Nutrient Density and the Evolving Nutrition Profiling Environment

Nutrient Rich Foods Coalition: A New Approach

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Obesity is Driving Change

Consumers Strive to Make Healthful Choices

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Americans Are Overweight Yet Undernourished

Americans are not meeting nutrient recommendations

• 97%: Potassium

• 93%: Vitamin E

• 70%: Calcium

• 56%: Magnesium

• 44%: Vitamin A

• 31%: Vitamin C

• 14%: Vitamin B6

• 12%: Zinc

*Ages 1 year and higher, USDA, ARS 2005, What We Eat in America, NHANES 2001-2002

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Proliferation of Profiles

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Nutrient Profiling at Retail

NUTRITIONThree-Star Snacks In Aisle FiveBy Anne Underwood

NOV 12, 2007 ISSUE

Overall Nutritional Quality Index (ONQI)

FDA Public HearingSeptember 10-11, 2007:Use of Symbols to Communicate

Nutrition Information,Consideration of Consumer Studies and Nutritional Criteria

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Implication of the Stars

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The Nutrient Rich Foods Approach

An evolution from being based on what to avoid …

To being based on what to include, and considering the “whole food” or total nutrient package …

A positive, common-sense approach to eating that emphasizes the total diet …

The Nutrient Rich Foods InitiativeWhat’s Best for Consumers?

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Nutrient Rich Foods Coalition

Funded by The Beef Checkoff

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Beginning the Dialogue

• Nutrient density to help consumers select the most nutrient-rich foods

• “We want to help consumers choose naturally nutrient-rich foods first - and then the less nutrient-dense foods as calorie needs allow.”

Drewnowski 3/16/2004

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Nutrient Density: Cornerstone of 2005 Dietary Guidelines for Americans

Choose the most nutritionally rich foods you can from each food

group each day.

Get the most nutrition out of your calories

Maximizing your nutrients -- making

calories count for you

• Develop a scientifically valid definition for "nutrient density” that could be useful on the food label

• Determine what criteria are necessary for foods to meet this definition

Dietary Guidelines Advisory Committee Call-to-Action

Overall Theme of 2005 DGAC Technical Report: Importance of

Nutrient-Rich Diets

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Scientific Advisory Committee•Adam Drewnowski, PhD, University of Washington•Victor Fulgoni, PhD, Nutrition Impact, LLC•Robert Heaney, MD, FACP, FAIN, Creighton University•Eileen Kennedy, PhD, Tufts University•Janet King, PhD, University of California, Berkeley & Davis•Nancy Krebs, MD, University of Colorado•Paul LaChance, PhD, Rutgers University•Esther Myers, PhD, RD, American Dietetic Association

NRF Coalition Advisory Committees

Consumer Communications & Nutrition Behavior Committee

•Jane Andrews, MS, RD, Wegmans•Robert McKinnon, YellowBrick Road•Amy Mobley, PhD, RD, Purdue University •Laura Peracchio, PhD, University of Milwaukee •Connie Diekman, MEd, RD, LD, FADA, Washington University St. Louis•Kathleen Zelman, MPH, RD, nutrition consultant

Building the Nutrient Rich Foods System

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NRF Coalition Vision

The Nutrient Rich Foods approach is a scientifically proven, consumer-tested system that is widely accepted and makes it easy for people to build and enjoy healthier diets by getting the most nutrition from their calories.

• Objective - based on accepted nutrition science and labeling practices

• Simple – based on published daily values and meaningful amounts of food

• Balanced – based on nutrients to encourage and on nutrients to limit

• Validated – against measures of a healthful diet

• Transparent – based on published algorithms and open-source data

• Consumer-driven – likely to guide better food choices and more healthful diets

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Nutrient Profiling Criteria

Drewnowski, Fulgoni. Nutr Rev 2008

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The Nutrient Rich Foods Index is the only index that meets all 6 criteria:

• Objective - based on 2005 Dietary Guidelines; 2005 MyPyramid and other expert panel data

• Simple – based on percent Daily Values and reference amounts (RACC) published by the FDA

• Balanced – based on nutrients to encourage and nutrients to limit

• Validated – against 2005 Healthy Eating Index (HEI)

• Transparent – algorithms published in peer-review journals; based on FNDDS and SR-20 data from USDA

• Consumer-driven – research on helping consumers to build healthier diets is in progress

Drewnowski, Fulgoni. Nutr Rev 2008

Objective and Simple

Select Nutrients to Encourage:

• The 2005 Dietary Guidelines sevenFiber, vitamins A, C, E, Ca, K, Mg

• The Food and Drug Administration six– FDA defines “healthy” foods as those that contain

>10% DV of protein, fiber, vitamins A, C, Ca, Fe

• Additional special population needs– Zn, Fe, folate, vitamins D, B12

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Objective and Simple

Select Nutrients to Limit:• The 2005 Dietary Guidelines five

– Saturated fat, trans fat, cholesterol, added sugar, and sodium

• The Food and Drug Administration four– FDA disqualifies foods from health claims if they contain fat,

saturated fat, cholesterol or sodium above specified amounts

• The European Union five– Article 4 lists total fat, saturated fat, trans fat, sugar, and sodium

• The French three– AFSSA uses saturated fat, added sugar, and sodium

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Determine Nutrition Criteria:

• Select reference amounts: use those used in food labels: FDA’s Daily Values

• Use algorithm across Food Groups but apply within Food Groups

• Use USDA sources for nutrient composition

• Select basis for calculations: 100 kcal, 100 g, FDA’s RACC

Objective and Simple

NRF RACC-based scores:

