Nutrient profiling can help identify foods of good nutritional quality for their price: a validation study with linear programming

Designing Optimal Food-Based Recommendations and Nutrient-Dense Canteen Menu for Oil and Gas Workers Using Linear Programming: A Preliminary Study in Oil and Gas Worksite in East Kalimantan, Indonesia

The objective of this study is to identify problem nutrients and to develop food-based recommendations (FBRs) and nutrient-dense menus based on the nutrient gaps. This study was conducted among male workers (n = 31) in an oil and gas worksite in East Kalimantan, Indonesia. Body weight, height, waist circumference, as well as systolic and diastolic blood pressure were measured. Weekly food consumption patterns were assessed using 1 day 24 h dietary recall (24HR), 1 day weighed food record (WFR), and 5 day food tally. Linear programming (LP) analysis using WHO Optifood software was used to identify problem nutrients and develop FBRs. The identified nutrient gaps were inserted in the nutrient-dense menu for the worksite canteen. Obesity, central obesity, and hypertension were reported in 64.5%, 48.4%, and 3.2% of the workers. Calcium, folate, total PUFA, n-6 PUFA, and dietary fiber were identified as problem nutrients. The FBRs can improve the intake of problem nutrients from 20% of recommended nutrient intake (RNI) in the nonoptimized diet to 50-70% RNI in the optimized diet, while controlling the intake of sodium and saturated fat within an acceptable range. The remaining nutrient gaps (calcium, total PUFA, n-6 PUFA, and dietary fiber) were inserted into the 14-day modified canteen snack menu. This study provides initial evidence that a combination of FBRs and a modified canteen menu can optimize the diet of the workers. Further studies assessing the effectiveness of the developed FBRs and modified menus are needed.

The Role of Agricultural Systems in Teaching Kitchens: An Integrative Review and Thoughts for the Future

Diet-related chronic disease is a public health epidemic in the United States. Concurrently, conventional agricultural and food production methods deplete the nutritional content of many foods, sever connections between people and the origin of their food, and play a significant role in climate change. Paradoxically, despite an abundance of available food in the US, many households are unable to afford or attain a healthful diet. The linkages between agriculture, health, and nutrition are undeniable, yet conventional agriculture and healthcare systems tend to operate in silos, compounding these pressing challenges. Operating teaching kitchens in collaboration with local agriculture, including farms, community gardens, vertical farms, and urban agriculture, has the potential to catalyze a movement that emphasizes the role of the food system in promoting human and planetary health, building resilient communities, and encouraging cross-disciplinary collaboration. This paper reviews the current state of agricultural systems, food is medicine, consumer behavior, and the roles within these sectors. This is followed by a series of case studies that fill the gaps between TKs and agriculture. The authors summarize opportunities to combine the knowledge and resources of teaching kitchens and agriculture programs, as well as challenges that may arise along the way.

Exploring the Complementarity of Fortification and Dietary Diversification to Combat Micronutrient Deficiencies: A Scoping Review

Achieving a balanced and diverse diet remains a challenge for many people, contributing to an ongoing burden of micronutrient deficiencies, particularly in low-income settings. Fortification or dietary diversification are common food-based approaches. We conducted a scoping review to: 1) find evidence on whether combined food-based strategies are more effective than single strategies, and 2) understand how strategies implemented together could complement each other to achieve optimal nutritional impact on populations. Peer-reviewed articles selected (n = 21) included interventions or observational studies (n = 13) and reviews (n = 8). We found little evidence of an added nutritional impact. On the other hand, it is apparent that fortification and dietary diversification target different types of settings (urban compared with rural) and foods (that is, low priced compared with highly priced). Further research is needed to understand the complementarity of these approaches and establish evidence of the effectiveness of combined strategies to foster policy adoption.

Nutrient density and cost of commonly consumed foods: a South African perspective

Food-based dietary guidelines promote consumption of a variety of nutritious foods for optimal health and prevention of chronic disease. However, adherence to these guidelines is challenging because of high food costs. The present study aimed to determine the nutrient density of foods relative to cost in South Africa, with the aim to identify foods within food groups with the best nutritional value per cost. A checklist of 116 food items was developed to record the type, unit, brand and cost of foods. Food prices were obtained from the websites of three national supermarkets and the average cost per 100 g edible portion was used to calculate cost per 100 kcal (418 kJ) for each food item. Nutrient content of the food items was obtained from the South African Food Composition Tables. Nutrient density was calculated using the Nutrient Rich Food (NRF9.3) Index. Nutrient density relative to cost was calculated as NRF9.3/price per 100 kcal. Vegetables and fruits had the highest NRF9.3 score and cost per 100 kcal. Overall, pulses had the highest nutritional value per cost. Fortified maizemeal porridge and bread had the best nutritional value per cost within the starchy food group. Foods with the least nutritional value per cost were fats, oils, foods high in fat and sugar, and foods and drinks high in sugar. Analysis of nutrient density and cost of foods can be used to develop tools to guide low-income consumers to make healthier food choices by identifying foods with the best nutritional value per cost.

Bi-objective goal programming for balancing costs vs. nutritional adequacy

Introduction

Linear programming (LP) is often used within diet optimization to find, from a set of available food commodities, the most affordable diet that meets the nutritional requirements of an individual or (sub)population. It is, however, not always possible to create a feasible diet, as certain nutritional requirements are difficult to meet. In that case, goal programming (GP) can be used to minimize deviations from the nutritional requirements in order to obtain a near feasible diet. With GP the cost of the diet is often overlooked or taken into account using the ε-constraint method. This method does not guarantee to find all possible trade-offs between costs and nutritional deficiency without solving many uninformative LPs.

Methods

We present a method to find all trade-offs between any two linear objectives in a dietary LP context that is simple, does not solve uninformative LPs and does not need prior input from the decision maker (DM). This method is a bi-objective algorithm based on the NonInferior Set Estimation (NISE) method that finds all efficient trade-offs between two linear objectives.

Results

In order to show what type of insights can be gained from this approach, two analyses are presented that investigate the relation between cost and nutritional adequacy. In the first analysis a diet with a restriction on the exact energy intake is considered where all nutrient intakes except energy are allowed to deviate from their prescription. This analysis is especially helpful in case of a restrictive budget or when a nutritionally adequate diet is either unaffordable or unattainable. The second analysis only relaxes the exact energy intake, where the other nutrients are kept within their requirements, to investigate how the energy intake affects the cost of a diet. Here, we describe in what situations the so-called more-for-less paradox takes place, which can be induced by requiring an exact energy intake.

Conclusion

To the best of our knowledge, we are the first to address how to obtain all efficient trade-offs of two linear objectives in a dietary LP context and how this can be used for analyses.

