Nutrient Rich Foods Index Research Articles

Dietary Greenhouse Gas Emissions and Diet Quality in a Cross-Sectional Study of Swedish Adolescents

BackgroundInterventions to improve dietary intake and reduce dietary greenhouse gas emissions (dGHGE) are urgently needed. Adolescence presents a unique time in life to promote sustainable diets. Detailed dietary data are needed to inform public health strategies aiming at improving adolescents’ diet quality and reducing dGHGE. ObjectiveThis study aimed to describe dGHGE in Swedish adolescents’ diets by socio-demographic characteristics, evaluate how food groups contribute to dGHGE, and examine dGHGE in relation to diet quality. MethodsData come from the national, school-based, cross-sectional dietary survey Riksmaten Adolescents 2016-17 of 3099 females and males attending school grades 5 (11–12 y old), 8 (14–15 y old) and 11 (17–18 y old). Participants completed 2 web-based 24-h recalls and questionnaires on lifestyle factors. dGHGE was estimated based on life cycle assessment data. Diet quality was estimated using NRF11.3 (Nutrient Rich Food Index) and SHEIA15 (Swedish Healthy Eating Index for Adolescents 2015). ResultsdGHGE were higher in males than females (medians 4.2 versus 3.8 kg CO2e/10 MJ, P < 0.001). In females, dGHGE were highest in grade 5 (4.0 kg CO2e/10MJ), whereas in males, emissions were highest in grade 11 (4.4 kg CO2e/10MJ), P < 0.001 for the sex/grade interaction. Overweight/obesity was positively associated with CO2e/10MJ, but parental education, birthplace, and degree of urbanization were not. In females, the proportion of dGHGE from animal-based foods was lowest in grade 11, whereas the proportions from plant-based foods and sweet foods/beverages were highest. In males, these proportions were similar across grades. NRF11.3 was not associated with CO2e/10MJ, whereas healthier eating, according to SHEIA15, was inversely associated with CO2e/10MJ. ConclusionsFood choices and dGHGE per calorie differ by sex in adolescents. Thus, intervention strategies to improve dietary sustainability need to be tailored differently to females and males. Diet quality should also be considered when promoting reduced GHGE diets.

Breakfast Consumption and Quality of Macro- and Micronutrient Intake in Indonesia: A Study from the Indonesian Food Barometer.

Breakfast is an important meal that has been shown to have a positive effect on health. The current study aimed to assess the patterns of breakfast consumption among adult Indonesians and to estimate the contribution of breakfast to their nutrient intake and dietary quality. The study used 24-h recall data from the 2018 Indonesian Food Barometer study to assess breakfast intake among 1333 adults aged 18 and above from six provinces in Indonesia. Diet quality was measured using the Nutrient Rich Food index (NRF) 9.3, and the nutritional profile of breakfast was compared across tertiles of NRF 9.3. In total, 5.2% of adults in Indonesia skipped breakfast. Breakfast contributed 26% to daily energy intakes and 22-28% to intakes of all reported nutrients, except for total sugar (12%), vitamin C (8%) and vitamin D (7%). With respect to daily requirements, breakfast contributed approximately 20% to energy, protein, fat and sodium requirements, 26% to saturated fat but <15% to the requirements for most micronutrients and only 5% for fiber. Among breakfast consumers, a higher NRF score was associated with higher daily intakes of protein, dietary fiber and micronutrients and lower intakes of sodium from breakfast. This study suggests that a balanced breakfast in Indonesia should aim to lower fat and saturated fat intake while increasing fiber, potassium, calcium and vitamin C and D intake. These findings could inform the development of nutrient-based guidelines for breakfast consumption in Indonesia.

