Nutrient Density and the Evolving Nutrition Profiling Environment Nutrient Rich Foods Coalition: A New Approach

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Nutrient Density and the Evolving Nutrition
Profiling EnvironmentNutrient Rich Foods
Coalition A New Approach
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Obesity is Driving Change
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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

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Proliferation of Profiles
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Nutrient Profiling at Retail
Overall Nutritional Quality Index (ONQI)
NUTRITION Three-Star Snacks In Aisle Five By Anne
Underwood NOV 12, 2007 ISSUE
FDA Public Hearing September 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
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The Nutrient Rich Foods InitiativeWhats Best
for Consumers?
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Nutrient Rich Foods Coalition
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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
Get the most nutrition out of your calories
Maximizing your nutrients -- making calories
count for you
Choose the most nutritionally rich foods you can
from each food group each day.
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Dietary Guidelines Advisory Committee
Call-to-Action

• 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

Overall Theme of 2005 DGAC Technical Report
Importance of Nutrient-Rich Diets
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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

• 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

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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.

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Nutrient Profiling Criteria

• 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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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

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Drewnowski, Fulgoni. Nutr Rev 2008
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Objective and Simple

• Select Nutrients to Encourage
• The 2005 Dietary Guidelines seven
• Fiber, vitamins A, C, E, Ca, K, Mg
• The Food and Drug Administration six
• FDA defines healthy foods as those that contain
  gt10 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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Objective and Simple

• Determine Nutrition Criteria
• Select reference amounts use those used in food
  labels FDAs 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,
  FDAs RACC

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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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Balanced

• Create Algorithm
• The total score balances nutrients to encourage
  and nutrients to limit
• Calculate Daily Value for nutrients to
  encourage (capped at 100DV/100 kcal or RACC)
• Subtract same for saturated fat, added sugars and
  sodium

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Validated
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)
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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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Healthy Eating Index 2005
Component Points Std. for max. score Std. for min. score
Total 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 Orange Vegetables 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
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Transparent
Sept/Oct 07
Jan 08
Feb 08
Additional Articles in Development
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2008
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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 dont know how to
• Overwhelmed
• Tend to give up on nutrients/nutrition
• Tools
• Dense means heavy or stupid

I dont know how to shop for nutrient-dense
foods. -- Consumer, Denver
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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

Take small steps, so someone might not be
overwhelmed They can do a little bit at a
time. -- Consumer, Denver
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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

I like how they point out non-fat, lowfat, lean
and whole and that youre going to be
satisfied. -- Consumer, Denver
If you follow these rules forthese food groups,
youregoing to live well. -- Consumer, Chicago
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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

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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
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Nutrient Rich Foods A New Way

• 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

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