Evaluating the Nutritional Properties of Food: A Scoping Review

There are many methods or indicators used for evaluating the nutritional value of foods; however, it is difficult to accurately reflect the comprehensive nutritional value of a food with a single indicator, and a systematic evaluation system is lacking. In this article, we systematically summarize the common evaluation methods and indicators of the nutritional value of foods. The purpose of this review was to establish an evaluation procedure for nutritional properties of foodstuffs and to help scientists choose more direct and economical evaluation methods according to food types or relevant indicators. The procedure involves the selection of a three-level evaluation method that covers the whole spectrum of a food’s nutritional characteristics. It is applicable to scientific research in the fields of agricultural science, food science, nutrition, and so on.

The cost of diets according to diet quality and sociodemographic characteristics in children and adolescents in Belgium

This study aims to estimate cost variations according to diet quality and sociodemographic characteristics in children. Data (n = 1,596; 5-17 y) from the Belgian National Food Consumption Survey were used. The "Kidmed index" and dietary patterns (DP) identified through principal component analysis were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the GfK ConsumerScan panel food prices. The mean diet cost was 4.68€/day (SEM: 0.05). Adjusted for covariates and energy intake, the mean diet cost was 9.1% higher in the highest Kidmed adherence (vs. the lowest) and 6.2% higher in the tercile T3 (vs. T1) of the "Healthy" DP score. It was 4.8% lower in the T3 (vs. T1) for the "Junk food" DP score. Diet cost was higher in 12-17 year-olds (vs. 5-11 years) and in medium and high educated household (vs. the lowest). These findings support policies to make healthy diets more affordable.

Additional costs of lactose-reduced diets: lactose-free dairy product substitutes are a cost-effective alternative for people with lactose intolerance

OBJECTIVE

People with lactose intolerance have to limit their consumption of lactose-containing dairy products which are a main source of Ca. In particular, for low-income people it is of interest which alternative diet form rich in Ca leads to the lowest additional costs. This study aims to calculate the additional costs of lactose-reduced diets and to show which of different options represent the most cost-effective alternative within a lactose-reduced diet.

DESIGN

Using linear programming, food baskets with different lactose contents were calculated and were compared to a basic model, reflecting a normal diet without a limitation of lactose. By comparing the costs and the composition of the food baskets, recommendations for a lactose-reduced diet were derived.

SETTING

Germany.

PARTICIPANTS

A consumer panel dataset representative for Germany is used for the calculations. Information on prices and nutrients is derived from the 9429 adult households without children, and information on consumed food quantities from the 3046 single households.

RESULTS

The minimum additional food costs depend on the severity of lactose intolerance and range from 0·2 % to 6·1 % per month. It was found that the greatest adjustments due to lactose reduction could be observed within the dairy product group. In this group, with a rising lactose limit, normal milk was increasingly replaced by lactose-free milk.

CONCLUSION

It was shown that a lactose-reduced diet is generally associated with higher food costs. When suffering from lactose intolerance, switching to lactose-free milk seems to be the most cost-effective way to cover nutrient requirements.

Nutritionally adequate food baskets optimised for cultural acceptability as basis for dietary guidelines for low-income Czech families

BACKGROUND

Czech nutrition recommendations prioritize health aspects without considering affordability. Low socio-economic groups have the highest risk of nutrition-related noncommunicable diseases and cost has been identified as an obstacle to achieve a healthy diet, making the implementation of affordability into dietary guidelines necessary. The aim of this study was to develop a food basket (FB) for a low income Czech family of four that is nutritionally adequate, health-promoting and culturally acceptable at an affordable price.

METHODS

Linear programming optimisation was used to ascertain that the FB covered the recommended nutrient intakes from the Czech Nutrition Society and from the World Health Organization (WHO). Cost of the FB was calculated on the basis of more than 3900 prices of 330 foods. Within a given cost constraint, all FBs were optimized for the highest possible similarity to the reported food group intake according to the most recent Czech National Food Consumption survey, which was used as a proxy for cultural acceptability.

RESULTS

The optimised FB affordable at a daily food budget for a Czech family on minimum wage (CZK 177, ~ € 6.8) contained 76 foods and had an average relative deviation of 10% per food category from reported intake. The main deviations were: 72% less sweets and confectionery; 66% less salt; 52% less meat; 50% less milk products; 8% less potatoes; and 484% more milk; 69% more oils and fats; 20% more cereals; and 6% more vegetables.

CONCLUSIONS

The optimised FB can help to guide the development of food-based dietary guidelines for low income households in Czech Republic.

Measures and metrics of sustainable diets with a focus on milk, yogurt, and dairy products

The 4 domains of sustainable diets are nutrition, economics, society, and the environment. To be sustainable, foods and food patterns need to be nutrient-rich, affordable, culturally acceptable, and sparing of natural resources and the environment. Each sustainability domain has its own measures and metrics. Nutrient density of foods has been assessed through nutrient profiling models, such as the Nutrient-Rich Foods family of scores. The Food Affordability Index, applied to different food groups, has measured both calories and nutrients per penny (kcal/$). Cultural acceptance measures have been based on relative food consumption frequencies across population groups. Environmental impact of individual foods and composite food patterns has been measured in terms of land, water, and energy use. Greenhouse gas emissions assess the carbon footprint of agricultural food production, processing, and retail. Based on multiple sustainability metrics, milk, yogurt, and other dairy products can be described as nutrient-rich, affordable, acceptable, and appealing. The environmental impact of dairy farming needs to be weighed against the high nutrient density of milk, yogurt, and cheese as compared with some plant-based alternatives.

Designing Optimal Breakfast for the United States Using Linear Programming and the NHANES 2011-2014 Database: A Study from the International Breakfast Research Initiative (IBRI)

The quality of dietary patterns can be optimized using a mathematical technique known as linear programming (LP). LP methods have rarely been applied to individual meals. The present LP models optimized the breakfast meal for those participants in the nationally representative National Health and Nutrition Examination Survey 2011-2014 who ate breakfast (n = 11,565). The Nutrient Rich Food Index (NRF9.3) was a measure of diet quality. Breakfasts in the bottom tertile of NRF9.3 scores (T1) were LP-modeled to meet nutrient requirements without deviating too much from current eating habits. Separate LP models were run for children and for adults. The LP-modeled breakfasts resembled the existing ones in the top tertile of NRF9.3 scores (T3), but were more nutrient-rich. Favoring fruit, cereals, and dairy, the LP-modeled breakfasts had less meat, added sugars and fats, but more whole fruit and 100% juices, more whole grains, and more milk and yogurt. LP modeling methods can build on existing dietary patterns to construct food-based dietary guidelines and identify individual meals and/or snacks that need improvement.

International approaches to developing healthy eating patterns for national dietary guidelines

As part of the revision of the 2007 Eating Well with Canada's Food Guide, a literature scan on statistical modeling approaches used in developing healthy eating patterns for national food guides was conducted. The scan included relevant literature and online searches, primarily since the 2007 Canada's Food Guide was released. Eight countries were identified as utilizing a statistical model or analysis to help inform their healthy eating pattern, defined as the amounts and types of food recommended, with many common characteristics noted. Detail on international modeling approaches is presented, highlighting similarities and differences as well as strengths and challenges.