#4456 HEALTHY PLANT-BASED DIET IN CHRONIC KIDNEY DISEASE THROUGH USE OF SODIUM ZIRCONIUM CYCLOSILICATE (HELPFUL TRIAL): RESULTS OF DIETARY INTAKE

Abstract Background and Aims The dietary restriction of healthy food sources of potassium (K) counselled to patients with chronic kidney disease (CKD) and hyperkalemia (HK) contributes to a diet with poor dietary quality. The K lowering medication sodium zirconium cyclosilicate (SZC) has the potential to treat HK, thereby allowing a healthy plant-based diet (PBD). We designed a clinical trial to explore the safety and feasibility of prescribing a healthy PBD to CKD patients with HK with the concomitant use of SZC. Method The HELPFUL trial is an ongoing single-arm study with CKD stage 4-5 patients not on dialysis and with plasma K (pK) between 5.1-6.5 mmol/L at inclusion. Patients are followed for six weeks. In the first three weeks, SZC is prescribed to normalize pK while patients ingest a low protein diet with low K content. In the subsequent three weeks, a healthy PBD with a target K intake of 3700 mg/day is prescribed while maintaining the use of SZC. A food basket with PBD is delivered to participants weekly. A weekly monitoring of pK and titration of SZC to keep normokalemia is performed. Two dietary quality scores were calculated using the 24-hour food record (24h-FR) at baseline, week three and six. The first index is the Swedish version of Nutrient rich food index (S-NRF11.3) that measures the density of 11 beneficial nutrients (fiber, folate, iron, calcium, potassium, protein and vitamins A, C, D and E) and three non-beneficial nutrients (saturated fat, sodium and added sugars). The second index is the mean adequacy ratio (MAR) with the average intake of the same 11 beneficial nutrients as a proportion of the recommended daily intake (RDI). Data was analyzed by repeated measures-ANOVA or by Friedman test for related samples, as appropriate. Registered at www.clinicaltrials.gov (identifier NCT04207203). Results 22 patients were included; 59±13 years; 13 men, eGFR 18±4 mL/min/1,73m2 (Table 1). The total intake of energy, fibre, folate and K increased significantly in week 6. Nutrient density did not change, but the MAR-score increased significantly. The intake of servings of fruits, vegetables and nuts increased significantly throughout the PBD. Regarding animal protein, there was a tendency to decrease the intake of servings of red meat and a significant increase in poultry and fish. The mean pK normalized in week three and six. After the start of PBD, three patients (13.6%) had pK between 5.1-5.3 mmol/L. Conclusion The strategy of PBD food baskets with concomitant use of SZC improved the dietary quality and increased the intake of servings of healthy foods. The K intake increased but not to target value. The pK was kept within normal values for most patients.

The evaluation of menus’ adherence to sustainable nutrition and comparison with sustainable menu example in a Turkish university refectory

Purpose It is very crucial to evaluate the suitability of food services from an environmental and economic point of view to design sustainable food menus. This study aims to analyse the food menus in a Turkish university refectory concerning sustainable nutrition and waste management and compare them with a proposed sustainable food menu. Design/methodology/approach The study examined lunch menus served in December and February 2021–2022 at Istanbul Medipol University refectory for a total of 20 days, considering the nutrient-rich food index (NRF 9.3), waste amount, food cost, water and carbon footprint parameters of the meals. Findings Comparing the December menu with the suggested sustainable December menu showed a significant reduction in carbon and water footprint (p = 0.001), food cost (p = 0.001) and NRF 9.3 score (p = 0.001). When February and the suggested sustainable February menu were compared, there was a significant decrease in carbon and water footprint (p = 0.001), food cost (p = 0.005) and NRF 9.3 score (p = 0.001). December and February menus had higher NRF 9.3 score compared to the sample sustainable menus, and the amounts of saturated fat, added sugar and sodium were also high in these menus. Originality/value The study revealed that university cafeteria menus are incompatible with sustainable nutrition. The findings can significantly contribute to improving the sustainability of meals and food services by minimizing the water and carbon footprint of menus.

A comparison of the nutritional profile and nutrient density of commercially available plant-based and dairy yogurts in the United States.

