offered 2-3
times a day as milk in
drinks, cheese,
yoghurt or milkbased puddings and
sauces.
Dried milk, goat’s and
sheep’s milk.
Cheeses – e.g. Cheddar,
cottage cheese, cheese
spreads, brie, feta, Edam,
goat’s cheese, stilton,
parmesan.
Yoghurt (fruit or plain,
whole milk or low-fat), or
fromage frais.
Older people with
small appetites who
may need to gain
weight or who are of
low weight should be
encouraged to have
full-fat milk and
yoghurt.
Milk-based sauces, custard
and milk puddings.
Semi-skimmed milk
is suitable for older
people with good
appetites.
Tips
•
•
•
•
•
•
•
•
To add extra calories, protein and nutrients to dishes, extra milk, cheese or dried milk powder
can be added in cooking.
Whole milk can be fortified further by the addition of extra dried skimmed milk powder for those
older people who are of low weight or who have small appetites.
Offer milky drinks at snacks and before bed. Milkshakes may be an acceptable alternative,
particularly in hot weather.
Frozen yoghurts can be offered as an alternative to ice cream.
Milk can be used in sweet and savoury sauces, custards and puddings.
Smooth yoghurt and fromage frais can be offered as a snack and is useful if older people have
eating difficulties.
It is worth highlighting that some dairy products can contain high salt levels. Strong cheese can
impart flavour in smaller amounts.
For dairy-free diets, serve soya drinks fortified with calcium as an alternative.
9
Food group
Guidance
Rationale
What’s included
Meat, fish and meat
alternatives
A meat or alternative
should be offered at all
main meals.
Meat is a good source
of protein and of
vitamins and minerals
such as iron and zinc
Meat, poultry, offal1,
fish, eggs, nuts, beans,
pulses and meat
alternatives.
Fish is an excellent
protein source and
contains selenium and
iodine.
Meat includes all cuts
of beef, lamb and pork
and meat and meat
products such as ham,
corned beef and
sausages. Look for
meat products with a
high meat content.
Red meat should be
offered a minimum of
twice a week.
Use lean meat (with a
fat content of about
10%).
Fish should be offered
at least twice a week.
It is strongly
recommended that oily
fish should be served
once a week.
Meat alternatives for
vegetarians should be
varied and use a
variety of foods from
this group (e.g. eggs,
peas, beans and
pulses, soy-based
meat alternatives,
nuts, quorn or tofu).
Oil-rich fish provides
omega-3 fatty acids
which may help to
prevent heart disease.
Such foods are also a
source of vitamins A
and D and iron.
Beans and pulses are
sources of protein, iron
and zinc.
Eggs are a good
source of protein,
vitamins A and D
Nuts provide a source
of protein, iron, fibre,
zinc and calcium.
Fish includes fresh,
frozen and tinned fish,
such as tuna, sardines,
pilchards and
mackerel, and fish
products such as fish
cakes and fish fingers.
Oily fish, such as
salmon and sardines.
Beans – e.g. baked
beans, butter beans,
kidney beans and
lentils are in this group
and provide a good
source of protein for
vegetarians.
Notes
•
•
•
•
•
•
•
Always select the leanest cuts of meat and remove visible fat and poultry skin.
Avoid processed meat and fish products which are high in fat and salt, such as crumb-coated
chicken products, burgers, pies, fish cakes and canned meats. These are often high in salt and
low in meat content.
Customers need to be made aware of nuts and nut products incorporated into dishes.
Eggs are a useful source of nutrients but they should always be well cooked for older people.
Oil-rich fish can be used in pâtés and spreads on bread and toast.
For older people who have difficulty chewing, offer soft lean meat and fish or meat and fish
dishes where the meat has been minced or served in a sauce.
1
Liver pâté is a useful source of nutrients for older people but liver and liver products should not
be served more than once a week.
10
Food group
Guidance
Rationale
What’s included
Foods
containing fat
and foods
and drinks
containing
sugar
These foods add palatability to
the diet and can be useful in
the diets of older people for
encouraging eating and
stimulating the appetite.
The main nutrients
provided by such foods
are fat, including some
essential fatty acids,
and also some fatsoluble vitamins.
Foods containing fat
include: butter,
margarine, other
spreading fats and
low-fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
and gravies.
These foods can be high in
calories and offer few other
nutrients. If appetites are poor,
it is important that these foods
do not displace more nutrientrich foods.
As for the rest of the
population, foods from this
group can contribute to excess
energy intakes if they are
eaten in large amounts.
Snacking on sugary foods and
drinks throughout the day is
discouraged as this can cause
tooth decay. Older people may
enjoy some sweet foods as
snacks, and moderate
amounts of these foods are
acceptable.
Carbohydrate (in the
form of sugars) is also
provided.
Some products also
contain salt.
Foods containing
sugar include: soft
drinks, sweets, jams
and sugar, as well as
foods such as cakes,
puddings, biscuits,
pastries and ice
cream.
Tips
Use mono- and poly- unsaturated fats wherever possible for cooking, spreading and in dressings.
Good choices of cooking and salad dressing fats include soya, rapeseed and olive oils and good
choices of fat spread are those made from sunflower oil, soya oil or olive oil.
Vitamin D
To increase the amount of dietary vitamin D in menus served for older people:
• Use margarine fortified with vitamin D for baking and as a fat spread.
• Include an oily fish that is rich in vitamin D in the menu at least once a week – for example,
herring, mackerel, pilchards, salmon, sardines, trout or roe. These fish contain between 514µg of vitamin D per 100g.
• Canned tuna fish can also make a significant contribution to vitamin D intake as it contains
about 3.6µg of vitamin D per 100g.
• Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin D per 100g.
• Meat and poultry contribute small but significant amounts of vitamin D.
11
6.4 Example menus for older people in residential care
Two example menus are given here which show the sorts, and amounts, of foods
and drinks that could be served to meet the nutrient-based and food-based
guidelines.
A nutritional analysis is provided for each of the menus, showing how the menu
compares with the nutritional guidelines.
Additional resources for caterers are given in Appendix 4.
Further practical guidance on preparing and serving food to older people in
residential care are can be found in The Caroline Walker Trust publications Eating
Well for Older People and Eating Well for Older People with Dementia, both available
from www.cwt.org.uk.
12
6.5 Example weekly menu for older people in residential care (menu 1)
Monday
Breakfast
Midmorning
Lunch
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Choice of porridge or cereal (i.e. weet bisks, bran flakes, muesli, shredded wheat, puffed wheat)
Fresh fruit juice or cranberry juice drink (150g)
Scrambled eggs or baked beans or grilled bacon or grilled tomatoes
with toast with Polyunsaturated margarine (7g)
Tea, coffee
Choice of fresh fruit slices (apple, orange and banana (80g))
Tea, coffee or milky drink
Pasta
Salmon
Lamb and
Cottage pie Savoury pie
Provencale
fish
potato
(180g)
(300g)
(180g)
Peas (80g) Braised rice
cakes
hotpot
Broad
Cauliflower (150g)
(120g)
(210g)
Oven
Carrot and
beans with
Celery (80g)
(80g)
Green beans swede
chips
baby
(80g)
(110g)
mash
carrots
Baked
(100g)
(80g)
Spinach
beans
(80g)
(90g)
Roast pork
apple
sauce and
gravy(145g
Roast
potatoes
(100g)
Courgette
(80g)
Spring
greens
(80g)
Water and
fruit juice
available
Chicken
Fricassee
(150g)
New
potatoes
(140g)
Broccoli
(80g)
Midafternoon
Chocolate
Lemon
Apricot
Queen of
Stewed
Raspberry
Fruit
meringue pudding
Conde
puddings
Plums
and apple
Compote
(90g) with
pie
(150g)
(140g)
(90g) and
pie (100g)
(160g)
Custard
Cream
ice cream
(115g)
fromage
(100g)
(40g)
(30g)
frais (40g)
Choice of: apple and sultana cake, banana tea bread, Sultana sponge, fruit scones with butter,
sticky prune cake, Madeira cake, lemon cake (average slice (52g))
Tea or coffee or milky drink
Tomato
Vegetable
Lentil soup
Chicken
Leek and Mushroom
Carrot and
soup (150g) Potato
soup
(150g)
soup
noodle
coriander
(150g)
(150g)
soup
soup
soup
(150g)
(150g)
(150g)
Evening
meal
Water and
fruit juice
available
Bedtime
Soft roll
white (45g)
or brown
(50g)
Soft roll
white (45g)
or brown
(50g)
Soft roll
white (45g)
or brown
(50g)
Soft roll
white (45g)
or brown
(50g)
Tuna and
tomato
pasta
(200g)
Green
salad (45g)
Cheese
and
pineapple
salad (95g)
Green
salad (45g)
Smoked
mackerel
(70g)
Mixed salad
(45g)
Roast
chicken
salad
(180g)
Potato
salad (90g)
Fresh
orange
(100g)
Banana
(100g)
Fruit yoghurt
(125g)
Tinned
mandarins
(100g) with
Milk jelly
(150g)
Soft roll
white (45g)
or brown
(50g)
Soft roll
white (45g)
or brown
(50g)
Omelette
(55g)
Tomato,
and basil
salad
(50g)
Chicken
and pasta
swirl salad
(210g)
Grated
carrot
salad (60g)
Broccoli
quiche
(70g)
Mixed bean
salad
(145g)
Rhubarb
fool
(120g)
Poached
pears
