A new reference method for the validation of the nutrient profiling schemes using dietary surveys

Nutrient profiles of foods are increasingly used as the scientific basis of nutritional labeling, health claims, or nutritional education. Nutrient profiling schemes are based on sets of rules, scores, or thresholds applied to the nutritional composition of foods. However, there is a lack of scientific validation of nutritional profiling schemes. To develop a reference method using existing dietary surveys, to define a set of indicator foods that are positively or negatively associated with a "healthy diet." Such indicator foods can be used both for establishing relevant nutrient profiles and for the validation of existing or future nutrient profiling schemes. The proposed validation method is based on food and nutrient intakes of adults participating in national dietary surveys in five EU countries: Belgium (n = 2,507), Denmark (n = 3,151), France (n = 1,474), Ireland (n = 1,379), and Italy (n = 1,513). The characterization of indicator foods is divided in two steps. First, "healthy diets" of individuals are identified in the five national dietary surveys by comparison to the Eurodiet reference intakes. Second, indicator foods associated positively or negatively to the "healthy diets" are determined. With a P-value of 10(-3) for the test of comparison of food intakes between the "most healthy eaters" and the "less healthy eaters," it was possible to identify 294 indicator foods out of 1,669 foods tested in the five countries. In all the countries except Italy, there were more indicator foods positively associated than indicator foods negatively associated with the "healthy diet." The food categories of these indicator foods were in good agreement with Food Based Dietary Guidelines like the USDA dietary guideline for Americans. A new reference method for the validation of profiling schemes was developed based on dietary intake data from using dietary surveys in five European countries. Only a minority of foods consumed in these dietary surveys could be used as indicator foods of healthy or unhealthy diets in order to subsequently test nutritional profiling schemes. Further work is needed to build a list of indicator foods that could be considered as a "gold standard."     

A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming

Economic constraints may contribute to the unhealthy food choices observed among low socioeconomic groups in industrialized countries. The objective of the present study was to predict the food choices a rational individual would make to reduce his or her food budget, while retaining a diet as close as possible to the average population diet. Isoenergetic diets were modeled by linear programming. To ensure these diets were consistent with habitual food consumption patterns, departure from the average French diet was minimized and constraints that limited portion size and the amount of energy from food groups were introduced into the models. A cost constraint was introduced and progressively strengthened to assess the effect of cost on the selection of foods by the program. Strengthening the cost constraint reduced the proportion of energy contributed by fruits and vegetables, meat and dairy products and increased the proportion from cereals, sweets and added fats, a pattern similar to that observed among low socioeconomic groups. This decreased the nutritional quality of modeled diets, notably the lowest cost linear programming diets had lower vitamin C and beta-carotene densities than the mean French adult diet (i.e., <25% and 10% of the mean density, respectively). These results indicate that a simple cost constraint can decrease the nutrient densities of diets and influence food selection in ways that reproduce the food intake patterns observed among low socioeconomic groups. They suggest that economic measures will be needed to effectively improve the nutritional quality of diets consumed by these populations.     

Linear and nonlinear programming to optimize the nutrient density of a population's diet: an example based on diets of preschool children in rural Malawi

BACKGROUND: Food consumption surveys are often used to detect inadequate nutrient intakes but not to determine whether inadequate nutrient intakes are due to suboptimal use of locally available foods or to insufficient availability of nutrient-dense foods. OBJECTIVES: The objectives were to describe the use of linear programming as a method to design nutrient-adequate diets of optimal nutrient density and to identify the most stringent constraints in nutritional recommendations and food consumption patterns in a population's diet. DESIGN: This analysis was conducted with the use of food consumption data collected during 2 seasons from rural Malawian children aged 3-6 y. Linear programming was used to select diets based on local foods that satisfied a set of nutritional constraints while minimizing the total energy content of the diet. Additional constraints on daily intakes of foods and food groups were also introduced to ensure that the diets were compatible with local food patterns. The strength of the constraints was assessed by analyzing nonlinear programming sensitivity. RESULTS: In the harvest season, it was possible to satisfy nutritional recommendations with little departure from the local diet. In the nonharvest season, nutritional adequacy was impaired by the low availability of riboflavin- and zinc-rich animal or vegetable foods and by the high phytate content of other foods. CONCLUSIONS: This analysis suggests that nutrition education may help improve the diets of children in the harvest season, whereas changes in the range of available foods might be needed in the nonharvest season. Linear and nonlinear programming can be used to formulate recommendations with the use of data from local food consumption surveys.     