Plant-based yogurts are sustainable alternatives to dairy yogurts, but a nutritional comparison of plant-based yogurts within the context of dairy yogurts has not yet been applied to commercially available products in the United States. Dairy yogurts provide significant dietary nutrients, and substituting plant-based yogurts may have unintended nutritional consequences. The objective of this study was to compare the macronutrient and micronutrient values of commercially available plant-based and dairy yogurts launched between 2016 and 2021. Nutritional information for yogurts were collected through Mintel Global New Products Database, and products were categorized according to their primary ingredient. Regular-style yogurts (n = 612) were included in this study: full-fat dairy (n = 159), low and nonfat dairy (n = 303), coconut (n = 61), almond (n = 44), cashew (n = 30), and oat (n = 15). We utilized the Nutrient Rich Foods (NRF) Index, a comprehensive food guidance system that assigns a score based on the nutrient density of individual foods. This allowed us to compare the nutritional density of the yogurts based on nutrients to encourage (protein, fiber, calcium, iron, potassium, vitamin D) and nutrients to limit (saturated fat, total sugar, sodium). Compared to dairy yogurts, plant-based yogurts contained significantly less total sugar, less sodium, and more fiber. However, plant-based yogurts contained significantly less protein, calcium, and potassium than dairy yogurts. The yogurts were ranked from the highest to lowest nutrient density based on the NRF Index as follows: almond, oat, low and nonfat dairy, full-fat dairy, cashew, and coconut. Almond yogurts scored significantly higher than all other yogurts, indicating the highest nutrient density. The highest NRF scores were awarded to almond and oat yogurts, likely a result of their low levels of total sugar, sodium, and saturated fat. By applying the NRF model to plant-based and dairy yogurts, we have identified opportunities for the food industry to improve the formulation and nutritional composition of plant-based yogurts. In particular, fortification is an opportunity to improve plant-based yogurt nutritional properties.

The Nutrient Rich Food Price Index: a nutrition-relevant adaptation of the Laspeyres price index to track the cost of affordable nutrient density.

The Laspeyres price index is the ratio of the current cost of a market basket of commodities or food groups relative to base period prices. To develop a nutrition-relevant version of the Laspeyres price index, using market baskets based on tertiles of the nutrient rich food (NRF9.3) nutrient density metric. Nutrient composition data for 151 foods from the 2012 Mexico national health and nutrition survey (ENSANUT) were merged with food prices and price indices from the national institute of geography and statistics (INEGI). Nutrient Rich Food Index (NRF9.3) was the measure of nutrient density. May 2012 was the base period. Nutrient rich food price index (NRFPI) values were calculated for each tertile of NRF nutrient density scores for each month between June 2011 and March 2022. The market basket of foods in the top tertile of NRF nutrient density scores cost more per 100 kcal and had higher NRFPI values compared to foods in the bottom tertile. Higher NRF9.3 scores were correlated with greater monthly inflation. The NRFPI for foods in the top tertile of NRF9.3 scores was marked by seasonal price spikes, and greater volatility compared to foods in the bottom tertile. The present adaptation of the Laspeyres Index used market baskets defined by nutrient density tertiles instead of commodity groups. This approach allows for easier tracking of the cost of nutrient dense foods and healthful diets across geographic regions and over time. Applied to Mexico food prices prior to and during the Covid-19 pandemic, the NRFPI was sensitive to time trends, seasonality, and price fluctuations. The new tool may be useful in monitoring the rising cost of healthy foods worldwide.

High Hemoglobin Levels is Associated with Incident Hypertriglyceridemia Among Adults in Zhejiang Province and Varied by Nutrient-rich Food Index 12.3

High Hemoglobin Levels is Associated with Incident Hypertriglyceridemia Among Adults in Zhejiang Province and Varied by Nutrient-rich Food Index 12.3

Correlation Between Dietary Index and Cardiovascular Disease in Zhejiang Province: Energy-adjusted Dietary Inflammatory Index (E-DII) and Nutrient-Rich Food Index 12.3 (NRF12.3)

Correlation Between Dietary Index and Cardiovascular Disease in Zhejiang Province: Energy-adjusted Dietary Inflammatory Index (E-DII) and Nutrient-Rich Food Index 12.3 (NRF12.3)

Consumption of highly processed foods in relation to overall diet quality among Japanese adults: a nationwide study.

