The MyPlate symbol (Fig. 20-1) encourages healthy eating from 5 food groups. Issued by the United States Department of Agriculture (USDA), MyPlate is a nutrition guide that encourages physical activity (Box 20-1). MyPlate helps you make wise food choices by:

Box 20-1

Physical Activities

Moderate Physical Activities

• Walking briskly (about 3½ miles per hour)

• Bicycling (less than 10 miles per hour)

• Gardening (raking, trimming bushes)

• Dancing

• Golf (walking and carrying clubs)

• Water aerobics

• Canoeing

• Tennis (doubles)

Vigorous Physical Activities

• Running and jogging (5 miles per hour)

• Walking very fast (4½ miles per hour)

• Bicycling (more than 10 miles per hour)

• Heavy yard work, such as chopping wood

• Swimming (freestyle laps)

• Aerobics

• Basketball (competitive)

• Tennis (singles)

From U.S. Department of Agriculture: What is physical activity? June 4, 2011.

• Balancing calories

• Eating less

• Avoiding over-sized portions

• Increasing certain foods

• Making half of your plate fruits and vegetables

• Making at least half of your grains whole grains

• Drinking fat-free or low-fat (1%) milk

• Reducing certain foods

• Choosing low-sodium foods

• Drinking water instead of sugary drinks

The amount needed from each food group depends on age, sex, and physical activity (Table 20-1). Activity should be moderate or vigorous (see Box 20-1). The USDA recommends that adults do at least 1 of the following.

TABLE 20-1

MyPlate Serving Sizes

Group	Daily Servings	Serving Sizes
Grains	• Adult women: 5 to 6 ounces (oz); at least 3 oz from whole grains • Adult men: 6 to 8 oz; at least 3 to 4 oz from whole grains	• 1 oz = 1 slice bread • 1 oz = 1 cup breakfast cereal • 1 oz = ½ cup cooked rice, cereal, or pasta
Vegetables	• Adult women: 2 to 2½ cups • Adult men: 2½ to 3 cups	• 1 cup = 1 cup raw or cooked vegetables or vegetable juice • 1 cup = 2 cups raw leafy greens
Fruits	• Adult women: 1½ to 2 cups • Adult men: 2 cups	• 1 cup = 1 cup fruit • 1 cup = 1 cup fruit juice • 1 cup = ½ cup dried fruit
Dairy	• Adult women: 3 cups • Adult men: 3 cups	• 1 cup = 1 cup milk or yogurt • 1 cup = 1½ oz natural cheese • 1 cup = 2 oz processed cheese
Protein foods	• Adult women: 5 to 5½ oz • Adult men: 5½ to 6½ oz	• 1 oz = 1 oz lean meat, poultry, or fish • 1 oz = 1 egg • 1 oz = 1 tablespoon peanut butter • 1 oz = ¼ cup cooked dry beans • 1 oz = ½ oz nuts or seeds

Modified from U.S. Department of Agriculture: MyPlate, June 2011.

• 2 hours and 30 minutes each week of moderate physical activity

• 1 hour and 15 minutes each week of vigorous physical activity

Physical activity at least 3 days a week is best. Each activity should be for at least 10 minutes at a time. Adults also should do strengthening activities at least 2 days a week. Push-ups, sit-ups, and weight-lifting are examples.

Factors Affecting Eating and Nutrition

Many factors affect eating and nutrition. Some begin in childhood and continue throughout life. Others develop later.

• Culture. Culture influences dietary practices, food choices, and food preparation. Frying, baking, smoking, or roasting food and eating raw food are cultural practices. So is using sauces, herbs, and spices. See Caring About Culture: Food Practices.

Caring About Culture

Food Practices

Rice, corn, and beans are protein sources in Mexico. In the Philippines, rice is a main food. And fish, vegetables, and native fruits are preferred. A diet high in sugar and animal fat is common in Poland. In China, a meal of rice with meat, fish, and vegetables is common. High sodium content is from the use of soy sauce and dried and preserved foods.

Eating beef is common in the United States. In India, Hindus do not eat beef.

Modified from D’Avanzo CE: Pocket guide to cultural health assessment, ed 4, St Louis, 2008, Mosby.

• Religion. Selecting, preparing, and eating food often involve religious practices. A person may follow all, some, or none of the dietary practices of his or her faith. Respect the person’s religious practices.

