Government and Policy related stuff

Nutritional Status and Nutrition-Related Health Measurement - BLUE; Knowledge, Attitudes and Behavior Assessments - GREEN; Availability of Community Resources - PURPLE;

USDA

Cabinet-level department

• Runs food assistance programs and food safety for meat, poultry, and processed egg products

• Co-publishes the Dietary Guidelines with HHS.

USDA FNS (Food and Nutrition Service)

Administers SNAP, WIC, NSLP, School Breakfast, CACFP, SFSP, TEFAP, CSFP, and FDPIR.

USDA FSIS (Food Safety and Inspection Service)

Inspects meat, poultry, and processed egg products. Enforces HACCP in those plants.

FDA

Agency within HHS

• Regulates about 80% of the food supply (everything except FSIS products), including shell eggs, seafood, produce, dairy, and packaged foods

• Also regulates drugs, supplements, medical foods, and infant formula

FDA Food Code

Model code for retail and foodservice safety. It is not federal law; states and localities adopt it

FDA and labeling

Nutrition Facts (NLEA, 1990), nutrient content claims, health claims (authorized or qualified), and structure/function claims (30-day notification plus disclaimer)

FDA and supplements

• Regulated as food under DSHEA (1994)

• No pre-market approval

• The manufacturer is responsible for safety, and FDA must prove a product unsafe to remove it

A dietary supplement, as defined by the FDA, must be:

• Intended to supplement the diet

• Intended to be taken by mouth

• Contain one or more dietary ingredients ( macronutrients, vitamins, minerals, herbs, etc.)

USDHHS - United States Department of Health and Human Services

Cabinet-level department. Parent of FDA, CDC, NIH, CMS, HRSA, ACL, and others

CDC - Centers for Disease Control and Prevention

Surveillance, including NHANES and BRFSS (via NCHS), and growth charts

NIH - National Institutes of Health

Funds and conducts biomedical and nutrition research

CMS - Centers for Medicare & Medicaid Services

Administers Medicare and Medicaid. Part B covers MNT for diabetes and CKD (non-dialysis or post-transplant) from an RD/RDN with a physician referral

Medicare

A federal health insurance program primarily for adults age 65 and older, as well as certain younger people with disabilities or end-stage renal disease. Unlike Medicaid, Medicare eligibility generally is not based on low income.

Medicaid

A jointly funded federal-state health insurance program administered by states for eligible low-income individuals, including children, pregnant people, older adults, and people who are blind or disabled. Eligibility and benefits vary by state, so low income alone does not always guarantee coverage.

a federal program administered by each state, designed to provide medical care to eligible low-income individuals, including:

• Children

• Pregnant women

• Elderly

• People who are blind or disabled

Healthy People

HHS (ODPHP) objectives on a 10-year cycle. Current edition is Healthy People 2030.

NSI

Nutrition Screening Initiative

• promote nutrition and improve nutritional care for the elderly to identify nutritional problems early

• DETERMINE checklist

  • identifies factors placing people at nutritional risk

    • increases awareness of factors that influence nutritional health

    • disease, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, needs assistance in self-case, elder years above age 80

• LEVEL I identifies those who need more comprehensive assessments

• LEVEL II screen provides more specific diagnostic info on nutritional status

Community Food Security Initiative

• development of sustainable, community-based strategies to ensure that all have access to culturally acceptable, nutritionally adequate food at all times

• strategies that strengthen local food systems:

  • farmers markets - increased access to fresh produce

  • food recovery and gleaning programs - collect excess wholesome foods that would otherwise be thrown away (from farms, packing houses, caterers, cafeterias, restaurants) for delivery to hungry people

  • PPFPs - Prepared and Perishable Food Programs - nonprofit programs that link sources of unused, cooked and fresh foods with social service agencies that serve the hungry

NNMRRP

National Nutrition Monitoring and Related Research Program

• includes all data collection and analysis activity of the federal government related to measuring the health and nutritional status, food consumption, attitudes about diet and health

• jointly run by the USDHHS and USDA

PedNSS

Pediatric Nutrition Surveillance System

• USDHHS

• low income, high-risk children, birth-17 years, emphasis on birth-5 years

• height, weight, birth-weight, hematocrit, hemoglobin, cholesterol, breastfeeding

• monitors growth and nutritional status, infant-feeding practices

PNSS

Pregnancy Nutrition Surveillance System

• USDHHS

• low income, high-risk pregnant women

• maternal weight gain, anemia, pregnancy behavioral risk-factors (smoking, alcohol), birth-weight, counts # of women who breast-feed

