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Food Cost Approach and Methods

METHODS USED TO ESTIMATE THE COST AND NUTRIENT CONTENT OF CACFP MEALS

No nationally representative survey has been conducted to study the meals provided by the Child and Adult Care Food Program (CACFP) since 1996 (USDA/FCS, 1997). Consequently, baseline data for the current program are limited regarding the meals served, and the 1996 study did not address the cost of foods served for the meals. This appendix describes the methods the committee used to develop a set of baseline data on the cost and nutrient content of CACFP meals and then to estimate the cost and nutrient content of meals under the assumption that the recommended meal requirements are implemented.

DEVELOPMENT OF THE CACFP BASELINE FOOD CLUSTERS AND COMPOSITE FOOD GROUPS

Weighted composite food groups can be used to represent menus of foods offered and hence to evaluate changes to the cost and nutrient content of meals and snacks offered to program participants. If based on relatively current data, they provide a profile of food currently consumed in CACFP. To form weighted composite food groups, the committee first needed to identify a set of food clusters (composite food items) based on the foods most commonly offered in the program. A description of the data, procedures used for compilation and matching to nutrient databases and prices,



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I Food Cost Approach and Methods METHODS USED TO ESTIMATE THE COST AND NUTRIENT CONTENT OF CACFP MEALS No nationally representative survey has been conducted to study the meals provided by the Child and Adult Care Food Program (CACFP) since 1996 (USDA/FCS, 1997). Consequently, baseline data for the current pro- gram are limited regarding the meals served, and the 1996 study did not address the cost of foods served for the meals. This appendix describes the methods the committee used to develop a set of baseline data on the cost and nutrient content of CACFP meals and then to estimate the cost and nutrient content of meals under the assumption that the recommended meal requirements are implemented. DEVELOPMENT OF THE CACFP BASELINE FOOD CLUSTERS AND COMPOSITE FOOD GROUPS Weighted composite food groups can be used to represent menus of foods offered and hence to evaluate changes to the cost and nutrient content of meals and snacks offered to program participants. If based on relatively current data, they provide a profile of food currently consumed in CACFP. To form weighted composite food groups, the committee first needed to identify a set of food clusters (composite food items) based on the foods most commonly offered in the program. A description of the data, proce- dures used for compilation and matching to nutrient databases and prices, 239

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240 CHILD AND ADULT CARE FOOD PROGRAM and an estimate of menu costs follow. Key terms used to explain the ap- proach include the following: Food items The names of the foods in the database, as listed by • participating centers (e.g., orange juice, granola bar) Food clusters (also called composite food items) 133 food item • groupings, each of which represents several or many similar food items (e.g., orange juice, which also includes lemon juice and lime juice) Weighted composite food groups (meal components) Specific • groupings of foods that make up each meal component (e.g., fruit, milk, meat and meat alternates), weighted to reflect their frequency of use Data The basic information on food items used by CACFP comes from data prepared for the committee’s use that recorded all items requested for reimbursement by family child care providers during two months: Au- gust 2009 and February 2010. The data on claims for food items offered through the program were compiled by a large CACFP claims processor that processes claims for more than 100,000 family day care providers to the central processing unit (Minute Menu Systems, LLC, 2008). The two months of data were combined to cover the large number of providers and any seasonal variation. The recorded data included the month of request, food item name (alphanumeric), meal (breakfast, lunch/supper, or snack), and food classification (fruit/vegetable; meat or meat alternate; grain/cereal product; or milk—the four current meal components) and number of serv- ings reported for reimbursement. After sorting and cleaning the data, the food items were ranked by frequency of use. The more frequently used items, as explained below, were included in the food cluster. The selected food items were assigned U.S. Department of Agriculture (USDA) Food Codes (Food and Nutrient Database for Dietary Studies [FNDDS], version 2.0) (USDA/ARS, 2009). The food codes allowed matching the food items in the claims processor file to the foods in the Center for Nutrition Policy and Promotion (CNPP)/ Food and Nutrition Service (FNS) (USDA/CNPP, 2009) food price series and to component nutrients (USDA Food and Nutrient Database for Di- etary Studies [FNDDS]). The CNPP/FNS prices represent foods as eaten at home. The food prices include the cost of food acquired through retail market stores, but they do not include any value of labor used in prepara- tion of the food. Foods included as servings in the database were for foods