(100g)
Fruit
mousse
(80g)
Soft roll
white
(45g) or
brown
(50g)
Milky drink: Horlicks, Ovaltine, hot chocolate, milky tea, milk shake
13
6.6 Example weekly menu for older people in residential care (menu 2)
Monday
Breakfast
Water and
fruit juice
available
MidAfternoon
Evening
Meal
Water and
fruit juice
available
Wednesday
Thursday
Friday
Saturday
Sunday
Stewed prunes or grapefruit (110g)
Porridge or cereals with milk (e.g. weet bisks, bran flakes, muesli, shredded wheat, puffed wheat)
Wholemeal (31g) or white toast (27g) with polyunsaturated margarine (7g) and jam (8g)
Fruit juice choice including Cranberry fruit drink (150g)
Tea or coffee with milk
MidMorning
Lunch
Tuesday
Tea coffee or milky drink with milk and digestive biscuit (26g)
Roast beef
(90g) and
Yorkshire
pudding (35g)
Roast
potatoes
(120g)
Gravy (50g)
Carrots (80g)
Cabbage
(80g)
Vegetable
lasagne
(250g)
Mixed
salad (60g)
Chicken
casserole
(250g)
Carrots
(80g)
Broccoli
(80g)
Mashed
potato
(130g)
Sweet and
sour pork
(200g)
Rice (150g)
Sweetcorn
(80g)
Beef olives
(250g)
Cauliflower
(80g)
Spring
greens
(80g)
Jacket
wedges
(120g)
Steamed
haddock
(75g)
Courgettes
(80g)
Peas (80g)
Boiled new
potatoes
(140g)
Irish stew
(200g)
Green
beans (80g)
Swede
(80g)
Baked
sliced
potatoes
(130g)
Plum
crunchies
(120g)
Rice
pudding
(180g)
Stewed
apple (80g)
Rhubarb
crumble
(100g)
Custard
(100g)
Fruit trifle
(150g)
Bread and
butter
pudding
(150g)
Crème
caramel
(100g)
Tea/coffee
with milk
Chocolate
yoghurt
cake (70g)
Tea/coffee
with milk
Apricot oat
bars (45g)
Tea/coffee
with milk
Lemon
sponge cake
(50g)
Tea/coffee
with milk
Madeira
cake (50g)
Tea/coffee
with milk
Shortbread
(30g)
Tea/coffee
with milk
Bran tea
loaf (65g)
Tea/coffee
with milk
Fruit scone
(40g) with
margarine
(7g)
Kedgeree
(200g)
Peas (80g)
Soft white
(45g) or
brown
(50g) roll
with
polyunsatur
ated
margarine
(7g)
Cream of
vegetable
soup
(200g)
Boiled egg
(50g)
White (30g)
or
Wholemeal
bread (35g)
Margarine
(7g)
Salmon Fish
cakes (120g)
Tomato
onion and
basil salad
(50g)
Green salad
(45g)
French stick
(60g)
Courgette
and
watercress
soup (200g)
Smoked
mackerel
pate (75g)
White o
wholemeal
(60g) toast
Mixed salad
(45g)
Tomato
soup (150g)
Bread roll
Roast beef
and salad
sandwich
(145g)
Macaroni
cheese
(200g)and
Sweetcorn
(80g)
Chicken soup
(150g)
Bread roll
Egg and
cress
sandwich
(130g)
Tropical
fruit salad
(160g)
Apricot and
pear
crunch
layer
(120g)
Fruit
compote
(120g)
Fromage
frais (40g)
Fresh fruit
salad
(120g)
Banana
and yogurt
dessert
(120g)
Melon and
grape salad
(100g)
Canned
peaches
(120g) and
ice cream
(30g)
Milky drink at bedtime Horlicks, Ovaltine, hot chocolate, milky tea, milk shake
14
Apple pie
(100g)
Custard
(100g)
6.7 Nutritional analyses of example menus for older people in residential
care compared to the nutritional guidelines for food served for this
group.
Nutritional
Guideline
Energy
Kcals
MJ
g
Max
Saturated fat
g
Max
Total
carbohydrate
g
Min
Non milk
extrinsic sugars
g
Fibre
g
Min
Protein
g
Min
Vitamin A
µg
Min
Vitamin C
mg
Min
Folate
µg
Min
Calcium
mg
Min
Iron
mg
Min
Zinc
mg
Min
Sodium
mg
Max
g
Max
Fat
Salt
1
Average nutrient values from
sample menus
Menu 1
Menu 2
1955
8.2
1956
8.2
1955
8.2
76
63
65
24
24
24
260
283
313
57
53
55
18
21
20
50
82
77
700
2149
1657
40
154
143
200
460
311
700
1282
1237
9
14
16
9.5
9.7
10.1
2400
2392
2085
6
6
5.2
Max
1
The salt content of menus will go down as the amount of salt in common commodities such
as bread is reduced
15
7.0
Nutritional guidelines for food served as community
meals
7.1 Background
Community meals in this report refers to
•
meals delivered to older people’s homes
•
meals provided for those living in sheltered accommodation, and
•
meals served in lunch clubs.
It is estimated that about 1 in 4 older people receives some form of home help and 1
in 12 older people receives a community meal at home 1 . Others may be referred to
lunch clubs or receive help from family and friends. There are little data on the quality
and nutritional content of community meals and how these meet the needs of the
clients for which they are designed, but it is likely that most service users are very
vulnerable and the provision of nutrient-dense food to this population group is
particularly important.
The number of community meals served to an individual each week varies from one
meal to fourteen meals a week, although frequently only five meals a week are
available to an older person through ‘meals-on-wheels’ services and many older
people may only receive these on several days each week. Most meals provided at
lunch clubs or delivered to people’s homes are the ‘main meal of the day’. In many
local authorities the nutritional content of community meals is based either on the
guidelines of the National Association for Care Catering (NACC) 2 or those produced
by The Caroline Walker Trust 3 . The NACC provide detailed guidance on the practical
aspects of providing community meals.
7.2 Rationale for the nutrient based guidelines
Conventionally a main meal would be expected to provide 33% of the Estimated
Average Requirement for energy and 33% of the Reference Nutrient Intakes for other
nutrients. Among vulnerable housebound older people, however, it is likely that a
community meal needs to provide a greater proportion of the day’s nutrients than
this, especially if community meals are not provided every day of the week. In order
1 Office for National Statistics 2004. General Household Survey: People Aged 65 Years and Over.
2002/2003. Available from: www.ons.gov.uk
2 National Association of Care Catering 2003. A Recommended Standard for Community Meals. See
www.carecatering.org.uk
3 Caroline Walker Trust 2003. Eating Well for Older People: Practical and Nutritional Guidelines.
CWT. See www.cwt.org.uk
1
to ensure that community meals make a significant contribution to the nutritional
needs of those vulnerable older people who are likely to be the recipients of these
meals, it is recommended that the proportion of requirements be increased from 33%
to 40% for energy, iron, zinc, calcium and vitamin A. This should enable community
meals to deliver as much nutritional benefit as possible, while keeping meals
attractive. This may be best achieved among those with smaller appetites by
providing a meal and a snack. A summary of these guidelines is given in Table 7.1
Alternative methods of providing food – such as providing smaller meals and snacks
which together comprise the nutrients more usually associated with a main meal –
also need to be evaluated. For those residents living in very sheltered housing
accommodation who are provided with two meals a day, which may form the majority
of their nutrient intake, it would be prudent for each meal to fulfil the
recommendations given here for a community meal. This would ensure that these
residents receive at least 80% of average energy needs and 100% of the current
reference nutrient intake for folate and vitamin C from the food provided.
Fibre, protein and vitamin D
The nutritional guidelines for the amounts of fibre, protein and vitamin D in
community meals have not been enhanced beyond a third of daily requirement for
the following reasons:
Fibre
While adequate fibre is important for good gut health, foods which are higher in fibre
may make meals bulky and reduce nutrient density. Older people with smaller
appetites may find that higher fibre dishes fulfil their appetite quickly and they may
therefore find it difficult to finish their meals. For this reason the amount of fibre is set
at 33% of the daily recommended intake.
Protein
It is likely that most menus will provide significantly more protein than the minimum
recommended figure. There is however debate about how much protein older people
can absorb and use efficiently and a balance is required between providing enough
protein and not overburdening the kidneys. The 33% guideline figure for protein
reflects this consideration.
2
Vitamin D
A daily total intake of 10µg of vitamin D a day is recommended and the nutrientbased guideline suggests that about a third of this should be provided by a
community meal. It is acknowledged however that it is generally impossible for older
people – particularly those on a vegetarian diet – to receive enough vitamin D
through diet alone and therefore the need for supplementation with vitamin D
among those receiving community meals should be highlighted. Older people
who are receiving community meals are likely to be housebound or have limited
exposure to summer sun and are therefore particularly likely to require additional
vitamin D through foods rich in vitamin D or through dietary supplements. Those on a
vegetarian diet are also unlikely to get enough vitamin D from diet alone. Good food
sources of vitamin D for inclusion in community meals are suggested in the foodbased guidelines on page 11. It is very likely however that older people in receipt of
community meals will require vitamin D supplementation.
Energy, iron, zinc and calcium
The following nutrients are recommended in amounts equivalent to at least 40% of
the daily recommendations.
