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Diet Manual for Long-Term Care Residents2014 RevisionThe Office of Health Care Quality is pleased to release the latest revision of the Diet Manual forLong-Term Care Residents. This manual is a premier publication—serving as a resource forproviders, health care facilities, caregivers and families across the nation.In long-term care facilities, meeting nutritional requirements is not as easy as it sounds. It isimportant to provide a wide variety of food choices that satisfy each resident’s physical, ethnic,cultural, and social needs and preferences. These considerations could last for months or evenyears. Effective nutritional planning, as well as service of attractive, tasty, well-prepared foodcan greatly enhance the quality of life for long-term care residents.The Diet Manual for Long Term Care Residents was conceived and developed to provideguidance and assistance to nursing home personnel. It has also been used successfully incommunity health programs, chronic rehabilitation, and assisted living programs. It serves as aguide in prescribing diets, an aid in planning regular and therapeutic diet menus, and as areference for developing recipes and preparing diets.The publication is not intended to be a nutrition-care manual or a substitute for individualizedjudgment of a qualified professional. Also included, is an appendix that contains valuableinformation to assess residents’ nutritional status.On behalf of the entire OHCQ agency, I would like to thank the nutrition experts whovolunteered countless hours to produce this valuable tool. We also appreciate Beth Bremner andCheryl Cook for typing the manual. The full committee includes:Committee ChairsBeth Bremner and Jan MaddenCommittee MembersHeather Albertson, Pat Cierniak, Blenda Eckert, Nancy Ferrone, Anita Gathogo, Angela Lang,Jonine Natale, Siony Placiente, Jean Smith, Tim Smith-Kayode, Joan Todd and Becky Weavil.Patricia Tomsko Nay, MD, CMD, CHCQM, FAAFP, FAIHQ, FAAHPMExecutive Director and Acting Medical Director2

Diet Manual 2014 RevisionTable of ContentsRegular DietMechanical Soft (Dental Diet)Dysphagia Level 1 (Pureed DietDysphagia Level 2 (Mechanically Altered Diet)Dysphagia Advanced Level 3 DietFull Liquid DietClear Liquid DietRestricted Fiber Diet / Restricted Residue DietIncreased Fiber DietPleasure FeedingsSmall Regular and Large Portion SizesSmall Portions DietLarge Portion DietVegetarian DietLacto-Ovovegetarian Meal PlanVegan Meal PlanNo Added Salt DietLow Sodium Diet (2 – 4 grams)Cholesterol Restricted and Fat Controlled DietLimited K Diet & Liberalized Renal DietRenal DietPotassium Containing Foods (over 300 mg K per serving)Renal Diet High Phosphorus FoodsRenal Diet ContinuedSimplified Guideline for Standard Carbohydrate Controlled DietCarbohydrate Controlled DietCalorie Restricted (Low Calorie) DietLimited Concentrated Sweets (LCS) DietDiabetic Diet CalculatedLactose Reduced DietKosher DietEnteral NutritionParenteral NutritionGluten Free DietFinger Food DietThickened 119-122123

AppendixEstimated Calorie Needs Method IEstimated Calorie Needs Method IIEstimated Protein NeedsMiffin – St. Jeor Equation and Cheat SheetEstimated Fluid Needs/Serum OsmolalityEstimated HeightNutrition Assessment Guidelines: When adjustments are requiredCalculation Metabolically Active Weight and Ireton Jones EquationReferences and Recommended Readings for Calculating Energy NeedsBody Mass Index & TableMAO Inhibitors and Food InteractionsFiber Content of Common FoodRecipes for Fiber SupplementsCaffeine Content of Foods and BeveragesScoop SizesMilligrams and Milliequivalent ConversionsMeasures and Metric ConversionsAbbreviationsOfficial “Do No Use” ListRecipe for Puree BreadFrench Toast Souffle RecipeSuper Shake RecipeFood Guide Pyramid, Dietary Guidelines for Americans 2005 andDASH Diet, DRI’s 2010, My Plate For Older Adults, Informationregarding risks of tube feeding for older adults and Culture 2-153154-158159160161

