Journal of Correctional Health Care
Volume 27, Number 3, 2021
ª The Author(s) 2021
DOI: 10.1089/jchc.19.08.0067

CoR'itECTIONAL
HEALTH CARE

RESEARCH ARTICLE

Nutrition in Midwestern State Department
of Corrections Prisons:
A Comparison of Nutritional Offerings
With Commonly Utilized Nutritional Standards

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Mitchel K. Holliday, EdD, RDN,1* and Kelli M. Richardson, RDN2
Abstract
Improvement in nutritional care in correctional institutions may reduce the burden of related chronic health
conditions. Even when nutritional standards are used, inconsistent use of standards and lacking regulations
may be leading to inappropriate or inconsistent nutrition care in corrections. Midwestern state department
of corrections’ menus revealed excessive calorie offerings and low offerings of vegetables on male and female menus, and low fruit and dietary fiber offerings on male menus. A majority of vitamin and mineral
offerings met recommendations when reported; however, they were inconsistently underreported across
states. When reported, potassium and vitamin E were offered at less than recommended levels while sodium was excessively offered. Consistency in use and increased accountability in meeting nutrition standards may improve nutrition care within corrections.
Keywords: diet, nutrition, food, prison, correctional health care

Introduction
Improvements are needed in correctional health care and
opportunities can be created to address identified health
care needs (Rich et al., 2011; Wilper et al., 2009). One
of these opportunities is improvement of correctional nutrition care.
There is limited research on the prevalence of noninfectious chronic medical conditions and nutritionassociated chronic diseases within U.S. prisons. What is
available shows mixed findings (Harzke et al., 2010).
Some research has shown rates of diabetes, hypertension,
and myocardial infarction comparable with or lower
than noninstitutionalized populations within the United
States (Binswanger et al., 2009; Wilper et al., 2009).
Other findings have shown higher rates of hypertension
and obesity, especially among women (Binswanger
et al., 2009; Clarke & Waring, 2012; Gates & Bradford,
2015; Herbert et al., 2012; Kendig et al., 2014). Bureau
of Justice Statistics reports have shown 74% of prisoners

are either overweight (45.7%), obese (25.5%), or morbidly obese (2.4%), and hypertension is the most common condition reported by prisoners at a rate of 30%
(Maruschak et al., 2015). Obesity among inmates has
been found to be significantly associated with diabetes
and cardiovascular disease (Bai et al., 2015). Rates
of nutrition-related chronic health diseases have also
shown to be higher among older incarcerated individuals (Skarupski et al., 2018). As prison populations and
the age of incarcerated populations continue to increase,
these conditions can be expected to continue to impact
correctional and community health care systems within
the United States (Harzke et al., 2010).
Limited information exists on foods served in correctional facilities, inmates have limited choices of
what they can eat, and the variety of food itself is limited within the correctional environment (Collins &
Thompson, 2012; Cook et al., 2015). Cost is a primary
contributor to these limitations. Typically, $2 to $4 are

1

United States Public Health Service, St. Charles, Minnesota, USA.
Nutrition and Dietetics Department, College of Nursing and Health, Viterbo University, Lacrosse, Wisconsin, USA.

2

*Address correspondence to: Mitchel K. Holliday, EdD, RDN, United States Public Health Service, 306 St. Charles Ave., St. Charles, MN 55972, USA, Email: mitchholliday@
gmail.com