An integrated look at the effect of structure on nutrient bioavailability in plant foods

The true bioavailability of a nutrient being intrinsically coupled to the specific food matrix in which it occurs remains poorly considered in nutrition science. During digestion, the food matrix and, in particular, the structure of food modulate the extent and kinetics to which nutrients and bioactive compounds make themselves available for absorption. In this perspective, we describe an integrated look at the effect of structure on nutrient bioavailability in plant foods. Based on this integrated look, cell wall integrity and the particle size of the plant material during its transit in the small intestine determine the bioavailability of plant nutrients; in turn, cell wall integrity and particle size are determined by the level of oral processing and, accordingly, what subsequently escapes digestion in the upper intestine and is utilized by colon microbiota. Ultimately, the effect on nutrient digestion is linked to food structure through each step of digestion. A consideration of the structure rather than just the composition of foods opens up possibilities for the design of healthier foods. © 2018 Society of Chemical Industry.

Mathematical Optimization to Explore Tomorrow's Sustainable Diets: A Narrative Review

A sustainable diet is, by definition, nutritionally adequate, economically affordable, culturally acceptable, and environmentally respectful. Designing such a diet has to integrate different dimensions of diet sustainability that may not be compatible with each other. Among multicriteria assessment methods, diet optimization is a whole-diet approach that simultaneously combines several metrics for dimensions of diet sustainability. This narrative review based on 67 published studies shows how mathematical diet optimization can help with understanding the relations between the different dimensions of diet sustainability and how it can be properly used to identify sustainable diets. Diet optimization aims to find the optimal combination of foods for a population, a subpopulation, or an individual that fulfills a set of constraints while minimizing or maximizing an objective function. In the studies reviewed, diet optimization was used to examine the links between dimensions of diet sustainability, identify the minimum cost or environmental impact of a nutritionally adequate diet, or identify food combinations able to combine ≥2 sustainability dimensions. If some constraints prove difficult to fulfill, this signals an incompatibility between nutrient recommendations, over-monotonous food-consumption patterns, an inadequate supply of nutrient-rich foods, or an incompatibility with other dimensions. If diet optimization proves successful, it can serve to design nutritionally adequate, culturally acceptable, economically affordable, and environmentally friendly diets. Diet optimization results can help define dietary recommendations, tackle food security issues, and promote sustainable dietary patterns. This review emphasizes the importance of carefully choosing the model parameters (variables, objective function, constraints) and input data and the need for appropriate expertise to correctly interpret and communicate the results. Future research should make improvements in the choice of metrics used to assess each aspect of a sustainable diet, especially the cultural dimension, to improve the practicability of the results.

A Review of the Use of Linear Programming to Optimize Diets, Nutritiously, Economically and Environmentally

The "Diet Problem" (the search of a low-cost diet that would meet the nutritional needs of a US Army soldier) is characterized by a long history, whereas most solutions for comparable diet problems were developed in 2000 or later, during which computers with large calculation capacities became widely available and linear programming (LP) tools were developed. Based on the selected literature (52 papers), LP can be applied to a variety of diet problems, from food aid, national food programmes, and dietary guidelines to individual issues. This review describes the developments in the search for constraints. After nutritional constraints, costs constraints, acceptability constraints and ecological constraints were introduced. The 12 studies that apply ecological constraints were analyzed and compared in detail. Most studies have used nutritional constraints and cost constraints in the analysis of dietary problems and solutions, but such research begin showing weaknesses under situations featuring a small number of food items and/or nutritional constraints. Introducing acceptability constraints is recommended, but no study has provided the ultimate solution to calculating acceptability. Future possibilities lie in finding LP solutions for diets by combining nutritional, costs, ecological and acceptability constraints. LP is an important tool for environmental optimization and shows considerable potential as an instrument for finding solutions to a variety of very complex diet problems.

Beyond nutrient-based food indices: a data mining approach to search for a quantitative holistic index reflecting the degree of food processing and including physicochemical properties

Processing has major impacts on both the structure and composition of food and hence on nutritional value.

Co-construction and Evaluation of a Prevention Program for Improving the Nutritional Quality of Food Purchases at No Additional Cost in a Socioeconomically Disadvantaged Population

Background: Food prices influence food choices. Purchasing foods with higher nutritional quality for their price may help improve the diet quality of socioeconomically disadvantaged individuals. Objective: This study aimed to describe the co-construction and evaluation of the Opticourses prevention program, which promotes healthy eating among participants in socioeconomically deprived situations by improving the nutritional quality of their household food purchases with no additional cost. Methods: Individuals were recruited in poor districts of Marseille, France. The intervention and evaluation tools and protocols were co-constructed with 96 individuals. Then, 93 adults willing to participate in a standardized intervention comprising 5 participative workshops on diet and budget were enrolled. Impact on food purchases was estimated with experimental economics: 2-d experimental food purchase intents were observed at baseline and endline for workshop participants (WPs, n = 35) and controls (n = 23), with the use of monetary incentives to limit social-desirability bias. Changes in food and nutrient content and energy cost (expressed in €/2000 kcal) of experimental purchases were assessed. Results: The co-constructed participative workshops included playful activities around food purchase practices and the nutritional quality, taste, and price of foods. Experimental purchases contained a large amount of energy at baseline for both WPs and controls (5114 and 4523 kcal ⋅ d-1 ⋅ person-1, respectively). For WPs only, the mean energy content decreased between baseline and endline (-1729 kcal ⋅ d-1 ⋅ person-1; P < 0.01; medium effect size: Cohen's d = 0.5), and the percentage of energy from free sugars and from foods high in fat, sugar, and salt also decreased (both P < 0.05 and medium effect sizes), whereas energy cost remained unchanged. No significant changes between baseline and endline were observed for the controls. Conclusions: After the intervention, the energy content of participants' experimental purchases was closer to their needs, suggesting that the workshops helped them plan and rationalize their food purchases better. The nutritional quality of the experimental purchases increased but energy cost did not, showing that the co-constructed Opticourses prevention program can favorably change food purchasing behaviors of socioeconomically disadvantaged individuals with no additional cost. This trial was registered at clinicaltrials.gov as NCT02383875.

Identifying foods with good nutritional quality and price for the Opticourses intervention research project

Objective

People on a limited budget want to know the ‘good price’ of foods. Here we report the methodology used to produce an educational tool designed to help recognize foods with good nutritional quality and price, and assess the validity and relevancy of the tool.

Design

A ‘Good Price Booklet’ presenting a list of foods with good nutritional quality and price was constructed. The validity of the in-booklet prices was assessed by comparing them with prices actually paid by households from the Opticourses project. The relevancy of the booklet tool was assessed by semi-structured interviews with Opticourses participants.