• identify and reduce pregnancy-related health risks

NHANES

National Health and Nutrition Examination Survey

• CDC

• collects nutritional, clinical, and biochemical data

• ongoing (repeated) survey to obtain infor on helath of American people

• evaluates clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometric, nutritional data (24-hour diet recall, food frequency lists)

• NHANES III - oversampling of adults ≥65 with NO upper age limit

• WWEIA - What We Eat in America - dietary intake component of NHANES

  • also known as National Food and Nutrition Survey NFNS

    • two days of 24 hour dietary recall data with times of eating occasions and sources of foods eaten away from home

    • USDA conducts over-sampling of adults ≥60, African Americans, Hispanics

USDA Nationwide Food Consumption Surveys (NFCS)

• to obtain info on food intake of individuals and total households from entire US

• evaluates 7 nutrients - protein, calcium, iron, thiamin, riboflavin, vitamins C, A

• diets rated good if intakes equaled or surpassed RDA; rated poor if less than 2/3 of RDA for 1 or more nutrients

BRFSS

Behavioral Risk Factor Surveillance System

• USDHHA

• adults 18 years and older residing in households with telephones

• telephone interview collect info on height, weight, smoking, alcohol use, food frequency of fat, F/V

YRBSS

Youth Risk Behavior Surveillance System

• USDHHS

• Grades 9-12. Smoking, alcohol use, weight control, exercise, eating habits

• prevalence of health risk behaviors among young people

FSANS

Food Safety and Nutrition Survey

• FDA

• assess consumers’ awareness, knowledge, understanding and reported behaviors related to food safety and nutrition-related topics

• help to make better informed regulatory, policy, education decisions to promote and protect public health

TANF

Temporary Assistance for Needy Families

• states determine the eligibility and the benefits and services provided

• helps needy families achieve self-sufficiency, time-limited, helps foster economic security and stability

• grants funds to states

USDA Commodity Food Donation / Distribution Program

• provides foods to help meet nutritional needs of children and adults and strengthens agricultural market for products produced by American farmers

• food given to School Lunch, elderly feeding, supplemental food programs

• CSFP - Commodity Supplemental Food Program

  • administered by state health agencies

  • monthly commodity canned or packaged foods

  • improve health of low-income elderly at least 60 years of age

  • states may require that participants be at nutritional risk

• TEFAP - The Emergency Food Assistance Program

  • quarterly distributions of commodity foods by local, public or private nonprofit agencies, food banks, soup kitchens, homeless shelters

  • supplements diets of low-income households, short term hunger relief

NSLP

National School Lunch Program

• USDA Food and Nutrition Services (FNS)

• entitlement program to improve nutrition of children, especially from low income families; utilize surplus production of foods

• cash grants and food donations; dollars reimburse schools on basis of numbers of meals served

• implements the Dietary Guidelines into the Lunch and Breakfast Programs

• lunch must provide on average over each school week: 1/3 of the recommended intake for protein, vitamin A and C, iron, calcium

• grades 9-12: 2 ounces meat serving; nuts must be combines and only used for half the requirement

• graham flour is considered whole grain

• K through 5: ¾ cup vegetables is one serving

• 100% full strength fruit juice may be used as ½ of weekly servings of fruit

• Team Nutrition implements School meals Initiatives for Healthy Children

  • motivate child to make healthy choices; helps schools meet Guidelines

  • provides recipes, training, support to child nutrition professionals

NSBP

National School Breakfast Program - USDA

• entitlement program, meals must meet federal Dietary Guidelines

• breakfast must provide on average over each school week: ¼ daily recommended levels for protein, calcium, iron, vitamin A, vitamin C

ASP

Afterschool Snack Programs

• USDA

• provides healthy snacks

  • cash subsidies for each snack served, same eligibility bases as NSLP

SMP

Special Milk Program

• USDA

  • provides milk to children in schools and childcare institutions who do not participate in other Federal meal service programs

  • reimburses schools for milk served

SFSP

Summer Food Service Program

• USDA School Lunch

• entitlement program; purpose is to initiate, maintain, or expand foodservice programs to children and teens in low-income areas when school is out

• reimburses providers for meals served at a central site, 18 and younger

• administered by FNS, state educational agencies, public or private nonprofit residential summer camps

CACFP

Child and Adult Care Food Program

• USDA

• supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless shelters, nonresidential adult daycare centers