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241 APPENDIX I that qualify as the meal component (e.g., ground beef) and not as prepared (e.g., spaghetti with meat sauce). Development of Food Clusters and Composite Food Groups The overall approach to developing food clusters and composite food groups follows the classifications developed and used by Marcoe et al. (2006) to form the composite food groups based on MyPyramid food groups. Initially, using specialized custom sorting and matching routines, the thousands of unique food items in the data set were sorted by meal and matched to key words used in the 133 composite foods identified by Marcoe et al. The matched food items were reviewed for accuracy. Un- matched items were sorted into one of the food clusters. For example, the food cluster “apples” served at lunch eventually included 335,000 servings (for the 2-month period) and included the following food items in order of frequency: apples, mixed fruit, fruit salad, fruit plate, mixed fruit salad, and apple slices. Once all identified CACFP food items had been grouped, the food items were sorted by the number of servings within each food cluster. Of those included with “apples,” for example, 72 percent were “apples,” 17 percent were “mixed fruit,” and 11 percent were “fruit salad.” This distribution was used in creating weights for the food items used in the food clusters. For each of the 133 food clusters, we identified any food items that rep- resented 5 percent or more of the cluster (e.g., the “apples” group). These would be the food items used to make up the weighted components of the food cluster. In this case, the fruit plate, mixed fruit salad, and apple slices were not included in the food cluster because they represented less than 5 percent of the cluster group. USDA Food Codes were matched to these food items and used in the subsequent analyses. For some food items, where the cooking method or the type of food (e.g., juice pack, water pack) was not specified, we used the food code option “NS.” Note that because the weighting was done by meal, the mix of food items in a food cluster used at breakfast could differ from the mix of food items in that food cluster for lunch. (In fact, for “apples,” the three items in the cluster were the same, but the weights changed slightly.) The actual numbers of servings (by meal and food cluster) were used to weight the food clusters within three of the four current meal component groups: fruits/vegetables, grains/cereals, and meats/meat alternate groups.1 1 Because meat is not currently served at breakfast, the committee had no data on which to base a meat/meat alternate for breakfast; therefore, the cost analysis for breakfast used Ca- nadian bacon as the only meat/meat alternate—a food whose price was midway in the price range for meat/meat alternates that would typically be considered acceptable at breakfast.

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242 CHILD AND ADULT CARE FOOD PROGRAM This produced weighted composite food groups. Because no information was available on the type of milk served, the following allocations were made based primarily on data in the Food and Consumer Service (FCS) 1997 national study (USDA/FCS, 1997). Based on public comment at the Institute of Medicine February 23, 2010, Public Workshop, Improving CACFP through Research, Outreach, and Implementation, the use of flavored milk has increased since 1997 and, therefore, its share was increased for lunch and snack composites (Table I-1). For the snack, the provider must offer two of the four components. Data obtained from Minute Menu Systems (Minute Menu Systems, LLC, 2008), shown in Table I-2, was the only source of information about the current allocation of components in snacks. For all age groups and types of day care facilities, the committee used the values shown in the table to estimate the distribution of snacks served. A similar approach was used for the infant food groups, although the data source for the foods was different. Representative composite food items and meal components for infants were developed from a set of 2-week TABLE I-1 Baseline Milk Allocations for CACFP Participants 2 Years and Older Type of Milk Breakfast Lunch Snack Whole milk 10 10 10 2% milk 40 30 30 1% milk 30 20 20 Nonfat milk 20 20 20 Flavored milk 0 20 20 TABLE I-2 Approximate Distribution of Meal Components in Snacks Served in Family Day Care Homes, August 2009 and February 2010 Approximate Distribution (%)a Meal Component Fruit/vegetable/juice 61.6 (37.0)b Fruit/vegetable (24.6)b Juice Grains/bread 82.8 Meat/meat alternate 35.2 Milk 20.3 aTotal equals 200 percent because snack patterns require providers to serve two of the four items per snack. bThe numbers in parentheses represent subcomponents of the aggregate fruit and vegetable component. SOURCE: Minute Menu Systems (based on data obtained from family day care homes during February 2010) (Minute Menu Systems, LLC, 2008).

