Aligning nutrient profiling with dietary guidelines: modifying the Nutri-Score algorithm to include whole grains

Katrina R Kissock,Jessica Smith,Nicola M Mckeown,Eleanor J Beck,Gabriel Masset,Florent Vieux,Adam Drewnowski,Kevin C Mathias,Chris J Seal,Heddie Mejborn

doi:10.1007/s00394-021-02718-6

Abstract

PurposeWhole grains, generally recognised as healthy choices, are not included in most nutrient profiling systems. We tested modifications to the Nutri-Score algorithm to determine whether including whole grains would provide an improved measure of food, and overall diet quality.MethodsThe whole-grain content of food, with a minimum cut-point of 25%, was added to the algorithm, following similar methods used to score other health-promoting components such as fibre. We applied and compared the original and the modified Nutri-Score to food composition and dietary intake data from Australia, France, the United Kingdom, and the United States.ResultsAt the food level, correlations between whole-grain content and food nutritional score were strengthened using the modified algorithm in Australian data, but less so for the other countries. Improvements were greater in grain-specific food groups. The largest shift in Nutri-Score class was from B to A (best score). At the dietary intake level, whole-diet nutritional scores for individuals were calculated and compared against population-specific diet-quality scores. With modifications, correlations with diet-quality scores were improved slightly, suggesting that the modified score better aligns with national dietary guidelines. An inverse linear relationship between whole-diet nutritional score and whole-grain intake was evident, particularly with modifications (lower whole-diet nutritional score indicative of better diet quality).ConclusionIncluding a whole-grain component in the Nutri-Score algorithm is justified to align with dietary guidelines and better reflect whole grain as a contributor to improved dietary quality. Further research is required to test alternative algorithms and potentially other nutrient profiling systems.

Highlights

Poor quality diets are associated with a higher risk of noncommunicable diseases and mortality [1]
This study shows the feasibility of modifying the NutriScore Nutrient profiling (NP) algorithm with the addition of whole grain as a beneficial component, to better align with dietary guidelines recommending increased whole-grain intake
A potential argument against inclusion of whole grain in NP algorithms that do not include this food component is that cereal fibre is already captured by dietary fibre scoring in existing systems, and cereal fibre is suggested to be a key attribute to health benefits observed with higher whole-grain intakes

Summary

Introduction

Poor quality diets are associated with a higher risk of noncommunicable diseases and mortality [1]. The Global Burden of Disease study estimated that diets low in whole grains and fruit and high in sodium accounted for more than half of diet-related deaths in 2017, and that the lack of whole grains in the diet may be the primary dietary contributor to cardiovascular mortality and disability-adjusted life years (DALYs) [1]. In an effort to promote positive dietary habits, dietary guidelines across the globe provide advice on consuming more whole grains, fruit, vegetables, and legumes and limiting sodium, added sugars, and saturated fat [2]. Dietary guidelines have encouraged the intake of whole grains, either as quantified recommendations [5, 6], or generically linked to choices within a food group [7,8,9]. Despite well-documented benefits and recommendations, whole-grain consumption remains low in most countries [10,11,12,13,14,15]

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