Energy
The importance of maintaining an adequate energy intake has been stressed by the
COMA Working Group on the Nutrition of the Elderly 4 . The ‘thin, frail, old lady’ is
usually an undernourished person whose smallness represents several years of
progressive weight loss. Such a person has no reserves for future episodes of ill
health. People who are ill need more calories, and extra care needs to be taken both
before and after illness to ensure that increased nutritional needs are met 5 . Since
being ill is often one of the criteria for receiving community meals at home, this group
may require more calories than their sedentary lifestyles may at first indicate.
Increasing the calorie intake of a community meal would also enable more nutrients
to be provided and help to compensate for the days when no community meal is
provided and lower energy intakes are likely.
4 Department of Health 1992. The Nutrition of Elderly People. Report on Health and Social Subjects
No 42. HMSO. London
5 McLaren S, Crawley H 2000. Managing Nutritional Risks in Older Adults. Nursing Times Clinical
Monographs. No. 44. NT Books. London.
3
Iron
Low iron status has been reported both among people in residential care and among
those living in their own homes, and low iron status increases with increasing age.6
Since the majority of people receiving community meals will be both very old and frail
and at increased risk of low iron status, community meals should aim to offer at least
40% of the daily Reference Nutrient Intake for iron. Ensuring sufficient vitamin C with
meals is also important as this may help the body to absorb the iron
Older people are vulnerable to iron deficiencies for three main reasons. Firstly, they
tend to have a reduced intake of iron-rich foods. Secondly, in some older people the
gut may absorb nutrients less efficiently, and thirdly some older people may consume
smaller amounts of vitamin C rich foods which can help iron to be absorbed.
Zinc
Average intakes of zinc among older people have been shown to be lower than the
Reference Nutrient Intake. Zinc plays an important role in maintaining the immune
system and in wound healing and low intakes may contribute to other chronic
diseases and undernutrition in older people.
Calcium
Low intakes of calcium among some older people living in their own homes have
been reported1 and therefore it seems prudent to ensure that the community meal
provides sufficient calcium to offer some protection against low intakes.
Vitamin C and folate
The following nutrients are frequently found to be lacking in the diets of older people
and they are nutrients that are sensitive to heating of food. They are therefore
recommended in amounts of at least 50% of current recommendations.
Vitamin C
Low vitamin C intakes have been reported both among older people in residential
care and among those living in their own homes.6 Sufficient vitamin C with meals is
also important as this may aid iron absorption. Vitamin C is sensitive to heat, light
and exposure to air and therefore caterers should follow good cooking guidance to
minimise the loss of vitamin C in meal preparation.
4
Folate
Folate deficiency is associated with a particular form of anaemia and both the intakes
of folate and folate status have been found to be low in some older people both in
residential care and living in their own homes. 6 Low folate status is also more
common among older people with dementia, many of whom live in their own homes
and receive community meals. Folates are extremely sensitive to heat and may be
lost in cooking and when heated food is left for long periods. Caterers should attempt
to minimise folate losses in cooking and food presentation.
Fluid Intakes
A regular and adequate intake of fluids is extremely important for older people. It
helps to prevent dehydration which can lead to confused states; helps to prevent and
alleviate the symptoms of constipation and fluids can also provide important nutrients
when appetites are small. It is recommended that older people drink at least 1.5 litres
or about 8 cups of non-alcoholic fluid a day 7 . As part of the community meal it is
recommended that older people receive a drink of fruit juice or water with their meal
and that wherever possible (for example where a hot meal is still delivered and
served), drinks of tea or coffee or additional water or another beverage are offered to
the older person after their meal. If the meal does not provide an additional snack, or
it may be difficult for the older person to make a drink for themselves to have with
their snack, it is recommended that both water and fruit juice are given with the main
meal.
Those responsible for the provision of community meals should make it a priority that
all older people for whom they provide a meal have access to 2 drinks or more as
part of this meal provision. In some cases there may be an opportunity as part of
community meal provision to organise drinks for other periods of the day and
community meals providers should work with other carers and service providers, and
the older person themselves, to ensure that they have access to 1.5 litres or about 8
cups of fluid every day.
6 Finch S, Doyle W, Lowe C, Bates CJ et al. 1998. National Diet and Nutrition Survey: People Aged
65 Years and Over. Volume 1: Report of the Diet and Nutrition Survey. London. TSO.
7 CWT 2003. Eating Well for Older People. London. Caroline Walker Trust.
5
Table 7.1 Nutrient-based guidelines for community meals for older
people
Dietary reference
value (DRV)
Energy
Men and
women aged 75
years and over
kcals
Not less than 40% EAR
MJ
782
3.3
Fat
g
About 35% of energy
MAX
30
Saturated fat
g
About 11% of energy
MAX
10
Total
carbohydrate
g
About 50% of energy
MIN
104
Non-milk
extrinsic sugars
g
About 11% of energy
MAX
23
Fibre
g
At least 33% of RNI
MIN
6
Protein
g
At least 40% of RNI
MIN
17
Vitamin A
μg
At least 40% of RNI
MIN
260
μg
About 33% of RNI
MIN
3
Vitamin C
mg
At least 50% of RNI
MIN
20
Folate
μg
At least 50% of RNI
MIN
100
Calcium
mg
At least 40% of RNI
MIN
280
Iron
mg
At least 40% of RNI
MIN
3.6
Zinc
mg
At least 40% of RNI
MIN
3.8
Sodium
mg
MAX
960
MAX
2.4
Vitamin D1
Salt
g
40% SACN
recommendation
40% SACN
recommendation
EAR = Estimated Average Requirement
DRV = Dietary Reference Value
RNI = Reference Nutrient Intake
For an explanation of these terms see Appendix 1.
1
Vitamin D
It is impossible for most older adults to obtain the full daily requirement of 10 micrograms of
vitamin D from the diet alone. It is very likely that older adults who receive community meals
will need vitamin D supplements
6
7.3 Food-based guidelines for community meals for older people
Below are some food-based guidelines that caterers may find useful in planning
menus for community meals.
Food group
Guidance
Rationale
What’s included
Bread, other cereals
and potatoes
Starchy foods should
make up a third of the
daily diet.
Foods from this group
are a good source of
energy and the main
source of a range of
nutrients in the diet.
As well as starch,
these foods supply
fibre, calcium iron and
B vitamins.
All varieties of bread
including wholemeal
and granary bread,
chapattis and bagels.
Older people may
prefer white bread and
higher-fibre white bread
may also be
acceptable.
A variety of breads
should be used with
sandwiches and
offered with soup or
light meals.
Offer a variety of
starchy foods with
main meals including
potatoes, rice, pasta,
noodles and other
grains.
Potatoes, plantain, yam
and sweet potato
Rice, couscous, bulgar
wheat, maize, cornmeal
Noodles, pasta
Tips
•
•
•
•
•
Older people with small appetites need nutrient-dense meals, and starchy foods should be
offered in moderate amounts if there is concern about how much someone is eating. Some
white bread has added nutrients and fibre, and can be useful for older people who not like
brown or wholemeal bread.
Some older people find it easier to eat brown or wholemeal bread if it has been lightly toasted.
Offer a variety of starchy foods with meals but ensure that potatoes are offered as a choice
each day, as older people may be less familiar with other starchy staple foods.
Boil potatoes in the minimum amount of water and for the shortest amount of time to retain
vitamins, but ensure they are cooked until soft. Roast potatoes in small amounts of vegetable
oil and use milk to mash potatoes to smoothness.
If you have customers who are allergic to wheat, oats, barley and rye, good alternatives are
foods made from maize (i.e. polenta), rice, rice flour, potatoes, potato flour, buckwheat, sago,
tapioca, soya and soya flour. Seek expert advice from a dietitian where necessary.
7
Food group
Guidance
Rationale
What’s included
Fruit and vegetables
Fruit and vegetables
should make up about
a third of the daily diet.
Fruit and vegetables
are good sources of
many vitamins and
minerals.
All types of fresh,
frozen and tinned
vegetables – e.g.
broccoli, Brussels
sprouts, cabbage,
carrots, frozen peas,
swede and green
beans
Aim for 1 or 2 portions
with each meal.
1 portion of fresh or
cooked fruit of
vegetables should be
about 80g.
Beans and pulses only
count as a maximum
of 1 portion per day
and cannot count as
both a meat alternative
and a vegetable in
meals.
For more information
on fruit and vegetable
portions see Appendix
0.
There is increasing
evidence that
consuming more than
400g of fruit and
vegetables every day
reduces the risk of
developing chronic
diseases such as
coronary heart disease
and some cancers.
All types of salad
vegetables, including
lettuce, cucumber,
tomato, raw carrots,
peppers and beetroot
All types of fresh fruit –
e.g. apples, bananas,
kiwi fruit, oranges,
pears, mango, plums
All types of tinned fruit
in juice – e.g.
pineapple, peaches
Stewed fruit
Dried fruit
Fruit juice (100% juice)
Notes
•
•
•
•
•
•
•
Steaming or cooking vegetables with minimum amounts of water and serving as soon as
possible will help retain vitamins.
Use fresh fruit and vegetables as soon as possible, rather than storing them, to avoid vitamin
loss.
Add vegetables and pulses to stews, casseroles or other dishes and offer a variety of
vegetables at main meals.
Baked beans (as a vegetable) should be served a maximum of twice a week.
Use tinned fruit in natural juice rather than in syrup.
Include cooked fruit in puddings and desserts.
Include dried fruit in cakes, puddings and desserts.