154

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NUTRITION IN MIDWESTERN STATE DEPARTMENT OF CORRECTIONS PRISONS

spent to feed an inmate three meals per day (Camplin,
2017). Other factors that limit food offerings are security
risks related to the offering of whole fresh fruit, canned
fruit, and fruit juice, which can be used to produce illicit
alcohol (Academy of Nutrition and Dietetics, 2019).
Correctional food and nutrition services are relatively
unregulated (Camplin, 2017). The American Correctional Association (ACA) is a nonprofit organization
that administers the only nationally accredited program
for all components of adult and juvenile corrections
(American Correctional Association [ACA], 2014). Its
purpose is to promote improvement in the management
of correctional agencies through the administration of
accreditation; however, accreditation is voluntary (ACA,
2014). According to the ACA Standards for Adult Correctional Institutions, ‘‘the principal function of food service is meals are nutritionally balanced, well-planned,
and prepared and served in a manner that meets established governmental health and safety codes.’’ In addition, following dietary allowances is mandatory and
ACA requires ‘‘documentation that the institution’s dietary allowances are reviewed at least annually by a qualified nutritionist or dietitian to ensure they meet the
nationally recommended allowances for basic nutrition’’
(ACA, 2003, pp. 87–88). ACA also provides comments
indicating allowances should be adjusted for age, gender,
and activity and should meet or exceed the recommended
dietary allowances (RDAs) published by the National
Academy of Sciences (ACA, 2003). No specific identification of which RDAs or to what extent they are to be
reviewed by an institution is noted. There is also no indication if additional dietary reference intakes (DRIs), to
include estimated average requirements (EARs), adequate intakes (AIs), or tolerable upper intake level, are to
be utilized. According to the Academy of Nutrition and
Dietetics (2019), common guidelines for nutritional assessment to determine the nutritional appropriateness
of foods offered within corrections that are possibly
being utilized to attempt to meet ACA standards include
the DRIs as well as Dietary Guidelines for Americans,
MyPlate.gov, therapeutic lifestyle change diet, and dietary approaches to stop hypertension (ACA, 2014).
Nutrition standards are regulated only by the facilities
themselves; each state, county, or facility has its own interpretation of the standards it utilizes, leaving nutritional
appropriateness fluidly interpreted (Academy of Nutrition and Dietetics, 2019; Camplin, 2017; Hardy, 2016).
In addition, correctional facilities not accredited by the
ACA may use no nutritional standards at all. Reportedly,
only 38 states have nutritional standards for jail and detention facilities, and not all of those require mandatory
implementation (Academy of Nutrition and Dietetics,
2019).
This lack of consistent regulation may be leading to inappropriate or inconsistent nutrition care within correc-

155

tions. In South Carolina, Collins and Thompson (2012)
found excessive dietary offerings of cholesterol, sodium,
and sugar along with lower than recommended levels of
fiber, magnesium, potassium, vitamin D, and vitamin E.
In Georgia, Cook et al. (2015) found macronutrient ranges
were met. However, sodium offerings were 303% of recommended levels, and higher than recommended levels
of cholesterol and sugar were evident. In addition, Georgia menus were shown to offer lower than recommended
levels of fiber, magnesium, potassium, vitamin D, and
vitamin E (Cook et al., 2015). No research was found
assessing food offerings in correctional facilities in the
Midwest or comparing offerings across correctional programs. The purpose of this study was to compare how
Midwestern state departments of corrections (DOCs)
average menu offerings compared with nutritional standards identified to be commonly used within corrections
including the DRIs and the 2015–2020 Dietary Guidelines for Americans (U.S. Department of Health and
Human Services [USDHHS] & U.S. Department of Agriculture [USDA], 2015) to determine whether (1) standards are being met and (2) standards are being
consistently utilized across Midwestern state DOCs.
Method
To examine nutritional offerings in comparison with
common nutritional standards used within Midwestern
state DOCs, copies of male, female, religious male, and
religious female menus and corresponding nutritional analyses were requested through 12 Midwestern state DOCs’
websites, direct email, or phone calls. Two follow-up
phone calls were administered to each DOC that did not
respond to the initial request.
In total, six male menus and corresponding nutritional
analyses were obtained from Iowa, Kansas, Minnesota,
Missouri, Ohio, and Wisconsin. A male menu without nutritional analysis was obtained from Illinois. Six female
menus and corresponding nutritional analyses were
obtained from Illinois, Iowa, Kansas, Minnesota, Ohio,
and Wisconsin. Six religious menus and corresponding
analyses were obtained from Iowa, Kansas, Minnesota,
Ohio, and Wisconsin. Kansas was the only state to provide
a religious menu specifically identified for both males
and females. There was no gender identification for religious menus provided by Iowa, Ohio, or Wisconsin.
Data Analysis
Midwestern state DOC menu cycles ranged from 1 day to
6 weeks. The DOC-provided nutritional analysis information was utilized to compare macronutrient ranges
and micronutrient offerings including 12 vitamins (A,
thiamine, riboflavin, niacin, pantothenic acid, B6, folate,
B12, C, D, E, and K) and 11 minerals (calcium, copper, iodine, iron, magnesium, manganese, phosphorus,