Setting

Socio-economically disadvantaged neighbourhoods of Marseille, France.

Subjects

Ninety-one participants collected household food-purchase receipts over a 1-month period.

Results

Based on the French food database, foods with higher-than-median nutritional quality were identified. After grouping similar foods, 100 foods were selected and their corresponding in-booklet prices were derived based on the distribution of average national prices by food group. Household food purchases data revealed that of the 2386 purchases of foods listed in the booklet, 67·1 % were bought at prices lower than the in-booklet prices. Nineteen semi-structured interviews showed that participants understood the tool and most continued using it more than a month after the intervention.

Conclusions

A method was developed to ease the identification of foods with good nutritional quality and price. The Good Price Booklet is an effective tool to help guide people shopping on a low budget.

From the SAIN,LIM system to the SENS algorithm: a review of a French approach of nutrient profiling

Nutrient profiling aims to classify or rank foods according to their nutritional composition to assist policies aimed at improving the nutritional quality of foods and diets. The present paper reviews a French approach of nutrient profiling by describing the SAIN,LIM system and its evolution from its early draft to the simplified nutrition labelling system (SENS) algorithm. Considered in 2010 by WHO as the 'French model' of nutrient profiling, SAIN,LIM classifies foods into four classes based on two scores: a nutrient density score (NDS) called SAIN and a score of nutrients to limit called LIM, and one threshold on each score. The system was first developed by the French Food Standard Agency in 2008 in response to the European regulation on nutrition and health claims (European Commission (EC) 1924/2006) to determine foods that may be eligible for bearing claims. Recently, the European regulation (EC 1169/2011) on the provision of food information to consumers allowed simplified nutrition labelling to facilitate consumer information and help them make fully informed choices. In that context, the SAIN,LIM was adapted to obtain the SENS algorithm, a system able to rank foods for simplified nutrition labelling. The implementation of the algorithm followed a step-by-step, systematic, transparent and logical process where shortcomings of the SAIN,LIM were addressed by integrating specificities of food categories in the SENS, reducing the number of nutrients, ordering the four classes and introducing European reference intakes. Through the French example, this review shows how an existing nutrient profiling system can be specifically adapted to support public health nutrition policies.

The degree of processing of foods which are most widely consumed by the French elderly population is associated with satiety and glycemic potentials and nutrient profiles

Food processing impacts both food structure and nutritional density. The effect of food structure on satiety and glycemic potentials is well recognized. However, the association between processing, satiety and glycemic potentials and nutrient profiles has not been much studied, especially in the diets of the elderly. Therefore, this study aimed at exploring relations between the level of food processing, consumption and nutrient profiles and satiety and glycemic potentials among 6686 French elderly people (≥65 years). Dietary assessment was realized through a web-based 24 h dietary record tool. Among a total of 2688 foods, 280 generic foods were aggregated based on a consumption threshold of at least 5% by the population. The satiety potential was calculated using the Fullness Factor equation, and the glycemic potential using the glycemic index and the glucose glycemic equivalent. Foods and dishes were ranked according to an adapted international NOVA classification as raw/minimally-processed (G1), processed (G2) and ultra-processed (G3). ANOVA and correlation analyses showed that the more food is processed, the lower its satiety potential and nutrient density and the higher its glycemic impact, especially when comparing G1 and G3. Besides, the foods consumed in the greatest quantity daily tend to be the most satiating, and ultra-processed foods were among the less frequently consumed both in terms of percentage and daily quantity (around two-fold difference between minimally- and ultra-processed foods). In conclusion, because it is partly related to health food potential, the degree of processing, especially for ultra-processed products, should be taken into consideration more when evaluating consumption profiles of different populations.

Dietary changes needed to reach nutritional adequacy without increasing diet cost according to income: An analysis among French adults

OBJECTIVE

To explore the dietary changes needed to achieve nutritional adequacy across income levels at constant energy and diet cost.

MATERIALS AND METHODS

Individual diet modelling was used to design iso-caloric, nutritionally adequate optimised diets for each observed diet in a sample of adult normo-reporters aged ≥20 years (n = 1,719) from the Individual and National Dietary Survey (INCA2), 2006-2007. Diet cost was estimated from mean national food prices (2006-2007). A first set of free-cost models explored the impact of optimisation on the variation of diet cost. A second set of iso-cost models explored the dietary changes induced by the optimisation with cost set equal to the observed one. Analyses of dietary changes were conducted by income quintiles, adjusting for energy intake, sociodemographic and socioeconomic variables, and smoking status.

RESULTS

The cost of observed diets increased with increasing income quintiles. In free-cost models, the optimisation increased diet cost on average (+0.22 ± 1.03 euros/d) and within each income quintile, with no significant difference between quintiles, but with systematic increases for observed costs lower than 3.85 euros/d. In iso-cost models, it was possible to design nutritionally adequate diets whatever the initial observed cost. On average, the optimisation at iso-cost increased fruits and vegetables (+171 g/day), starchy foods (+121 g/d), water and beverages (+91 g/d), and dairy products (+20 g/d), and decreased the other food groups (e.g. mixed dishes and salted snacks), leading to increased total diet weight (+300 g/d). Those changes were mostly similar across income quintiles, but lower-income individuals needed to introduce significantly more fruit and vegetables than higher-income ones.

CONCLUSIONS

In France, the dietary changes needed to reach nutritional adequacy without increasing cost are similar regardless of income, but may be more difficult to implement when the budget for food is lower than 3.85 euros/d.

In-store marketing of inexpensive foods with good nutritional quality in disadvantaged neighborhoods: increased awareness, understanding, and purchasing

BACKGROUND

Consumers often do not understand nutrition labels or do not perceive their usefulness. In addition, price can be a barrier to healthy food choices, especially for socio-economically disadvantaged individuals.

METHOD

A 6-month intervention combined shelf labeling and marketing strategies (signage, prime placement, taste testing) to draw attention to inexpensive foods with good nutritional quality in two stores located in a disadvantaged neighborhood in Marseille (France). The inexpensive foods with good nutritional quality were identified based on their nutrient profile and their price. Their contribution to customers' spending on food was assessed in the two intervention stores and in two control stores during the intervention, as well as in the year preceding the intervention (n = 6625). Exit survey (n = 259) and in-depth survey (n = 116) were used to assess customers' awareness of and perceived usefulness of the program, knowledge of nutrition, understanding of the labeling system, as well as placement-, taste- and preparation-related attractiveness of promoted products. Matched purchasing data were used to assess the contribution of promoted products to total food spending for each customer who participated in the in-depth survey.

