Food-Based Dietary Guidelines: The Relevance of Nutrient Density and a Healthy Diet Score

ABSTRACT The 2015 – 2020 Dietary Guidelines for Americans provides guidance for choosing a healthy diet. There is a focus on preventing and alleviating the effects of diet-related chronic diseases. These include obesity, diabetes, cardiovascular disease, and stroke, among others. This article briefly reviews the primary guideline items that can be used to teach patients with respect to improving their diet. Clinical exercise physiologists who work with patients with chronic disease can use these guidelines for general discussions regarding a heart-healthy diet.

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Sustainability Indicators for Foods Benefiting Climate and Health

Sustainability ◽

10.3390/su13073621 ◽

2021 ◽

Vol 13 (7) ◽

pp. 3621

Author(s):

Anna Strid ◽

Elinor Hallström ◽

Ulf Sonesson ◽

Josefin Sjons ◽

Anna Winkvist ◽

...

Keyword(s):

Product Development ◽

Food Product ◽

Climate Impact ◽

Sustainability Indicators ◽

Dietary Guidelines ◽

Alternative Methods ◽

Sustainable Food ◽

Nutrient Density ◽

Trade Offs ◽

Food Product Development

New methods for combined evaluation of nutritional and environmental aspects of food products are needed to enable a transformation of dietary guidelines integrating both health and environmental perspectives. We evaluated two sustainability aspects; nutrition and climate impact, of foods commonly consumed in Sweden and the implications of using parallel or integrated assessments of these two aspects, also discussing the usability and suitability of these food sustainability indicators in relation to Swedish dietary guidelines, industry food product development, and consumer communication. There were large differences in both nutrient density and climate impact among the different foods. The parallel assessment easily visualized synergies and trade-offs between these two sustainability aspects for the different foods. Coherence with dietary guidelines was good, and suitability and usability deemed satisfying. The integrated indicator showed better coherence with dietary guidelines than indicators based solely on nutrient density or climate impact; however, the difficulty to interpret the score limits its usability in product development and consumer communication. With both methods, advantageous as well as less advantageous plant-based and animal-based food alternatives were suggested. The two alternative methods evaluated could serve as useful tools to drive individual and societal development towards more sustainable food production and consumption.

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Evaluation of a nutrient-rich food index score in the Netherlands

Journal of Nutritional Science ◽

10.1017/jns.2015.4 ◽

2015 ◽

Vol 4 ◽

Cited By ~ 12

Author(s):

Diewertje Sluik ◽

Martinette T. Streppel ◽

Linde van Lee ◽

Anouk Geelen ◽

Edith J. M. Feskens

Keyword(s):

Energy Density ◽

Saturated Fat ◽

Dietary Guidelines ◽

Dietary Quality ◽

Cereal Products ◽

Nutrient Density ◽

Rich Food ◽

The Individual ◽

Methodological Considerations ◽

Development And Validation

AbstractNutrient-rich food (NRF) index scores are dietary quality indices based on nutrient density. We studied the design aspects involved in the development and validation of NRF index scores, using the Dutch consumption data and guidelines as an example. We evaluated fifteen NRF index scores against the Dutch Healthy Diet Index (DHD-index), a measure of adherence to the Dutch dietary guidelines, and against energy density. The study population included 2106 adults from the Dutch National Food Consumption Survey 2007–2010. The index scores were composed of beneficial nutrients (protein, fibre, fatty acids, vitamins, minerals), nutrients to limit (saturated fat, sugar, Na) or a combination. Moreover, the influence of methodological decisions was studied, such as the choice of calculation basis (100 g or 100 kcal (418 kJ)). No large differences existed in the prediction of the DHD-index by the fifteen NRF index scores. The score that best predicted the DHD-index included nine beneficial nutrients and three nutrients to limit on a 100-kcal basis, the NRF9.3 with a model R2 of 0·34. The scores were quite robust with respect to sex, BMI and differences in calculation methods. The NRF index scores were correlated with energy density, but nutrient density better predicted the DHD-index than energy density. Consumption of vegetables, cereals and cereal products, and dairy products contributed most to the individual NRF9.3 scores. In conclusion, many methodological considerations underlie the development and evaluation of nutrient density models. These decisions may depend upon the purpose of the model, but should always be based upon scientific, objective and transparent criteria.

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Abstract P108: Metabolic Profile Of Diet Quality In The Multi-Ethnic Study Of Atherosclerosis

Circulation ◽

10.1161/circ.143.suppl_1.p108 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Meghana Gadgil ◽

Alexis F Wood ◽

Ibrahim Karaman ◽

Goncalo Gomes Da Graca ◽

Ioanna Tzoulaki ◽

...