8
Food group
Guidance
Rationale
What’s included
Milk and dairy
products
Milk and dairy foods
should be served
every day.
Milk and dairy
products are
excellent sources of
calcium which is
needed for optimal
bone strength
protein, vitamin A,
riboflavin and vitamin
D.
All types of milk
Community meals
should include a
source of calcium in
the main meal or
snack which
accompanies it. This
could be a milky
drink.
Dried milk, goat’s and
sheep’s milk
Cheeses e.g. Cheddar,
cottage cheese, cheese
spreads, brie, feta, Edam,
goat’s cheese, stilton,
parmesan
Yoghurt (fruit or plain,
whole-milk or low-fat),
fromage frais
Older people with
small appetites who
may need to gain
weight or who are of
low weight should be
encouraged to have
full-fat milk and
yoghurt.
Milk-based sauces, custard
and milk puddings
Semi-skimmed milk
is suitable for older
people with good
appetites.
Tips
•
•
•
•
•
•
•
To add extra calories, protein and nutrients to dishes, extra milk, cheese or dried milk powder
can be added in cooking.
Whole milk can be fortified further by the addition of extra dried skimmed milk powder for those
older people who are of low weight or who have small appetites.
Frozen yoghurts can be offered as an alternative to ice cream.
Milk can be used in sweet and savoury sauces, custards and puddings.
It is worth highlighting that some dairy products can contain high salt levels. Strong cheese can
impart flavour in smaller amounts.
Vegetarian cheese should be used where appropriate
For dairy-free diets: serve soya drinks (fortified with calcium) as an alternative.
9
Food group
Guidance
Rationale
What’s included
Meat, fish and
alternatives (e.g.
beans, pulses, nuts,
eggs, textured
vegetable protein,
quorn, tofu)
A meat or alternative
should be offered at all
main meals.
Meat is a good source
of protein and of
vitamins and minerals
such as iron and zinc
Meat, poultry, offal1,
fish, eggs, nuts, beans,
pulses and meat
alternatives
Fish is an excellent
protein source and
contains selenium and
iodine.
Meat includes all cuts
of beef, lamb and pork
and meat and meat
products such as ham,
corned beef and
sausages. Look for
meat products with a
high meat content.
Red meat should be
offered at least twice a
week.
Use lean meat (with a
fat content of about
10%).
Fish should be offered
at least twice a week.
It is strongly
recommended that oily
fish should be served
once a week
Meat alternatives for
vegetarians should be
varied and use a
variety of foods from
this group (e.g. eggs,
peas, beans and
pulses, soy-based
meat alternatives,
nuts, quorn or tofu).
Oil-rich fish provides
omega-3 fatty acids
which may help to
prevent heart disease.
Such foods are also a
source of vitamins A
and D and iron.
Beans and pulses are
sources of protein, iron
and zinc.
Eggs are a good
source of protein and
vitamins A and D
Nuts provide a source
of protein, iron, fibre,
zinc and calcium.
Fish includes fresh,
frozen and tinned fish
such as tuna.
Oil rich fish include,
sardines, pilchards
mackerel, salmon,
trout and herring. Fish
products include foods
such as fish cakes and
fish fingers.
Beans – e.g. baked
beans, butter beans,
kidney beans, lentils
are in this group and
provide a good source
of protein for
vegetarians.
Tips
•
•
•
•
•
•
•
•
Always choose the leanest cuts of meat and remove visible fat and poultry skin.
Reduce intakes of processed meat and fish products which are high in fat and salt such as
crumb-coated chicken products, burgers, pies, fish cakes and canned meats. These are often
high in salt and low in meat content.
Customers need to be made aware of nuts and nut products incorporated into dishes.
Eggs are a useful source of nutrients but these should always be well cooked for older people.
Oil-rich fish can be used in pâtés and spreads on bread and toast.
For older people who have difficulty chewing, offer soft lean meat and fish or meat dishes
where the meat has been minced or served in a sauce.
Reduce intakes of processed foods made as alternatives to meat such as vegetarian pasties,
pies and sausages as these can be high in salt
Lean red meat, oil rich fish and offal1 are good sources of iron and zinc
1
Liver pâté is a useful source of nutrients for older people but liver and liver products should not be
served more than once a week
10
Food group
Guidance
Rationale
What’s included
Foods containing fat
and foods containing
sugar
These foods add
palatability to the diet
and can be useful in
the diets of older
people for encouraging
eating and stimulating
the appetite.
The main nutrients
provided by such foods
are fat, including some
essential fatty acids,
and also some fatsoluble vitamins.
Foods containing fat
include butter,
margarine, other
spreading fats and
low-fat spreads,
cooking oils, oil-based
salad dressings,
mayonnaise, cream,
chocolate, crisps,
biscuits, pastries,
cakes, puddings, ice
cream, rich sauces,
and gravies.
These foods can be
high in calories and
offer few other
nutrients. If appetites
are poor it is important
that these foods do not
displace more nutrientrich foods.
As for the rest of the
population, foods from
this group can
contribute to excess
energy intakes if they
are eaten in large
amounts.
Carbohydrate (in the
form of sugars) is also
provided.
Some products also
contain salt.
Foods containing
sugar include soft
drinks, sweets, jams
and sugar, as well as
foods such as cakes,
puddings, biscuits,
pastries and ice
cream.
Tips
•
•
•
•
Use mono- and polyunsaturated fat (such as sunflower, soya, olive, safflower, rapeseed, corn
oil) based spreading fats and in salad dressings
For cooking use fats high in monounsaturates such as soya, rapeseed and olive oils
When making cakes and puddings include dried fruit or fresh fruit, wholemeal flours and ground
nuts if acceptable
If older people have a sweet tooth and a poor appetite make sure that the sweet foods on offer
are as nutrient dense as possible by including dairy products, cereal foods and fresh and dried
fruits.
Vitamin D
To increase the amount of dietary vitamin D in menus served for older people:
• Use margarine fortified with vitamin D for baking and as a fat spread.
• Include an oily fish that is rich in vitamin D in the menu at least once a week – for example,
herring, mackerel, pilchards, salmon, sardines, trout or roe. These fish contain between 514µg of vitamin D per 100g.
• Canned tuna fish can also make a significant contribution to vitamin D intake as it contains
about 3.6µg of vitamin D per 100g.
• Egg yolks are rich in vitamin D and eggs contain about 2.0µg of vitamin D per 100g.
• Meat and poultry contribute small but significant amounts of vitamin D.
11
7.4 Example menus
Some example menus are given here which show the sorts, and amounts of foods
and drinks that could be served to meet the nutritional and food-based guidance.
A nutritional analysis is provided for each of the three menus, showing how the menu
compares with the nutritional guidelines.
For further advice on practical aspects of catering for community meals see the
National Association of Care Catering publication Recommended Standard for
Community Meals 8 and Eating Well for Older People: Practical and Nutritional
Guidelines 9 produced by the Caroline Walker Trust.
8
National Association of Care Catering 2003. A Recommended Standard for Community Meals. See
www.carecatering.org.uk
9
Caroline Walker Trust 2003. Eating Well for Older People: Practical and Nutritional Guidelines.
CWT. See www.cwt.org.uk
12
7.5 Example of a community meal with an afternoon snack (menu 1)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Steak and
kidney pie
(160g)
Chicken
fricassee
(190g)
Roast pork
(80g)and
apple sauce
(35g)
Savoury
pie (150g)
Steamed
haddock
(75g)
Lamb and
potato hot
pot (175g)
Mixed
vegetables
(80g)
Cauliflower
(80g)
Carrots
(80g)
Broccoli
(80g)
Roast beef
Yorkshire
pudding
Gravy
(150g)
Mashed
potato
(100g)
Mashed
potato
(100g)
Roast
potatoes
(120g)
Mashed
potato
(100g)
Chipped
potatoes
(100g)
Mashed
potato
(100g)
Roast
potatoes
(120g)
Trifle
(130g)
Apple pie
(100g) and
custard
(100g)
Rhubarb
crumble
(125g) and
custard
(100g)
Lemon
meringue
pie (80g)
Bread and
butter
pudding
(145g)
Apple tart
(100g) and
custard
(100g)
Rice
pudding
and jam
(200g)
Tea or
coffee with
milk
Tea or
coffee with
milk
Tea or
coffee with
milk
Tea or
coffee with
milk
Tea or
coffee with
milk
Tea or
coffee with
milk
Tea or
coffee with
milk
Toasted
teacake
(55g)
Fruit scone
(50g)
Jam sponge
(53g)
Plain scone
with jam
(65g)
Shortbread
(50g)
Fairy Cake
(30g)
Madeira
cake (40g)
Lunch
Fruit juice
or water
should be
provided
MidAfternoon
A drink
should be
provided
Swede
(80g)
Peas (80g)
Cabbage
(80g)
Sweetcorn
(80g)
.