RESULTS

The contribution of inexpensive foods with good nutritional quality to customers' total food spending increased between 2013 and 2014 for both the control stores and the intervention stores. This increase was significantly higher in the intervention stores than in the control stores for fruits and vegetables (p = 0.001) and for starches (p = 0.011). The exit survey revealed that 31 % of customers had seen the intervention materials; this percentage increased significantly at the end of the intervention (p < 0.001). The in-depth survey showed that customers who had seen the intervention materials scored significantly higher on quizzes assessing nutrition knowledge (p < 0.001) and understanding of the labeling system (p = 0.024).

CONCLUSION

A social marketing intervention aimed at increasing the visibility and attractiveness of inexpensive foods with good nutritional quality may improve food purchasing behaviors in disadvantaged neighborhoods.

First-Stage Development and Validation of a Web-Based Automated Dietary Modeling Tool: Using Constraint Optimization Techniques to Streamline Food Group and Macronutrient Focused Dietary Prescriptions for Clinical Trials

BACKGROUND

Standardizing the background diet of participants during a dietary randomized controlled trial is vital to trial outcomes. For this process, dietary modeling based on food groups and their target servings is employed via a dietary prescription before an intervention, often using a manual process. Partial automation has employed the use of linear programming. Validity of the modeling approach is critical to allow trial outcomes to be translated to practice.

OBJECTIVE

This paper describes the first-stage development of a tool to automatically perform dietary modeling using food group and macronutrient requirements as a test case. The Dietary Modeling Tool (DMT) was then compared with existing approaches to dietary modeling (manual and partially automated), which were previously available to dietitians working within a dietary intervention trial.

METHODS

Constraint optimization techniques were implemented to determine whether nonlinear constraints are best suited to the development of the automated dietary modeling tool using food composition and food consumption data. Dietary models were produced and compared with a manual Microsoft Excel calculator, a partially automated Excel Solver approach, and the automated DMT that was developed.

RESULTS

The web-based DMT was produced using nonlinear constraint optimization, incorporating estimated energy requirement calculations, nutrition guidance systems, and the flexibility to amend food group targets for individuals. Percentage differences between modeling tools revealed similar results for the macronutrients. Polyunsaturated fatty acids and monounsaturated fatty acids showed greater variation between tools (practically equating to a 2-teaspoon difference), although it was not considered clinically significant when the whole diet, as opposed to targeted nutrients or energy requirements, were being addressed.

CONCLUSIONS

Automated modeling tools can streamline the modeling process for dietary intervention trials ensuring consistency of the background diets, although appropriate constraints must be used in their development to achieve desired results. The DMT was found to be a valid automated tool producing similar results to tools with less automation. The results of this study suggest interchangeability of the modeling approaches used, although implementation should reflect the requirements of the dietary intervention trial in which it is used.

Construct and criterion-related validation of nutrient profiling models: A systematic review of the literature

Nutrient profiling (NP) is defined as the science of ranking foods according to their nutritional composition for the purpose of preventing disease or promoting health. The application of NP is ultimately to assist consumers to make healthier food choices, and thus provide a cost effective public health strategy to reduce the incidence of diet-related chronic disease. To our knowledge, no review has assessed the evidence to confirm the validity of NP models. We conducted a systematic review to investigate the construct and criterion-related validity of NP models in ranking food according to their nutritional composition for the purpose of preventing disease and promoting health. We searched peer-reviewed research published to 30 June 2015 and used PUBMED, Global Health (CABI), and SCOPUS databases. Within study bias was assessed using an adapted version of the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies -2) tool for all diagnostic studies and the Cochrane Collaboration's Risk of Bias tool for all non-diagnostic studies. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach was used to guide our judgement of the quality of the body of evidence for each outcome measure. From a total of 83 studies, 69 confirmed the construct validity of NP models; however most of these studies contained methodological weaknesses. Six studies used objective external measures to confirm the criterion-related validity of NP models; which inherently improved quality. The overall quality of evidence on the accuracy of NP models was judged to be very low to moderate using the GRADE approach. Many carefully designed studies to establish both construct and criterion-related validity are necessary to authenticate the application of NP models and provide the evidence to support the current definition of NP.

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

CONTEXT

It is well established in the literature that healthier diets cost more than unhealthy diets.

OBJECTIVE

The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality.

DATA SOURCES

A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed.

STUDY SELECTION

Publications linking food prices, dietary quality, and socioeconomic status were selected.

DATA EXTRACTION

Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices.

DATA SYNTHESIS

Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets.

CONCLUSIONS

Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.

Food Price Spikes Are Associated with Increased Malnutrition among Children in Andhra Pradesh, India

BACKGROUND

Global food prices have risen sharply since 2007. The impact of food price spikes on the risk of malnutrition in children is not well understood.

OBJECTIVE

We investigated the associations between food price spikes and childhood malnutrition in Andhra Pradesh, one of India's largest states, with >85 million people. Because wasting (thinness) indicates in most cases a recent and severe process of weight loss that is often associated with acute food shortage, we tested the hypothesis that the escalating prices of rice, legumes, eggs, and other staples of Indian diets significantly increased the risk of wasting (weight-for-height z scores) in children.

METHODS

We studied periods before (2006) and directly after (2009) India's food price spikes with the use of the Young Lives longitudinal cohort of 1918 children in Andhra Pradesh linked to food price data from the National Sample Survey Office. Two-stage least squares instrumental variable models assessed the relation of food price changes to food consumption and wasting prevalence (weight-for-height z scores).

RESULTS

Before the 2007 food price spike, wasting prevalence fell from 19.4% in 2002 to 18.8% in 2006. Coinciding with India's escalating food prices, wasting increased significantly to 28.0% in 2009. These increases were concentrated among low- (χ(2): 21.6, P < 0.001) and middle- (χ(2): 25.9, P < 0.001) income groups, but not among high-income groups (χ(2): 3.08, P = 0.079). Each 10.0 rupee ($0.170) increase in the price of rice/kg was associated with a drop in child-level rice consumption of 73.0 g/d (β: -7.30; 95% CI: -10.5, -3.90). Correspondingly, lower rice consumption was significantly associated with lower weight-for-height z scores (i.e., wasting) by 0.005 (95% CI: 0.001, 0.008), as seen with most other food categories.

CONCLUSION

Rising food prices were associated with an increased risk of malnutrition among children in India. Policies to help ensure the affordability of food in the context of economic growth are likely critical for promoting children's nutrition.

Increased Intake of Foods with High Nutrient Density Can Help to Break the Intergenerational Cycle of Malnutrition and Obesity

A workshop held at the University Medical Center in Groningen, The Netherlands, aimed at discussing the nutritional situation of the population in general and the role diet plays during critical windows in the life course, during which the body is programmed for the development of non-communicable diseases (NCDs). NCDs are increasingly prevalent as our society ages, and nutrition is well known to play an important role in determining the risk and the time of onset of many common NCDs. Even in affluent countries, people have difficulties to achieve adequate intakes for a range of nutrients: Economic constraints as well as modern lifestyles lead people to consume diets with a positive energy balance, but low in micronutrients, resulting in increasing prevalence of obesity and suboptimal nutritional status. Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese. Given the impact a nutrient dense, low energy diet can have on health, researchers, food industry and governments jointly should develop options for affordable, appealing nutrient-rich food products, which, in combination with physical activity, allow for optimal health throughout the life-course.

