Nutrient Standards and Nutrient Rich Foods

1
Nutrient Standards andNutrient Rich Foods

• Karen Bakies, RD, LD
• Nutrition Affairs Manager
• American Dairy Association Mideast

2
National Dairy Council Affiliate

• Nutrition education arm of the
• American Dairy Association Mideast
• Dedicated to improving the nutrition status of
  the community
• Serves as the local affiliate of the National
  Dairy Council, which has been conducting
  nutrition education and nutrition research
  programs since 1915.

3
Obesity is Driving Change
4
Overweight yet Undernourished

• Adults
• Two-thirds of adults are overweight or obese
• Only 10 meet US Department of Agriculture
  Healthy Eating Index criteria for a healthful diet

• Kids
• In Ohio.
• 35 are overweight or obese
• OH Dept Health Division of Family Community
  Health Services, School and Adolescent Section,
  May 2006
• Only 2 meet recommendations for all five food
  groups16 do not meet any recommendations
• Food and Nutrition Service, Nutrition Education
  and Promotion Campaign, USDA

5
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

6
Consumers Strive to Make Healthful Choices
7
The Evolving Nutrition Profiling Environment
8
Proliferation of Profiles
9
Industry Nutrient Profiles 2006
9
10
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
11
Implication of the Stars
12
Cause for Concern.

• All based on differing nutrient profiling
• To date determined by food manufacturers,
  health professional organizations, grocery
  chains
• Lack of standardized criteria to define
  nutritional quality of food and beverages can
  lead to confusion and misinformation

13
The Nutrient Rich Foods Initiative
14
Nutrient Rich Foods Coalitionformed in 2003
15

Beginning the Dialogue 2004 Scientific Symposium

• 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

16
The Nutrient Rich Foods Approach
Aims to shift focus from good foods/bad foods
or nutrients to avoid. To being based on what
to include, and considering the whole food or
total nutrient package A positive,
science-based, common-sense approach to eating
that emphasizes overall diet quality
17
Nutrient Density Renewed interest in a
long-standing concept and the cornerstone of the
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.
18
2005 Dietary Guidelines

• Defines Nutrient-dense foods on a nutrient to
  calorie basis
• Nutrient-dense foods are those foods
• that provide substantial amounts of vitamins and
  minerals (micronutrients) and relatively few
  calories

19
2005 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
20
Building the Nutrient Rich Foods System
21
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.

22
Nutrient Profiling Criteria Guiding Principles

• 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

Drewnowski, Fulgoni. Nutrition Reviews, January
2008
23
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 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
24
Objective and Simple

• Selecting 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

25
Objective and Simple

• Selecting 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
• total fat, saturated fat, trans fat, sugar, and
  sodium
• The French three
• saturated fat, added sugar, and sodium

26
Objective and Simple

• Next Step.. Determine Nutrition Criteria
• Select reference amounts use whats on food
  labels base on FDAs Daily Values as the
  reference amount
• Use algorithm across Food Groups but apply
  within Food Groups
• Use USDA databases to serve as sources for
  nutrient composition
• Select basis for calculations on FDAsRACC
  referenced amount commonly consumed (100 kcal,
  100 g)

27
Objective and Simple

• NRF RACC-based scores
• Consistent with US labeling regulations (100g
  EU)
• Scores/serving more relevant to consumers
• Rank foods similarly (100 kcal)
• Consistent with the nutrient density definition

28
Balanced

• Create Algorithm
• The total score balances nutrients to encourage
  and nutrients to limit making your calories
  count more
• Calculate the sum of the Daily Value for
  nutrients to encourage and Subtract the same for
  nutrients to limit

29
Validated
30
Validated

• A family of NRF scores has been tested and
  validated against objective measures of a healthy
  diet, including the Healthy Eating Index, BMI,
  blood pressure and cholesterol levels.

• Validation identified NRF 9.3 to be consumer
  tested
• Nutrients to encourage (9)
• Protein, Fiber, Vitamin A, C, E, Calcium,
  Magnesium, Iron, Potassium
• Nutrients to Limit (3)
• Saturated Fat, Sodium and Added Sugars

31
Transparent
Sept/Oct 07
Jan 08
Feb 08
Additional Articles in Development
2008
32
How do you effectively communicate the science?
33
Making it Relevant

• Step I (completed)
• What does nutrient density mean to you?
• Which messages resonate
• Understand the right ways to communicate nutrient
  density concepts
• Step II (in progress)
• Consumer research to bring index application to
  life
• Application will be where consumers interact with
  food
• User-driven design

34
Making it Relevant Findings Step I

• 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 (like rich
  better)
• Enjoy nutrient-rich foods from all five food
  groups
• 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
• Take Small Steps for a Healthier You
• 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

I dont know how to shop for nutrient-dense
foods. -- Consumer, Denver
35
How can schools use this concept?
35
36
2005 US Dietary Guidelines
PROBLEM NUTRIENTS

• Children and Adolescents
• Calcium
• Potassium
• Fiber
• Magnesium
• Vitamin E
• Iron

• Adults
• Calcium
• Potassium
• Fiber
• Magnesium
• Vitamin A
• Vitamin C
• Vitamin E

Nutrients to encourage (9) Protein, Fiber,
Vitamin A, C, E, Calcium, Magnesium, Iron,
Potassium
37
Avoidance Standards