13
Green
beans
(80g)
Cauliflower
(80g)
Cabbage
(80g)
Carrots
(80g)
7.6 Example of a multicultural community meal with an afternoon snack
(menu 2)
South
Asian
vegetarian
meal
South
Asian nonvegetarian
meal
AfroCaribbean
meal
AfroCaribbean
vegetarian
meal
Middle
Eastern
meal
Asian
meal
Asian
vegetarian
meal
Red lentil
dahl (45g)
Chicken
curry
(150g)
African beef
and bean
stew (250g)
Sweetcorn
Chowder
(180g)
Shammi
(lamb)
kebabs
(151g)
Fish Curry
(100g)
Sweet and
sour
vegetables
(200g)
Rice (120g)
Dumplings
(60g)
Fried yam
cakes (50g)
Spicy pilau
rice (190g)
Rice (120g)
Spinach
(80g)
Rice and
peas
(150g)
Stir-fried
vegetables
(200g)
Spiced
banana
crumble
(75g)
Rice
pudding
(180g)
Lunch
Fruit juice
or water
should be
provided
Spinach
and chick
pea curry
(165g)
Yoghurt
raita (30g)
Yoghurt
raita (30g)
Side salad
(45g)
Side salad
(45g)
Sweet
potato
(130g)
Chapatti
(55g)
Banana
(80g)
Afternoon
Snack
Grapes
(80g)
Semolina
pudding
(180g)
Tinned
pineapple
(100g)
Rice (120g)
Tofu (60g)
Tabbouleh
(65g)
Green
salad (45g)
Greek
yoghurt
(100g)
Tea or coffee with: sticky prune cake (50g), carrot cake (60g), coconut short cake (60g), honey
cake (45g), fruit loaf (45g), orange and cinnamon cake (60g) or gingerbread (55g)
A drink
should be
provided
14
7.7 Example of a community meal without an afternoon snack (menu 3)
Lunch
Fruit juice
and water
should be
provided
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Lamb
Moussaka
(330g)
Pork and
apple
casserole
(250g)
Pork
sausages
(105g)
Savoury
minced
beef
(150g)
Salmon
fish cakes
(120g)
Cheese
and
vegetable
bake
(250g)
Garlic
bread (55g)
Wholemeal
roll (50g)
margarine
(7g)
Baked
sliced
potatoes
(140g)
Oven chips
(150/120g)
Roast
chicken and
gravy (150g)
Sage and
onion stuffing
(50g)
Broccoli
(80g)
Sweetcorn
and peas
(80g)
Sliced
tomato
(80g)
Green
salad (45g)
Red
pepper
(40g) and
tomato
(40g)
garnish
Apple and
blackberry
crumble
(170g)
Custard
(100g)
Mashed
potato
(120g)
Potato
croquettes
(120g)
Baked beans
(70g)
Cauliflower
(80g)
Rice pudding
with jam
(200g)
Carrots
(80g)
Mixed
Salad (60g)
Roast
potatoes
(120g)
Soft white
roll with
margarine
(55g)
Brussels
sprouts (80g)
Swede (80g)
Sticky
Prune cake
(55g)
Custard
(100g)
Queen of
puddings
(160g)
Runner
beans
(80g)
Fruit trifle
(170g)
Apple
meringue
pie (120g)
Custard
(100g)
Fresh
banana
(80g)
15
Stewed
fruit
compote
(120g)
Vanilla ice
cream
(40g)
7.8 Nutritional contribution from community meal menus
Average nutrient values from sample
menus
Energy
Nutrient
based
guideline
782
3.3
Menu 1
Menu 2
Menu 3
832
4.1
805
3.3
782
3.2
Kcals
MJ
MIN
Fat
g
About
30
30
29
28
Saturated fat
Total
carbohydrate
Non milk
extrinsic sugars
g
About
10
10
9
10
g
About
104
114
116
139
g
About
23
23
19
18
Fibre
g
Min
6
8
6.8
8
Protein
g
Min
17
33.7
28.7
32.6
Vitamin A
µg
Min
260
1140
804
794
Vitamin C
mg
Min
20
37
36
60
Folate
µg
Min
100
140
95
143
Calcium
mg
Min
280
335
379
367
Iron
mg
Min
3.6
4.2
5.8
4.1
Zinc
mg
Min
3.8
3.9
4.5
3.8
Sodium
mg
Max
960
669
767
963
g
Max
2.4
1.7
1.9
2.4
Salt1
1
The salt content of menus will go down as the amount of salt in common commodities such
as bread is reduced
16
8.0
Example lunch and evening meal
menus for adults
EXAMPLE LUNCH MENU
Soup
Tomato
and lentil
soup
(180g)
Courgette
and
watercres
s soup
(180g)
Irish Stew
(190g)
Tomato soup
(180g)
Scotch
broth
(180g)
Mushroom
soup
(180g)
Onion soup
(180g)
Spicy lentil
soup
(180g)
Main
choice 1
Beef
Olives
(150g)
Gravy
(50g)
Chicken and
mushroom
pasta (340g)
Pork and
potato
bake
(260g)
Braised
Steak
(120g)
Gravy
(50g)
Lamb
Curry
(200g)
Vegetable
shepherds
pie 200g
Vegetable
bake
(90g)
(110g)
Mixed bean
casserole
(250g)
Mixed
vegetable
crumble
(160g)
Mushroom
stroganoff
(150g)
Vegetable
chilli (150g)
Roast Beef
(70g) and
Yorkshire
Pudding
(35g)
Gravy 50g)
Vegetable
lasagne
(240g)
Main
choice 2
Main
choice 3
Goujons
of fish
(80g) with
tartare
sauce
(10g)
Chips
(100g)
Chicken
chasseur
(200g)
Prawn
curry
(140g)
Tuna (45g)
Salad (50g)
Option of
Coleslaw
(40g) and/or
Potato salad
(85g)
Chicken
and
vegetable
casserole
(225g)
Salmon in
spicy
tomato
sauce
(230g)
Seafood
pasta
(230g)
Tuna and
tomato
pasta
(260g)
Beef
stew
(150g)
Beef curry
(180g)
Oriental
Roast
Calypso
beef stir
chicken
turkey
fry (135g)
(60g)
(165g)
Egg fried
rice (140g)
Boiled new potatoes (120g), Jacket potato (120g), Mashed potato (120g)
Rice (150g), Pasta (205g)
Pork with
apricots
(140g)
Vegetable
choices
Leeks
(80g)
Broccoli
(80g)
Side
salad
(80g)
Dessert
choice 1
Fresh fruit slices (100g) or Low fat fruit yoghurt (125g)
Dessert
choice 2
Rhubarb
crumble
(100g)
with
Custard
(150g)
Chocolat
e fudge
pudding
(100g)
Main
choice 4
Starchy
choices
Dessert
choice 3
Drinks
Cauliflower
Gratin
(90g)
Peas (80g)
Side salad
(80g)
Apple Pie
(100g) with
Cream
(40g)
Aubergine
(90g)
Brussels
sprouts
(80g)
Side salad
(80g)
Fruit
compote
(160g) with
Custard
(150g)
Carrots
(80g)
Parsnips
(80g)
Side salad
(80g)
Bread &
Butter
Pudding
(115g)
Custard
(150g)
Sweet oat
cake (45g)
Spinach
(80g)
Mixed
diced
vegetables
(80g)
Side salad
(80g)
French
beans
(80g)
Ratatouille
(90g)
Side salad
(80g)
Cabbage
(80g)
Curly Kale
(80g)
Side salad
(80g)
Apple
crumble
(100g)
with
Custard
(150g)
Bakewell
tart (100g)
Apricot and
pear layer
(100g)
with
Custard
(150g)
Lemon
Meringue
pie (100g)
Dutch
apple tart
(100g) with
Custard
(150g)
Apricots
Trifle (150g)
canned in
juice
(125g) with
Custard
(150g)
Water, tea or coffee (with semi-skimmed milk 30ml), 100% fruit juice
Chocolate
mousse
(80g)
EXAMPLE EVENING MEALS
Bread
Main
choice 1
Main
choice 2
Main
choice 3
Starchy
choices
Vegetable
choices
Dessert
choice 1
Dessert
choice 2
Dessert
choice 3
Drinks
Bread roll selection – granary, wholemeal, crusty white and soft white rolls with soft margarine
(60g)
Fish Pie
Baked cod
Steamed fish Breaded
Chicken
Kedgeree - Plaice
(220g)
(70g)
with Ginger
cod (95g)
dansak
(200g)
Veronique
and Spring
(230g)
(100g)
Onion (70g)
Chicken
Macaroni
Vegetable
Vegetable Vegetable Cheese
Mushroom
and
cheese
curry (225g) pie (250g) crumble
and onion
and pepper
broccoli
(250g)
(160g)
turnovers
bake
lasagne
(120g)
(110g)
(300g)
Corned
Salmon
Cottage
beef salad
(salad
cheese &
(100g)
(95g)
pineapple
Option of
salad
Option of
Coleslaw
(100g)
Option of
Coleslaw
(40g)
Coleslaw
(40g)
and/or
(40g)
and/or
Potato
and/or
Potato
salad
Potato
salad (85g)
(85g)
salad
(85g)
Boiled new potatoes (120g), Jacket potato (120g) or Mashed potato (120g)
Rice (150g), Pasta (200g)
Turkey
salad
(100g)
Spinach
(80g)
Ratatouill
e (90g)
Side
salad
(80g)
Cauliflower
gratin (90g)
Broccoli
(80g)
Side salad
(80g)
Cheese
salad
(90g)
Coleslaw
(40g)
and/or
Potato
salad
(85g)
Oriental
chicken
curried rice
(300g)
Mixed
salad (50g)
Coleslaw
(40g)
and/or
Potato
salad (85g)
Chicken
salad (100g)
Option of
Coleslaw
(40g) and/or
Potato salad
(85g)
Leeks
Cabbage
Aubergine
(80g)
(80g)
(90g)
French
Parsnips
Peas
beans with (80g)
(80g)
Side salad
Side salad
tomato
(80g)
(80g)
sauce
(90g)
Side salad
(80g)
Fresh fruit (100g) or low fat fruit yoghurt (125g)
Curly kale
(80g)
Carrots
(80g)
Side salad
(80g)
Brussels
sprouts
(80g)
Mixed
diced
vegetables
(80g)
Side salad
(80g)
Muesli
Chocolate
Flapjack
Spiced
Fruit tea
Sultana
slice
brownie
(55g)
apple slice bake (60g) sponge
(50g)
(60g)
(50g)
(50g)
Melon
Fruit jelly
Fresh fruit
Poached
Fruit flan
Rhubarb
and
(160g)
salad (120g) pear
(150g)
fool (120g)
grape
(140g)
salad
(120g)
Water, tea or coffee with semi-skimmed milk (30ml), 100% fruit juice
Option of
Coleslaw
(40g)
and/or
Potato
salad (85g)
Flapjack
(60g)
Tropical
fruit salad
(120g)
Analysis of average lunch and evening meal menus
Energy
kcals
MJ
Dietary reference
value (DRV)
Average
Lunch
Average
Evening
Meal
EAR
710
662
Fat
g
No more than 35% of
energy
MAX
19.1
15.7
Saturated fat
g
No more than 11% of
energy
MAX
6.5
4.8
Total
carbohydrate
g
At least 50% of energy
MIN
109
109
Non-milk
extrinsic
sugars
g
No more than 11% of
energy
MAX
16.4
13.9
Fibre
g
DRV
MIN
8.2
7.4
Protein
g
RNI
MIN
32
29
Vitamin A
µg
RNI
MIN
671
436
Vitamin C
mg
RNI
MIN
86
54.5
Folate
μg
RNI
MIN
158
141
Calcium
mg
RNI
MIN
350
352
Iron
mg
RNI
MIN
5.0
4.1
Zinc
mg
RNI
MIN
4.1
3.3
Sodium
mg
MAX
711
645
MAX
1.8
1.6
1
Salt
1
g
SACN
recommendation
SACN
recommendation
The salt content of menus will go down as the amount of salt in common commodities such as
bread is reduced
Appendix 1
Rationale for derived dietary reference values for use in preparation of
the nutrient based guidelines for food served in public institutions
Derived dietary reference values have been used to calculate the recommended
average nutrient content of meals and snacks provided for population groups over
periods of one week or more in this report. This Appendix explains how these were
calculated and Table A1 on page 9 provides a summary of these values.