A new reference method for the validation of the nutrient profiling schemes using dietary surveys

Nutrient profiles of foods are increasingly used as the scientific basis of nutritional labeling, health claims, or nutritional education. Nutrient profiling schemes are based on sets of rules, scores, or thresholds applied to the nutritional composition of foods. However, there is a lack of scientific validation of nutritional profiling schemes. To develop a reference method using existing dietary surveys, to define a set of indicator foods that are positively or negatively associated with a “healthy diet.” Such indicator foods can be used both for establishing relevant nutrient profiles and for the validation of existing or future nutrient profiling schemes. The proposed validation method is based on food and nutrient intakes of adults participating in national dietary surveys in five EU countries: Belgium (n = 2,507), Denmark (n = 3,151), France (n = 1,474), Ireland (n = 1,379), and Italy (n = 1,513). The characterization of indicator foods is divided in two steps. First, “healthy diets” of individuals are identified in the five national dietary surveys by comparison to the Eurodiet reference intakes. Second, indicator foods associated positively or negatively to the “healthy diets” are determined. With a P-value of 10^?3 for the test of comparison of food intakes between the “most healthy eaters” and the “less healthy eaters,” it was possible to identify 294 indicator foods out of 1,669 foods tested in the five countries. In all the countries except Italy, there were more indicator foods positively associated than indicator foods negatively associated with the “healthy diet.” The food categories of these indicator foods were in good agreement with Food Based Dietary Guidelines like the USDA dietary guideline for Americans. A new reference method for the validation of profiling schemes was developed based on dietary intake data from using dietary surveys in five European countries. Only a minority of foods consumed in these dietary surveys could be used as indicator foods of healthy or unhealthy diets in order to subsequently test nutritional profiling schemes. Further work is needed to build a list of indicator foods that could be considered as a “gold standard.”     

Identifying Sustainable Foods: The Relationship between Environmental Impact,Nutritional Quality,and Prices of Foods Representative of the French Diet

BackgroundSustainable diets, as defined by the Food and Agriculture Organization, need to combine environment, nutrition, and affordability dimensions. However, it is unknown whether these dimensions are compatible, and no guidance is available in the official recommendations.ObjectiveTo identify foods with compatible sustainability dimensions.MethodsFor 363 of the most commonly consumed foods in the Second French Individual and National Study on Food Consumption, environmental impact indicators (ie, greenhouse gas [GHG] emissions, acidification, and eutrophication), and prices were collected. The nutritional quality of the foods was assessed by calculating the score for the nutritional adequacy of individual foods (SAIN) to score for disqualifying nutrients (LIM) ratio. A sustainability score based on the median GHG emissions, price, and SAIN:LIM was calculated for each food; the foods with the best values for all three variables received the highest score.ResultsThe environmental indicators were strongly and positively correlated. Meat, fish, and eggs and dairy products had the strongest influence on the environment; starchy foods, legumes, and fruits and vegetables had the least influence. GHG emissions were inversely correlated with SAIN:LIM (r=–0.37) and positively correlated with price per kilogram (r=0.59); the correlation with price per kilocalorie was null. This showed that foods with a heavy environmental impact tend to have lower nutritional quality and a higher price per kilogram but not a lower price per kilocalorie. Using price per kilogram, 94 foods had a maximum sustainability score, including most plant-based foods and excluding all foods with animal ingredients except milk, yogurt, and soups. Using price per kilocalorie restricted the list to 42 foods, including 52% of all starchy foods and legumes but only 11% of fruits and vegetables (mainly 100% fruit juices).ConclusionsOverall, the sustainability dimensions seemed to be compatible when considering price per kilogram of food. However, this conclusion is too simplistic when considering price per kilocalorie, which highlights the need to integrate the data at the diet level.     

