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5/8/08 NUTRI ENT RI CH FOODS: PACKI NG MORE POW ER PACKI NG MORE POW ER ON YOUR PLATE By Constance J. Geiger, PhD, RD Geiger & Associates LLC Geiger & Associates, LLC Fort Bridger, Wyoming The University of Utah Salt Lake City,

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NUTRI ENT– RI CH FOODS: PACKI NG MORE POW ER PACKI NG MORE POW ER ON YOUR PLATE

By Constance J. Geiger, PhD, RD Geiger & Associates LLC Geiger & Associates, LLC Fort Bridger, Wyoming The University of Utah Salt Lake City, Utah

Overview

  • Introduction
  • Review Government Recommendations

R di N t i t D it Regarding Nutrient Density

  • Address Research Questions Posed in ADA’s

Practice Paper on Nutrient Density

  • Understand Nutrition Profiling
  • Articulate Government actions regarding

FOP

  • Interpret Consumer Research on Nutrient

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  • Interpret Consumer Research on Nutrient

Density

  • Provide Nutrient-Dense/Nutrient-Rich

Foods Applications for Consumers

  • Summary and Conclusions
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I ntroduction: Nutrition I s High on the Grocery List

People Read Food Labels People Read Food Labels

100% 85% 85% 83% 83% 86% 86% 77% 77% 40% 60% 80% 85% 85% 83% 83% 86% 86% 77% 77%

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ADA 1997 FMI 2004 IFIC 2006 FDA 2008

0% 20%

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Food Label Use is I ncreasing

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Nutrition Matters

Eight in 10 shoppers (85%) are concerned (85%) are concerned about the nutritional content of their food … up from 46% in 2000 Nearly 66% of shoppers think their diet could be h lthi t h hil

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FMI U.S. Grocery Shopping Trends

healthier at home, while 77% think it could be healthier at restaurants

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W eighty Matters

  • 70% of Shoppers Are

Concerned About Their Weight Weight

  • Shoppers Look for:

–Calories (75%) –Total fat (69%) –Sugar (61%) –Sodium (56%) Sat fat (56%)

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–Sat fat (56%) –Fiber (44%)

(IFIC Food & Health Survey 2009)

Fam ilies Pursue Healthy Eating Strategies

90 100 20 30 40 50 60 70 80 90 All Shoppers

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10 20 Decr SS Whole Grain LF Foods Limit Trans

FMI 2009

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Obesity Continues to Drive Change

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On-Pack Labeling System s Abound in 2 0 0 9

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Retailers Are Responding

Wegmans Whole Grain Wellness Key Stop & Shop Kids’ Corner Program

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Harris Teeter Wellness Labeling Program Hannaford Guiding Stars Program

G t Governm ent Recom m endations Regarding Nutrient Density

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  • 2 0 0 5 / 2 0 1 0 Dietary Guidelines

for Am ericans

Governm ent Recom m endations

for Am ericans

  • MyPyram id
  • Major Changes in the

Food Label

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Am ericans Are Overw eight Yet Undernourished

Americans Not Meeting DRIs

  • 95%: Vitamin E
  • 95%: Vitamin E
  • 78%: Folate
  • 76%: Calcium
  • 72%: Magnesium
  • 48%: Vitamin A
  • 46%: Vitamin C
  • 38%: Zinc

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  • 38%: Zinc
  • 32%: Iron
  • 24%: Vitamin B12

Source: Based on the RDA, Continuing Survey of Food Intake by Individuals (CSFII) 1994-1996, 1998

2 0 0 5 DGAC Recom m endations

The 2005 DGAC identified nutrient density as a key concept, stressing the need to:

  • Develop a scientific definition
  • f nutrient density of foods
  • Convey the concept of

nutrient density to the consumer consumer

  • Assist consumers in making

wise food choices

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Are building on the 2005 g recommendations Definition of Nutrient Density

Nutrient-dense foods are those foods that provide substantial amounts of vitamins and minerals (micronutrients) and relatively few calories. Foods that are low in nutrient density are foods that supply calories but

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that supply calories but relatively small amounts

  • f micronutrients,

sometimes none at all

(2005 Dietary Guidelines for Americans)

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Key Messages to Get Back to Sound Nutrition