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156

HOLLIDAY AND RICHARDSON

potassium, selenium, sodium, and zinc) to DRI recommendations for acceptable macronutrient distribution ranges
(AMDRs), RDAs, EARs, and AIs. Nutritional analysis
information for protein and carbohydrates provided in
grams was multiplied by 4 to calculate the total calories
per day offered. This number was divided by the total
daily calories to calculate the percent of calories offered
from that macronutrient in the given day. The same procedure was followed for fats, except the value in grams
was multiplied by 9.
DOC-provided menu nutritional analysis information
was also utilized to compare offerings of energy, fruits,
vegetables, fiber, and percent calories from saturated fat
to recommended intake levels according to 2015–2020
Dietary Guidelines for Americans (USDHHS & USDA,
2015). The recommended values of energy, fruits, and
vegetables were based on a sedentary lifestyle and an
average age range of 25–39 years (Bronson & Carson,
2019). Specifically, male menus were compared with a
2,400-calorie diet with three servings of vegetables and
two servings of fruit per day. Female menus were compared with an 1,800-calorie diet with 2.5 servings of
vegetables and 1.5 servings of fruit per day. Fiber recommendations were established at 33.6 g/day for males and
25.2 g/day for females based on a recommended AI of
14 g/1,000 kcal. Nutritional analysis information for saturated fat provided in grams of fat used the same conversion to percent of total calories as total fat.
For fruit and vegetable offerings, Midwestern state
DOC-provided menus and noted serving sizes were
used to determine the average fruit and vegetable cupequivalent offerings per day. Each fruit and vegetable
with a serving listed in ounces or partial or whole units
was converted to cup-equivalents of fruits and vegetables
using MyPlate cup equivalents conversation tables (U.S.
Department of Agriculture, n.d.).

Both male and female menu analyses were compared
with the same saturated fat limitations, as well as the
same AMDRs for percent protein, fat, and carbohydrate
recommendations listed in the 2015–2020 Dietary Guidelines for Americans. Specifically, recommendations include
a diet with less than 10% total calories from saturated fat,
10%–35% total calories from protein, 20%–35% total calories from fat, and 45%–65% total calories from carbohydrate (USDHHS & USDA, 2015). For all menu analyses,
daily nutrition offerings were totaled and divided by the
number of days within the menu to calculate average
daily offerings.

Results
To assess food offerings in correctional facilities in Midwestern state DOCs and to compare offerings across multiple correctional programs, the DOCs’ average menu
offering was compared with DRIs and the 2015–2020
Dietary Guidelines for Americans. The target population
of the study was 12 Midwestern states contacted. Seven
states provided a variety of menus and nutritional analysis information including menus and analyses for men’s,
women’s, and men’s religious and women’s religious
diets. Kansas and Minnesota were the only states to provide a religious menu specifically identified for males.
Due to the percentage of males compared with females
within incarcerated populations and noted calorie levels
provided as part of nongender identified menus, nongender identified menus were presented as part of male average dietary offerings (Table 1).
As reported in Table 1, daily calorie offerings for male
menu offerings range from 2,500 to 2,929 calories per
day, while daily percent of calories from protein ranged
from 11.7% to 18.5%, percent of calories from carbohydrates ranged from 50.4% to 66.8%, percent of calories

Table 1. Average Dietary Offering Based on Male General and Religious State Department of Corrections Menus
States

Recommended
IL (regular)
IA (regular)
IA (religious)
KS (regular)
KS (religious)
MN (regular)
MN (religious)
MO (regular)
OH (regular)
OH (religious)
WI (regular)
WI (religious)
a

Average
calories

% Calories
protein

% Calories
carbohydrates

% Calories
fat

% Calories
saturated fat

Fruit
cup-equivalents

Vegetable
cup-equivalents

Fiber (g)