Nutrient-dense food groups have high energy costs: an econometric approach to nutrient profiling

Consumers wishing to replace some of the foods in their diets with more nutrient-dense options need to be able to identify such foods on the basis of nutrient profiling. The present study used nutrient profiling to rank 7 major food groups and 25 subgroups in terms of their contribution to dietary energy, diet quality, and diet cost for 1332 adult participants in the French National INCA1 Study. Nutrient profiles were based on the presence of 23 qualifying nutrients, expressed as the percentage of nutrient adequacy per 8 MJ, and 3 negative or disqualifying nutrients, expressed as the percentage of the maximal recommended values for saturated fatty acids, added sugar, and sodium per 1.4 kg. Calculated cost of energy (euro/8 MJ) was based on the mean retail price of 619 foods in the nutrient composition database. The meat and the fruit and vegetables food groups had the highest nutritional quality but were associated with highest energy costs. Sweets and salted snacks had the lowest nutritional quality but were also one of the least expensive sources of dietary energy. Starches and grains were unique because they were low in disqualifying nutrients yet provided low-cost dietary energy. Within each major food group, some subgroups had a higher nutritient-to-price ratio than others. However, the fact that food groups with the more favorable nutrient profiles were also associated with higher energy costs suggests that the present structure of food prices may be a barrier to the adoption of food-based dietary guidelines, at least by low-income households.     

Dairy Products: How They Fit in Nutritionally Adequate Diets

Individual diet modeling with linear programming recently provided evidence that plant-based products, fish, and fresh dairy products consumption should be increased in the French population to reach nutrient-based recommendations. The aim of our study was to estimate the number of portions of the different milk-based food categories fitting into nutritionally adequate diets. Starting from the diet observed for each adult in the 1999 French Enquête Individuelle et Nationale sur les Consommations Alimentaires survey (n=1,171), an isocaloric nutritionally adequate diet was modeled that simultaneously met a whole set of nutrient constraints (based on nutrient recommendations) while deviating the least from the observed diet food content. Variations in weight, energy, and nutrients between observed and modeled diets were calculated for each food group (n=7), with a focus on milk-based products (n=4 categories). The diet optimization process increased the weights of three food groups: fruit and vegetables (+62%), starchy foods (+37%), and dairy products (+19%). Across milk-based food categories, the optimization increased yogurts (+60%) and milk (+17%) and decreased cheeses (?48%) without change to milk desserts. Cheeses represented one out of two consumed portions of milk-based products in observed diets, whereas in modeled diets cheeses, milk, and yogurts each represented about one portion per day. Milk desserts were similar before and after optimization, at approximately one portion per week. These results confirm that a large increase in intake of plant-based products is needed. They show that rebalancing the intake of milk-based products in favor of the least energy-dense ones (ie, yogurts and milk) will help individuals in this population reach nutritional adequacy.     

Food-based dietary guidelines can be developed and tested using linear programming analysis

Effective food-based dietary guidelines (FBDGs) are required to combat micronutrient deficiencies. This study aimed to develop a rigorous approach for designing population-specific FBDGs. A 4-phase approach based on linear programming analysis was used to design, test, and refine the FBDGs. This was illustrated for Malawian children. In phase I, the objective function minimized the difference in the energy contributed by different food groups between modeled and observed diets for 16 observed diet types, while preferentially selecting foods most often consumed. Constraints ensured nutrient adequacy and diet palatability. In phase II, the meal/snack patterns of the phase I modeled diets were examined to develop season-specific FBDGs. In phase III, the robustness of these FBDGs, for ensuring a nutritionally adequate diet, was tested. The objective function, in this analysis, minimized selected nutrient levels in the modeled diets (i.e., chose the "worst-case scenario"), while respecting the FBDGs, palatability, and energy constraints. The FBDGs were refined in phase IV. In the Malawian example used to illustrate our approach, the FBDGs promoted daily consumption of maize flour, small dry fish (>or=20 g), leaf relish, and 2-3 snacks. The last mentioned included mangoes, in the food-shortage season, and pumpkin in the food-plenty season. In addition, legume relish was recommended in the food-shortage season. The approach presented here can be used to design and then test the robustness of FBDGs for meeting nutrient recommendations.     

