Perspective: Why Whole Grains Should Be Incorporated into Nutrient-Profile Models to Better Capture Nutrient Density

Drewnowski, Adam; McKeown, Nicola M.; Kissock, Katrina R; Beck, Eleanor; Mejborn, Heddie; Vieux, Florent; Smith, Jessica; Gabriel, Miroslav; Seal, Chris

doi:10.1093/advances/nmaa172

Cited by 24 publications

(29 citation statements)

References 55 publications

(66 reference statements)

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“…Research has demonstrated that the health star rating system is inadequate in highlighting whole grain food choices to consumers, with less than a star separating the higher quality whole grain products from refined varieties across several food categories including bread, rice, noodles, flour, breakfast cereal, and muesli bars [47]. Others have raised similar concerns regarding the Nutri-score and Nutrient Rich Food Index [48]. Currently there are six front-of-pack tools incorporating whole grains-the Singapore Healthier Choices logo, the Keyhole (in Sweden, Denmark and Norway), the Weqaya logo (in the United Arab Emirates), the Healthy Living Guarantee (Croatia), the Healthier Choice Logo (in Malaysia), and the Healthier Choice Symbol (in Brunei) [49], proving that the addition of whole grain content to the algorithm used in the various scoring tools is not impossible.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults

Abdullah

Hughes²,

Grafenauer

2021

Nutrients

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Many dietary guidelines emphasise “mostly” whole grain food choices as part of an overall healthy eating pattern based on evidence for enhancing nutritional status and reducing chronic disease. Still, countries including Australia fall short of their consumption targets. Furthermore, healthcare cost savings associated with increasing the consumption of whole grains in alignment with the Daily Target Intake (DTI) recommendation of 48 g are unknown. The aim of this study was to assess the potential savings in costs of healthcare and lost productivity associated with a reduction in the incidence of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD) through meeting the 48 g DTI recommendation for whole grains among the Australian adult population (>20 years). A three-step cost-of-illness analysis was conducted using input parameters from: 1) estimates of proportions of consumers (5%, 15%, 50%, and 100%) who would increase their current intake of whole grains to meet the recommended DTI in Australia; 2) relative reductions in risk of T2DM and CVD associated with specific whole grain consumption, as reported in meta-analysis studies; and 3) data on costs of healthcare and productivity loss based on monetary figures by national healthcare authorities. A very pessimistic (5% of the population) through to universal (100% of the population) adoption of the recommended DTI was shown to potentially yield AUD 37.5 (95% CI 22.3–49.3) to AUD 750.7 (95% CI 445.7–985.2) million, and AUD 35.9 (95% CI 8.3–60.7) to AUD 717.4 (95% CI 165.5–1214.1) million in savings on annual healthcare and lost productivity costs for T2DM and CVD, respectively. Given such economic benefits of the recommended consumption of whole grains, in exchange for refined grains, there is a real opportunity to facilitate relevant socioeconomic cost-savings for Australia and reductions in disease. These results are suggestive of a much greater opportunity to communicate the need for dietary change at all levels, but particularly through food-based dietary guidelines and front-of-pack labelling initiatives.

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Section: Discussionmentioning

confidence: 99%

Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults

Abdullah

Hughes²,

Grafenauer

2021

Nutrients

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“…The new hybrid NRFh models need to be compared to the established ones [9,10] and also tested in relation to the foods' energy density, defined as kcal/100 g. In past studies [11,12], the preference was for those profiling algorithms that showed low correlations between nutrient density scores and energy density of foods. Those NP models that score calories, total sugar, and saturated fat tend to capture the foods' energy density as opposed to their nutrient content [13][14][15]. Second, it is important to ensure that nutrient density scores generated by NP models are not correlated too highly with food prices, also expressed per 100 kcal of food [11,16].…”

Section: Introductionmentioning

confidence: 99%

“…The inclusion of food groups in nutrient profiling will help align nutrient density metrics with the current dietary guidelines, both in the US and elsewhere [7,8]. One example is provided by whole grains [13]. Included as a key component of dietary guidelines worldwide [1- 3,13], whole grains are not a part of most nutrient density metrics.…”

