uSE OF THE nATURALLY nUTRIENT rICH (nnr) SCORE CAN HELP TO REDEFINE THE CONCEPT OF A NUTRITIOus FOOD

Though the 2005 Dietary Guidelines for Americans offer specific guidance to choose more nutrient-dense foods for better health, consumers generally define healthful foods as those low in problematic nutrients (e.g. fat, sugar, sodium). A widely accepted nutrient-density standard would lay the foundation for educating consumers on how to choose nutrient-rich foods. However, reviews of the literature in both 1975 and 2004 show the lack of quantifiable criteria and firm standards for defining nutritious foods. This report in the October issue of the Journal of Nutrition by Adam Drewnowski looks at the various attempts to define the nutrient density of foods and diets over the past 30 years. There has been little consensus about what constitutes a nutrient-rich food, with theories ranging from membership in a particular food group to the use of a variety of more or less defined measurement tools that assess nutritional value.

The Food and Agriculture Organization (FAO) of the United Nations has suggested that a nutrient density approach should replace the RDA-driven measures of diet quality. Since the nutrient density concept is more relevant when energy intake is low, identification of nutrient-dense foods becomes even more essential to ensure a healthful diet. The use of RDAs was based on the premise that a wide variety of food choices ensure nutrient adequacy.  However, dietary variety can be related to socio-economic status so the challenge is to provide and identify foods that maximize the nutrient-to-calorie ratio at an affordable price. 

The 2005 Dietary Guidelines for Americans distinguish between nutrient-dense foods and discretionary calories by encouraging consumers to choose nutrient-rich foods first and then enjoy energy-dense foods up to their calorie limits. To act on this advice and compare different food choices, Americans need some tool for measuring nutritional value. In this report, Dr. Drewnowski reviews a variety of tools that have been proposed over the last 30-plus years. The most recent, the Naturally Nutrient Rich (NNR) Score, is a nutrients-to-calories ratio developed by Dr. Drewnowski. The number score represents a food's nutrients in relation to energy provided. A tool such as the NNR Score could be objectively applied to individual foods to help consumers prioritize their food choices as suggested by the FAO and the 2005 Dietary Guidelines Advisory Committee. Applications for its use include the Nutrition Facts label, school nutrition programs, weight management plans, and dietary standards for special needs groups such as the elderly.

Citation:
Concept of a nutritious food: toward a nutrient density score. Drewnowski A. American Journal of Clinical Nutrition:2005 Oct;82(4):721-32.

To read the abstract and the full text of the article, go to Concept of a nutritious food: toward a nutrient density score.

To order a free reprint of the article, go to e-mail Drewnowski Reprint.  Include Drewnowski Reprint in the subject line and give us your mailing address.

recommendations from the task force on community preventive services for school and worksite interventions aimed to maintain or achieve healthy weights

The reduction of morbidity and mortality related to overweight and obesity is a national public health priority. The Task Force on Community Preventive Services has conducted a systematic review of the effectiveness of nutrition, physical activity, a combination of nutrition and physical activity, and other behavioral interventions in schools and worksites designed to address obesity issues. Both are locations where children and adults spend substantial time and both offer opportunities for nutrition and physical activity interventions. 

The Task Force directs the production of the Community Guide, a resource providing reviews on a variety of public health topics. The U.S. Department of Health and Human Services (DHHS) in collaboration with public and private partners supports the Community Guide development.

Because of limited studies available, the Task Force concluded that insufficient evidence existed to determine the effectiveness of all reviewed interventions in schools. There was not a sufficient number of studies identified with methodologic quality on which to base recommendations. This stigma attached to obesity makes weight measurement as part of a school program a challenge for school officials. Task Force suggestions to achieve modest but positive success include combined nutrition and physical activity programs, increased physical activity time allotments during the school day, noncompetitive sport programs, and reduced sedentary activities. Further research is needed on parent involvement in school-based interventions, school environmental and policy changes, and the value of college-based interventions.

There was insufficient evidence to base Task Force recommendations on single-component worksite interventions. However, the literature supports combined nutrition education and increased physical activity programs in the workplace.  Incentives for employers to provide such programs include cost effectiveness data supporting existing efforts. Evidence from two studies indicates the cost is less than $1 per employee per year to engage 1% of the at risk population in onsite weight-loss programs.  The Task Force also identified several potential worksite interventions that warrant study. 

Citation:
Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings. Katz DL, O'Connell M, Yeh MC, Nawaz H, Njike V, Anderson LM, Cory S, Dietz W; Task Force on Community Preventive Services.  MMWR Recomm and Rep. 2005 Oct 7;54(RR-10):1-12.

To access the report, go to Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings.

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