To (i) examine the consumption of highly processed foods (HPF) in relation to diet quality among Japanese adults and (ii) compare the results when dishes prepared away home are disaggregated into food ingredients before classification by processing levels and the results when they are not. Cross-sectional analysis using 4-day dietary record data. Foods were categorised by level of processing using the framework developed by the University of North Carolina at Chapel Hill. Specifically, dishes prepared away from home were classified at both the food level (classified after disaggregation into ingredients) and dish level (classified without disaggregation). Diet quality was assessed using the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9·3. Twenty areas in Japan. Adults aged 20-69 years (n 388). Energy contribution of HPF was higher when dishes prepared away from home were classified at dish level than food level (48·3 % v. 32·9 %, P < 0·0001). Regardless of the classification method, cereals and starchy foods were the top food groups contributing to total energy intake from HPF. After adjusting for potential confounders, participants in higher tertiles of the energy contribution of HPF had lower total scores for Healthy Eating Index-2015 and Nutrient-Rich Food Index 9·3 (P for trend ≤ 0·007 for all), irrespective of the food- or dish-level classification. HPF accounted for at least one-third of energy intake of Japanese adults. Regardless of the classification methods for dishes prepared away from home, higher consumption of HPF was associated with lower diet quality.

Diet Quality and Its Relationship with Weight Characteristics in Pregnant Japanese Women: A Single-Center Birth Cohort Study

Maternal underweight and inadequate gestational weight gain (GWG) are problems in Japan. However, increases in food intake aimed at weight gain alone are not sufficient for mother-child health. This study assessed diet quality based on the 3-day dietary records of pregnant women in an urban area of Japan in order to show the importance of evaluating diet quality, using the Nutrient-Rich Food Index 9.3 (NRF9.3), which is one metric based on nutrition profiling, and the Japanese Food Guide Spinning Top (JFGST). After excluding misreporters of energy intake, we stratified women (n = 91) by pre-pregnancy body mass index (BMI) and determined energy intake, diet quality status, and their relationship with GWG. Intakes of carbohydrate-containing staple foods, vegetable dishes, and fruit were insufficient regardless of BMI. Most of the underweight women with inadequate GWG had insufficient energy intake but high diet quality, as assessed by NRF9.3. In contrast, most women who consumed energy within the recommended range had low diet quality and gained weight at inappropriate levels. These results highlight the importance for pregnant Japanese women to maintain diet quality through a nutrient-dense diet, while simultaneously increasing energy intake after evaluation of their individual diet quality.

Dietary Patterns of Off-Reserve Indigenous Peoples in Canada and Their Association with Chronic Conditions

Nationally representative nutrition surveys (Canadian Community Health Survey (CCHS) Cycle 2.2, Nutrition 2004 and 2015) were used to examine dietary patterns and their association with socioeconomic/sociodemographic factors and chronic conditions in off-reserve Indigenous population in Canada. A cluster analysis was used to identify dietary patterns (DPs), and the Nutrient Rich Food Index (NRF 9.3) was used as the diet quality score and stratified by age/gender groups. In 2004 (n = 1528), the dominant DPs among Indigenous adults (age = 41 ± 2.3) were "Mixed" (mean NRF = 450 ± 12) and "Unhealthy" among men (mean NRF = 426 ± 18), "Fruits" among women (mean NRF = 526 ± 29), and "High-Fat/High-Sugar" among children (age = 10.2 ± 0.5) (mean NRF = 457 ± 12). In 2015 (n = 950), the dominant DPs were "Unhealthy" (mean NRF = 466 ± 6), "Mixed" (mean NRF = 485 ± 21), Healthy-Like (mean NRF = 568 ± 37), and "Mixed" (mean NRF = 510 ± 9) among adults (age = 45.6 ± 2.2), men, women, and children (age = 10.9 ± 0.3) respectively. The majority of Indigenous peoples had the "Unhealthy" DP with a low diet quality, which may contribute to a high prevalence of obesity and chronic diseases. The income level and smoking status among adults and physical inactivity among children were recognized as important factors that may be associated with the dietary intake of off-reserve Indigenous population.

