Balanced Hybrid Nutrient Density Score Compared to Nutri-Score and Health Star Rating Using Receiver Operating Characteristic Curve Analyses

Abstract

BackgroundNutrient profiling (NP) models that are used to assess the nutrient density of foods can be based on a combination of key nutrients and desirable food groups.ObjectiveTo compare the diagnostic accuracy of a new balanced hybrid nutrient density score (bHNDS) to Nutri-Score and Health Star Rating (HSR) front-of-pack systems using receiver operating characteristic (ROC) curve analyses. The diet-level bHNDS was first validated against Healthy Eating Index (HEI-2015) using data from the 2017–18 National Health and Nutrition Examination Survey (2017–18 NHANES). Food-level bHNDS values were then compared to both the Nutri-Score and HSR using ROC curve analyses.ResultsThe bHNDS was based on 6 nutrients to encourage (protein, fiber, calcium, iron, potassium, and vitamin D); 5 food groups to encourage (whole grains, nuts and seeds, dairy, vegetables, and fruit), and 3 nutrients (saturated fat, added sugar, and sodium) to limit. The algorithm balanced components to encourage against those to limit. Diet-level bHNDS values correlated well with HEI-2015 (r = 0.67; p < 0.001). Food-level correlations with both Nutri-Score (r = 0.60) and with HSR (r = 0.58) were significant (both p < 0.001). ROC estimates of the Area Under the Curve (AUC) showed high agreement between bHNDS values and optimal Nutri-Score and HSR ratings (>0.90 in most cases). ROC analysis identified those bHNDS cut-off points that were predictive of A-grade Nutri-Score or 5-star HSR. Those cut-off points were highly category-specific.ConclusionThe new bHNDS model showed high agreement with two front-of-pack labeling systems. Cross-model comparisons based on ROC curve analyses are the first step toward harmonization of proliferating NP methods that aim to “diagnose” high nutrient-density foods.

“Some are healthy and others not”: Characterization of vended food products by Accra-based food retailers

“…In their descriptions, they mentioned terms like “balanced diet” and “diversity,” or referred to the nutrient profile that a healthy food should have. Currently, some of the science-based models for classifying food as healthy or unhealthy are nutrient-based ( 32 , 33 ), food-based ( 34 ), or based on the level of processing ( 35 ).…”

Perspective: Seeing the Forest Through the Trees: The Importance of Food Matrix in Diet Quality and Human Health

“…The need for nuance in nutrition strategies aimed at improving public health is apparent when considering nutrient profiling schemes [ 14 ], and FOP labeling fails to capture food-matrix effects on human health. The food matrix refers to not only the chemical and physical components of food but also their molecular relationships that affect how food is digested and metabolized [ 15 ].…”

A three-component Breakfast Quality Score (BQS) to evaluate the nutrient density of breakfast meals

“…We also explored the effects of assigning differential weights to the eLIMf, PF, and VMn sub-scores on the total score. This was done because the weighting of the sub-scores affects the final evaluation ( 23 ). Although some NP models are driven by negative elements, energy, sugar, and fat, others are weighted to favor protein, fiber, vitamins, and minerals.…”