2400
—a
2875
—
2917
2929
2677
2500
2727
2563
2914
2649
2639

10–35
—
14.0
—
11.7
11.9
17.0
—
14.1
16.2
14.3
18.5
14.6

45–65
—
55.0
—
60.8
56.6
53.0
—
62.9
57.3
50.4
66.8
62.9

20–35
—
33.0
—
27.1
31.6
30.0
—
21.7
27.3
36.9
18.5
23.5

<10
—
—
—
8.7
8.1
8.4
—
—
8.2
7.7
9.3
6.4

2.0
1.0
1.2
2.0
1.0
3.0
1.4
2.8
2.3
3.4
3.0
1.9
1.9

3.0
2.3
2.9
2.0
2.2
1.4
2.4
2.2
2.8
3.3
1.8
1.8
1.3

33.6
—
32.7
—
25.5
32.9
31.9
—
—
34.5
40.6
34.5
24.3

Information not available.

NUTRITION IN MIDWESTERN STATE DEPARTMENT OF CORRECTIONS PRISONS

157

Table 2. Average Dietary Offering Based on Female General and Religious State Department of Corrections Menus
States

Recommended
IL (regular)
IA (regular)
KS (regular)
KS (religious)
MN (regular)
OH (regular)
WI (regular)

Average
calories

% Calories
protein

% Calories
carbohydrates

% Calories
fat

% Calories
saturated fat

Fruit
cup-equivalents

Vegetable
cup-equivalents

Fiber (g)

1800
—a
2869
2427
2405
2164
2152
2154

10–35
—
14.0
13.2
13.3
19.0
17.0
17.0

45–65
—
55.0
61.1
56.0
52.0
58.7
69.8

20–35
—
33.0
25.3
31.7
29.0
25.5
14.9

<10
—
—
7.9
8.0
8.2
9.7
9.1

1.5
1.0
1.2
1.0
3.0
1.4
3.2
1.7

2.5
2.3
2.9
2.2
1.4
2.4
3.0
2.2

25.2
—
26.5
25.3
27.6
26.6
29.7
30.8

a

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from fat ranged from 18.5% to 36.9%, and percent of calories from saturated fat ranged from 6.4% to 9.3%. Daily
fruit-cup equivalents offering ranged from 1.0 to 3.4 servings per day and daily vegetable cup-equivalents offering
ranged from 1.3 to 3.3 servings per day. Lastly, daily average offering of fiber ranged from 24.3 to 40.6 g/day.
Table 2 reports daily calorie offerings for female menu
ranging from 2,152 to 2,869 calories per day. Daily percent calories from protein ranged from 13.2% to 19.0%,
percent calories from carbohydrates ranged from 52.0%
to 69.8%, percent calories from fat ranged from 14.9%
to 33.0%, and percent calories from saturated fat ranged
from 7.9% to 9.7%. Daily fruit cup-equivalent serving
ranged from 1.0 to 3.2 servings per day and vegetable
cup-equivalent offering ranged from 1.4 to 3.0 servings
per day. Lastly, average offerings of fiber ranged from
25.3 to 30.8 g/day.
Table 3 shows that a majority of male menus nutrient
analyses provided for vitamins met or exceeded DRI recommendations including vitamin A, thiamin, riboflavin,
niacin, pantothenic acid, vitamin B6, folate, vitamin B12,
vitamin C, and vitamin K. Two of four of nutrient analyses provided for vitamin D were below the recommended
DRIs, and both nutrient analyses provided for vitamin E
were below the DRIs.
Table 4 shows that a majority of female menus nutrient
analyses provided for vitamins exceeded DRI recommen-

dations including vitamin A, thiamin, riboflavin, niacin,
pantothenic acid, vitamin B12, vitamin C, and vitamin K.
Four of five nutrient analyses provided for folate were
above the recommended DRIs. Two of three nutrient analyses provided for vitamin D were below the recommended DRIs. None of the nutrient analyses provided for
vitamin E were above the DRIs.
DRI offerings for minerals were also assessed. Table 5
shows a majority of male menus nutrient analyses provided exceeded DRI recommendations including calcium,
copper, iodine, iron, manganese, phosphorus, selenium,
and zinc. One of two of nutrient analyses provided for
magnesium were below the recommended DRIs and three
of five nutrient analyses for potassium were below the
DRIs. For sodium, all nutrient analyses exceeded the recommended DRIs.
As shown in Table 6, a majority of female menus nutrient analyses provided exceeded DRI recommendations
including calcium, copper, iodine, iron, manganese, magnesium, phosphorus, potassium, selenium, and zinc. For
sodium, five of six nutrient analyses exceeded the recommended DRIs.
Discussion
This study examined how Midwestern state DOC average menu offerings compared with commonly used nutritional standards within corrections, including the DRIs