Regular DietI.DescriptionThe regular diet is designed for residents who do not require any dietaryrestrictions. The “Dietary Guidelines for Americans”, 2010 and “My Plate for OlderAdults” 2011 (see appendix) have been used as the basis for this and all otherdiets and menus in this edition. The meal patterns and daily amounts of each foodgroup in the regular diet have been calculated to meet the needs of sedentarymales and females age 51 and over. Refer to Appendix 5, 6, and 7 of the DietaryGuidelines for Americans 2010 to adjust the meal patterns for other age/genderand activity levels. Individual meal preferences must also be considered inplanning this and other diets in the manual.II.Approximate CompositionCalories 1600-2000Protein60-75 gramsIII.AdequacyThis diet contains all nutrients necessary to provide and maintain adequatenutrition based on the Dietary Reference Intakes, 2010FOOD GROUPSFOODS INCLUDEDDAILY AMOUNTSMilkAll types; yogurt3 or more servings(1 serving equals 8 ounces)Meat and equivalentsMeat, fish, shellfish,poultry, cheese, eggs,dried beans, peas andlentils, peanutbutter, seeds, and nutsAt least 5 meatequivalentsLean meats, fish,poultry no skin, lowerfat cheeses1 oz. cooked meat, fish,shellfish, ¼ cup canned tunaor salmon, 1 oz. poultry,1 oz. cheese¼ cup cottage or ricottacheese, 1 egg, 2 egg whitesLegumes and meatalternatives½ cup cooked driedbeans, peas, lentils, 2 tbsppeanut butter, 4 oz. of tofu;51 meat equivalentequals:

Regular DietFOOD GROUPSFOODS INCLUDEDDAILY AMOUNTSFruitsAll typesCitrus or highvitamin C fruitdaily2 or more servings1 serving equals:½ cup fruit,1 medium fresh fruit or4 ounces fruit juiceVegetablesAll types, includingpotatoes, corn, limabeans, peas; legumes,dark green leafy oryellow vegetables(3-4 times a week)3 or more servings1 serving equals:1 cup chopped raw; or½ cup cooked; or 4–6ounces vegetable juiceSoupsAll typesAs desired1 serving equals:6 ouncesBread, Cereal& GrainsAll types, especiallywhole grains6 or more servings1 serving equals:1 slice of bread;3/4 cup ready toeat cereal;½ cup cooked cereal;½ cup rice, or½ cup pastaFatsOils, soft margarine,butter, (avoid trans-fat)As needed for adequatecaloric intakeDessertsAll typesAs desired for adequatecaloric intakeBeveragesAll types, include 8 ormore cups of wateror other fluids per dayAs needed to meetfluid requirementMiscellaneousSugar, condiments, jam,jelly, preserves, syrup,sweets, herbs, spices,flavorings, salt, pepperAs desired for flavor andpalatability6

Regular DietSample Menu PlanBreakfastFruit or juiceCerealMeat or equivalentBreadFatMilkBeverageMiscellaneousOrange juiceOatmealEggs, scrambledToast, whole wheatSoft margarineMilk, 2%Beverage of choiceJellySugarCreamerSalt, Pepper4 ounces½ cup11 slice1 packet8 ounces6-8 ounces1 tablespoon2 packetsas desired1 packet eachTuna saladVegetable soupTossed saladItalian dressingWhole wheat breadChilled peachesMilk, 2%Beverage of choiceSugarCreamerSalt, Pepper½ cup6 ounces1 cup1 ounce2 slices½ cup8 ounces6-8 ounces1-2 packetsas desired1 packet eachBaked chicken breastMashed potatoes, gravySeasoned carrotsMixed fruit saladDinner roll, whole wheatSoft margarineMilk, 2%Vanilla ice creamBeverage of choiceSugarCreamerSalt, Pepper½ breast (3 ounces)½ cup, 1 ounce½ cup½ cup11 packet8 ounces½ cup6-8 ounces1-2 packetsas desired1 packet eachJuiceGraham crackers4 ounces3 squaresLunch or SupperMeat or aneousDinnerMeat or everageMiscellaneousEvening Nourishment7