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243 APPENDIX I cycle menus used by a large CACFP service provider (Personal communica- tion, S. Cotto-Moreno, April 30, 2010). These menus (and two weekly av- erage values) were used as “representative” of infant menus for the baseline. The menus were based on the limited foods infants can consume and the variety available. For example, the “infant cereal” was dry, iron-fortified cereal with a weighted combination of oat, rice, and barley cereals. The formula used was assumed to be iron-fortified, ready-to-feed (RTF). Most states encourage RTF because of the possibility of dilution concerns. For infants younger than 9 months, the committee assumed fruits/vegetables to be in the form of strained baby food (first food and second food). For infants 9–11 months, the committee assumed that half of the infants moved to toddler foods (as representative foods, e.g., “bananas,” “applesauce,” and “peas”). DEVELOPMENT OF COMPOSITE FOOD ITEMS AND GROUPS FOR RECOMMENDED MEAL REQUIREMENTS Data The data set described above was used to develop a new set of food clusters and composite food groups to reflect the recommended meal re- quirements. The data on fruits and vegetables were re-sorted to reflect the separation of the fruits/vegetables meal component into two distinct meal components. The recommended meal patterns found in Tables 7-1, 7-2, 7-4, and 7-6 of Chapter 7 and the food specifications found in Table 7-8 were used in the revision of the composite food items and groups. Revision of the Composite Food Items and Groups The percentages of specific food items in the food clusters were revised only if the recommended meal requirements or food specifications called for a change in the use of those food items in the cluster. For example, the food cluster called “chicken” was revised by reducing the percentage of chicken nuggets (the predominant item in the cluster) and increasing the proportion of chicken breast (the second most frequently reported item in the cluster). Food group composites were revised by adding, subtracting, and reweighting clusters. For example, reduced use of fruit juice led to some substitution of whole fruit and reweighting within the total fruit composite group, although the share of orange juice remained the same among juices; and reduced use of fried potatoes led to giving increased weight to baked potatoes, corn, and green peas in the starchy vegetable group. The main ways in which the composite food groups (the composite meal components) were revised include the following:

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244 CHILD AND ADULT CARE FOOD PROGRAM • separation of fruits and vegetables; • increased weights of dark green vegetables, orange vegetables, and legumes and decreased weights of starchy vegetables at lunch and snack; and, • for all meals and snacks, an increased proportion of grains that are whole grain-rich and a decreased proportion of certain food clusters that are high in solid fats and/or added sugars (e.g., toaster pastries, luncheon meats—mainly hot dogs). For the infant food composites and groups, the only changes were dividing the fruits/vegetables into separate groups for fruits and vegetables and the removal of infant juice from the snack. COST AND NUTRIENT ESTIMATION Baseline and Revised Composites The baseline and revised composites were used to provide proxies for representative baseline menus and revised menus. The compilation and analysis of the CACFP servings data provided the information needed to derive the cost and nutrient profiles of the food clusters, their weights, and the cost and nutrient data for the four baseline composite food groups (meal components) and the revised composite food groups. The matching of the foods and price data on food items was done through an expansion of the Meals Menu Analysis Program, which is described in Appendix K of School Meals: Building Blocks for Healthy Children (IOM, 2010). The program allowed the development of a database of composite food items and weighted composite food groups with both price and nutrient informa- tion expressed per 100 grams. Component food items (identified by food code) were matched to the CNPP price data and to the FNDDS food composition database to obtain price and nutrients, respectively, for each food cluster and weighted food group. Those estimates represent averages (for price and for nutrients) that vary by meal (e.g., fruit at breakfast may include different food items and weights than fruit at snack). In order to develop realistic baseline es- timates of the cost of and nutrients in foods served by CACFP providers, the committee applied specific quantities (serving sizes) to the composite food groups based on the amounts of the food required for a reimbursable meal or snack according to the current CACFP meal patterns, as shown in Appendix E. The same process was used to estimate costs under the recommended Meal Requirements, using the specific quantities specified in the recommended meal patterns (Tables 7-1, 7-2, 7-4, and 7-6). It was

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245 APPENDIX I assumed that 10 percent of adults were offered yogurt in place of the milk for each meal. The estimated costs of the food clusters and composite food groups were weighted by share of the servings. Servings-weighted matched price data (per 100 g) from the CNPP price database were used. Nutrient pro- files for the baseline food clusters were based on the matched USDA food codes for the component foods through FNDDS (V2.0) (USDA/ARS, 2009), weighted by share of the servings. Subsequently, as was done for costs, a nutrient profile of each of the four baseline meal components was developed based on the servings-weighted food clusters, and the same process was used for the five revised meal components. Estimated costs for the baseline and revised composite food servings were developed from the servings- weighted price data. Estimation of Differences Between Revised and Baseline Amounts Table 8-1 shows how the amounts of the meal components change for the lunch/supper meal for children. Table I-3 shows the changes in the amounts of meal components for the adults for the lunch/supper meal. Ta- bles are not appropriate to show the changes in the amounts of components in snacks for any age group or in meals for the youth ages 14–18 years: the current regulations are not sufficiently specific to determine reliable baseline values. The committee used the data from Table I-2 to set baseline values for snacks for all of the age groups, except infants, and assumed that two components were served at the snack. (Providers were required to serve at least two of four components.) For the purposes of the comparisons be- tween the current “baseline” and “revised,” the age groups specified for the current program were redistributed to age categories specified in the revised based on the relative share of the age groupings. For the infants, the current CACFP meal pattern specifies the amount of food provided as ranges (Appendix E, Tables E-1 and E-2). The age groups TABLE I-3 Weekly Changes in Amounts of Meal Components in Lunch in Recommended Meal Patterns for Adults, Compared with Current CACFP Meal Pattern Amounts Meal Component Difference: Recommended Minus Current Amounts Fruit and vegetables (c) 2½ Grains (oz eq) 0 Meat/meat alternate (oz eq) 0 Milk (c) 0 NOTE: c 5 cup; CACFP 5 Child and Adult Care Food Program; oz eq 5 ounce equivalent. SOURCE: Data on current CACFP meal patterns are from USDA/FNS, 2010.