Table 3. The Quantity of Vitamins Offered in Male Menus in Midwest State Departments of Corrections
States

Vitamin
A (lg)

Thiamin
(lg)

Riboflavin
(mg)

Niacin
(mg)

Pantothenic
acid (mg)

Vitamin
B6 (mg)

Folate
(lg)

Vitamin
B12 (mg)

Vitamin
C (mg)

Vitamin
D (lg)

Vitamin
E (mg)

Vitamin
K (lg)

Recommended
IA (regular)
KS (regular)
KS (religious)
MN (regular)
MO (regular)
OH (regular)
OH (religious)
WI (regular)
WI (religious)

900.0
1254.6
1067.2
1101.7
1563.3
—a
1522.8
2418.3
—
—

1.2
2.2
2.9
3.1
1.8
—
2.7
2.8
—
—

1.3
3.0
2.2
1.8
2.2
—
2.7
2.9
—
—

16.0
35.6
34.8
26.5
17.0
—
27.0
37.3
—
—

5.0
5.7
—
—
5.5
—
—
—
—
—

1.3
2.0
1.4
1.3
1.5
—
2.0
3.0
—
—

400.0
448.8
648.1
834.3
460.1
—
719.9
597.2
—
—

2.4
5.6
5.8
7.5
4.3
3.6
4.0
5.9
—
—

90.0
208.6
185.3
237.1
266.2
—
153.6
170.1
—
—

15.0
16.4
—
—
28.4
—
—
—
9.2
12.1

15.0
14.1
—
—
9.3
—
—
—
—
—

120.0
172.8
—
—
173.4
—
—
—
—
—

a

Information not available.

158

HOLLIDAY AND RICHARDSON

Table 4. The Quantity of Vitamins Offered in Female Menus in Midwest State Departments of Corrections
States

Vitamin
A (lg)

Thiamine
(lg)

Riboflavin
(mg)

Niacin
(mg)

Pantothenic
acid (mg)

Vitamin
B6 (mg)

Folate
(lg)

Vitamin
B12 (mg)

Vitamin
C (mg)

Vitamin
D (lg)

Vitamin
E (mg)

Vitamin
K (lg)

Recommended
IA (regular)
KS (regular)
KS (religious)
MN (regular)
MO (regular)
OH (regular)
WI (regular)

700.0
1267.0
971.7
939.1
1525.3
—a
1582.0
—

1.1
2.0
2.5
2.4
1.7
—
2.4
—

1.1
2.9
2.0
1.6
2.5
—
2.8
—

14.0
35.5
25.1
21.0
21.0
—
23.9
—

5.0
5.7
—
—
5.6
—
—
—

1.3
2.0
1.5
1.1
1.4
—
2.1
—

400.0
459.2
643.7
650.4
388.1
—
612.1
—

2.4
6.5
5.7
7.3
5.1
—
5.1
—

75.0
213.0
180.5
234.5
278.2
—
146.1
—

15.0
16.4
—
—
30.3
—
—
9.2

15.0
13.7
—
—
8.4
—
—
—

90.0
169.6
—
—
169.5
—
—
—

a

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Information not available.