Section: Introductionmentioning

confidence: 99%

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The New Hybrid Nutrient Density Score NRFh 4:3:3 Tested in Relation to Affordable Nutrient Density and Healthy Eating Index 2015: Analyses of NHANES Data 2013–16

Drewnowski

Smith

Fulgoni³

2021

Nutrients

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Background: Hybrid nutrient density scores are based on both nutrients and selected food groups. Objective: To compare the new hybrid nutrient-rich food NRFh 4:3:3 score to other nutrient-rich food (NRF) scores, energy density, and energy cost and to model the impact on the Healthy Eating Index (HEI-2015) of partially replacing less nutrient-rich with more nutrient-rich foods. Methods: Analyses were based on 5870 foods and beverages in the Food and Nutrient Database for Dietary Studies and on 24 h dietary recalls from the National Health and Nutrition Examination Survey (NHANES 2013–16). The NRFh 4:3:3 model was based on four nutrients to encourage (protein fiber, potassium, MUFA + PUFA); three food groups to encourage (dairy, fruit, whole grains); and three nutrients to limit (saturated fat, added sugar, sodium). Ratings generated by NRFh 4:3:3 and by other NRF models were correlated with score components, energy density (kcal/100 g), and energy cost (USD/100 kcal). The impact on HEI-2015 of replacing foods in the lowest nutrient density tertile (T1) with top tertile (T3) foods at 10%, 20%, 30%, and 100% equicaloric replacement was modeled using NHANES 2013–16 dietary data by population subgroups. Results: The NRFh 4:3:3 model awarded higher scores to foods containing dairy, fruit, and whole grains and proportionately lower scores to vegetables when compared to the NRF 9.3 model. Higher NRF and NRFh nutrient density scores were linked to lower energy density and higher energy cost; however, both correlations were lower for the NRFh 4:3:3. Isocaloric replacement of bottom tertile with top tertile foods as rated by both models led to significantly higher HEI-2105 values, based on complete (100%) and on partial (10–30%) replacement. Conclusion: The new NRFh 4:3:3 model provides the basis for developing new metrics of affordable nutrient density. The model identified “best value” food categories that were both affordable and nutrient-rich. Total and partial replacement of low nutrient density with high nutrient density foods was associated with higher HEI-2015 scores, suggesting that even partial inclusion of more nutrient dense foods in the diet may have an important impact on total diet quality.

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“…Plant-based diets can improve inflammation, obesity, and microbiota because of their higher contents of polyphenols. Modern nutritional national guidelines underline the importance of vegetable foods, particularly in their unprocessed status [ 154 , 155 ].…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Diet-Derived Antioxidants and Their Role in Inflammation, Obesity and Gut Microbiota Modulation

et al. 2021

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It is generally accepted that gut microbiota, inflammation and obesity are linked to the development of cardiovascular diseases and other chronic/non-communicable pathological conditions, including cancer, neurodegenerative diseases and ageing-related disorders. In this scenario, oxidative stress plays a pivotal role. Evidence suggests that the global dietary patterns may represent a tool in counteracting oxidative stress, thus preventing the onset of diseases related to oxidative stress. More specifically, dietary patterns based on the regular consumption of fruits and vegetables (i.e., Mediterranean diet) have been licensed by various national nutritional guidelines in many countries for their health-promoting effects. Such patterns, indeed, result in being rich in specific components, such as fiber, minerals, vitamins and antioxidants, whose beneficial effects on human health have been widely reported. This suggests a potential nutraceutical power of specific dietary components. In this manuscript, we summarize the most relevant evidence reporting the impact of dietary antioxidants on gut microbiota composition, inflammation and obesity, and we underline that antioxidants are implicated in a complex interplay between gut microbiota, inflammation and obesity, thus suggesting their possible role in the development and modulation of chronic diseases related to oxidative stress and in the maintenance of wellness. Do all roads lead to Rome?

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Perspective: Why Whole Grains Should Be Incorporated into Nutrient-Profile Models to Better Capture Nutrient Density

Cited by 24 publications

References 55 publications

Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults

Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults

The New Hybrid Nutrient Density Score NRFh 4:3:3 Tested in Relation to Affordable Nutrient Density and Healthy Eating Index 2015: Analyses of NHANES Data 2013–16

Diet-Derived Antioxidants and Their Role in Inflammation, Obesity and Gut Microbiota Modulation

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