The Nutrient Balance Concept: A New Quality Metric for Composite Meals and Diets

Background

Combinations of foods that provide suitable levels of nutrients and energy are required for optimum health. Currently, however, it is difficult to define numerically what are ‘suitable levels’.

Objective

To develop new metrics based on energy considerations—the Nutrient Balance Concept (NBC)—for assessing overall nutrition quality when combining foods and meals.

Method

The NBC was developed using the USDA Food Composition Database (Release 27) and illustrated with their MyPlate 7-day sample menus for a 2000 calorie food pattern. The NBC concept is centered on three specific metrics for a given food, meal or diet—a Qualifying Index (QI), a Disqualifying Index (DI) and a Nutrient Balance (NB). The QI and DI were determined, respectively, from the content of 27 essential nutrients and 6 nutrients associated with negative health outcomes. The third metric, the Nutrient Balance (NB), was derived from the Qualifying Index (QI) and provided key information on the relative content of qualifying nutrients in the food. Because the Qualifying and Disqualifying Indices (QI and DI) were standardized to energy content, both become constants for a given food/meal/diet and a particular consumer age group, making it possible to develop algorithms for predicting nutrition quality when combining different foods.

Results

Combining different foods into composite meals and daily diets led to improved nutrition quality as seen by QI values closer to unity (indicating nutrient density was better equilibrated with energy density), DI values below 1.0 (denoting an acceptable level of consumption of disqualifying nutrients) and increased NB values (signifying complementarity of foods and better provision of qualifying nutrients).

Conclusion

The Nutrient Balance Concept (NBC) represents a new approach to nutrient profiling and the first step in the progression from the nutrient evaluation of individual foods to that of multiple foods in the context of meals and total diets.

Higher nutritional quality at no additional cost among low-income households: insights from food purchases of "positive deviants"

BACKGROUND

It is unknown whether diet quality is correlated with actual food expenditure. According to the positive deviance theory, the study of actual food expenditure by people with limited economic resources could help identify beneficial food-purchasing behavior.

OBJECTIVES

The aims were to investigate the relation between actual expenditure on food and nutritional quality and to identify "positive deviants" among low-income households.

DESIGN

Individuals in deprived social situations (n = 91) were recruited as part of the "Opticourses" nutrition intervention conducted in 2012-2014 in poor districts of Marseille, France. Opticourses participants collected food-purchase receipts for their household over a 1-mo period. "Actual diet costs" and "estimated diet costs" were calculated per 2000 kcal of food purchases by using actual expenditures and a standard food price database of food consumed by a representative sample of French adults, respectively. Mean adequacy ratio (MAR), mean excess ratio (MER), and energy density (ED) were used as nutritional quality indicators. "Positive deviants" were defined as having a higher MAR and a lower MER than the respective median values.

RESULTS

Opticourses participants selected less-expensive food options than the average French population, both within a food group and for a given food item. Higher diet costs were associated with higher nutritional quality (higher MAR, lower ED), regardless of whether costs were calculated from actual expenditure or on the basis of standard food prices. Twenty-one positive deviants were identified. They made significantly healthier purchases than did other participants (MAR: +13%; MER: -90%. ED: -22%) at higher estimated diet costs. Yet, they did not spend more on food (having the same actual diet costs), which showed that they purchased food with a higher nutritional quality for their price.

CONCLUSION

In this low-income population, actual diet cost was positively correlated with nutritional quality, yet the results showed that higher diet quality is not necessarily more costly when foods with higher nutritional quality for their price are selected. The Opticourses intervention was registered at clinicaltrials.gov as NCT02383875.

The carbohydrate-fat problem: can we construct a healthy diet based on dietary guidelines?

The inclusion of nutrition economics in dietary guidance would help ensure that the Dietary Guidelines for Americans benefit equally all segments of the US population. The present review outlines some novel metrics of food affordability that assess nutrient density of foods and beverages in relation to cost. Socioeconomic disparities in diet quality in the United States are readily apparent. In general, groups of lower socioeconomic status consume cheaper, lower-quality diets and suffer from higher rates of noncommunicable diseases. Nutrient profiling models, initially developed to assess the nutrient density of foods, can be turned into econometric models that assess both calories and nutrients per reference amount and per unit cost. These novel metrics have been used to identify individual foods that were affordable, palatable, culturally acceptable, and nutrient rich. Not all nutrient-rich foods were expensive. In dietary surveys, both local and national, some high-quality diets were associated with relatively low cost. Those population subgroups that successfully adopted dietary guidelines at an unexpectedly low monetary cost were identified as "positive deviants." Constructing a healthy diet based on dietary guidelines can be done, provided that nutrient density of foods, their affordability, as well as taste and social norms are all taken into account.

Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007-2010

BACKGROUND

Food prices may be one reason for the growing socioeconomic disparities in diet quality.

OBJECTIVE

To evaluate the association between diet costs and the Healthy Eating Index-2010 (HEI-2010).

METHODS

Cross-sectional study based on 11,181 adults from the 2007-2010 National Health and Nutrition Examination Survey, analyzed in spring 2014. Diet cost was estimated by linking dietary data with a national food price database. The HEI-2010, a measure of adherence to the dietary guidelines, was the outcome. The population ratio method was used to estimate the average HEI-2010 scores by quintile of energy-adjusted diet cost. Additional analyses evaluated the association between cost and HEI-2010 components.

RESULTS

There was a strong positive association between lower energy-adjusted diet costs and lower HEI-2010 scores. The association was stronger among women (p-interaction=0.003). Lower diet costs were associated with lower consumption of vegetables, fruits, whole grains, and seafood, and higher consumption of refined grains and solid fat, alcohol and added sugars.

CONCLUSIONS

Lower energy-adjusted diet costs were associated with lower-quality diets. Future efforts to improve the nutritional status of the US public should take food prices and diet costs into account.

Which functional unit to identify sustainable foods?

Objective

In life-cycle assessment, the functional unit defines the unit for calculation of environmental indicators. The objective of the present study was to assess the influence of two functional units, 100 g and 100 kcal (420 kJ), on the associations between three dimensions for identifying sustainable foods, namely environmental impact (via greenhouse gas emissions (GHGE)), nutritional quality (using two distinct nutrient profiling systems) and price.

Design

GHGE and price data were collected for individual foods, and were each expressed per 100 g and per 100 kcal. Two nutrient profiling models, SAIN,LIM and UK Ofcom, were used to assess foods’ nutritional quality. Spearman correlations were used to assess associations between variables. Sustainable foods were identified as those having more favourable values for all three dimensions.

Setting

The French Individual and National Dietary Survey (INCA2), 2006–2007.