These values are based on those prepared for the United Kingdom by the
Department of Health 1 and additional information on sodium/salt published in 2003. 2
When prescribing diets for groups of people the intention is to ensure adequacy of
the diet. The Dietary Reference Values are designed to provide guidance for groups
of individuals by age and gender. It is recommended that where appropriate the
Reference Nutrient Intakes (RNI) are used for groups to ensure that the risk of
deficiency to any individual is small. (For an explanation of the terms dietary
reference values and reference nutrient intake please see page 2). The aim of the
derived reference values described in this appendix is to ensure that all individuals in
a group are likely to have their needs met for those nutrients where there is a
minimum requirement without providing too much of those nutrients for which there is
a maximum recommendation.
In many public institutions food will be served to groups of people mixed by age and
gender. A pragmatic approach has therefore been taken to develop simple reference
values which can be used to develop the nutrient based guidelines. The rationale for
the calculation of the derived dietary reference values for each age group is
explained on the following pages.
For simplicity the values have been rounded to whole numbers (or where it is the
convention to the nearest 5 or 10). These values are intended to act as guidance
only to encourage menu planners to produce menus which contain the types of food
which provide nutrients in the proportions recommended for good health.
1
Department of Health 1991. Dietary Reference Values for Food and Energy and Nutrients for the
United Kingdom. Report on Health and Social Subjects No.41. HMSO London.
2
SACN 2003. Salt and Health. TSO. London
1
Definition of Dietary Reference Value 3 terms
Dietary Reference Values (DRVs)
Dietary Reference Values (DRVs) are benchmark intakes of energy and nutrients.
They indicate the amount of energy or individual nutrients needed by a group of
people of a certain age range (and sometimes gender) for good health. They are not
designed for working out a diet for an individual; eating less of a nutrient than is
recommended cannot tell us that an individual is deficient. However, if more than
quite a few people in a group fall below the recommendations, this suggests that
some individuals in that population may be at risk of deficiency.
The DRVs for energy are described as the Estimated Average Requirement (EAR).
Most other nutrients have an EAR and also a Reference Nutrient Intake (RNI)
Estimated Average Requirement (EAR)
The average amount of energy or nutrients needed by a group of people. Half the
population will have needs greater than this, and half will have needs below this
amount.
Reference Nutrient Intake (RNI)
This is the amount of a nutrient which is enough to meet the dietary requirements of
about 97% of a group of people. If people get more than this amount they will almost
certainly be getting enough.
Percentage (%) of Energy
This describes what proportion of the energy consumed should come from fat,
carbohydrates or protein. It is calculated from the known contribution that each of
these macronutrients makes to energy intake: fat provides 9 kcals/g, carbohydrates
3.75 kcals/g and protein 4 kcals/g.
Recommendations for sodium/salt intakes
The Scientific Advisory Committee on Nutrition (SACN) 4 made the following
recommendations on maximum recommended salt intakes for the population.
Age
1-3 years
4-6 years
7-10 years
11 years +
SACN recommendation
for maximum daily salt and sodium intakes
Salt g/day
2
3
5
6
3
Sodium mg/day
800
1200
2000
2400
Department of Health 1991. Dietary Reference Values for Food and Energy and Nutrients for the
United Kingdom. Report on Health and Social Subjects No.41. HMSO London
4
SACN 2003. Salt and Health. TSO. London
2
Derivation of nutrient values by age group
1. Children aged 1-4 years
Energy
The Estimated Average Requirements (EAR) for energy for children aged 1 year to 4
years are shown below.
Estimated Average Requirements for energy for children under 5 years
Age of child
1 year
1½years
2 years
2½years
3 years
4 years
Estimated Average Requirement
in kcal (MJ) per day*
Boys
Girls
960kcal (4.0 MJ)
910kcal (3.8MJ)
1,080kcal (4.5MJ)
1,020kcal (4.3MJ)
1,190kcal (5.0MJ)
1,130kcal (4.7MJ)
1,280kcal (5.4MJ)
1,230kcal (5.1MJ)
1,490kcal (6.2MJ)
1,370kcal (5.7MJ)
1,600kcal (6.7MJ)
1,460kcal (6.1MJ)
* In practice the intakes of energy and of nutrients needs to be averaged over several days to take
account of variations in appetite and in the diverse foods in a diet from day to day.
Derived energy values for 1-4 year old are based on the average dietary reference
values for boys and girls based on the figures in the table above.
Fat and carbohydrate
There are no recommendations for the 1-4 year olds in terms of the proportion of
energy in the diet which should come from fat and total carbohydrate. If 1-4 year olds
have too little fat, this may affect their growth and development and their diet may be
too low in other essential nutrients. Between the ages of 2 and 5 years children's
diets should move towards the recommendations currently made for those over 5
years of age. However, in this report it is argued that diets which provide about 35%
of energy from fat are likely to be suitable for children aged 1-4 years (see page 00).
There is however no recommendation for the amount of saturated fat in the diets of
1-4 year olds since restriction on milk and dairy products is not desirable. Similarly no
recommendation is made for fibre since it is important that the diets of 1-4 year olds
are not too bulky but remain nutrient dense.
The recommendation currently made for the whole population to restrict the amount
of NME sugars in the diet to no more than 11% of energy intake is however
appropriate to children under the age of 5.
Protein
Protein values are based on ¾ of the RNI for 1-3 year olds plus ¼ of the RNI for 4-6
year olds
Other nutrients
1-2 year olds: Values are taken from those for the age group 1-3 year olds
3-4 year olds: Values are taken as 50% of the DRV for 1-3 year olds and 50% of the
DRV for 4-6 year olds.
3
The values for children aged 1-4 years are therefore the average of those aged 1-2
and 3-4 years.
When setting nutritional guidance for population groups it is normal practice to
ensure that the needs of the group with the highest needs are met – so that where
there are discrepancies by age and gender for a specific nutrient for which there is a
minimum, the higher value is selected.
For children aged 1-4 years however, there is already an expectation that the diet will
be nutrient dense and in practice it becomes difficult to enhance the micronutrient
intakes relatively higher than the energy value when energy intakes are small. In this
group therefore, micronutrient recommendations remain proportional to energy
intake: the assumption is that the bigger and hungrier children will eat more and if
they eat the types of food as suggested in the sample menus, they will obtain
proportionally higher amounts of micronutrients to meet their needs.
Sodium/salt values are taken as 75% of the value for 1-3 year olds and 25% of the
value for 4-6 year olds.
2. Children aged 5-10 years
Estimated Average Requirements for energy for children
Age of child
4-6 years
7-10 years
Estimated Average Requirement
in kcal (MJ) per day*
Boys
Girls
1,715kcal (7.2MJ)
1,545kcal (6.5MJ)
1,970kcal (8.2MJ)
1,740kcal (7.3MJ)
* In practice the intakes of energy and of nutrients needs to be averaged over several days to take
account of variations in appetite and in the diverse foods in a diet from day to day.