and the 2015–2020 Dietary Guidelines for Americans, to
determine whether (1) standards are being met and (2)
whether standards are being consistently used across
Midwestern state DOCs. Most calorie offerings were reported to be offered in excessive amounts, with male
menus averaging 2,739 calories per day or 114% of the
DRIs and women’s menus averaging 2,361 calories per
day or 131% of the DRIs. These excessive calorie offering may be associated with the reported 74% of prisoners
who are overweight (45.7%), obese (25.5%), or morbidly
obese (2.4%; Maruschak et al., 2015).
Most macronutrients were reported with ranges found
to be within AMDRs. These findings are in line with
Cook et al.’s (2015) findings of macronutrient ranges in
a large county jail in Georgia. Saturated fat recommendations were also found to be met. These findings are also
in line with Cook et al.’s (2015) findings; however,
they are not in line with previous findings of saturated
fat offerings within a correctional setting of >10% of
total calories identified by Collins and Thompson (2012).
Average fruit offerings exceed intake recommendations for regular females at 1.6 servings per day, religious
males at 2.5 servings per day, and religious females at 3.0
servings per day; however, regular male menus offered
below the recommended value at 1.7 servings per day.
These findings are in line with previous low fruit offerings in male correctional settings identified by Collins

and Thompson (2012) and Cook et al. (2015). These findings also partially support the perception that fruit offerings may be limited due to security concerns related to
fruit being used to produce illicit alcohol, especially in
male correctional facilities (Academy of Nutrition and
Dietetics, 2019).
Average vegetable offerings were below intake recommendations at 2.6 servings per day for males and 2.3 servings per day for females. Both religious and regular male
menu average offerings were below recommended levels,
with religious menus offering 1.7 servings per day and
regular menus offering 2.5 servings per day. These findings are in line with previously identified low vegetable
offerings in correctional settings (Collins & Thompson,
2012; Cook et al., 2015).
Most Midwestern state DOC average fiber offerings
were reported. Male menus fell below recommended intakes, while average fiber offerings on all female menus
were above recommended intakes. For males, these findings were consistent with past findings showing lower
than recommended levels of fiber offerings on prison
menus (Collins & Thompson, 2012; Cook et al., 2015).
For both males and females, a majority of vitamins met
or exceeded DRI levels; however, there was inconsistent
reporting across states. In addition, only 55% of the vitamins reviewed as part of this research were reported by
states for males and only 78% were reported by states

Table 5. The Quantity of Elements and Minerals Offered in Male Menus in Midwest State Departments of Corrections
States

Ca (mg)

Cu (lg)

I (mg)

Fe (mg)

Mg (mg)

Mn (lg)

P (mg)

K (mg)

Se (lg)

Na (mg)

Zn (lg)

Recommended
IA (regular)
KS (regular)
KS (religious)
MN (regular)
MO (regular)
OH (regular)
OH (religious)
WI (regular)
WI (religious)

1000.0
1564.0
1441.5
1460.4
1388.5
—a
1506.6
1374.9
1818.0
2123.0

900.0
1141.2
—
—
1110.0
—
—
—
—
—

150.0
183.3
—
—
—
—
—
—
—
—

8.0
21.4
21.1
24.9
11.6
—
22.7
39.4
21.9
24.3

420.0
563.6
—
—
308.7
—
—
—
—
—

2.3
4.7
—
—
4.0
—
—
—
—
—

700.0
1727.6
1664.5
1304.8
1425.5
1710.9
1615.1
1184.0
—
—

3400.0
3327.6
—
—
3237.2
4441.9
—
—
4433.0
2678.0

55.0
125.3
—
—
—
—
—
—
—
—

2300.0
4788.0
3681.6
2430.1
3579.9
4242.0
3504.8
3666.0
3093.0
3640.0

11.0
24.3
—
—
21.4
—
—
—
—
—

a

Information not available.

NUTRITION IN MIDWESTERN STATE DEPARTMENT OF CORRECTIONS PRISONS

159

Table 6. The Quantity of Elements and Minerals Offered in Female Menus in Midwest State Departments of Corrections
States

Ca (mg)

Cu (lg)

I (mg)

Fe (mg)

Mg (mg)

Mn (lg)

P (mg)

K (mg)

Se (lg)

Na (mg)

Zn (lg)

Recommended
IA (regular)
KS (regular)
KS (religious)
MN (regular)
MO (regular)
OH (regular)
WI (general)