• Finances. People with limited incomes often buy the cheaper carbohydrate foods. Their diets often lack protein and certain vitamins and minerals.

• Appetite. Appetite relates to the desire for food. Loss of appetite (anorexia) can occur. Causes include illness, drugs, anxiety, pain, and depression. Unpleasant sights, thoughts, and smells are other causes.

• Personal choice. Food likes and dislikes are influenced by foods served in the home. Usually food likes expand with age and social experiences.

• Body reactions. People usually avoid foods that cause allergic reactions. They also avoid foods that cause nausea, vomiting, diarrhea, indigestion, gas, or headaches.

• Illness. Appetite usually decreases during illness and recovery from injuries. However, nutritional needs increase. The body must fight infection, heal tissue, and replace lost blood cells. Nutrients lost through vomiting and diarrhea need replacement.

• Drugs. Drugs can cause loss of appetite, confusion, nausea, constipation, impaired taste, or changes in GI function. They can cause inflammation of the mouth, throat, esophagus, and stomach.

• Chewing and swallowing problems. Mouth, teeth, and gum problems can affect chewing. Examples include oral pain, dry or sore mouth, gum disease (Chapter 16), dental problems, and dentures that fit poorly. Stroke; pain; confusion; dry mouth; and diseases of the mouth, throat, and esophagus can affect swallowing. See “The Dysphagia Diet,” on p. 315.

• Disability. Disease or injury can affect the hands, wrists, and arms. Assistive devices let the person eat independently. (See p. 312.)

• Impaired cognitive function. Impaired cognitive function may affect the person’s ability to use eating utensils. And it may affect eating, chewing, and swallowing.

• Age. Many GI changes occur with aging.

See Focus on Older Persons: Factors Affecting Eating and Nutrition.

Focus on Older Persons

Factors Affecting Eating and Nutrition

With aging, changes occur in the GI system.

• Taste and smell dull.

• Appetite decreases.

• Secretion of digestive juices decreases. Fried and fatty foods are hard to digest and may cause indigestion.

Some people must avoid high-fiber foods needed for bowel elimination. High-fiber foods are hard to chew and can irritate the intestines. Examples are apricots, celery, and fruits and vegetables with skins and seeds.

Foods providing soft bulk are often ordered for persons with chewing problems or constipation. These foods include whole-grain cereals and cooked fruits and vegetables.

Calorie needs are lower. Energy and activity levels are lower. Foods that contain calcium help prevent musculo-skeletal changes. Protein is needed for tissue growth and repair. Because of cost, diets may lack high-protein foods.

OBRA Dietary Requirements

The Omnibus Budget Reconciliation Act of 1987 (OBRA) has requirements for food served in nursing centers.

• Each person’s nutritional and dietary needs are met.

• The person’s diet is well-balanced. It is nourishing and tastes good. Food is well-seasoned. It is not too salty or too sweet.

• Food is appetizing. It has an appealing aroma and is attractive.

• Foods vary in color and texture.

• Hot food is served hot. Cold food is served cold.

• Food is served promptly. If not, hot food cools and cold food warms.

• Food is prepared to meet each person’s needs. Some people need food cut, ground, or chopped. Others have special diets ordered by the doctor.

• Other foods are offered to residents who refuse the food served. Substituted food must have a similar nutritional value to the first food served.

• Each person receives at least 3 meals a day. A bedtime snack is offered.

• The center provides needed assistive devices and utensils (Fig. 20-2). They promote independence in eating. Make sure the person has needed equipment.

FIGURE 20-2 Assistive devices for eating.
A, The fork and spoon are angled. Fingers are inserted through the opening or wrapped around the handle. B, The utensils can be adjusted for the person’s grip strength. C, Eating utensils have tapered and angled handles. The knife cuts with slicing and rocking motions. D, The plate guard helps keep food on the plate. E, The thumb grips on the cup help prevent spilling.

Special Diets

Doctors may order special diets for a nutritional deficiency or a disease (Table 20-2). They may also order them for weight control (gain or loss) or to remove or decrease certain substances in the diet. Regular diet, general diet, and house diet mean no dietary limits or restrictions.