Mechanical Soft (Dental) DietI.DescriptionThis diet modifies the consistency of the regular diet and is used when anindividual has difficulty chewing regular food. Most foods on the regular diet maybe included, with mechanical alterations based on individual tolerance.II. Approximate CompositionCalories 1600-2000Protein60-75 gramsIII. AdequacyThis diet provides all nutrients necessary based on the Dietary Guidelines forAmericans 2010.FOOD GROUPSFOODS INCLUDEDFOODS EXCLUDEDMilkAll types; yogurtNoneMeat and EquivalentGround meat & poultry (gravy/sauces may be added tomoisten); soft boneless fish;ground meat casseroles;cheese sauce, soft cheese,cottage cheese; shavedluncheon meat; eggs;creamy peanut butter; meatloaf/ham loaf, Salisbury Steak;finely chopped meat, tuna oregg saladsWhole meats,whole hot dogs,hard cheeses; anyother difficult-to-chewfoodsFruitAll fruit juices, cooked orcanned fruit, soft fresh fruitas toleratedDried fruits; hardfresh fruitsVegetablesAll vegetable juices;well-cooked soft vegetables:chopped or diced; shreddedsalads as toleratedWhole rawvegetables; corn on the cobSoupsAll typesAny not toleratedBread & Cereal& GrainsBreads, crackers, dry cereals;French toast, pancakes andwaffles with syrup; doughnuts,muffins without nuts/seeds,croissants, pastries withoutnuts or dried fruitGranola orgranola-typecereals, any foodswith nuts or driedfruits, bagels8

Mechanical Soft (Dental) DietFOOD GROUPSFOODS INCLUDEDFOODS EXCLUDEDPotatoes & StarchesBaked, boiled or mashedpotatoes, french fries; pastaWild riceFatsAll types, crisp bacon astoleratedNoneDessertsMost typesAny containing nuts,coconut, or dried fruitBeveragesAll typesNoneMiscellaneousHerbs, spices, salt, peppergravies/sauces, ketchup,mayonnaise, mustard,pickle slicesNuts, coconut, wholepickles, popcorn9

Mechanical Soft (Dental) DietSample Menu PlanBreakfastFruit or juiceCerealMeat or equivalentBreadFatMilkBeverageMiscellaneousOrange juiceOatmealEgg, scrambledWhole wheat toastSoft margarineMilk, 2%of choiceJellySugarCreamerSalt, Pepper4 ounces½ cup11 slice1 packet8 ounces6-8 ounces1 tablespoon2 packetsas desired1 packet eachFinely chopped tuna saladVegetable soupShredded tossed saladSweet potatoesItalian dressingWhole wheat breadChilled peachesMilk, 2%of choiceSugarCreamerSalt, Pepper½ cup6 ounces½ cup½ cup1 ounce2 slices½ cup8 ounces6-8 ounces1-2 packetsas desired1 packet eachMoist ground chicken breastwith gravyMashed potatoes/gravyCooked sliced carrotsCanned fruit saladSoft dinner rollSoft margarineMilk, 2%Vanilla ice creamof choiceSugarCreamerSalt, pepper3 ounces1 ounce½ cup/1 ounce½ cup½ cup11 packet8 ounces½ cup6-8 ounces1-2 packetsas desired1 packet eachApple juiceGraham crackers4 ounces3 squaresLunch or SupperMeat or equivalentVegetableSaladPotato or DinnerMeat or equivalentPotato or eEvening Nourishment10