Nuval: My New Year Wishes For Nutrition

The typical American diet was badly broken, and needed fixing. The need for such a Nutrition Guidance System for the food supply was clear.
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Here's hoping that 2011 will be a very good year for NuVal!

I say this not because I am involved with NuVaI, but I hasten to confess right away that I am. I am the principal inventor of the Overall Nutritional Quality Index (ONQI) algorithm used in the NuVal nutritional guidance system, and the chief science officer for NuVal, LLC. As such, I might be expected to have a pro-NuVal bias. If so inclined, by all means read on with that in mind -- some skepticism is fine. Although as I will indicate at the end, pro-NuVal bias isn't at all what this is about.

I am hoping 2011 is a great year for NuVal because I am involved in public health, and a good year for NuVal would likely mean a good year, and would certainly be a very good portent for public health. This, in turn, is because of what NuVal does, and what it could do if it were at everyone's fingertips.

NuVal, as you may know, is a nutritional guidance system. Based on the work of an international team of experts, it uses the sophisticated ONQI algorithm to factor in a wide array of nutrient properties, and their associations with specific health outcomes, to generate a single, summative score for overall nutritional quality on a scale from 1 to 100. The higher the number, the more nutritious the food. The scores go on supermarket shelf tags, right where the prices are posted, and are currently on display in nearly 1,000 supermarkets around the U.S. The system has fairly obvious online applications as well, some already available to select populations, others due to launch this year.

Third, we know that the modern food supply with tens of thousands of packaged foods, most sporting some claim about nutrition and health, is overwhelming for the average consumer -- and, frankly, even the above-average-consumer -- who consequently winds up lost and confused.

Fourth, we know that advice to avoid the challenges of packaged foods by just eating more vegetables and fruits -- while good advice -- has gone over like the proverbial lead balloon, and failed to make any difference over a span of decades.

If more healthful eating is the destination, NuVal is the GPS. It is a powerful tool to help improve the typical American diet I know. It is the most important effort of my career.

There are a lot of things a "GPS for the food supply" ought to do -- and all of them, NuVal does.

A nutritional guidance system of this kind should have the backing of a prestigious group of nutrition and public health scientists. NuVal's team was developed by an international team of top experts I was privileged to convene.

A system such as this should score all foods in the food supply. Some 80,000 foods, each matched to a UPC/bar code, have been scored to date, and more are being scored daily. To the best of our knowledge, our operation has developed the world's largest, most detailed, and most current nutrition database.

A system such as this should include all relevant nutrients and actually be able to make use of them. NuVal scores factor in a wide variety of vitamins, minerals, fat quality and quantity, protein quality and quantity, glycemic load, antioxidants, energy density, trans fat, omega-3 fat, added sugar, sodium and more. Every nutrient is weighted based on its specific associations with specific health conditions. A distinction is made between naturally occurring nutrients, and those added through fortification. I have noticed that some other systems make claims about incorporating a wide array of nutrients, but if you read the fine print, you find they can only apply these nutrients when they are readily available.

While very useful, the USDA Nutrient Database for Standard Reference provides nutrient details mostly for commodity products, and cannot be used to compare all of the branded products within any given category of packaged foods. Consequently, systems other than NuVal that claim to address this level of nutrient detail are in reality limited to a very small portion of the food supply, and specifically that portion where guidance is least needed, such as the produce aisle. A true "GPS for the food supply" should have access to all of the nutrient detail needed to generate a reliable score for every branded product.

A system providing nutrition guidance should maintain full independence from all entities involved in selling food. The funding to develop the ONQI algorithm was provided by Griffin Hospital, a not-for-profit, Yale-affiliated community hospital. Griffin Hospital owns the ONQI algorithm, and it is maintained with complete independence from the business of NuVal. The algorithm was built by public health scientists to assist consumers, and by no one else and for no other reason. It is maintained in just this way, in perpetuity. This is what a good nutrition guidance system should do.