• Consistent with US labeling regulations (100g EU)

• Scores/serving (RACC) more relevant to consumers

• RACC-based scores rank foods similarly to 100 kcal

• Consistent with the nutrient density definition

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Objective and Simple

Balanced

Create Algorithm:• The total score balances nutrients to encourage

and nutrients to limit

• Calculate % Daily Value for nutrients to encourage (capped at 100%DV/100 kcal or RACC)

• Subtract same for saturated fat, added sugars and sodium

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Type of test Reference

Does a list of foods look “right”? Drewnowski 2005; Braesco 2007, Rayner 2007

Do target foods score higher? Drewnowski 2005; Rampersaud 2007

Is the ranking of foods the same? Rayner 2007, Rampersaud 2007

Are scores correlated with each other? Rayner 2007

Are scores correlated with expert opinion? Braesco 2007, Rayner 2007, Gazibarich 1998

Are scores correlated with consumer attitudes?

Drewnowski (in preparation)

How are scores linked to other food components, energy density, and cost?

Drewnowski, Maillot, Darmon (in preparation)

Are index foods linked to DQI measures? Rayner 2007; Volatier 2007,

Are index foods linked to HEI measures? Fulgoni and Drewnowski (in preparation)

Validated

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Validated

• Family of NRF Indices have been validated against objective measures of a healthy diet – Measure of diet quality (Healthy Eating Index)– Body Mass Index – Blood pressure– Cholesterol levels

• Validation identified NRF 9.3 to be consumer tested

Protein, Fiber, Vitamin A, C, E, Calcium, Magnesium. Iron, Potassium Saturated Fat, Sodium and Added Sugars

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Component Points Std. for max. score Std. for min. scoreTotal Fruit (includes 100% juice) 5 ≥0.8 cup equiv. per 1,000 kcal No Fruit

Whole Fruit (not juice) 5 ≥0.4 cup equiv. per 1,000 kcal No Whole Fruit

Total Vegetables 5 ≥1.1 cup equiv. per 1,000 kcal No vegetables

Dark Green and OrangeVegetables and Legumes

5 ≥0.4 cup equiv. per 1,000 kcal No Dark Green or Orange Vegetables and Legumes

Total Grains 5 ≥3.0 oz equiv. per 1,000 kcal No Grains

Whole Grains 5 ≥1.5 oz equiv. per 1,000 kcal No Whole Grains

Milk 10 ≥1.3 cup equiv. per 1,000 kcal No Milk

Meat and Beans 10 ≥2.5 oz equiv. per 1,000 kcal No Meat or Beans

Oils 10 ≥12 grams per 1,000 kcal No Oil

Saturated Fat 10 ≤7% of energy ≥15% of energy

Sodium 10 ≤0.7 gram per 1,000 kcal ≥2.0 g per 1,000 kcal

Calories from Solid Fat, Alcohol,and Added Sugar (SoFAAS)

20 ≤20% of energy ≥50% of energy

Healthy Eating Index 2005

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Sept/Oct ‘07 Jan ‘08

Additional Articles in Development …

Feb ‘08

2008

Transparent

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Making the NRF Approach Relevant to Consumers

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Making it Relevant for Consumers I

• Talked to consumers about nutrient density and what it means to them to

– Determine which messages resonate

– Understand the right ways to communicate nutrient density concepts

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Making it Relevant for Consumers I

• Consumers want to get more nutrients in their diets …

• But they don’t know how to – Overwhelmed – Tend to give up on

nutrients/nutrition– Tools

• “Dense” means heavy or stupid“I don’t know

how to shop for nutrient-dense

foods.”-- Consumer,

Denver

“Take small steps, so someone might not be overwhelmed … They can do a little bit at a time.”

-- Consumer, Denver

Headlines Must Empathize and Empower

• Take Small Steps for a Healthier You– Get more nutrition out of your calories by choosing the most

nutritionally rich foods from each food group each day• Recognized that healthy eating can be difficult … made the goal

seem less intimidating and less challenging• Gave them permission to make changes a little bit at a time• Avoid “calories,” which can intimidate consumers

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“If you follow these rules forthese food groups, you’re

going to live well.”-- Consumer, Chicago

“I like how they point out non-fat, lowfat, lean and whole … and that you’re going to be satisfied.”

-- Consumer, Denver

Headlines Must Deliver A Strong Consumer Benefit

• Live Well– Enjoy nutrient-rich foods from all five food groups including fruits,

vegetables, nonfat and lowfat dairy, lean meats, and whole grains

• Spoke to their primary goals related to food and health: taste and general well-being

• Liked messages that emphasized the health benefits of all food groups

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Making it Relevant for Consumers II

• Consumer research to bring index application to life for consumers

• Application will be where consumers interact with food

• User-driven design– Consumer-driven brand/design– Educational tools– Total diet translation– Diets/menus/recipes– Expanded web site

Supporting the Research: Influencer & Consumer

Communications

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Health Professional/ScientistBriefings & Symposia

EB 2008: NRF Scientific Forum

and PIC Symposium

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Resources

www.NutrientRichFoods.org

• A science-based, simple, objective, and validated approach

• A consumer-driven eating system that helps people get more nutrition from their calories by emphasizing the complete nutrient package of foods and beverages

• A positive, total food / total diet approach

Nutrient Rich Foods: A New Way

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