Development and validation of the nutrient-rich food index for China

To select the nutrient-rich food(NRF) index applicable to the food characteristics of Chinese residents through population-based dietary quality validation. Sixteen NRF indices were constructed based on the Chinese Food Composition Table and the Chinese Food Labelling Nutrient Reference Values, using 100 g as the base amount of food for calculation. The NRF indices were validated by the China Prime Diet Quality Score(CPDQS), a dietary quality assessment index, using food intake data collected from 14 068 adult residents in 15 provinces in 2018 under the China Health and Nutrition Survey. The CPDQS was used as the dependent variable and the dietary NRF index score was used as the independent variable. The multiple linear regression models were performed after adjusting the covariates and the NRF index with the largest coefficient of determination R~2 was used as the most appropriate index. Regression analysis showed that the R~2 of NRF8.2 index was the largest, which was 0.16. Dried legumes, fungi and algae, nuts, vegetables, eggs and aquatic products scored higher on the NRF8.2 index. The high scoring subgroups had higher average daily intakes of cereals and potatoes, vegetables, fruits, soybeans and nuts, dairy, eggs and aquatic products, as well as lower consumption of livestock and poultry meat, beverages, salt and cooking oil, compared to the low scoring subgroup on the Dietary NRF8.2 Index. In terms of nutrient intake, the medium and high NRF8.2 subgroups had relatively high intakes of energy, protein, vitamins and minerals and relatively low intakes of fat and sodium. The NRF8.2 index explains the maximum variation in CPDQS and is a relatively suitable NRF index for the Chinese population.

Food and nutrition literacy: a predictor for diet quality and nutrient density among late adolescents.

Evidence regarding an individual`s food and nutrition literacy (FNL), and its impact on dietary behaviours, could guide the development of more effective interventions. This study sought to examine the association between FNL and its components with diet quality and nutrient density among Iranian senior highschool students. In this cross-sectional study, 755 senior high school students were recruited from high schools in Tehran, Iran. FNL was assessed using the Food and Nutrition Literacy Assessment Tool (FNLAT), a selfadministered questionnaire which has been locally designed and validated. Dietary assessment was performed by obtaining two 24-hour dietary recalls. Healthy Eating Index-2010 (HEI-2010) and nutrient-rich food index 9.3 (NRF9.3) were calculated to evaluate diet quality. Socioeconomic status, anthropometric measures, and the health status of participants were also assessed. Higher FNL score was significantly correlated with higher HEI-2010 (β = 0.167, p < 0.001) and NRF9.3 (β = 0.145, p < 0.001) scores. Subgroup analysis indicated that these associations were significant only among males, but not females. Regarding components of FNL, skill dimension of FNL was a stronger predictor for HEI- 2010 (β = 0.174, p < 0.001) and NRF9.3 (β = 0.153, p < 0.001) than knowledge (β = 0.083, p = 0.054 for HEI-2010 and β = 0.107, p = 0.01 for NRF9.3). FNL may be a significant predictor of diet quality and nutrient density among late adolescents. To improve the effectiveness of food and nutrition education, emphasis must be placed on skill development.

Nutrient density and cost of commonly consumed foods: a South African perspective.

Food-based dietary guidelines promote consumption of a variety of nutritious foods for optimal health and prevention of chronic disease. However, adherence to these guidelines is challenging because of high food costs. The present study aimed to determine the nutrient density of foods relative to cost in South Africa, with the aim to identify foods within food groups with the best nutritional value per cost. A checklist of 116 food items was developed to record the type, unit, brand and cost of foods. Food prices were obtained from the websites of three national supermarkets and the average cost per 100 g edible portion was used to calculate cost per 100 kcal (418 kJ) for each food item. Nutrient content of the food items was obtained from the South African Food Composition Tables. Nutrient density was calculated using the Nutrient Rich Food (NRF9.3) Index. Nutrient density relative to cost was calculated as NRF9.3/price per 100 kcal. Vegetables and fruits had the highest NRF9.3 score and cost per 100 kcal. Overall, pulses had the highest nutritional value per cost. Fortified maizemeal porridge and bread had the best nutritional value per cost within the starchy food group. Foods with the least nutritional value per cost were fats, oils, foods high in fat and sugar, and foods and drinks high in sugar. Analysis of nutrient density and cost of foods can be used to develop tools to guide low-income consumers to make healthier food choices by identifying foods with the best nutritional value per cost.

Food combination questionnaire for Japanese: relative validity regarding food and nutrient intake and overall diet quality against the 4-day weighed dietary record.