Comparison of different nutrient profiling schemes to a new reference method using dietary surveys

A new EU regulation on nutrition and health claims made on foods has entered into force in January 2007. The regulation provides for the use of nutrient profiles to determine which foods may bear claims but does not specify what the profiles should be or how they should be developed. Several nutrient profiling schemes have already been established. Therefore, it is necessary to develop approaches to test if the existing profiling schemes could fulfil the new regulation needs. The aim of the present study is to investigate how reference “indicator foods” derived from national dietary surveys in five different countries, are classified according to three existing nutrient profiling schemes: The UK Food Standards Agency (FSA) model, The Dutch Tripartite classification model and the US FDA model used for regulating health claims. “Indicator foods” that have been shown to be positively or negatively associated with healthy diets in adults in five EU countries were classified according to each of the three profiling schemes. The performance and effectiveness of each profiling scheme in correctly classifying the “indicator foods” were assessed using sensitivity and specificity ratios. The sensitivity and the specificity ratios of the three profiling schemes tested were relatively good. There were only small differences of performance between the three systems. A significant negative correlation between sensitivity and specificity was observed. The level of concordance between the classification of the “indicator foods” that have been selected because of being positively or negatively associated with a healthy diet and the classification by each of the three profiling methods tested was quite good. However, further improvement of the “indicator foods” approach is needed if it is to serve as a “gold standard”.     

Comparison of different nutrient profiling schemes to a new reference method using dietary surveys

A new EU regulation on nutrition and health claims made on foods has entered into force in January 2007. The regulation provides for the use of nutrient profiles to determine which foods may bear claims but does not specify what the profiles should be or how they should be developed. Several nutrient profiling schemes have already been established. Therefore, it is necessary to develop approaches to test if the existing profiling schemes could fulfil the new regulation needs. The aim of the present study is to investigate how reference "indicator foods" derived from national dietary surveys in five different countries, are classified according to three existing nutrient profiling schemes: The UK Food Standards Agency (FSA) model, The Dutch Tripartite classification model and the US FDA model used for regulating health claims. "Indicator foods" that have been shown to be positively or negatively associated with healthy diets in adults in five EU countries were classified according to each of the three profiling schemes. The performance and effectiveness of each profiling scheme in correctly classifying the "indicator foods" were assessed using sensitivity and specificity ratios. The sensitivity and the specificity ratios of the three profiling schemes tested were relatively good. There were only small differences of performance between the three systems. A significant negative correlation between sensitivity and specificity was observed. The level of concordance between the classification of the "indicator foods" that have been selected because of being positively or negatively associated with a healthy diet and the classification by each of the three profiling methods tested was quite good. However, further improvement of the "indicator foods" approach is needed if it is to serve as a "gold standard".     

Assessing the SAIN,LIM nutrient profile of foods sold by fast food restaurants in Tunisia: Exploring ways for improvement

ObjectivesNon-communicable diseases have increased in Tunisia after the epidemiological transition. That is why the national strategy to prevent and control obesity was elaborated and implemented. Improving the quality of foods is one axis of this strategy. The purpose of this paper was to estimate and evaluate the nutritional profiles of Tunisian foods sold by fast food restaurants, and explore ways for improvement.Material and methodsNutritional quality of 35 average recipes or items was assessed by 70 recipes of dishes sold by fast food restaurants. The SAIN,LIM French scoring system was used. Foods were classified into the four SAIN,LIM classes, i.e. from the healthiest (class 1) to the least healthy (class 4). The recipes were then reformulated and improved by deleting or reducing some unfavorable ingredients like salt.ResultsBefore reformulation, the items were spread over the 4 SAIN,LIM classes (class 1: 42.9%; class 2: 8.6%; class 3: 20.0% and class 4: 28.6%). After reformulation, the items were spread over class 1 (85.7%) and class 3 (14.3%), showing clear improvement of their nutritional quality.ConclusionIn Tunisia, an important percentage of foods sold by fast food restaurant have a good nutrient profile (43%). After reformulation, most items were in the healthiest class. This study is the first to show that it is possible to improve the nutritional quality of foods sold by fast food restaurants, and that the SAIN,LIM system can help to that end.     