Keyword(s):

Cardiovascular Disease ◽

Diet Quality ◽

Spectral Feature ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Elastic Net ◽

Dietary Quality ◽

Spectral Features ◽

Ethnic Study ◽

Diet Score

Introduction: Poor dietary quality is a well-known risk factor for diabetes and cardiovascular disease (CVD), however metabolites marking adherence to U.S. dietary guidelines are unknown. Our goal was to determine a pattern of metabolites associated with the Healthy Eating Index-2015 (HEI-2015). We hypothesize that there will be metabolites positively and negatively associated with the HEI-2015 score, including those previously linked to diabetes and CVD. Methods: Sample: 2269 adult men and women from the Multi-Ethnic Study of Atherosclerosis (MESA) longitudinal cohort study without known cardiovascular disease or diabetes. Data/specimens: Fasting serum specimens, diet and demographic questionnaires at baseline. Metabolomics: Untargeted 1 H NMR CPMG spectroscopy (600 MHz) annotated by internal and external reference data sets. Statistical analysis: Metabolome-wide association study (MWAS) using linear regression models specifying each spectral feature as the outcome in separate models, HEI-2015 score as the predictor, and adjustment for age, sex, race, and study site, accounting for multiple comparisons. Elastic net regularized regression was used to select an optimal subset of features associated with HEI-2015 score. Separately, hierarchical clustering defined discrete groups of correlated NMR features also tested for association with HEI-2015 score. Results: MWAS identified 1914 spectral features significantly associated with the HEI-2015 diet score. After elastic net regression, 35 metabolomic spectral features remained associated with HEI-2015 diet score. Cluster analysis identified seven clusters, three of which were significantly associated with HEI-2015 score after Bonferroni correction. (Table) Conclusions: Cholesterol moieties, proline betaine, proline/glutamate and fatty acyls chains were significantly associated with higher diet quality in the MESA cohort. Further analysis may clarify the link between dietary quality, metabolites, and pathogenesis of diabetes and CVD.

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Development of a Korean Diet Score (KDS) and its application assessing adherence to Korean healthy diet based on the Korean Food Guide Wheels

Nutrition Research and Practice ◽

10.4162/nrp.2013.7.1.49 ◽

2013 ◽

Vol 7 (1) ◽

pp. 49 ◽

Cited By ~ 10

Author(s):

Myoungsook Lee ◽

Soo Wan Chae ◽

Youn-Soo Cha ◽

Mi Sook Cho ◽

Hea Young Oh ◽

...

Keyword(s):

Healthy Diet ◽

Diet Score ◽

Korean Food

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Nutrition For The Healthy Child

10.2310/im.9013 ◽

2017 ◽

Author(s):

Meera Boghani ◽

Mollie Studley

Keyword(s):

Chronic Diseases ◽

Eating Habits ◽

Life Stage ◽

Failure To Thrive ◽

Dietary Guidelines ◽

Healthy Diet ◽

School Age Children ◽

Food Groups ◽

Energy Needs ◽

Physical Findings

Preschool and school-age children are children ages 3 to 6 and 7 to 12 years, respectively. This life stage is characterized by a period of slower growth velocity compared with infancy, which precedes it, and adolescence, which follows it. During the early school years, children continue to develop and refine feeding skills, expand their food choices, and learn to eat a variety of flavors and textures. Parents and other caregivers control the type of foods and the environment in which the foods are presented, often influencing eating habits and behaviors later in life. A healthy diet is needed not only to maximize the child’s growth but also to prevent chronic diseases, such as type 2 diabetes, hypertension, and obesity. When assessing a child’s nutrition, emphasis should be placed on not just weight and body mass index but also assessing intake of macro- and micronutrients from foods. A healthy diet should include a variety of food groups, with emphasis on whole foods over processed foods. Recently developed tools such as MyPlate and the Dietary Guidelines help American families move toward a healthful diet to help minimize the risk of chronic diseases. This review contains 3 figures, 7 tables and 78 references Key words: childhood obesity, developmental disability, energy needs of children, evaluation of growth charts, failure to thrive, food allergy, nutrition-focused physical findings, nutritional status, SoFAS

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Abstract 52: Plasma Metabolomic Signatures of the American Heart Association Diet Score: Findings From the Boston Puerto Rican Health Study

Circulation ◽

10.1161/circ.141.suppl_1.52 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Cited By ~ 1

Author(s):

Danielle E Haslam ◽

Jun Li ◽

Liming Liang ◽

Clary Clish ◽

Alice H Lichtenstein ◽

...

