Evaluating and simulating long-term care menus to meet nutrient- and food-based standards

BACKGROUND: Most provinces require long-term care (LTC) home menus to meet nutrient requirements and align with Canada's food guide (CFG-2019). However, compliance remains challenging for dietitians and food service staff due to limited tools and guidance to support implementation in practice. This study evaluated current and simulated LTC menus against nutrient- and food-based standards to identify the characteristics of menus meeting both requirements. METHODS: A database of 1,365 menu items from a four-week LTC menu cycle provided by a major North American foodservice company was used to simulate 10,000 one-day LTC menus. Compliance with LTC-specific nutrient targets and alignment with CFG-2019 were assessed. Menus meeting both standards were further evaluated using the Canadian Food Scoring System (CFSS) and Healthy Eating Food Index (HEFI)-2019. RESULTS: Current LTC menus (n = 28) met most macronutrient and 10 micronutrient targets, with a mean HEFI-2019 score of 45.3/80 (57%), below the desired 75% compliance threshold. Of the 10,000 simulated menus, 28 met all nutrient-based targets and six met both nutrient- and food-based standards. These compliant menus provided an average of 2,857 kcal, 107 g protein, 32 g fibre, and a mean HEFI-2019 score of 61.7/80 (77%). On average, 58% of menu items were classified as "Good & Excellent" according to the CFSS, with approximately 10 serving equivalents of fruits and vegetables, 2.5 of whole grains, and 5 of protein foods. CONCLUSION: Although provincial regulations require LTC menus to comply with both nutrient- and food-based standards, full compliance was not achieved using foods available from a single large provider. Nutrient-compliant menus were characterized by higher energy provision and greater nutrient density, underscoring the need for more healthy options and practical supports, including LTC-specific planning tools, food guide serving benchmarks, and accessible resources to facilitate routine menu planning and regulatory compliance.