Nutritional characterisation of foods: science-based approach to nutrient profiling. Summary report of an ILSI Europe workshop held in April 2006

The background of the workshop was the proposed EU legislation to regulate nutrition and health claims for foods in Europe. This regulation will require the development of a science-based nutrient profiling system in order to determine which foods or categories of foods will be permitted to make nutrition or health claims. Nutrient profiling can also be used to categorize foods, based on an assessment of their nutrient composition according to scientific principles. Today, various nutrient profiling schemes are available to classify foods based on their nutritional characteristics. The aim of the workshop was to discuss the work developed by ILSI Europe's expert group and to explore wider scientific aspects of nutrient profiling, including their relative effectiveness, strengths and weaknesses. In particular, the focus of the workshop was on scientific approaches to the development of nutrient profiles for the purpose of regulating nutrition and health claims. The 76 workshop participants were scientists from European academic institutions, research institutes, food standards agencies, food industry and other interested parties, all of whom contributed their thinking on this topic. The workshop reached a degree of agreement on several central points. Most participants favored a food category approach rather than an 'across the board' system for nutrient profiling. Most also felt that nutrient profiling schemes should focus on disqualifying nutrients, while taking into due account relevant qualifying nutrients. Levels of each nutrient should be clearly defined for all food categories to be profiled. Reference amounts selected for further considerations were: (1) per 100 g/100 ml, (2) legislated reference amounts, and (3) per 100 kcal. The majority of workshop participants agreed that nutrient profiling schemes should allow for a two-step decision process; step (1) identify which nutrients to take into account, and step (2) define the thresholds for these nutrients. All participants agreed that an objective validation should be conducted before implementation of nutrient profiling. This would include determination of sensitivity and specificity using "indicator foods" selected on their potential to affect major health issues. The management of any adopted system needs to allow it to be dynamic over time and revise the system when new scientific knowledge emerges. The majority of participants favored a food category approach rather than an 'across the board' system. Further work is required to identify the final list of qualifying and disqualifying nutrients for any food category that may be identified and for the selection of optimal reference amounts. It is essential that key stakeholders continue to communicate and work together on the complex issues of nutrient profiling.     

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.     

Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples

Excessive consumption of ultra-processed foods (UPFs), as described by the NOVA classification system, represents a potential threat to human health. The nutritional composition of UPFs may explain their observed adverse effects. The present study aimed to provide a quantitative meta-analysis of nationally representative surveys on the consumption of UPFs and the dietary/nutrient composition of respondents’ diets. A systematic search for relevant studies published prior to July 2021 was conducted via electronic databases. The studies that provided the dietary/nutrient composition of foods categorized according to the NOVA classification system were selected. The association between UPFs and other dietary variables was modelled using ordinary least squares linear regression based on aggregated data extracted from the selected articles. Consumption of UPFs represented up to 80% of total caloric intake in the US and Canada, with confectionery and sugar-sweetened beverages being the most consumed items. When considered in relation to other food groups, an inverse linear relation between UPFs and less-processed foods was evident. Increased UPF intake correlated with an increase in free sugars, total fats, and saturated fats, as well as a decrease in fiber, protein, potassium, zinc, and magnesium, and vitamins A, C, D, E, B12, and niacin. In conclusion, the data indicate that increased UPF consumption negatively affects the nutritional quality of diets.     

An Objective Measure of Nutrition Facts Panel Usage and Nutrient Quality of Food Choice

ObjectiveThe relationship between time viewing nutrition information and nutrient quality of foods chosen in a food selection task was objectively evaluated through direct observation using an eye-tracking camera.MethodsA total of 202 participants' food choices were scored for nutrient density. Multivariate linear regression analysis was conducted with mean nutrient density of foods selected regressed on mean label viewing time and participants' sociodemographic characteristics.ResultsLabel viewing time was not significantly associated with nutrient density food score. A significant relationship emerged between the covariate, age, and mean nutrient density food score such that mean nutrient density scores were higher for older participants compared with younger ones (P = .04). Foods selected by males had a higher mean nutrient density score than foods selected by females (P = .03).Conclusions and ImplicationsFindings suggest that those who spend more time viewing nutrition facts panels during a single shopping trip may not select more nutritious foods.     