1000.0
1564.0
1370.3
1371.2
1594.5
—a
1655.5
1805.0

900.0
1128.6
—
—
930.0
—
—
—

150.0
182.7
—
—
—
—
—
—

18.0
21.7
20.4
19.9
19.4
—
18.7
18.4

310.0
350.9
—
—
292.1
—
—
—

2.3
4.7
—
—
3.2
—
—
—

700.0
1716.4
1645.0
1115.9
1489.6
—
1681.0
—

2600.0
3261.8
—
—
3202.2
—
—
4019.0

55.0
124.9
—
—
—
—
—
—

2300.0
4761.0
3363.4
2195.6
3091.0
—
2472.0
2472.0

8.0
24.2
—
—
21.5
—
—
—

a

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Information not available.

for females. Vitamins, including pantothenic acid and
vitamins D, E, and K, were more commonly underreported. When reported, a majority of values for both vitamins D and E were below recommended levels. These
findings were again consistent with previous findings of
lower than recommended levels of vitamin D and E offerings on prison menus (Collins & Thompson, 2012;
Cook et al., 2015).
There was also inconsistent and underreporting of
minerals. Only 47% of the minerals reviewed were reported on both male and female menus. Specifically, most
minerals except calcium, iron, phosphorus, and sodium
were underreported across states. When they were reported, a majority of male potassium offerings were at less
than recommended levels. Sodium was offered in excess
across 14 of the 15 menus reviewed. The average daily
offering was 3,625 mg or 158% of the recommended
level for males and 3,059 mg or 133% of recommended
levels for females. These findings are also in line with
previously reported below-recommended offerings of
potassium with exceedingly high offerings of sodium
(Collins & Thompson, 2012; Cook et al., 2015).
Recommendations
As commonly used nutritional standards are not consistently being used or met, regulations should be established to require correctional institutions to specifically
identify which nutrition standards they are utilizing as
well as requirements to meet them, whether they are
accredited or not. Accrediting organizations, such as
the ACA, should adopt more specific standardized definitions on which DRIs should be assessed and to what
extend they should be implemented. These changes
could help correctional programs to provide enhanced nutritional care and continuity of nutritional care across DOCs.
Internally, DOCs should voluntarily increase accountability to meet common nutritional standards and guidelines to include the DRIs and Dietary Guidelines for
Americans. Specifically, calories and sodium levels should
be reduced to recommended levels as excessive offerings
could be associated with higher rates of hypertension,
overweight, and obesity in corrections (Binswanger et al.,

2009; Clarke & Waring, 2012; Gates & Bradford, 2015;
Herbert et al., 2012; Kendig et al., 2014; Maruschak
et al., 2015). In addition, as vitamin D, potassium, and dietary fiber are nutrients of public health concern, DOCs
could benefit from increasing offerings to recommended
levels to reduce the risk of associated chronic health conditions (USDHHS & USDA, 2015).
Conclusion
Improving the nutritional adequacy of food is an opportunity for improvement in correctional health care as research has shown there are potentially higher rates of
nutrition-related chronic health conditions among incarcerated populations. A lack of or ambiguous regulations may
be leading to inappropriate or inconsistent nutrition care
within corrections. This may be resulting in no nutritional
standards being utilized or commonly utilized nutritional
standards not being met. Correctional health care may be
improved if all correctional institutions enforced nutritional
standards, and if correctional accreditation agencies developed and enforced more specific nutritional standards. In
addition, correctional health care may be improved if correctional institutions voluntarily increased their accountability to meeting nutrition recommendations, especially
for calorie levels and nutrients of public health concern.
Author Disclosure Statement
The authors disclosed no conflicts of interest with respect
to the research, authorship, or publication of this article.
Funding Information
The authors received no financial support for the research, authorship, and/or publication of this article.
References
Academy of Nutrition and Dietetics. (2019). ADA nutrition care manual.
https://www.nutritioncaremanual.org
American Correctional Association. (2003). Standards for adult correctional
institutions. Baltimore, MD; Victor Graphics, Inc.
American Correctional Association. (2014). Standards supplement. Mayfield,
PA: The P.A. Hutchinson Company.
Bai, J. R., Befus, M., Mukherjee, D. V., Lowy, F. D., & Larson, E. L. (2015).
Prevalence and predictors of chronic health conditions of inmates newly
admitted to maximum security prisons. Journal of Correctional Health
Care, 21(3), 255–264. https://doi.org/10.1177/1078345815587510

Downloaded by 12.0.105.18 from www.liebertpub.com at 09/21/21. For personal use only.

