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RESEARCH METHODS TO
ASSESS DIETARY INTAKE AND
PROGRAM PARTICIPATION
IN CHILD DAY CARE
application to the child and adult care food program
w or k shop s u m m a r y
Leslie Pray, Ann Yaktine, and Sheila Moats, Rapporteurs
Food and Nutrition Board
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Govern-
ing Board of the National Research Council, whose members are drawn from the
councils of the National Academy of Sciences, the National Academy of Engineer-
ing, and the Institute of Medicine.
This study was supported by Contract No. AG-3198-C-08-0001 between the Na-
tional Academy of Sciences and the U.S. Department of Agriculture, Food and
Nutrition Service. The views presented in this publication do not necessarily reflect
the views of the organizations or agencies that provided support for the project.
International Standard Book Number-13: 978-0-309-25731-2
International Standard Book Number-10: 0-309-25731-X
Additional copies of this report are available from the National Academies Press,
500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202)
334-3313; http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page
at: www.iom.edu.
Copyright 2012 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost
all cultures and religions since the beginning of recorded history. The serpent ad-
opted as a logotype by the Institute of Medicine is a relief carving from ancient
Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2012. Research methods to as-
sess dietary intake and program participation in child day care: Application to the
Child and Adult Care Food Program: Workshop summary. Washington, DC: The
National Academies Press.
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
— Goethe
Advising the Nation. Improving Health.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating society
of distinguished scholars engaged in scientific and engineering research, dedicated to
the furtherance of science and technology and to their use for the general welfare.
Upon the authority of the charter granted to it by the Congress in 1863, the Acad-
emy has a mandate that requires it to advise the federal government on scientific
and technical matters. Dr. Ralph J. Cicerone is president of the National Academy
of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding en-
gineers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi-
dent of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The Insti-
tute acts under the responsibility given to the National Academy of Sciences by its
congressional charter to be an adviser to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Harvey V.
Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sci-
ences in 1916 to associate the broad community of science and technology with the
Academy’s purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the
Council has become the principal operating agency of both the National Academy
of Sciences and the National Academy of Engineering in providing services to the
government, the public, and the scientific and engineering communities. The Coun-
cil is administered jointly by both Academies and the Institute of Medicine. Dr.
Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of
the National Research Council.
www.national-academies.org
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PLANNING COMMITTEE ON THE REVIEW OF
THE CHILD AND ADULT CARE FOOD PROGRAM
MEAL REQUIREMENTS: A WORKSHOP1
SUZANNE P. MURPHY (Chair), Professor Emeritus, University of
Hawaii Cancer Center, Honolulu
KAREN WEBER CULLEN, Associate Professor of Pediatrics, Baylor
College of Medicine, Children’s Nutrition Research Center, Houston,
TX
LYNNE OUDEKERK, Director, Child and Adult Care Food Program,
New York State Department of Health, Albany (Retired)
CHARLENE RUSSELL-TUCKER, Associate Commissioner, Connecticut
Department of Education, Middletown
IOM Staff
ANN YAKTINE, Senior Program Officer and Study Director
SHEILA MOATS, Program Officer
HEATHER BREINER, Research Associate
JULIA HOGLUND, Research Associate
ALLISON BERGER, Senior Program Assistant
ANTON L. BANDY, Financial Associate
GERALDINE KENNEDO, Administrative Assistant
LINDA D. MEYERS, Director, Food and Nutrition Board
1 Institute of Medicine planning committees are solely responsible for organizing the work-
shop, identifying topics, and choosing speakers. The responsibility for the published workshop
summary rests with the workshop rapporteurs and the institution.
v
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Reviewers
This report has been reviewed in draft form by individuals chosen
for their diverse perspectives and technical expertise, in accordance with
procedures approved by the National Research Council’s Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the institution in making its published
report as sound as possible and to ensure that the report meets institutional
standards for objectivity, evidence, and responsiveness to the study charge.
The review comments and draft manuscript remain confidential to protect
the integrity of the process. We wish to thank the following individuals for
their review of this report:
Mary Kay Crepinsek, Senior Researcher, Mathematica Policy Research,
Inc., Cambridge, MA
Suzanne P. Murphy, Professor Emeritus, University of Hawaii,
Honolulu
Sandra J. Rhoades, Homes Administrative Unit Director, Child and
Adult Care Food Program, New York State Department of Health,
Albany
Marlene B. Schwartz, Deputy Director, Rudd Center for Food Policy
& Obesity, Yale University, New Haven, CT
Although the reviewers listed above have provided many constructive
comments and suggestions, they did not see the final draft of the report be-
vii
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viii REVIEWERS
fore its release. The review of this report was overseen by Hugh H. Tilson,
University of North Carolina at Chapel Hill. Appointed by the Institute
of Medicine, he was responsible for making certain that an independent
examination of this report was carried out in accordance with institutional
procedures and that all review comments were carefully considered. Re-
sponsibility for the final content of this report rests entirely with the authors
and the institution.
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Contents
1 INTRODUCTION 1
2 ALIGNMENT OF YOUNG CHILDREN’S DIETARY INTAKE
WITH CURRENT DIETARY GUIDANCE 15
3 BARRIERS AND FACILITATORS TO PROVIDING
MEALS AND SNACKS THAT ALIGN WITH THE
CURRENT DIETARY GUIDANCE 35
4 EVALUATING PROGRAM ACCESS AND PARTICIPATION
49
TRENDS
5 65
MOVING FORWARD
APPENDIXES
A WORKSHOP AGENDA 79
B BIOGRAPHICAL SKETCHES OF MODERATORS AND
SPEAKERS 83
C WORKSHOP ATTENDEES 93
D ABBREVIATIONS AND ACRONYMS 95
ix
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