The derived energy values for children aged 5-10 years for this report are taken
proportionally from these figures:
1/3 x mean EAR at 4-6 years (for those aged 5 and 6 years) + 2/3 mean EAR at 7-10
years (for those aged 7, 8, 9,10 years)
The values for fat and carbohydrate are derived as a proportion of these based on
their energy contribution as described in table 1.
Protein is estimated as 1/3 x the RNI 4-6 year olds (for those aged 5 and 6 years)
and 2/3 of the RNI of 7-10 year olds (for those aged 7, 8, 9,10 years)
Fibre (non-starch polysaccharides) estimates are made for this group based on
their energy requirement relative to an adult, where the DRV for fibre is 18g per day.
The values for vitamins and minerals (except sodium/salt) for this group are
however taken as the highest requirement in the group: i.e. the values for 7-10 year
olds.
4
Sodium/salt values are taken as 1/3 of the value for 4-6 year olds and 2/3 of the
value for 7-10 year olds in line with energy requirements, however to aid menu
planners this figure has been rounded up to the nearest 0.5g salt.
5
3. Young people aged 11-18 years
Estimated average requirements of energy for young people
Age of child
11-14 years
15-18years
Estimated Average Requirement
in kcal (MJ) per day*
Boys
Girls
2,220kcal (9.3MJ)
1,845kcal (7.7MJ)
2,755kcal (11.5MJ)
2,110kcal (8.8MJ)
* In practice the intakes of energy and of nutrients needs to be averaged over several days to take
account of variations in appetite and in the diverse foods in a diet from day to day.
For this age group there will be wide variations in energy need depending on growth
rate, stage of development, activity levels and gender and it is difficult to provide an
average figure for young people of this age. Table 1 therefore provides a range of
figures for energy and macronutrients. Menu planners should aim to provide food
which allows the range of energy intakes to be accessed by those with smaller and
bigger appetites (i.e. by offering a range of portion sizes) while maintaining the
micronutrient intakes recommended.
Protein is given as a range of figures representing the RNI for males and females
aged from 11--18 years.
Values for vitamins and minerals for the whole group are taken using the principle
of meeting the needs of the members of the group with the highest requirement. For
example for calcium the value for boys aged 15-18 years has been taken and for iron
the value for girls 15-18 years has been taken.
6
4. Adults aged 19-74 years
The energy needs of adults are likely to be highly variable but it is generally accepted
that energy requirements fall among older adults as energy expenditure declines and
there are changes to body composition which affect the basal metabolic rate. These
differences are however relatively small and for practical purposes an average
energy value for adults has been determined which is likely to apply to the majority of
adults in this group. Those with higher energy needs will be able to meet these needs
by having larger portion sizes and more carbohydrate foods such as bread with
meals.
Average requirements of energy for adults aged 19-74 years
Age
19-50 years
51-59 years
60-64 years
65-74 years
Estimated Average Requirement
in kcal (MJ) per day*
Men
Women
2,550kcal (10.6MJ)
1,940kcal (8.1MJ)
2,550kcal (10.6MJ)
1,900kcal (8.0MJ)
2,380kcal (9.9MJ)
1,900kcal (8.0MJ)
2,330kcal (9.7MJ)
1,900kcal (8.0MJ)
* In practice the intakes of energy and of nutrients needs to be averaged over several days to take
account of variations in appetite and in the diverse foods in a diet from day to day.
Since the differences between age groups are relatively small, for practical purposes
in this report the average energy intakes for this group have been estimated as:
the average of 80% of the EAR for 19-50 year olds plus 20%of the EAR for 60-64
year olds
The values for fat and carbohydrate for this group have been calculated
proportionally to the derived energy value
For protein the value is taken as the mean RNI for men and women aged 19-50
years and for those aged 50+ years
For vitamins and minerals the principle applies that the values should meet the
needs of those with the highest needs in the group.
Vitamin D
There is an RNI for vitamin D for all adults over 65 years of 10µgday. It is however
difficult to obtain vitamin D from the diet alone and therefore it is unlikely that menus
will be able to provide this level of vitamin D. Adults who live normal lives (i.e. are
active and spend time out of doors in summer) are likely to make enough vitamin D in
their skin to provide for their needs. Any older adult who is housebound or spends
limited time outdoors or wears very restrictive clothing so that their skin is not
exposed to the sun is likely to need vitamin D supplements.
Single gender groups
Where caterers are providing for single gender groups, the values for men only and
women only in the age group 19-74 years is also provided here calculated using the
same principles.
7
5. Adults aged 75 years and over
The needs of older adults aged 75 years and over will vary from those for the
younger adult age group since they are likely to have lower energy requirements.
The need for nutrient dense foods for this age group is fully explained in chapter 8.
Age
75 years +
Estimated Average Requirement
in kcal (MJ) per day*
Men
Women
2,100kcal (8.8MJ))
1,810kcal (7.6MJ)
* In practice the intakes of energy and of nutrients needs to be averaged over several days to take
account of variations in appetite and in the diverse foods in a diet from day to day.
For this group energy values are taken as the average for men and women
The values for fat and carbohydrate are taken proportionally to the energy value as
shown in Table 1
The protein value is taken as the mean of the RNI for men and women aged 75
years and over
Recommendations for vitamins and minerals are calculated using the principle that
the highest needs of any member of the group should be met
Vitamin D
There is an RNI for vitamin D for all adults over 65 years of 10µgday. It is however
difficult to obtain vitamin D from the diet alone and therefore it is unlikely that menus
will be able to provide this level of vitamin D. Adults who live normal lives (i.e. are
active and spend time out of doors in summer) are likely to make enough vitamin D in
their skin to provide for their needs. Any older adult who is housebound or spends
limited time outdoors or wears clothing which covers their body so that their skin is
not exposed to the sun is likely to need vitamin D supplements.
All older people in residential care or having community meals are likely to need
vitamin D supplements.
8
Table A1 Derived nutrient values for nutrient-based standards
Nutrient
requirement
based on
Nutrient
Energy kcals
MJ
EAR
Fat g
MAX
Saturated fat g
MAX
Carbohydrate g
MIN
Non milk extrinsic MAX
sugars g
Fibre g
MIN
Derived dietary reference values for population groups by age
Children
1-4 years
Children
5-10 years
Young people
11-18 years
1845 – 2755
7.7 – 11.6
Adults
19-74
years
2225
9.4
Men
19-74
years
2515
10.6
Women
19-74
years
1930
8.1
Adults 75
years and
over
1955
8.2
1290
5.4
1780
7.5
501
70
72 -107
87
98
75
76
No more than
35% energy
No more than
11% energy
At least 50%
energy
No more than
11% energy
DRV
*
22
23 -34
27
31
24
24
1721
237
246 - 367
297
335
257
260
38
52
54 - 81
65
74
57
57
*
15
18
18
18
18
18
Protein g
MIN
RNI
16
25
41-55
50
55
45
50
Vitamin A µg
MIN
RNI
425
500
700
700
700
600
700
Vitamin D µg
MIN
RNI
7
-
-
-
- **
- **
10
Vitamin C mg
MIN
RNI
30
30
40
40
40
40
40
Folate µg
MIN
RNI
85
150
200
200
200
200
200
Calcium mg
MIN
RNI
375
550
1000
700
700
700
700
Iron mg
MIN
RNI
7
9
15
15
9
15
9
Zinc mg
MIN
RNI
5.5
7
9.5
9.5
9.5
7
9.5
Sodium mg
MAX
900
1800
2400
2400
2400
2400
2400
Salt g
MAX
SACN
maximum
SACN
maximum
2.3
4.5
6
6
6
6
6
1
For children aged 1-4 years it is recommended that about 35% energy comes from fat and about 50% of energy from carbohydrate
* No value is given for these nutrients for this age group.
** For adults aged over 65 years the reference nutrient intake is 10µg per day
9
.