160
Binswanger, I. A., Krueger, P. M., & Steiner, J. F. (2009). Prevalence of chronic
medical conditions among jail and prison inmates in the USA compared
with the general population. Journal of Epidemiology and Community
Health, 63(11), 912–919. https://doi.org/10.1136/jech.2009.090662
Bronson, J., & Carson E. A. (2019). Prisoners in 2017 (NCJ 252156). Bureau
of Justice Statistics. https://www.bjs.gov/content/pub/pdf/p17.pdf
Camplin, E. (2017). Prison food in America. Rowman & Littlefield.
Clarke, J. G., & Waring, M. E. (2012). Overweight, obesity, and weight change
among incarcerated women. Journal of Correctional Health Care, 18(4),
285–292. https://doi.org/10.1177/1078345812456010
Collins, S. A., & Thompson, S. H. (2012). What are we feeding our inmates?
Journal of Correctional Health Care, 18(3), 210–218. https://doi.org/
10.1177/1078345812444875
Cook, E. A., Lee, Y. M., White, B. D., & Gropper, S. S. (2015). The diet of
inmates: An analysis of the 28-day cycle menu used in a large county jail
in the state of Georgia. Journal of Correctional Health Care, 21(4), 390–399.
https://doi.org/10.1177/1078345815600160
Gates, M. L., & Bradford, R. K. (2015). The impact of incarceration on
obesity: Are prisoners with chronic diseases becoming overweight
and obese during their confinement? Journal of Obesity, 2015, 532468.
https://doi.org/10.1155/2015/532468
Hardy, K. (2016). Nutrition services in correctional facilities. Today’s Dietitian,
18(6), 32. https://www.todaysdietitian.com/newarchives/0616p32.shtml
Harzke, A. J., Baillargeon, J. G., Pruitt, S. L., Pulvino, J. S., Paar, D. P., & Kelley,
M. F. (2010). Prevalence of chronic medical conditions among inmates in
the Texas prison system. Journal of Urban Health, 87(3), 486–503. https://
doi.org/10.1007/s11524-010-9448-2

HOLLIDAY AND RICHARDSON
Herbert, K., Plugge, E., Foster, C., & Doll, H. (2012). Prevalence of risk factors for non-communicable diseases in prison populations worldwide:
A systematic review. Lancet, 379(9830), 1975–1982. https://doi.org/10
.1016/S0140-6736(12)60319-5
Kendig, N., Brown, B., & Dretsch, D. (2014, March 20–21). An examination of
the health history and clinical findings of newly incarcerated federal inmates
[Conference session]. Academic Consortium on Criminal Justice Health
7th Academic & Health Policy Conference on Correctional Health,
Houston, TX.
Maruschak, L. M., Berzofsky, M., & Unangst, J. (2015). Medical problems
of state and federal prisoners and jail inmates, 2011–2012 (NCJ 248491).
Bureau of Justice Statistics. www.bjs.gov/content/pub/pdf/mpsfpji1112.pdf
Rich, J. D., Wakeman, S. E., & Dickman, S. L. (2011). Medicine and the epidemic of incarceration in the United States. New England Journal of
Medicine, 364(22), 2081–2083. https://doi.org/10.1056/NEJMp1102385
Skarupski, K. A., Gross, A., Schrack, J. A., Deal, J. A., Eber, G. B. (2018). The
health of America’s aging prison population. Epidemiologic Reviews, 40(1),
157–165. https://doi.org/10.1093/epirev/mxx020
U.S. Department of Agriculture. (n.d.). What is MyPlate? https://www
.choosemyplate.gov/WhatIsMyPlate
U.S. Department of Health and Human Services & U.S. Department of
Agriculture. (2015). Dietary guidelines for Americans 2015–2020 (8th ed.).
https://health.gov/dietaryguidelines/2015/guidelines
Wilper, A. P., Woolhandler, S., Boyd, J. W., Lasser, K. E., McCormick, D.,
Bor., D. H., & Himmelstein, D. U. (2009). The health and health care of US
prisoners: Results of a nationwide survey. American Journal of Public
Health, 99(4), 666–672. https://doi.org/10.2105/AJPH.2008.144279