  • Get the most

nutrition out of your calories

  • Make smart food

choices from every food group

  • Maximize your

nutrients make

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nutrients –make calories count for you

Purpose of NLEA

  • To help consumers select foods to build

healthy diets T li i t f i

  • To eliminate consumer confusion
  • To encourage product innovation

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Nutrition Labeling Changes

  • Calorie Labeling
  • Daily Values Updated

Symbols on Food

  • Symbols on Food

Packages/Nutrition Profiling

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Possible Changes in Calorie I nform ation

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  • Update Daily Values

for the food label

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Global Nutrition Profiling Reform

FDA Public Hearing on Use

  • f Sym bols to Com m unicate

Nutrition I nform ation, Consideration of Consum er Studies and Nutritional Criteria

  • Addressed proliferation
  • f profiles
  • Drove standardization
  • Drove standardization

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ADA’ P ti P ADA’s Practice Paper on Nutrient Density

Questions related to the 2 0 0 5 DGAC Definition What is substantial? What is low? What nutrients should be included in the definition

  • f nutrient density?

Should nutrient-dense foods be in their lowest fat form and have no added sugar? Sh ld t i t d it b

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Should nutrient density be defined by food group? Should nutrient density be defined differently for naturally nutrient-dense foods vs fortified foods?

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“Research needs include … A more specific definition for nutrient-dense foods Verification of whether the Verification of whether the nutrient density approach is feasible, economical, culturally sensitive and relevant Verification of whether the nutrient density approach helps consumers to

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helps consumers to change their behaviors so that they select the foods they need and reach or maintain healthful body weights”

W h t I N t iti W hat I s Nutrition Profiling?

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W hat I s Nutrient Profiling?

  • Nutrient profiling is the science of

ranking or classifying foods based on their nutrient composition their nutrient composition

  • Each food is assigned a unique score

that reflects its nutrient quality

(UK Food Standards Agency, FSA)

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Key Players in Nutrition Profiling

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http://www.eatwell.gov.uk/foodlabels/trafficlights/

UK

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Nutrient Profiling Criteria

  • Objective
  • Simple

B l d

  • Balanced
  • Validated
  • Transparent
  • Consumer-driven

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Drewnowski, Fulgoni. Nutr Rev 2008. Nutrient Profiling Criteria

W hat Actions Are Being Taken by Governm ent?

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Exam ination of Front-of-Package Nutrition Rating System s and Sym bols Nutrition Rating System s and Sym bols

  • Identify FOP systems being used
  • Consider the purpose and merits of FOP

systems

  • Evaluate the scientific basis of criteria
  • Consider advantages and disadvantages

Pl Ph II

  • Plan Phase II
  • Expect report in 2010
  • 2nd meeting 4/9/10

(Supported by FDA and CDC and probably USDA)

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sss

  • Request for Comments Fall 2007

New Front-of-Package Labeling Initiative

  • Request for Comments, Fall 2007
  • Letter to Smart Choices Program,

August 2009

  • Guidance on Front-of-Pack Symbols/Logos,

October 2009

  • Letter to Industry, October 2009
  • Background on POP Labeling, October 2009

g g,

  • Consumer Studies Ongoing
  • Warning Letters, March 2010

http//www.fda.gov

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FDAgov FDAgov FDAgov xml no d *

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Study on Existing Schem es: 3 Schem es + 2 Controls

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No FOP labeling

Target Study: 9 Schem es + 2 Controls

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No FOP labeling

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ADA’s Position on FOP

  • Accounts for overall nutrient profile of the food

S ifi l i t t

  • Specifies calorie content
  • Is consistent with the DGA & MyPyramid
  • Encourages consumers to use Nutrition Facts
  • Is consumer tested
  • Is truthful and not misleading, follows CFR

regulations

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Consum er Research on Nutrient Density

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W ays to Assess Nutrient Density

Nutritional Quality I d ( NQI ) Hansen 1 9 7 6 I ndex ( NQI ) Calories-for-Nutrient Score ( CFN) LaChance 1 9 8 6 Recom m ended/ Restricted Ratio ( RRR) Scheidt 2 0 0 4 Naturally Nutrient Rich ( NNR) I ndex Drew now ski 2 0 0 5

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Rich ( NNR) I ndex Nutrient Rich Food Quality I ndex Drew now ski 2 0 0 7

Definition of Nutrient Density

  • How would you define nutrient

density? Wh t ld id t i t

  • What would you consider a nutrient-

dense food?