Keyword(s):

Risk Factors ◽

Puerto Rican ◽

American Heart Association ◽

Cardiometabolic Risk ◽

American Heart ◽

Metabolic Response ◽

Heart Association ◽

Dietary Guidelines ◽

Health Study ◽

Diet Score

Introduction: Puerto Rican adults living on the US mainland tend to have poor quality diets and adverse cardiometabolic risk. Plasma metabolomic signatures reflect dietary intakes and variability in metabolic response to diet. Hypothesis: A plasma metabolomic signature reflecting adherence to the American Heart Association (AHA) dietary guidelines will be associated with cardiometabolic risk. Methods: We used LC/MS to measure plasma metabolites (>700) among Boston Puerto Rican Health Study participants, aged 45-75 years, without (n=252) and with (n=254) type 2 diabetes (T2D). We calculated a modified version of a previously validated AHA diet score (AHA-DS), which included variety and amounts of fruits/vegetables, whole grains, fish, saturated fat, trans fat, sodium, and added sugars. We used elastic net regression to identify a metabolomic signature that associated with higher adherence to the AHA-DS among those without T2D (training set) and replicated the associations among those with T2D (testing set). A metabolomic score was calculated as the weighted sum of the diet associated metabolites. We used general linear models to determine the cross-sectional associations between the AHA-DS, metabolomic score, and cardiometabolic risk factors. Results: A diet-associated metabolomic signature with 58 metabolites, primarily lipids and amino acids, was identified. This metabolomic score correlated moderately with the AHA-DS among those with and without T2D (r=0.42-0.46, P <5.7x10 -12 ). In all participants (n=506), the metabolomic score, but not the AHA-DS, was significantly associated with higher HDL-C and LDL-C concentrations, and lower waist circumference ( P <0.004; Table 1). No associations were observed for triglyceride concentrations, glycemia measures, or blood pressure. Conclusions: In individuals of Puerto Rican descent, we identified a metabolomic signature that reflected adherence and metabolic response to the AHA dietary guidelines and that associated with cardiometabolic risk factors.

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Defining Diet Quality: A Review of Diet Metrics as Applied to the Double Burden of Malnutrition (OR17-01-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.or17-01-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Victoria Miller ◽

Patrick Webb ◽

Renata Micha ◽

Dariush Mozaffarian

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Fruits And Vegetables ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Healthy Diet ◽

Food Groups ◽

Policy Action ◽

Double Burden ◽

Meta Analyses

Abstract Objectives Meeting most of the UN Sustainable Development Goals (SGDs) will require a strong focus on tackling all forms of malnutrition─ addressing maternal and child health (MCH) as well as diet-related non-communicable diseases (NCDs). Yet, the optimal metrics to define a healthy diet remain unclear. Our aim was to comprehensively review diet metrics and assess the evidence on each metric's association with MCH and NCDs. Methods Using comprehensive searches and expert discussions, we identified metrics that i) are used in ≥3 countries to link diet to health, ii) quantify the number of foods/food groups consumed and/or iii) quantify recommended nutrient intakes. We reviewed and summarized each metric's development, components and scoring. For each identified metric, we systematically searched PubMed to identify meta-analyses or narrative reviews evaluating these metrics with nutrient adequacy and health outcomes. We assessed validity by grading the number of studies included and the consistency of the diet metric-disease relationship. Results We identified 6 MCH, 13 NCD and 0 MCH/NCD metrics. Most were developed for describing adherence to dietary guidelines or patterns, and others were developed for predicting micronutrient adequacy. On average, the metrics included 14 food groups/nutrients (range 4–45), with 10 food-group only metrics and 0 nutrient-only metrics. The most frequent metric components were grains/roots/tubers, fruits and vegetables. We identified 16 meta-analyses and 14 narrative reviews representing 102 metric-disease relationships (98 metric-NCD and 4 metric-MCH relationships, respectively). We found 5 metrics that have been consistently validated in meta-analyses and narrative reviews for NCDs, 1 metric with limited evidence for MCH, but 0 metrics for both. Of the metrics, the Alternative Healthy Eating Index (aHEI), Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI), and Mediterranean Diet Score (MED) were most commonly validated, especially for all-cause mortality and cardiovascular disease (Figure 1). Conclusions Few diet metrics have been used in multiple countries to define a healthy diet. This suggests a serious gap in global analyses of diet quality relating to malnutrition in all its forms, which hinders effective policy action. Funding Sources Gates Foundation. Supporting Tables, Images and/or Graphs

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