• reimburses operators for meal costs, provides commodity foods and nutrition education materials

• meals must meet guidelines; must offer free or reduced-price to eligible

• eligibility standards same as NSLP

FFVP

Fresh Fruit and Vegetable Program

• USDA

• introduces children to fresh fruits and vegetables; help develop eating habits that improve health, prevent obesity and subsequent chronic disease

• free to children at eligible elementary schools who operate NSLP

WIC Special Supplemental Nutrition Program for Women, Infants, and Children

• USDA

• SUPPLEMENTAL NOT ENTITLEMENT

• for pregnant, postpartum, breast-feeding women; infants and children up to 5

• provides food for low income mothers at nutritional risk (abnormal weight gain, history of high risk, LBW, underweight, overweight, anemia)

• risk: weight, height, head circumference in infants, hemoglobin, hematocrit

• provides food, nutrition education, referrals to other agencies

• health exam is REQUIRED

• must meet income standards, be at nutritional risk, and in need of foods offered

• food provided included: iron-fortified formula, cereal, milk, cheese, fruit juice

• not and entitlement program: cap on the amount of federal dollars allocated

• priorities: pregnant and breast-feeding women, infants up to 1 year

• WIC FMNP - Farmers’ Market Nutrition Program: coupons to purchase fresh, locally grown foods at farmers; markets

• EBT electronic benefits transfer care

EFNEP

Expanded Food and Nutrition Education Program

• USDA

• provides grants to universities that assist in community development

• trains nutrition aides to educate the public

• works with small groups; teaches skills needed to obtain a healthy diet (how to budget, meal planning, shop, cook)

• does NOT provide food

Maternal and Child Health Block Grant

• USDHHS

• under Title V of the Social Security Act

• fosters public health nutrition programs at the state and local levels

• provides training, consultation, funding

• women of child-bearing age, infants, children; state eligibility requirements

Healthy Start

• USDHHS

• reduce infant mortality, improve health of low-income women, infants, children, families

NSIP

Nutrition Services Incentive Program

• AoA - Administration on Aging

• developed services to foster independent living; cash and commodities to state agencies

• OAANP - Older Americans Act Nutrition Program (formerly Elderly Nutrition Program)

  • USDHHS - Title III

  • one hot meal each day, 5 days/week, provide 1/3 recommended intake

  • eligibility: all aged 60 and older plus spouse, regardless of income

  • Congregate Meals: ambulatory; transportation essential for rural elderly

  • Home delivered meals - Meals on Wheel - must be homebound

  • counseling, nutrition education, referrals, social interaction

SNAP

Supplemental Nutrition Assistance Program

• USDA

• largest food assistance program: entitlement

• assist low income with monthly benefits; net income must be at or below certain % of poverty level; income limits vary by household size and are adjusted to the cost of living. Nutrition risk NOT a consideration

• designed to increase their purchasing power; not for non-food items

• figures are adjusted to reflect cost of food in Thrifty Food Plan for June of preceding year - least costly of USDA four food plans

• SNAP nutrition education program: provided to program participants

• EBT electronic benefits transfer card

Headstart

• USDHHS

• helps low income children; ages 3 through 5

• introduces new foods, teaches food food habits

• child’s participation in food activities is important

NETP

Nutrition Education and Training Program

• USDA

• amendment to School Lunch Act

• provides nutrition education training to teachers and school foodservice personnel

SFMNP

Senior Farmers’ Market Nutrition Program

• USDA

• cash grants to states to provide low income seniors (≥60 years) with coupons to be exchanged for eligible foods at farmers’ markets, roadside stands, community supported agriculture programs (CSA)

• fresh, nutritious, unprepared fruits, vegetables, herbs and honey

• may be limited to specific and locally grown foods

• nutrition education and information are provided (how to select, store, prepare)

Quasi-governmental agencies

receives both federal and private funds

• American Red Cross

• National Research Council - Food and Nutrition Board (developed RDAs)

Non-governmental agencies

• Feeding America is the LARGEST domestic hunger relief organization in the US

  • food banks, shelters, soup kitchens

• Voluntary health agencies - private non-profit organizations, chartered and licensed by a government agency, funded by contributions from citizens or organizations: American Heart Association (AHA)

• Professional organizations - Academy of Nutrition and Dietetics

International agencies

• FAO - Food and Agricultural Organization - raising world-wide levels of nutrition by increasing efficiency of production and distributions of foods