10
Appendix 2 Good sources of nutrients
This Appendix shows a number of foods and drinks which are useful sources of certain
vitamins and minerals. These are based on average servings. This data has been
adapted from tables prepared for the Caroline Walker Trust report Eating Well at School 1
1
Crawley 2005. Eating well at school. The Caroline Walker Trust. www.cwt.org.uk
EXCELLENT
GOOD
USEFUL
VITAMIN A
Liver*
liver sausage/pâté*
carrots
spinach
sweet potatoes
red peppers
mango
canteloupe melon
dried apricots
canned salmon
herrings
egg
honeydew melon
prunes
orange
sweetcorn
peas
whole milk
VITAMIN D
fortified breakfast cereals
herrings
pilchards
sardines
tuna
canned salmon
egg
liver and liver pâté*
pork, bacon and ham
fortified breakfast cereals
malted drinks
nectarine
peach
blackcurrants
fresh or canned apricots
watercress
tomatoes
cabbage (dark)
broccoli
Brussels sprouts
runner beans
broad beans
margarine
butter
cheese
kidney
lLiver* (other than
chicken liver)
liver sausage/pâté*
margarine
wholemeal bread
yeast extract
oatcakes
currant buns
nuts
potatoes
milk
malted drinks
fortified breakfast
cereals
almonds
lean meat
chicken and other
poultry
eggs
white or brown bread
semi-sweet biscuits
lean meat or poultry
bacon
mackerel, tuna, salmon
sardines, pilchards
cheese
yoghurt
eggs
wholemeal bread
peanut butter
yeast extract
bacon
liver sausage*
baked beans
lentils and other pulses
green vegetables
tomatoes
wholemeal bread
cheese
THIAMIN
RIBOFLAVIN
liver*
kidney
NIACIN
fortified breakfast cereals
canned salmon, tuna
pilchards
chicken
VITAMIN B6
bran flakes
red meat
poultry
liver*
oily fish
VITAMIN B12
liver*
kidney
oily fish
beef
lamb
pork
turkey
white fish
eggs
FOLATE
most fortified breakfast
cereals, e.g. cornflakes,
branflakes, crisped rice
liver*
spinach
yeast extract
cabbage
Brussels sprouts
broccoli
peas
orange
melon
lean meat
sausages
kidneys
herrings
sardines
potatoes
bananas
nuts
peanut butter
dried fruit
white fish
chicken liver
malted-style drinks
chicken
milk
cheese
yoghurt
marmite
ribena
bran flakes
wholemeal bread/flour
wheat bisks
cauliflower
beef
runner beans
tomatoes
parsnip
kidney
VITAMIN C
blackcurrants
orange (and orange juice)
strawberries
canned guava
spring greens
green and red peppers
(raw)
broccoli, cabbage
cauliflower, spinach
tomato
Brussels sprouts
watercress
kiwi fruit
mango
grapefruit
IRON
fortified breakfast cereals
liver*
kidney
liver sausage/pâté*
CALCIUM
green leafy vegetables
sardines
cheese
tofu
wholemeal bread/flour
wheat bisks
beef, beefburger
corned beef
lamb
sardines, pilchards
soya beans
chick peas, lentils
spinach, broccoli
spring greens
dried apricots
raisins
pilchards
yoghurt
milk (all types)
soya drink fortified with
calcium
cheese spread
sesame seeds
bacon
ham
poultry
canned sardines
shrimps and prawns
tofu
wholegrain breakfast
cereals, e.g. puffed
wheat, bran flakes,
wheat bisks
nuts
muesli
wholemeal pasta
brown breads
white bread with added
fibre
baked potato with skin
sweet potato
broad beans
fresh or frozen peas
sweetcorn
broccoli, Brussels
sprouts
quorn
blackberries
dried dates
almonds, hazelnuts
ZINC
FIBRE
(non-starch
polysaccharides –
NSP)
liver*
kidney
lean meat
corned beef
wholegrain or wholewheat
breakfast cereals such
as bran flakes, wheat
bisks, shreddies,
shredded wheat,
sultana bran
wholemeal breads
baked beans, chick peas,
kidney beans (and most
beans)
lentils
dried apricots, figs, prunes
potatoes
green leafy salads
ackee
peanuts
potatoes
green beans
peas
satsumas
eating apples
nectarines
peaches
raspberries
blackberries
white bread
baked beans
broad beans
black-eyed peas
blackcurrants
salmon, tuna
herrings
sausage
chicken and other
poultry
egg
tofu
canned salmon
muesli
white bread/flour
peas, beans, lentils
dried fruit
orange
egg yolk
sausages
cold cooked meats
canned tuna or pilchards
eggs
milk
cheese
beans and lentils
brown or wholemeal
bread
plain popcorn
sesame seeds
puffed wheat cereal
brown rice
white pitta bread
pizza
potatoes
yam
houmous
canned peas
cabbage
carrots
plantain
banana
mango
raisins
sunflower seeds
potato crisps
* Liver and liver pate are very rich in vitamin A and these foods should be consumed no more
than once a week. For more information see SACN (2005) Review of Dietary Advice on Vitamin
A. London. TSO.
Food-related customs
This is a guide to some of the differences in food choice commonly observed by those from
different religious and cultural groups. It is important to emphasise that there may be
individual differences in food choices between families and individuals
Jewish Hindu1
Sikh1
Muslim Buddhist Rastafarian2
It may
vary
Yes
Yes
It may
vary
It may vary
Yes
Yes
Yes
Yes
It may vary
Yes
Yes
It may vary
It may vary
Kosher
Halal
No
It may vary
Beef and beef
products
Pork and pork
products
Fish
Kosher
It may
vary
It may
vary
No
No
Mutton/lamb
It may
vary
It may
vary
No
It may
vary
Halal
Yes
Chicken
No
blood
spots
Not with
meat
Not with
meat
Kosher
Halal
No
It may vary
No
Rarely
Rarely
No
No
No
It may
vary
It may
vary
Yes
It may
vary
Yes
No
Kosher
It may
vary
Yes
No
Butter/ghee
With
fins and
scaes
It may
vary
Yes
It may
vary
Shellfish
With
fins and
scales
No
No
It may vary
Lard
No
No
No
No
No
No
Cereal foods
Yes
Yes
Yes
Yes
Yes
Yes
Nuts/pulses
Yes
Yes
Yes
Yes
Yes
Yes
Fruits/vegetables
Yes
Yes3
Yes
Yes
Yes
Yes
Fasting4
Yes
Yes
Yes
Yes
Yes
Yes
Eggs
Milk/yoghurt
Cheese
1 Strict Hindus and Sikhs will not eat eggs, meat, fish, and some fats.
2 Some Rastafarians are vegan.
3 Jains have restrictions on some vegetable foods. Check with the individuals.
4 Fasting is unlikely to apply to young children.
Reproduced from Crawley 2006. Eating Well for Under 5s in Child Care. The Caroline Walker Trust.
www.cwt.org.uk
Resources and Useful Addresses
This list is not intended to be comprehensive but provides details of some of the
organisations and publications which may be useful to caterers in the public sector.
Better Hospital Food
www.betterhospitalfood.com
This site provides information on all aspects of food service and delivery within the NHS.
Chartered Institute of Environmental Health
Chadwick Court
15 Hatfields
London SE1 8DJ
T: 020 7928 6006
E: [email protected]
www.cieh.org.uk
LACORS
Local Authorities Coordinators of Regulatory Services
10 Albert Embankment
London SE1 7SP
TL 020 7840 7200
www.lacors.com
Local Authorities Catering Association (LACA)
Bourne House
Horsell Park
Woking
GU21 4LY
T: 01483 766777
www.laca.co.uk
National Association Care Catering
45, Palace View
Bromley
BR1 3EJ
T 020 8460 4477
www.carecatering.org.uk
The Royal Institute of Public Health and Hygiene
28 Portland Place
London W1B 1DE
T: 020 7580 2731
www.riph.org.uk
Vegan Society
Donald Watson House
7 Battle Road
St Leonard's on Sea
East Sussex TN37 7AA
T: 01424 427393
www.vegansociety.com
Vegetarian Society
Parkdale
Dunham Road
Altrincham
Cheshire WA14 4QG
T: 0161 928 0793
www.vegsoc.org
Food Standards Agency publications
Available from:
PO Box 369
Hayes
Middlesex UB3 1UT
T: 0845 606 0667
F: 020 8867 3225
Minicom (for people with hearing disabilities): 0845 606 0678
E: [email protected]
Be Allergy Aware FSA0002
Catering for Health ISBN 0 907667 27 9 (also available in Welsh)
Ten Tips for Food Safety FSA0006
The Food Safety Act 1990 and You FSA0238. Booklet summarising the Food Safety Act.
The Balance of Good Health FSA/0008/0604
The following resources can be downloaded from the FSA website: www.food.gov.uk
A guide for healthier eating for the over 60s
FSA Northern Ireland 2006 Calendar
A guide to healthier eating for the over 60s
FSA Wales publication
BSE and Beef: A Brief Guide to New Controls
Leaflet published by the FSA
BSE and Beef: New Controls Explained
Booklet published by the FSA
Germs Love To Travel
Labelling claims
Labels
Preventing food poisoning
When you need to avoid a food
A guide for people with food allergy or intolerance
Further information on healthy eating can be obtained from:
www.eatwell.gov.uk
www.salt.gov.uk
www.food.gov.uk
Publications from the National Audit Office
157-159 Buckingham Palace Road
London SW1W 9SP
T: 020 7798 7400
E: [email protected]
www.nao.gsi.gov.uk
Smarter food procurement in the public sector (2006)
London. TSO
Smarter food procurement in the public sector: A good practice guide (2006)
Smarter food procurement in the public sector: Case Studies (2006)
Serving Time: Prisoner Diet and Exercise (2006)
SUSTAIN Publication
The Manual for Sustainability in Public Sector Food and Catering (2003)
Available from Sustain, 94, White Lion Street, London N1 9PF
T: 020 7837 7200
www.sustainweb.org
Additional resources on catering across the public sector in Scotland and Wales are
available via The Scottish Executive Website and the website of the Welsh
Assembly
www.scotland.gov.uk
www.wales.gov.uk
Menu analysis
The menu plans in this report were put together by nutritionists using a combination of food
and recipe composition data from a number of sources:
Data from a number of volumes of McCance and Widdowson’s The Composition of Food 1
and other food composition information in tables and scientific papers
Data from manufacturers and food labels
Data provided by other menu planners and caterers
Data included in the Nutmeg Menu Planner software package
The Caroline Walker Trust recommends that caterers use appropriate software to analyse
their menus. This should include information about cooked foods and dishes and should be
designed to ensure that all the nutrients of interest, including non-milk extrinsic sugars, are
included for all the foods and recipes that are included in the database.
The Nutmeg Menu Planner fulfils all these functions and further details can be found on
www.nutmeg-uk.com
1
For details of these publications see www.food.gov.uk