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246 CHILD AND ADULT CARE FOOD PROGRAM for the infants were redistributed (and weighted) from three age groups (specified in the current program) to the two age groups (0–5 months and 6–11 months) based on the relative number of months in each age group. For each age group, the midpoint of the amount of food specified was as- sumed for the baseline and the revised menus. For the revised menus, the amount of formula for 0–6 months was 5 ounces for each eating occasion, and for 6–12 month was 7 ounces for breakfast and lunch/supper and 3 ounces for snack. For foods at baseline, the amount of cereal was 2.5 tablespoons; the amount of fruit or vegetables was 1/5 tablespoons; and the amount of meat was 2.5 tablespoons. For the revised menus for infants ages 6 months and older, the foods include the following: for breakfast or lunch/supper, formula, a serving of meat or infant cereal, and a serving of fruit or vegetable; and for snack, formula, and bread or crackers, plus a serving of fruit or vegetable. Meal Component Composite Cost Comparisons The meal component composites (both baseline and revised) differ by eating occasion because they reflect the foods that were served at breakfast, lunch/supper, and snack. Thus, differences that arise from recommended revisions to the current Meal Requirements must be examined by eating occasion. Table I-4 shows the baseline and revised costs of the breakfast, lunch, and snack meal component composites for children ages 2–4 years old. The costs of the baseline and revised components differ because of differences in the proportions of food clusters in the composites (e.g., food clusters representing dark green vegetables are weighted more heavily in the revised composites); and, in some cases, the foods in the clusters dif- fer somewhat. See section “Revision of the Composite Food Items and Groups” above. Sample Menus Two weeks of sample menus that conform to the recommended Meal Requirements were developed (see Appendix K). To estimate the costs and nutrient content of the sample menus (see Appendix K) for each of the age groups and eating occasions, the weekly menu food items were assigned USDA Food Codes (FNDDS, V2.0) (USDA/ARS, 2009), serving sizes were entered, and costs and nutrient values were calculated using the Meals Menu Analysis Program (see IOM, 2010). Table I-5 compares the daily cost of the revised meal pattern (based on the constructed food com- posites) to the cost estimated for the sample menus. Except for the adult sample menus, the estimated costs for the two were within 15 percent of each other. In most cases, the estimated cost of the sample lunch/supper

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TABLE I-4 Comparison of Adjusted Average Daily Cost of Baseline Meal Components and Components Revised to Align with Recommended Meal Requirements Based on the Meal Pattern for Children Ages 2–4 Years and 2003–2004 Prices Breakfast Composites Lunch Composites Snack Composites Cost/ Cost/ Cost/ Cost/ Cost/ Cost/ Meal Baseline Meal Revised Meal Baseline Meal Revised Meal Baseline Meal Revised Meal Component Amt ($) Amt ($) Amt ($) Amt ($) Amt ($)a Amt ($)a Fruit 0.42 cb 0.18c 0.5 c 0.23c 0.42 cb 0.23c 0.5 c 0.52d 0.5 cb 0.11c 0.5 c 0.12c,e Vegetable 0d 0.25 c 0.25 c Grain 0.5 oz eq 0.06 1 oz eq 0.17 0.5 oz eq 0.04 1 oz eq 0.09 0.5 oz eq 0.06 1 oz eq 0.05 Meat/meat alternate 0 0 1 oz eq 0.13 f 1.33 oz eq 0.23 1 oz eq 0.18 0.5 oz eq 0.03 1 oz eq 0.08 Milk 0.67 c 0.15 0.5 c 0.12 0.67 c 0.15 0.5 c 0.09 0.5 c 0.02 0.5 c 0.05 Total NA 0.40 NA 0.66 NA 0.65 NA 0.89 NA 0.23 NA 0.29 NOTES: Amt 5 amount; c 5 cup; NA 5 not applicable oz eq 5 ounce equivalent. aTakes into account that not all snack components are served every day. bThis value represents the amount of fruit and vegetable combined for children age 2 years (¼ c serving) and children ages 3–4 years (½ c serving) for breakfast (see Table 2-5) and for lunch/supper (see Table E-5) in the current CACFP meal patterns. For the current CACFP snack meal pattern, children age 2 years and ages 3–4 years had the same serving size (½ c serving) (see Table E-6). cThis value represents the weighted cost of the fruit and vegetable combined (see Table 8-4 for per unit costs). dThe revised meal pattern allows for either fruit or non-starchy vegetables at breakfast, but the revised breakfast composite includes only fruit. eThis is the weighted cost of two servings of ½ c each of fruit and two servings of ¼ c each of vegetables. fTakes into account that meat is not served at breakfast every day. SOURCE: Cost data based on representative food composites and USDA/CNPP Price Database, 2003–2004 prices (USDA/CNPP, 2009). 247

