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Nutrition Guidance: What's Novel, What's NuVal

My career is devoted to the use of lifestyle practices -- and above all, diet and physical activity -- to the promotion of health and the prevention of disease. Feet and forks, along with fingers that do or don't hold cigarettes, are well established as the master levers of medical destiny.
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• The overall nutritional quality index (ONQI™) used in the NuVal™ nutritional guidance system was developed by an international team of leading nutrition and public health experts with no personal incentive.

• The project was funded solely by a not-for-profit, Yale-affiliated community hospital that owns the algorithm, permanently.

• The ONQI is entirely and permanently free of any food industry or political influence.

• The ONQI is the one and only nutritional profiling system shown to correlate directly with health outcomes, including all-cause mortality.

• The use of NuVal in real-world settings has resulted in a wide array of stunning health benefits reported, including, in a number of instances, the loss of over 100 lbs. Such results are, of course, merely anecdotal-- unless they happen to you or your family. Then they are a fact.

OK, I'm glad I got that off my chest; I'm beginning to feel better.

NuVal is the public face of the nutrition profiling algorithm I helped build, the Overall Nutritional Quality Index. If it isn't quite my life's work, it is a whopping big chunk. Or, to use my favorite metaphor, if my life's work is a levee to contain and turn a floodtide of obesigenic and morbidigenic factors, NuVal is the best and biggest sandbag I've been able to contribute to it. Hefting it into its current position has required years of arduous effort.

My career is devoted to the use of lifestyle practices -- and above all, diet and physical activity -- to the promotion of health and the prevention of disease. Feet and forks, along with fingers that do or don't hold cigarettes, are well established as the master levers of medical destiny, and I want to do all I can to empower people to put them to the best possible use in the service of adding years to life, and life to years. Feet, forks, and fingers put to good use can turn the tide of obesity and chronic disease as nothing else can.

To that end, NuVal is my greatest effort by any reasonable metric. It was developed with an illustrious dream team of colleagues. It was developed with an impressive allocation of resources. It has met the high standards its purposes required. It has conferred dramatic benefits where the rubber hits the road. And it is now reaching, by various means -- most prominently, its placement in nearly 1,700 supermarkets nationwide, but increasingly in other settings such as hospitals and schools -- over 30 million people.

It's timely to make a few public comments about NuVal and the ONQI that powers it, in part because an article recently appeared in the Journal of the Academy of Nutrition and Dietetics contending that another such algorithm was "novel" because it now included weighting coefficients for nutrient entries, rather than treating them as if all nutrients had comparable effects on health; because it accounted for the health benefits of unsaturated fat; and because it was correlated with total diet quality.

What's most interesting about the contentions made in that paper is that even as the authors repeatedly use words such as "novel" and "unique" to describe their efforts, the article -- which includes three citations to the ONQI/NuVal in a total bibliography of 23 references -- acknowledges in every such instance that the ONQI does it, too. And the ONQI did it first, since it was completed in 2007. So, apparently, "novel" in this context both sounds, and means, a lot like NuVal. The paper, in other words, seems to conflate what's "new" with what's... NuVal.

The article also suggests that the "weighted nutrient density score" it describes is an advance because it correlates more highly with a measure of diet quality, the Healthy Eating Index (HEI), than other such formulas do -- including both its own immediate predecessor, the Nutrient Rich Foods Index, and NuVal. But there's a problem with this assertion.

The only reason we care about nutrition at all is because it accounts for variations in health. It is the variations in health that truly matter.

The HEI was established as a measure of diet quality because, in principle, variation in the HEI score correlates with variation in important health outcomes -- including such chronic diseases as diabetes, heart disease, cancer and stroke, along with all-cause mortality. But, in fact, the HEI correlates only poorly with such outcomes. There are other metrics that do so better.

NuVal is, so far as I or any of my colleagues know, the only nutritional guidance system on the planet thus far shown to correlate directly with the health outcomes that matter most. In a Harvard study with diet and health data from over 100,000 people followed for two decades, NuVal scores correlated with overall rates of chronic disease, body mass index, and death from any cause -- and did so more strongly than the HEI. The higher the average NuVal score of foods consumed, the lower the rate of dying prematurely from any cause. The studies we know about that have tested other nutrient profiling systems in a similar way have had negative outcomes.

So it's quite misleading to imply a system has advantages over NuVal because it correlates better with the HEI than NuVal does, since NuVal corresponds with health outcomes better than the HEI. It's like claiming my arrow is better than your arrow because it's nearer to the chief's arrow -- even though your arrow hit the bull's eye, and the chief and I both missed the target. The bull's eye is better, and insinuations to the contrary are bull... well, you know.

Defending NuVal this way feels to me like answering the "so, when did you stop beating your wife?" question. NuVal shouldn't need defending, any more than this question should need an answer from those who would never dream of what it alleges.

But there are, it seems, entities with reasons to hate NuVal:

  • Those who make, sell, or market junk food and like to get away with putting lipstick on their pigs don't much care for a system that puts the unvarnished truth on at-a-glance display.

  • Those with adamant opinions about nutrition, whether or not they are based on any meaningful evidence, don't like seeing those convictions challenged.
  • Those who feel they already provide all the nutrition guidance anyone should need, notably the federal authorities with skin in this game.
  • With regard to those selling food, it's really not for the fox to judge the suitability of the henhouse guard. The fox, in fact, will be unhappiest when the henhouse is best guarded. The more those peddling junk food fuss about NuVal, the more indication it is that the system works just as intended.

    For those with strong opinions about nutrition that diverge from NuVal scores, they are as at liberty to follow where they lead as are those with different opinions about how to get there from here than their GPS. GPS shows you what's what, it doesn't tell you what to do. NuVal is GPS for nutrition, and is intended for use when you want guidance -- not when you don't.

    As for the federal authorities involved in nutrition guidance, the ONQI was actually built for their use. Before ever a business was established, the algorithm was offered to scientists in the federal government. Only because they were unready to put it to use did a private sector effort get launched. That said, there is substantial evidence that most shoppers cannot reliably interpret nutrition fact panels and ingredients lists, and no evidence that such information has ever translated directly into improved health, or weight loss. It's good information, but it needs to be put together in a way that informs efficient choices, and that's just what NuVal does. NuVal works like this: On a scale from 1 to 100, the higher the number, the more nutritious the food.

    I realize, of course, that it can look like bias for the guy who led the development of a system to conclude it is the best. But the situation is the other way around entirely. The illustrious figures in nutrition and public health who joined with me to build the ONQI did so exclusively to build the best and most impartial system possible. Concluding NuVal is so is not an assessment at the end -- it was the mission from the beginning. The evidence we've gathered along the way corroborates our faithfulness to that mission.

    The ONQI is not perfect, of course, any more than an iPhone or iPad is perfect. It's just the best we can do, until we can do better. Improvements are in the works, even now -- based on lessons learned scoring 100,000 foods -- just as improvements are always in the works for iPhones and iPads. But as of right now, the ONQI is objectively the closest arrow to the bull's eye.

    So apply an attentive eye to all you read, keep in mind which end of the bull you're dealing with, and consider that just a couple of letters stand between "novel" and... NuVal.


    Disclosure: Dr. David Katz is Chief Science Officer for NuVal and the principal inventor of the ONQI.

    For more by David Katz, M.D., click here.

    For more on diet and nutrition, click here.

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