Food pattern modeling shows that the 2010 Dietary Guidelines for sodium and potassium cannot be met simultaneously

The 2010 US Dietary Guidelines recommended limiting intake of sodium to 1500 mg/d for people older than 50 years, African Americans, and those suffering from chronic disease. The guidelines recommended that all other people consume less than 2300 mg sodium and 4700 mg of potassium per day. The theoretical feasibility of meeting the sodium and potassium guidelines while simultaneously maintaining nutritional adequacy of the diet was tested using food pattern modeling based on linear programming. Dietary data from the National Health and Nutrition Examination Survey 2001-2002 were used to create optimized food patterns for 6 age-sex groups. Linear programming models determined the boundary conditions for the potassium and sodium content of the modeled food patterns that would also be compatible with other nutrient goals. Linear programming models also sought to determine the amounts of sodium and potassium that both would be consistent with the ratio of Na to K of 0.49 and would cause the least deviation from the existing food habits. The 6 sets of food patterns were created before and after an across-the-board 10% reduction in sodium content of all foods in the Food and Nutrition Database for Dietary Studies. Modeling analyses showed that the 2010 Dietary Guidelines for sodium were incompatible with potassium guidelines and with nutritionally adequate diets, even after reducing the sodium content of all US foods by 10%. Feasibility studies should precede or accompany the issuing of dietary guidelines to the public.     

Nutritional characterisation of foods: Science-based approach to nutrient profiling

Background

The background of the workshop was the proposed EU legislation to regulate nutrition and health claims for foods in Europe. This regulation will require the development of a science-based nutrient profiling system in order to determine which foods or categories of foods will be permitted to make nutrition or health claims. Nutrient profiling can also be used to categorize foods, based on an assessment of their nutrient composition according to scientific principles. Today, various nutrient profiling schemes are available to classify foods based on their nutritional characteristics.

Aim

The aim of the workshop was to discuss the work developed by ILSI Europe’s expert group and to explore wider scientific aspects of nutrient profiling, including their relative effectiveness, strengths and weaknesses. In particular, the focus of the workshop was on scientific approaches to the development of nutrient profiles for the purpose of regulating nutrition and health claims. The 76 workshop participants were scientists from European academic institutions, research institutes, food standards agencies, food industry and other interested parties, all of whom contributed their thinking on this topic.

Results

The workshop reached a degree of agreement on several central points. Most participants favored a food category approach rather than an ‘across the board’ system for nutrient profiling. Most also felt that nutrient profiling schemes should focus on disqualifying nutrients, while taking into due account relevant qualifying nutrients. Levels of each nutrient should be clearly defined for all food categories to be profiled. Reference amounts selected for further considerations were: (1) per 100 g/100 ml, (2) legislated reference amounts, and (3) per 100 kcal. The majority of workshop participants agreed that nutrient profiling schemes should allow for a two-step decision process; step (1) identify which nutrients to take into account, and step (2) define the thresholds for these nutrients. All participants agreed that an objective validation should be conducted before implementation of nutrient profiling. This would include determination of sensitivity and specificity using “indicator foods” selected on their potential to affect major health issues. The management of any adopted system needs to allow it to be dynamic over time and revise the system when new scientific knowledge emerges.

Conclusions

The majority of participants favored a food category approach rather than an ‘across the board’ system. Further work is required to identify the final list of qualifying and disqualifying nutrients for any food category that may be identified and for the selection of optimal reference amounts. It is essential that key stakeholders continue to communicate and work together on the complex issues of nutrient profiling.

