Two researchers entered the seven-day cycle menu into a dietary assessment tool used to assess macronutrients (NutritionCalc® Plus version 5.0.19, McGraw-Hill Education, New York, NY, 2018) [18]. A reference male (36 years old, 5′10″ tall, weighing 200 lb/90.9 kg) and female (36 years old, 5′ 3″ tall, weighing 169 lb/76.8 kg) [19] were used to determine the DRIs for macronutrients in the seven-day cycle menu. A 36-year-old individual was chosen because the greatest numbers of individuals incarcerated are aged 36 to 40 years [20]. Weight data for the reference male and female were identified from 2015–2016 Centers for Disease Control and Prevention data detailing estimates of mean body weight for adult men and women aged 20 years and over [21]. Discrepancies in data entry were reviewed by another team member. Individual profiles were created for the menu provisions for each day of the week (Sunday-Saturday) and meals were entered as breakfast, lunch, and dinner. Each menu item was entered as if eaten in its entirety, using the exact gram or ounce amounts indicated and “USDA” whenever possible. If NutritionCalc® Plus lacked a food or recipe in the database, entries were modified to represent the nutritional value of the menu item. Fruits were inputted as “fresh” and beans and vegetables were inputted as “canned” (Supplementary Table 1).
The same two researchers entered the menu into the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24®) [22], another dietary assessment tool used to assess the dietary quality of the menu. ASA24® was used to determine the overall Healthy Eating Index-2015 (HEI-2015) [23] score and to provide added sugars, measured in grams. Individual profiles and meal entries were completed identically as reported for NutritionCalc® Plus. Food items were converted into tablespoons and cups when appropriate.
Commissary data entry
Four options for purchasing commissary food packs were provided by the jail. Each commissary pack was considered as an independent addition to the weekly seven-day cycle menu and entered into NutritionCalc® Plus and ASA24® as a new profile. Each commissary pack comprised shelf-stable, ready-to-eat foods that contained all items without opportunities for substitution. Based on contents, the commissary packs were categorized as “Dinner Pack”, “Snack Pack”, “Breakfast Pack”, and “Sweets Pack.” The Dinner Pack ($35.00) included 23 entrée items, such as ramen noodles and tuna. The Snack Pack ($26.00) included 23 single-serving savory snack items, such as peanuts and potato chips. The Breakfast Pack ($21.50) included 52 breakfast-type items, such as freeze-dried coffee, sugar packets, and honey buns. The Sweets Pack ($10.00) included eight single-serving sugary snacks, such as cookies and candy. The macronutrient results from each food pack were then individually determined. It was assumed that all food items in the food pack were consumed within a week. To note, each commissary food pack was evaluated in combination with the seven-day cycle menu as well as independently as individuals incarcerated might only consume the food in the commissary food pack if they choose to not eat the food provided by the jail.
Data evaluation
Constructing total values and mean values of energy, protein, carbohydrate, total fat, saturated fat. Mean values for protein, carbohydrate, total fat, and saturated fat in the seven-day cycle menu and for the combination of the menu plus each individual food pack were calculated by summing each macronutrient and dividing by seven. Mean daily calories were calculated by summing calorie content from all meals provided by the seven-day cycle menu and for the combination of the menu plus each individual food pack and dividing by seven. The 2020–2025 Dietary Guidelines for Americans (DGAs) provide healthy dietary patterns guidelines for U.S. adults ages 19 through 59 years, with daily calorie level of patterns ranging from 1,600–3,000 kcal [10]. Available calories were compared to the 2,000 kcal dietary recommendation established in the 2020–2025 DGAs, falling within the range of caloric recommendations for all sedentary adults, and used for general nutrition indicated on a standard nutrition facts label [10].
Constructing percentage of total calories from grams of added sugars. ASA24® was used to collect nutrition information and amounts of food groups consumed from the menu and commissary items to determine their added sugars. To analyze the percentage of added sugars in the diet, totals for each day of the seven-day cycle menu and each of the commissary food packs were used. Mean values were calculated for the seven-day cycle menu and the seven-day cycle menu plus the individual commissary food packs. Grams of added sugars were converted to calories, and then divided by 2,000 kcal to generate the percentage of added sugars.
Constructing percentage of total calories from nutrients for comparison to Acceptable Macronutrient Distribution Range (AMDR). Using a 2,000 kcal diet standard, the percentage of calories from each macronutrient was compared to AMDR percentages for the studied macronutrients [10]. Grams of protein, carbohydrate, and added sugars were converted to calories (4 kcal/g), and then divided by 2,000 kcal to generate percentages of protein, carbohydrate, and added sugars. Grams of total fats and saturated fats were converted to calories (9 kcal/g) and then divided by 2,000 kcal to generate percentages of total fats and saturated fats. A similar approach was taken to evaluate individual commissary food packs.
Constructing percentage of total grams of protein and carbohydrate for comparison to Dietary Reference Intakes (DRI). The Recommended Dietary Allowance (RDA) for protein consumption for adult men and women is 0.8 g protein/kg body weight/day [24]. Active adults are advised to consume 130 g carbohydrate/day [10]. Grams of protein and carbohydrate provided by the seven-day cycle menu and the four commissary food packs were divided by the RDA, and multiplied by 100 to generate percentage of DRI. The standard male weight of 200 lb (90.9 kg) and standard female weight of 169 lb (76.8 kg) were used to generate the RDA for protein.
Constructing HEI-2015 scores. HEI-2015 scores range from 0–100 and comprise adequacy components and moderation components, food groups encouraged for consumption (total fruits, vegetables, greens and beans, whole grains, dairy, total protein foods, seafood, plan proteins, and fatty acids) and food groups recommended for limited consumption (refined grains, sodium, added sugars, and saturated fats), respectively. Estimated HEI-2015 scores indicated how close the jail menu aligns with dietary recommendations, with a higher score representing greater availability of the adequacy component food groups and a lower score representing reduced availability of the moderation component food groups [23]. Data used to generate the HEI-2015 total scores for the seven-day cycle menu and four commissary food packs were computed using the HEI scoring macro in SAS 9.4 (https://epi.grants.cancer.gov/hei/sas-code.html). Mean HEI-2015 was calculated by summing HEI-2015 scores for each day of the seven-day cycle menu and for the combination of the menu plus each individual food pack and dividing by seven.