Subjects

Three hundred and seventy-three foods highly consumed in INCA2, covering 65 % of total energy intake of adult participants.

Results

When GHGE and price were expressed per 100 g, low-GHGE foods had a lower price and higher SAIN,LIM and Ofcom scores (r=0·59, −0·34 and −0·43, respectively), suggesting a compatibility between the three dimensions; 101 and 100 sustainable foods were identified with SAIN,LIM and Ofcom, respectively. When GHGE and price were expressed per 100 kcal, low-GHGE foods had a lower price but also lower SAIN,LIM and Ofcom scores (r=0·67, 0·51 and 0·47, respectively), suggesting that more environment-friendly foods were less expensive but also less healthy; thirty-four sustainable foods were identified with both SAIN,LIM and Ofcom.

Conclusions

The choice of functional unit strongly influenced the compatibility between the sustainability dimensions and the identification of sustainable foods.

Nutrient density: principles and evaluation tools

Nutrient profiling is the technique of rating or classifying foods on the basis of their nutritional value. Foods that supply relatively more nutrients than calories are defined as nutrient dense. Nutrient profile models calculate the content of key nutrients per 100 g, 100 kcal, or per serving size of food. For maximum effectiveness, nutrient profile models need to be transparent, based on publicly accessible nutrient composition data, and validated against independent measures of a healthy diet. These rigorous scientific standards were applied to the development of the Nutrient-Rich Foods (NRF) family of nutrient profile models. First, the NRF models included nutrients to encourage as well as nutrients to limit. Second, NRF model performance was repeatedly tested against the Healthy Eating Index (HEI), an independent measure of a healthy diet. HEI values were calculated for participants in the 1999-2002 NHANES. Models based on 100 kcal and serving sizes performed better than those based on 100 g. Formulas based on sums and means performed better than those based on ratios. The final NRF9.3 index was based on 9 beneficial nutrients (protein; fiber; vitamins A, C, and E; calcium; iron; potassium; and magnesium) and on 3 nutrients to limit (saturated fat, added sugar, and sodium). Higher NRF9.3 scores were associated with lower energy density and more nutrient-rich diets. The nutrient density of foods, paired with a comprehensive program of consumer education, can become the foundation of dietary recommendations and guidelines.

Vegetable cost metrics show that potatoes and beans provide most nutrients per penny

Vegetables are important sources of dietary fiber, vitamins and minerals in the diets of children. The United States Department of Agriculture (USDA) National School Lunch Program has new requirements for weekly servings of vegetable subgroups as well as beans and peas. This study estimated the cost impact of meeting the USDA requirements using 2008 national prices for 98 vegetables, fresh, frozen, and canned. Food costs were calculated per 100 grams, per 100 calories, and per edible cup. Rank 6 score, a nutrient density measure was based on six nutrients: dietary fiber; potassium; magnesium; and vitamins A, C, and K. Individual nutrient costs were measured as the monetary cost of 10% daily value of each nutrient per cup equivalent. ANOVAs with post hoc tests showed that beans and starchy vegetables, including white potatoes, were cheaper per 100 calories than were dark-green and deep-yellow vegetables. Fresh, frozen, and canned vegetables had similar nutrient profiles and provided comparable nutritional value. However, less than half (n = 46) of the 98 vegetables listed by the USDA were were consumed >5 times by children and adolescents in the 2003–4 National Health and Nutrition Examination Survey database. For the more frequently consumed vegetables, potatoes and beans were the lowest-cost sources of potassium and fiber. These new metrics of affordable nutrition can help food service and health professionals identify those vegetable subgroups in the school lunch that provide the best nutritional value per penny.

Energy allowances for solid fats and added sugars in nutritionally adequate U.S. diets estimated at 17-33% by a linear programming model

The 2010 Dietary Guidelines Advisory Committee has recommended that no more than 5-15% of total dietary energy should be derived from solid fats and added sugars (SoFAS). The guideline was based on USDA food pattern modeling analyses that met the Dietary Reference Intake recommendations and Dietary Guidelines and followed typical American eating habits. This study recreated food intake patterns for 6 of the same gender-age groups by using USDA data sources and a mathematical optimization technique known as linear programming. The analytic process identified food consumption patterns based on 128 food categories that met the nutritional goals for 9 vitamins, 9 minerals, 8 macronutrients, and dietary fiber and minimized deviation from typical American eating habits. Linear programming Model 1 created gender- and age-specific food patterns that corresponded to energy needs for each group. Model 2 created food patterns that were iso-caloric with diets observed for that group in the 2001-2002 NHANES. The optimized food patterns were evaluated with respect to MyPyramid servings goals, energy density [kcal/g (1 kcal = 4.18 kJ)], and energy cost (US$/2000 kcal). The optimized food patterns had more servings of vegetables and fruit, lower energy density, and higher cost compared with the observed diets. All nutrient goals were met. In contrast to the much lower USDA estimates, the 2 models placed SoFAS allowances at between 17 and 33% of total energy, depending on energy needs.

Diet cost, diet quality and socio-economic position: how are they related and what contributes to differences in diet costs?

OBJECTIVE

To examine diet costs in relation to dietary quality and socio-economic position, and to investigate underlying reasons for differences in diet costs.

DESIGN

Dietary intake was assessed by a 4 d food diary and evaluated using the 2005 Healthy Eating Index (HEI). National consumer food prices collected by Statistics Sweden and from two online stores/supermarkets were used to estimate diet costs.

SETTING

Sweden.

SUBJECTS

A nationally representative sample of 2160 children aged 4, 8 or 11 years.

RESULTS

Higher scores on the HEI resulted in higher diet costs and, conversely, higher diet costs were linked to increased total HEI scores. Children who consumed the most healthy and/or expensive diets ate a more energy-dilute and varied diet compared with those who ate the least healthy and/or least expensive diets. They also consumed more fish, ready meals and fruit. Regression analysis also linked increased food costs to these food groups. There was a positive, but weak, relationship between HEI score and diet cost, parental education and parental occupation respectively.

CONCLUSIONS

Healthy eating is associated with higher diet cost in Swedish children, in part because of price differences between healthy and less-healthy foods. The cheapest and most unhealthy diets were found among those children whose parents were the least educated and had manual, low-skill occupations. Our results pose several challenges for public health policy makers, as well as for nutrition professionals, when forming dietary strategies and providing advice for macro- and microlevels in society.

Are socio-economic disparities in diet quality explained by diet cost?

BACKGROUND

Socio-economic disparities in nutrition are well documented. This study tested the hypothesis that socio-economic differences in nutrient intakes can be accounted for, in part, by diet cost.