     

Meeting adequate intake for dietary calcium without dairy foods in adolescents aged 9 to 18 years (National Health and Nutrition Examination Survey 2001-2002)

BACKGROUND: In the United States, >50% of dietary calcium is provided by milk and milk products. Calcium intakes in the United States are inadequate for many children, and a large proportion do not drink milk or consume dairy products. However, no studies have addressed whether dairy-free diets can provide adequate calcium while meeting other nutrient recommendations. OBJECTIVE: To determine the highest calcium intake for adolescents obtained from dairy-free diets, and to examine the relationship between intakes of calcium-fortified foods, using citrus juice as an example, and maximal calcium intakes. DESIGN: In the National Health and Nutrition Examination Survey 2001 to 2002, 65 females and 62 males, aged 9 to 18 years, reported no intake of dairy. We used linear programming to generate diets with maximal calcium intake, while meeting Dietary Reference Intakes for a set of nutrients, limiting energy and fat intakes, and not selecting food quantities exceeding amounts usually eaten in the population. RESULTS: With food use and energy and fat constraints, diets formulated by linear programming provided 1,150 and 1,411 mg/day of calcium for girls and boys, respectively. With the Dietary Reference Intakes constraints, these decreased to 869 and 1,160 mg/day. When we introduced 1.5 servings of fortified juice to the diets, the highest calcium intake increased to 1,302 mg/day for girls and to 1,640 mg/day for boys. CONCLUSIONS: Adequate intake for calcium cannot be met with dairy-free diets while meeting other nutrient recommendations. To meet the adequate intake for calcium without large changes in dietary patterns, calcium-fortified foods are needed. In addition, greater physical activity and responsible sunlight exposure should be encouraged to promote vitamin D adequacy.     

Influence of food cost on diet quality and risk factors for chronic disease: A systematic review

Aim: To undertake a systematic literature review to examine the effect of food cost on diet quality and risk factors for chronic disease, specifically focusing on diet‐related lifestyle diseases affecting the Australian population. Methods: A search of six databases resulted in the inclusion of one systematic review, three cohort studies, 41 cross‐sectional studies and four modelling studies in this review. Results: Between 2000 and 2006, the price of healthy foods has increased more than the price of less healthy foods. Healthy Food Access Basket surveys show that a healthy diet may often be unaffordable for low‐ and average‐income households. Diets of higher energy density were associated with lower diet cost, whereas diets of higher nutrient density and nutritional quality were associated with higher diet cost. Recent studies report an inverse association between food price and food consumption. Consequently, an increase in food cost was associated with a significant reduction in weight, waist circumference, body mass index, obesity and insulin resistance. Conclusions: Manipulation of food cost may alter food consumption and therefore risk factors for chronic disease. Further longitudinal studies investigating the impact of pricing strategies on diet quality and disease risk are needed.     

Low-cost, ready-to-use therapeutic foods can be designed using locally available commodities with the aid of linear programming

According to the United Nations (UN), 25 million children <5 y of age are currently affected by severe acute malnutrition and need to be treated using special nutritional products such as ready-to-use therapeutic foods (RUTF). Improved formulations are in demand, but a standardized approach for RUTF design has not yet been described. A method relying on linear programming (LP) analysis was developed and piloted in the design of a RUTF prototype for the treatment of wasting in East African children and adults. The LP objective function and decision variables consisted of the lowest formulation price and the weights of the chosen commodities (soy, sorghum, maize, oil, and sugar), respectively. The LP constraints were based on current UN recommendations for the macronutrient content of therapeutic food and included palatability, texture, and maximum food ingredient weight criteria. Nonlinear constraints for nutrient ratios were converted to linear equations to allow their use in LP. The formulation was considered accurate if laboratory results confirmed an energy density difference <10% and a protein or lipid difference <5 g · 100 g(-1) compared to the LP formulation estimates. With this test prototype, the differences were 7%, and 2.3 and -1.0 g · 100 g(-1), respectively, and the formulation accuracy was considered good. LP can contribute to the design of ready-to-use foods (therapeutic, supplementary, or complementary), targeting different forms of malnutrition, while using commodities that are cheaper, regionally available, and meet local cultural preferences. However, as with all prototype feeding products for medical use, composition analysis, safety, acceptability, and clinical effectiveness trials must be conducted to validate the formulation.