The aim of this cross-sectional study was to examine the relative validity of food and nutrient intakes and overall diet quality scores derived using a newly developed dietary assessment questionnaire (food combination questionnaire, FCQ). Dietary data were collected from 222 Japanese adults (111 for each sex) aged 30-76 years using the online FCQ and then the 4-non-consective-day weighed dietary record (DR). The median of Spearman correlation coefficients for sixteen food groups was 0⋅32 among women and 0⋅38 among men. The median of Pearson correlation coefficients for forty-six nutrients was 0⋅34 among women and 0⋅31 among men. The Pearson correlation coefficient between the total scores of Healthy Eating Index-2015 (HEI-2015) derived from the DR and FCQ was 0⋅37 among women and 0⋅39 among men. The corresponding value for the Nutrient-Rich Food Index 9.3 (NRF9.3) total scores was 0⋅39 among women and 0⋅46 among men. Bland-Altman plots for these diet quality scores showed poor agreement at the individual level, although mean difference was small for the HEI-2015 (but not NRF9.3). Similar results were obtained using the paper version of FCQ, which was answered after conducting the DR, except for somewhat high Pearson correlation coefficients for the total scores of HEI-2015 (0⋅50 among both women and men) and NRF9.3 (0⋅37 among women and 0⋅53 among men). In conclusion, this analysis may lend support to the possible use of the FCQ as a rapid dietary assessment tool in large-scale epidemiologic studies in Japan, but further refinement of this tool should be pursued.

Most Plant-Based Milk Alternatives in the USDA Branded Food Products Database Do Not Meet Proposed Nutrient Standards or Score Well on Nutrient Density Metrics.

Plant-based milk alternatives and plant-based waters are of variable nutritional value. The present objective was to assess nutrient density of all plant-based beverages in the US Department of Agriculture Branded Food Products Database and determine whether plant-based milk alternatives met the proposed nutrient standards. Plant-based milk alternatives (n = 1042) were identified as almond, soy, coconut, cashew, other tree nut, flax/hemp, pea, and oat, quinoa, and rice products. Plant-based waters (n = 550) were coconut, aloe, tree, fruit, and plain. Machine searches of ingredient lists identified products with added sugars, salt, vitamins, and minerals. Plant-based milk alternatives were tested for compliance with previously developed nutrient standards. The Nutrient Rich Food Index (NRF5.3), two versions of Nutri-Score, and Choices International were the nutrient density metrics. Plant-based milk alternatives had mean energy density of 49 kcal/100 g, were low in protein (~1.1 g/100 g), often contained added sugars and salt, and tended to be fortified with calcium, vitamin A, vitamin D, and vitamin B12. Only 117 milk alternatives (11.2%) met nutrient standards and only 80 (7.7%) met the more stringent “best of class” standards for ≥2.8 g/100 g protein and <3.1 g/100 g added sugars. The latter were mostly soy milks. Nutri-Score grades varied depending on whether the beverages were treated as beverages or as solid foods, as is currently required. The highest NRF5.3 scores were given to soy, almond, and tree nut milk alternatives. Plant-based waters had low energy density (~23 kcal/100 g), contained added sugars (4.6 g/100 g), and some had added vitamin C. Applying nutrient standards to plant-based milk alternatives can aid new product development, promote more transparent labeling, and inform potential regulatory actions. Guidance on minimum protein content, maximum recommended amounts of fat, added sugars, and sodium, and consistent fortification patterns would be of value to regulatory agencies and to the food industry.

Relative validity of the online Meal-based Diet History Questionnaire for evaluating the overall diet quality and quality of each meal type in Japanese adults.

The aim of this study was to examine the relative validity of the online Meal-based Diet History Questionnaire (MDHQ) for assessing the overall diet quality and quality of each meal type (breakfast, lunch, dinner and snacks). In total, 222 Japanese adults (111 for each sex) aged 30-76 years completed the online MDHQ and then the 4-non-consecutive-day weighed dietary record (DR). The diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). For the HEI-2015, compared with the DR, the MDHQ provided high median values for breakfast (in women only) and dinner and low median values for snacks. There were no significant differences observed for overall diet and lunch. For the NRF9.3, the MDHQ provided higher median values for breakfast and dinner and a lower median value for overall diet than the DR in women, with no significant differences for lunch and snacks. In men, no significant difference was observed, except for overall diet (the MDHQ providing a lower median value). For the HEI-2015, median Spearman correlation coefficient was 0·43, with a range from 0·12 (snacks in women) to 0·68 (breakfast in men). For the NRF9.3, median Spearman correlation coefficient was 0·47, with a range from 0·26 (snacks in men) to 0·65 (breakfast in men). Bland-Altman plots showed wide limits of agreement and, in some cases, proportional bias. In conclusion, the online MDHQ showed an acceptable ability for ranking individuals according to the quality of overall diet, breakfast, lunch and dinner, but not snacks.