METHODS

A representative sample of 1295 adults in King County (WA) was surveyed in 2008-2009, and usual dietary intakes were assessed based on a food-frequency questionnaire. The monetary value of individual diets was estimated using local retail supermarket prices for 384 foods. Nutrients of concern as identified by the 2005 Dietary Guidelines Advisory Committee were fibre, vitamins A, C and E, calcium, magnesium and potassium. A nutrient density score based on all seven nutrients was another dependent measure. General linear models and linear regressions were used to examine associations among education and income, nutrient density measure and diet cost. Analyses were conducted in 2009-2010.

RESULTS

Controlling for energy and other covariates, higher-cost diets were significantly higher in all seven nutrients and in overall nutrient density. Higher education and income were positively and significantly associated with the nutrient density measure, but these effects were greatly attenuated with the inclusion of the cost variable in the model.

CONCLUSIONS

Socio-economic differences in nutrient intake can be substantially explained by the monetary cost of the diet. The higher cost of more nutritious diets may contribute to socio-economic disparities in health and should be taken into account in the formulation of nutrition and public health policy.

Quantifying the contribution of foods with unfavourable nutrient profiles to nutritionally adequate diets

That 'all foods can fit' into a healthy diet is a long-standing principle of dietetic practice. The present study quantified the relative contributions of foods to encourage and foods to limit, using new techniques of individual diet optimisation and nutrient profiling. Individual foods from every food group were assigned to four nutrient profile classes based on the French SAIN,LIM system. Foods with the most favourable nutrient profiles were in class 1, and foods with the least favourable nutrient profiles were in class 4. An optimised diet that met the recommendations for thirty-two nutrients and that respected the existing eating habits was designed for each adult in the nationally representative 'Enquête Individuelle et Nationale sur les Consommations Alimentaires 1' dietary survey (n 1171). The relative proportions of the four nutrient profiling classes were assessed before and after the optimisation process. The contribution of fruits and vegetables, whole grains, milk and fish was significantly increased, whereas the contribution of refined grains, meats, mixed dishes, sugars and fats was decreased. The optimised diets derived more energy (30 v. 21 % in the observed diets) from class 1 foods and less energy (41 v. 56 %) from class 4 foods. They also derived a higher amount of class 1 foods (61 v. 51 %) and a lower amount of class 4 foods (22 v. 32 %). Thus, nutrient adequacy was compatible with the consumption of foods with an unfavourable nutrient profile (one-fifth the basket weight), provided that the diet also contained almost two-thirds of foods with the most favourable profile. Translating these results into concrete and quantified advice may have very tangible public health implications.

The rising disparity in the price of healthful foods: 2004-2008

Nutrient dense foods that are associated with better health outcomes tend to cost more per kilocalorie (kcal) than do refined grains, sweets and fats. The price disparity between healthful and less healthful foods appears to be growing. This study demonstrates a new method for linking longitudinal retail price data with objective, nutrient-based ratings of the nutritional quality of foods and beverages. Retail prices for 378 foods and beverages were obtained from major supermarket chains in the Seattle, WA for 2004-8. Nutritional quality was based on energy density (kcal/g) and two measures of nutrient density, calculated using the Naturally Nutrient Rich (NNR) score and the Nutrient Rich Foods index (NRF_9.3). Food prices were expressed as $/100g edible portion and as $/1,000 kcal. Foods were stratified by quintiles of energy and nutrient density for analyses. Both measures of nutrient density were negatively associated with energy density and positively associated with cost per 1,000 kcal. The mean cost of foods in the top quintile of nutrient density was $27.20/1,000 kcal and the 4 y price increase was 29.2%. Foods in the bottom quintile cost a mean of $3.32/1000 kcal and the 4 y price increase was 16.1%. There is a growing price disparity between nutrient-dense foods and less nutritious options. Cost may pose a barrier to the adoption of healthier diets and so limit the impact of dietary guidance. Nutrient profiling methods provide objective criteria for tracking retail prices of foods in relation to their nutritional quality and for guiding food and nutrition policy.

The cumulative effect of small dietary changes may significantly improve nutritional intakes in free-living children and adults

BACKGROUND/OBJECTIVES

The ELPAS (Etude Longitudinale Prospective Alimentation et Santé) study was an 8-month randomized controlled dietary modification trial designed to test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in 2026 free-living children and parents. It resulted in significant nutritional changes, with beneficial effects on body mass index in adults. In these ancillary analyses, we investigated dietary changes throughout the intervention.

SUBJECTS/METHODS

Before the study, modeling analyses were carried out on the French Association Sucre Produits Sucrés Consommation et Communication (ASPCC) food-consumption database to identify the most efficient dietary intervention strategy. During the study, all participants performed monthly three nonconsecutive 24-h dietary recalls: this allowed for measuring changes in the number of servings per day and serving size for each targeted food category throughout the intervention.

RESULTS

Modeling analyses showed that targeting only the 10 main foods contributing to fat and carbohydrate intakes did not allow for reaching the ELPAS nutritional goals. As a result, it was decided to target more foods and to propose several types of dietary advice (such as change in serving size, change in cooking method, food substitution). This strategy led to many appropriate dietary changes during the intervention, but only a few of them reached significance. The mean number of servings per day was indeed significantly modified for only 7% of the targeted food categories in children and 17% in parents. The mean serving size was modified for only 12% of targeted food categories in children and 9% in parents.

CONCLUSIONS

The cumulative effect of small dietary changes may induce significant nutritional improvements, with limited burden for populations.

The Nutrient Rich Foods Index helps to identify healthy, affordable foods

BACKGROUND

The Nutrient Rich Foods (NRF) Index is a formal scoring system that ranks foods on the basis of their nutrient content. When used in conjunction with a food prices database, it can help identify foods that are both nutritious and affordable.

OBJECTIVE

Our aim was to identify healthy, affordable foods and food groups by using the NRF index and US Department of Agriculture (USDA) nutrient composition and food prices data sets.

DESIGN

Foods in the USDA Food and Nutrition Database for Dietary Studies 1.0 were scored by using the NRF index. This NRF algorithm was represented by the sum of the percentage of the daily values of 9 nutrients to encourage (protein, fiber, vitamin A, vitamin C, vitamin E, calcium, iron, magnesium, and potassium) minus the sum of the percentage of the maximum recommended values for 3 nutrients to limit (saturated fat, added sugar, and sodium). NRF scores and mean national food prices were calculated per calorie and per US Food and Drug Administration-defined serving.

RESULTS

Each of the 9 USDA food groups offered foods of diverse nutritive value and cost. Eggs, dry beans and legumes, and meat and milk products were the lowest-cost sources of protein. Milk and milk products were the lowest-cost sources of calcium, whereas vegetables and fruit were the lowest-cost sources of vitamin C. Milk, potatoes, citrus juices, cereals, and beans had more favorable overall nutrient-to-price ratios than did many vegetables and fruit. Energy-dense grains, sweets, and fats provided most of the calories but fewer nutrients per dollar.

CONCLUSION

One important application of nutrient profile models is to help consumers identify foods that provide optimal nutrition at an affordable cost.