• Based on what a food should not contain
• Has created a public misperception
• fewer bad nutrients a nutritious food

calories
fat, saturated fat, trans fat
cholesterol, sodium
sugars
38
Less fat, fewer calories, but not more nutrients
39
Alliance for a Healthier Generation Guidelines

• Beverage Guidelines (elementary, middle, high)
• Water Any size
• Fat-free or low fat regular and flavored milk
  with up to 150 calories / 8 ounces
• 8, 10 ,12 ounces
• 100 juice with no added sweeteners and up to
  120 calories / 8oz
• 8, 10, 12 ounces
• No- or low-calorie beverages with up to 10
  calories / 8 ounces
• Any size (High School)
• Other drinks with no more than 66 calories / 8
  ounces
• 12 oz. (High School)
• Snack Foods Guidelines (elementary, middle, high)
• Calories 150, 180, 200
• Fat no more than 35 total calories
• Saturated Fat less than 10 total calories
• Trans Fat 0 grams
• Sugar 35 or less total weight
• Sodium 230mg or less
• Nutrients at least 1 required

40
Institute of Medicine

• All Beverages
• Fat
• No more than 35 of total calories from Fat
• Less than 10 total calories from saturated fat
• Zero Trans fat
• Sugar
• No more than 35 of calories from total sugars
  per portion as packaged
• Exceptions Tier 1
• Plain potable water at no cost available all day
• Water without flavoring, additives or carbonation
• 100 fruits and fruit juices in all forms
  without added sugar 4 oz ES 8 oz (2 portions) HS
  MS
• 100 vegetables and vegetable juices without
  added sugars
• Unflavored nonfat and (low-fat milk--1 milk) and
  yogurt Flavored non-fat and low-fat milk with no
  more than 22 grams of total sugar per 8 ounce
  serving
• Beverages caffeine free
• Tier 2 Beverages High School Only---After School
  Non-Caffeinated, non-fortified beverages with
  less than 5 calories per portion as packaged
  (with or without nonnutritive sweeteners,
  carbonation, or flavoring).

41
continuedInstitute of Medicine

• IOM Recommendations---Foods
• Tier 1 foods are fruits, vegetables, whole
  grains, and related combination products and
  nonfat and low-fat dairy that are limited to 200
  calories or less per portion as packaged and
• Fat
• No more than 35 of total calories from Fat
• Less than 10 total calories from saturated fat
• Zero Trans fat ( 0.5 g per serving)
• Sugar
• 35 or less of calories from total sugars, except
  for yogurt with no more than 30 g total sugars,
  per 8-oz portion as packaged.
• Sodium
• 200 mg or less per portion as packaged
• A La Carte Items Meet fat and sugar limits as
  above and
• NSLP menu items
• Have sodium content of 480 mg or less
• 200 calorie limit does not apply, cannot exceed
  calorie content of comparable NSLP entrée item.

42
OH - Sub HB 254

• Beverage Guidelines- Beverages (Vending, School
  Stores, A la Carte)
• Water - Any Size
• Regular or Flavored Milk Fat-Free or Low-Fat with
  no more than 170 calories/8 oz
• 8, 16 ounces
• 100 juice with no added sweeteners and up to 120
  calories / 8 ounces, with at least 10 of the
  recommended daily value for three or more
  vitamins and minerals
• 8, 10 and 12 ounces
• No- or low-calorie beverages with up to 10
  calories / 8 ounces
• up to 20 ounces (high school only)
• Other drinks with no more than 66 calories / 8
  ounces
• up to 12 oz. (high school only)
• Snack Foods
• Vending, School Stores and A la Carte
• Nutrition Standards are based on an algorithm
  that adds or subtracts points to determine
  nutrition density of snack food. Algorithm
  considers both nutrients that are desirable with
  those to limit.
• Nutrient Parameters
• Calories150 Fiber 10 Daily Value
• Calories Fat 35 of total calories Protein
  5 grams
• Saturated Fat Trans Fat 10 of total calories
  Vitamin A 10 Daily Value
• Sodium 230 milligrams Vitamin C 10 Daily
  Value

43
National Nutrition Standards

• Traditional cut sugar, fat, trans fat, sodium,
  cholesterol, calories
• How about nutrient density
• Contribute to daily nutrition
• Portion size
• US Dietary Guidelines
• Discretionary calories, sugars and fats drive
  nutrients

44
Schools

• Nutrition education in the classroom focus on
  what you should eat and why so they dont end up
  being confused adults! Do you teach the negative
  or the positive approach to nutrition?
• Nutrient Rich Foods include
• Brightly colored fruits and vegetables
• Regular and whole-grain products
• Low-fat and fat-free milk, cheese and yogurt
• Lean meats, skinless poultry, fish and legumes
• Use Nutrient Rich messages, foods, posters, etc
  in the cafeteria
• A consistently determined nutrient density score
  could form the basis of nutrition policy (eg
  nutrition standards for foods offered in schools)

45
Rate the Whole Label
46
Application
Nutrition Rating System It's all about healthier
snack choices...
www.snackwise.org Nationwide Childrens Hospital
47
Resources
www.NutrientRichFoods.org
48
Contact Information

• American Dairy Association Mideast
• 614/890-7894
• 614-890-1800 (Columbus, OH office)
• Karen.bakies_at_drink-milk.com
• Local Web Site
• www.drink-milk.com
• To order nutrition education materials or
  catalog, contact
• National Dairy Council
• Customer Service Department
• 3030 Airport Road
• La Crosse, WI 54603
• 1-800-426-8271
• www.nationaldairycouncil.org