TABLE 20-2

Special Diets

Diet	Use	Foods Allowed
Clear liquid—foods liquid at body temperature and that leave small amounts of residue; non-irritating and non–gas forming	After surgery, for acute illness, infection, nausea and vomiting, and to prepare for GI exams	Water, tea, and coffee (without milk or cream); carbonated drinks; gelatin; fruit juices without pulp (apple, grape, cranberry); fat-free broth; hard candy, sugar, and Popsicles
Full liquid—foods liquid at room temperature or that melt at body temperature	Advance from clear-liquid diet after surgery; for stomach irritation, fever, nausea, and vomiting; for persons unable to chew, swallow, or digest solid foods	Foods on the clear-liquid diet; custard; eggnog; strained soups; strained fruit and vegetable juices; milk and milk shakes; cooked cereals; plain ice cream and sherbet; pudding; yogurt
Mechanical soft—semi-solid foods that are easily digested	Advance from full-liquid diet, chewing problems, GI disorders, and infections	All liquids; eggs (not fried); broiled, baked, or roasted meat, fish, or poultry that is chopped or shredded; mild cheeses (American, Swiss, cheddar, cream, cottage); strained fruit juices; refined bread (no crust) and crackers; cooked cereal; cooked or pureed vegetables; cooked or canned fruit without skin or seeds; pudding; plain cakes and soft cookies without fruit or nuts
Fiber- and residue-restricted—foods that leave a small amount of residue in the colon	Diseases of the colon and diarrhea	Coffee, tea, milk, carbonated drinks, strained fruit and vegetable juices; refined bread and crackers; creamed and refined cereal; rice; cottage and cream cheese; eggs (not fried); plain puddings and cakes; gelatin; custard; sherbet and ice cream; canned or cooked fruit without skin or seeds; potatoes (not fried); strained cooked vegetables; plain pasta; no raw fruits or vegetables
High-fiber—foods that increase residue and fiber in the colon to stimulate peristalsis	Constipation and GI disorders	All fruits and vegetables; whole-wheat bread; whole-grain cereals; fried foods; whole-grain rice; milk, cream, butter, and cheese; meats
Bland—foods that are non-irritating and low in roughage; foods served at moderate temperatures; no strong spices or condiments	Ulcers, gallbladder disorders, and some intestinal disorders; after abdominal surgery	Lean meats; white bread; creamed and refined cereals; cream or cottage cheese; gelatin; plain puddings, cakes, and cookies; eggs (not fried); butter and cream; canned fruits and vegetables without skin and seeds; strained fruit juices; potatoes (not fried); pastas and rice; strained or soft cooked carrots, peas, beets, spinach, squash, and asparagus tips; creamed soups from allowed vegetables; no fried or spicy foods
High-calorie—3000 to 4000 calories daily; includes 3 full meals and between-meal snacks	Weight gain and some thyroid problems	Dietary increases in all foods; large portions of regular diet with 3 between-meal snacks
Calorie-controlled—adequate nutrients while controlling calories to promote weight loss and reduce body fat	Weight loss	Foods low in fats and carbohydrates and lean meats; avoid butter, cream, rice, gravies, salad oils, noodles, cakes, pastries, carbonated and alcoholic drinks, candy, potato chips, and similar foods
High-iron—foods high in iron	Anemia, after blood loss, for women during the reproductive years	Liver and other organ meats; lean meats; egg yolks; shellfish; dried fruits; dried beans; green leafy vegetables; lima beans; peanut butter; enriched breads and cereals
Fat-controlled (low cholesterol)—foods low in fat and prepared without adding fat	Heart disease, gallbladder disease, disorders of fat digestion, liver disease, diseases of the pancreas	Skim milk (fat free) or buttermilk; cottage cheese (no other cheeses allowed); gelatin; sherbet; fruit; lean meats, poultry, and fish (baked, broiled, or roasted); fat-free broth; soups made with skim milk (fat-free); margarine; rice, pasta, breads, and cereals; vegetables; potatoes
High-protein—aids and promotes tissue healing	Burns, high fever, infection, and some liver diseases	Meat, milk, eggs, cheese, fish, poultry; breads and cereals; green leafy vegetables
Sodium-controlled—a certain amount of sodium is allowed	Heart disease, fluid retention, liver diseases, and some kidney diseases	Fruits and vegetables and unsalted butter are allowed; adding salt at the table is not allowed; highly salted foods and foods high in sodium are not allowed; the use of salt during cooking may be restricted
Diabetes meal plan—the same amount of carbohydrates, protein, and fat are eaten at the same time each day	Diabetes	Determined by nutritional and energy requirements