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I nterest in Nutrient Density 1/3 of shoppers are very interested in

  • btaining maximum

nutrition from every

  • calorie. Importantly,

another 1/3 are somewhat interested

(Gilbert 2005)

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Consum ers Use the Package to Choose Nutritious Foods

69%: A package

69%

front that includes calorie and nutrient call-outs would be most effective in helping consumers

22%

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choose nutritious foods

Calorie & Calorie None No Nutrition Only Preference Shugoll Research, June 2005

5% 4% Shugoll Research, May 2005

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Consum er Research Overview

Phase I: Research and Synthesis Phase II: Concept Development and Design Phase III: Validation, Refinement and Prototyping

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Consum er Research

  • Conducted focus groups

and survey research

  • Talked to consumers

about nutrient density and what it means to them –To determine which messages consumers prefer consumers prefer

  • To understand the best way to

communicate nutrient density concepts

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StrategyOne, January 2005

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Key Consum er I nsights

  • Consumers want to get

more nutrients in th i di t

“I don’t know how to shop for nutrient-

their diets

  • Consumers

–Want tools –Are overwhelmed with food choices –Tend to give up when they’re pressed for time

dense foods”

  • - Consumer,

Denver

they re pressed for time

  • Consumers equate the term

“dense” with heavy

  • r stupid

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StrategyOne, January 2005

Messages Must Em pow er

  • Take Small Steps for a Healthier You: Get

more nutrition out of your calories by choosing the most nutritionally rich foods

“Take sm all steps, so som eone m ight not be

  • verw helm ed …

They can do a little bit at a tim e” Consumer Denver

choosing the most nutritionally rich foods from each food group each day

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  • - Consumer, Denver

Shugoll Research, May 2005 Economic, 2007

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Tips Must Be Specific

  • Live Well! Enjoy:

–Brightly colored fruits D d d –Deep green, red and orange vegetables –Whole, fortified and fiber-rich grain foods –Lean meats –Nonfat and lowfat milk, yogurt and cheese

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“I t’s sim ple. I t just spells it out,

briefly, exactly w hat you need to look for”

  • - Consumer, Denver

and cheese

Shugoll Research, May 2005 Economic, 2007

Consum er Om nibus Survey

  • Surveyed 1,019 US adults
  • 48% male and 52% female
  • Aged 25-64

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Ipsos Public Affairs 2008

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Consum er Om nibus Survey: Key I nsights

  • 54% Americans surveyed agree

they are overwhelmed by the information they are overwhelmed by the information and advice they receive on what to eat and what not to eat

  • 66% Americans agree they are

more likely to follow advice about nutrition goals for the whole day versus

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individual foods they should or should not eat

Ipsos Public Affairs 2008

Consum er Om nibus Survey: Key I nsights

  • 77% agree that dietary advice is useful when

it helps them understand the total nutrient it helps them understand the total nutrient contribution a food provides

  • 61% are interested in learning about both

the positive nutrients and nutrients they should limit

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Ipsos Public Affairs 2008

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Quantitative Findings

  • Consumers like the idea of nutrient-rich

foods N l 8 i 10 th

  • Nearly 8 in 10 consumers say they

would use the tool once a week or more

  • One-third of consumers say they’d use

the tool every day

  • Three-fourths of consumers do NOT find

the tool confusing the tool confusing

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Nutrition Educator Research

  • Found nutrition educators

–Support an education program that emphasi es hat foods cons me s sho ld emphasizes what foods consumers should add to their diet rather than what they should delete “…Thinking of things that can be added can be viewed as a positive approach and I

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Shugoll Research, May 2005 Economic, 2007

can be viewed as a positive approach and I think people respond to this better … ”

  • - RD, Denver
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Nutrition Educator Research

  • Utilized research findings insights to create

a comprehensive tool kit for health a comprehensive tool kit for health professionals

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Shugoll Research, May 2005 Economic, 2007

Nutrient-Dense/ Nutrient- Rich Foods Applications for Consum ers

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The Nutrient Rich Foods I ndex

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Drewnowski: American J Clinical Nutrition 2005;82:721-32