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248 TABLE I-5 Comparison of the Daily Costs of Revised Meal Patterns (Composites) with Average Costs of 2-Week Sample Menusa Estimated Based on 2003–2004 Prices Cost of Breakfast ($) Cost of Lunch/Supper ($) Cost of Snack ($) Sample % Sample % Sample % Age Group Composite Menub Difference Composite Menub Difference Composite Menub Difference Infants 0–5 mo 0.85 0.85 0 0.85 0.85 0 0.85 0.85 0 Infants 6–11 mo 1.30 1.44 11 1.39 1.36 –3 0.57 0.63 10 Children 1 y 0.45 0.49 8 0.58 0.54 –7 0.24 0.27 10 Children 2–4 y 0.66 0.71 7 0.89 0.79 –11 0.29 0.32 10 Children 5–13 y 0.73 0.83 14 1.51 1.33 –12 0.33 0.35 6 Children 14–18 y 1.03c 1.04 1 1.65c 1.45 –12 0.51c 0.50 –3 Adults 0.83 1.03 24 1.56 1.46 –6 0.40 0.59 48 NOTE: mo 5 month; y 5 year. aCost of infant menus include servings of iron-fortified infant formula at all meals. Cost of menus for children $ 2 years and adults include the cost of low-fat milk on all menus that contain milk. bAverage cost of 2 weeks of sample menus. cBaseline cost relies on assumptions about serving amounts because current regulations specify only that children ages 12 and older may be served larger portions than required for the child meals and snacks based on their greater food needs, but no less. SOURCE: Cost data based on representative food composites and USDA/CNPP Price Database, 2003–2004 prices (USDA/CNPP, 2009).

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249 APPENDIX I menus was less than the composite menus, and the estimated costs of the sample breakfast and snack menus were higher than the composite menus. REFERENCES IOM (Institute of Medicine). 2010. School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press. Marcoe, K., W. Juan, S. Yamini, A. Carlson, and P. Britten. 2006. Development of food group composites and nutrient profiles for the MyPyramid food guidance system. Journal of Nutrition Education and Behavior 38(6 Suppl):S93–S107. Minute Menu Systems, LLC. 2008. Minute Menu Systems. http://www.minutemenu.com/web/ index.html (accessed August 27, 2010). USDA/ARS (U.S. Department of Agriculture/Agricultural Research Service). 2009. USDA Food and Nutrient Database for Dietary Studies. http://www.ars.usda.gov/services/docs. htm?docid512089 (accessed August 30, 2010). USDA/CNPP (U.S. Department of Agriculture/Center for Nutrition Policy and Promotion). 2009. USDA Food Plans: Cost of Food. http://www.cnpp.usda.gov/usdafoodplanscostof food.htm (accessed August 30, 2010). USDA/FCS (U.S. Department of Agriculture/Food and Consumer Service). 1997. Early Child- hood and Child Care Study: Nutritional Assessment of the CACFP: Final Report, Vol- ume 2. Alexandria, VA: USDA/FCS. http://www.fns.usda.gov/ora/menu/Published/CNP/ cnp-archive.htm (accessed July 9, 2010). USDA/FNS (U.S. Department of Agriculture/Food and Nutrition Service). 2010. Child & Adult Care Food Program Meal Patterns. http://www.fns.usda.gov/cnd/care/Program Basics/Meals/Meal_Patterns.htm (accessed March 24, 2010).

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