A nutrition guidance system, like NuVal, should allow for the comparison of any food to any other. While an apple is a fruit, and carrots are vegetables, both are also potential snacks in a child's lunch, and as such, should be comparable to other snack items on the same scale. Some other systems actually use a different algorithm for every food category, so two items in different aisles of the supermarket will get the same high score with no basis to compare the two. A good GPS system puts all the routes on the same map, and uses the same criteria applied to each to point out the best directions. For the foodscape, rather than the landscape, this is what NuVal does. (Some comparisons are silly, of course, so just because you can compare any food to any other doesn't mean you should; I don't think a comparison of hot dogs to salad dressing would be very informative, for instance.)

A system such as this should keep pace with changes in nutrition science. An independent scientific advisory board is currently reviewing the latest nutrition science, and the imminent 2010 dietary guidelines, as work on version 2.0 of the ONQI algorithm begins.

A system such as this should influence selections at point of purchase. Preliminary data we hope to publish this year suggest the system works just as intended, encouraging people to trade up to higher scoring items within a given category. No one is swapping out steak for sprouts, but people are moving up to better breads, better cereals, better yogurts,and so on. A point-of-purchase GPS for the food supply should empower people to improve their diets one well-informed choice at a time.

A system such as this should correlate with actual health outcomes. A Harvard study, currently in press for publication in April, examined NuVal scores for all foods consumed by over 100,000 men and women and health outcomes over a 20-year span. The higher the average scores of the foods eaten, the lower the risk of dying prematurely from any cause; the lower the risk of cardiovascular disease; the lower the risk of diabetes; and the lower the BMI. To our knowledge, no other nutrition guidance system on the planet has cleared this bar, and we certainly know of some that have fallen over (i.e., they did not correlate with health outcomes). For a nutrition guidance system to be useful, it should meaningfully correlate with the health outcomes we truly care about.

A system such as this should apply everywhere and every way people and food come together. This year, it is moving into both schools and hospitals. Recipe scoring has begun. Ultimately, the same nutrition guidance could be universal. A truly robust nutrition GPS should have the potential to be as big as the foodscape.

A system such as this should tell you when a food contains trans fat, even though FDA rules allow manufacturers to round down to 0 whenever there is less than 0.5 grams per serving (this is why some products have "0 grams trans fat!" on the front of pack, but still have "partially hydrogenated oil" in the ingredient list). The nutrient database used by NuVal includes actual trans fat values, and does not round them down and let them disappear.

A system such as this should indicate whether the front-of-pack claims about "added this" or "reduced that" actually mean better overall nutrition. One of the more notorious examples? Regular peanut butter scores a 20; fat reduced scores a much worse 7! Why? The fat reduced peanut butter has a bit less healthful fat, half as much fiber, and a lot more sugar and salt. And it costs more, too! In the vast NuVal database, there are innumerable examples of foods with packages highlighting a nutrient change that suggests better nutrition (e.g., fat reduced, salt reduced, sugar reduced, vitamin fortified, etc.), with lower scores for overall nutrition rather than higher, due to all of the other changes in the product the front of the package fails to mention!

I could keep going like this, but you get the idea. NuVal isn't perfect, but we're working to make the improvements. All breakthrough technologies can be improved over time.

I am involved with NuVal, so I might have a pro-NuVal bias. But here's why that isn't at all what this is about:

That actually puts the horse behind the cart. The only reason I became involved in the effort that turned into NuVal in the first place is because I am involved in public health. Because something -- the typical American diet- was badly broken, and needed fixing. The need for such a GPS for the food supply was clear. Improving health by improving diets is in large measure what my career, and life, are all about. I do not have any convictions about NuVal because I helped create it rather, I helped create a system that responded to all of my convictions about diet and health. Had I not wound up with a system I could support with full enthusiasm, it would mean the mission had failed.

The mission did not fail. So again, here's to a good 2011 for NuVal. Not for NuVal's sake, but for the sake of public health. Not because of what NuVal is to me or I to NuVal, but because of what it could be to your family, and every other. Because of what NuVal does.

Dr. David L. Katz

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