Nutrient Rich I ndex

  • Regulations:

%DV

  • Science/ Criteria:

Yes T t Y

  • Transparent:

Yes

  • Review process:

Not applicable

  • Consistent:

Yes

  • Tested:

Yes

  • Education program :

Yes

  • Evaluated:

Yes

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  • http:/ / w w w .nutrientrichfoods.org/
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I ndex Com ponents

  • Includes nutrients with a DRI

(except added sugars) B d t bli h d th it ti

  • Based on established, authoritative sources
  • Capped nutrient contributions to 100% Daily

Value

  • Validated against USDA’s Healthy Eating

Index

  • Is a scientifically valid definition of nutrient

density density

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Nutrient Rich I ndex Com ponents

  • Based on 9 nutrients to encourage,

3 nutrients to limit U “ i ht d”

  • Uses “unweighted” scores
  • Based reference amount on FDA’s Daily

Value

  • Based on 100 kcal basis
  • Created with open-source, transparent

databases

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Nutrient Rich I ndex

NRF 9 3 ∑ 9 (%DV 100 k l)

  • NRF 9.3 = ∑ 9 ENC (%DV per 100 kcal) –

∑ 3 LIM (%DV per 100 kcal)

  • ENC = protein, fiber, vitamins A, C and E,

calcium, magnesium, iron and potassium

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  • LIM = SFA, sodium, added sugars
  • Scores range from 1-5 in each food group

Sam ple Fruit Scores

  • Orange

5

  • Kiwi

5 Bl b i 3

  • Blueberries

3

  • Avocado

3

  • Strawberries 5
  • Peach slices

in syrup 1

  • Peach

4

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How to Build a Healthy Diet

  • Foods balance each other’s nutrient

content in building a healthy diet

  • Each food group brings its own nutrient

contributions

  • Consider using an approach that incorporates

food label and %DV of calories

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How RDs Can Help Consum ers

  • MyPyramid Website
  • MyPyramid

t l e-catalog

  • USDA Food and

Nutrition Service Website

  • ADA Practice Paper
  • Live Well Tool Kit and

Resource Kit

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Resource Kit

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Nutrient Rich Foods Nutrition Profiling

  • Nutrient Rich Foods (NRF)

Coalition is conducting Coalition is conducting scientific and market research to refine an approach that focuses on the total nutrient package

  • f a food

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–Emphasizes getting more nutrition from your calories

Live Well

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Achieve Better Health w ith Nutrient Rich Foods Resource Guide Comprehensive background on the science and consumer insights behind the and consumer insights behind the Nutrient Rich Foods approach

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S d C l i Sum m ary and Conclusions

Points to Rem em ber

  • All sectors emphasizing obesity-related

information P fil lif ti f d l b l

  • Profiles proliferating on food labels
  • Nutrient density emphasized in some

programs

  • Research needs to be conducted

to validate the definition and communication of nutrient density

  • ADA practice paper on nutrient density

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  • ADA practice paper on nutrient density

in May 2007 JADA is a good resource

  • Further guidance and/or regulations are likely
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  • 2 0 0 5 / 2 0 1 0 Dietary Guidelines for

Am ericans

Governm ent Recom m endations

Am ericans

  • MyPyram id
  • Major Changes in the Food Label

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ADA Practice Paper Research Needs: Next Steps

  • A more specific definition for nutrient-dense

foods

  • Consumer testing and validation
  • Verification of whether the nutrient density

approach helps consumers to

  • Change their behaviors so that they select

the foods they need and

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the foods they need and

  • Reach or maintain healthful

body weights

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Key Messages

  • Each food group brings unique nutrients to

the table

  • Foods balance each other’s nutrient

content in building a healthy diet

  • An approach that incorporates

%DV of calories may be helpful

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Key Messages

Labeling should help Americans make i f d d i i informed decisions to build better diets

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Key Message

  • Live Well! Enjoy:

–Brightly colored fruits D d d –Deep green, red and orange vegetables –Whole, fortified and fiber-rich grain foods –Lean meats, poultry, fish –Nonfat and lowfat milk, yogurt and cheese

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and cheese

Shugoll Research, May 2005 Economic, 2007

Changing the Conversation About Health and W ellness

From nutrient avoidance

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To helping Americans build healthier diets