A comparative analysis of sustainability of the usual food intakes of the Iranian population, Iranian food-based dietary guidelines, and optimized dietary models

Promoting sustainable diets might contribute toward achieving sustainable development goals. Considering the importance of national food-based dietary guidelines (FBDGs), this study aimed to assess and compare the sustainability dimensions of the usual Iranian dietary intakes with sustainable optimal diets based on Iranian (2006 and 2015 versions), Mediterranean, and vegetarian FBDGs. The usual dietary intakes of Iranian households were estimated using household expenditure survey data. Diet sustainability, including environmental (water, carbon, and land) footprints, cost, and nutrient-rich food (NRF) index, was calculated for the usual diet and compared with those of different FBDGs. Using linear and goal programming, optimal food models were calculated by minimizing environmental footprints and cost and maximizing NRF simultaneously for each FBDG, while maintaining nutritional considerations recommended by the FBDGs. Replacing the usual dietary intake of Iranians with the optimal diet based on the 2016 Iranian FBDG was associated with reductions equal to 20.9% for water footprint, 22.48% for carbon footprint, 20.39% for land footprint, 31.83% for cost, and 7.64% increase in NRF index. The optimal model based on the 2016 Iran FBDG was 10% more sustainable compared with the 2005 version. Changing the usual consumption of Iranians to the optimal model based on the Mediterranean pyramid was accompanied by the highest NRF index, lower environmental footprints, and cost compared to other models. The recent Iranian FBDG, compared with the older one, was more sustainable. Considering the dimensions of a sustainable diet for future FBDG revisions is recommended.

Association between ultra-processed foods consumption and micronutrient intake and diet quality in Iranian adults: a multicentric study.

To identify ultra-processed foods (UPF) contribution to daily energy and nutrient intake in Iranians and examine whether UPF intake is associated with nutrient profile and diet quality. In this cross-sectional study, a validated FFQ was used to evaluate usual dietary intake over the preceding year. NOVA system was applied to categorise foods based on their levels of processing. Diet quality was evaluated using the nutrient adequacy ratio (NAR), Nutrient Rich Food Index (NRF) and hybrid nutrient density. The LIPOKAP study conducted in five cities of Iran (Isfahan, Birjand, Bandar Abbas, Kermanshah and Shahrekord). A total of 1994 adults aged ≥18 years were recruited using stratified multistage random cluster sampling method. UPF were responsible for 8·5 % of daily energy intake. In the adjusted model, UPF consumption was inversely associated with carbohydrate, protein, refined and whole grains, fibre, fruit and meat, but was positively linked to energy, total fat, saturated and trans fatty acids and cholesterol. Compared with those in the lowest tertile, individuals in the highest tertile of UPF had smaller NAR for Ca, Mg, Zn, Fe, phosphorus, thiamin, niacin, folate and vitamin C. Both NRF and hybrid nutrient density decreased when the share of daily energy intake from UPF increased. The higher consumption of UPF is associated with poorer diet quality and lower nutrient intake. It is recommended that UPF be replaced with minimally processed foods to improve diet quality and nutrient profile.

Affordable Nutrient Density in Brazil: Nutrient Profiling in Relation to Food Cost and NOVA Category Assignments

Affordable nutrient density is provided by low-cost and nutrient-rich foods. We explored nutrient density, cost, and NOVA category assignments within and across food groups in Brazil. The nutrient density of the foods (n = 591) was assessed using the Nutrient Rich Food Index (NRF9.3) based on protein, fiber, vitamin A (RAE), vitamin C, vitamin E (mg), Ca, Fe, K and Mg; and NRF6.3 score for priority nutrients: Ca, Fe, Zn, vitamin A, vitamin B12, and folate. Nutrients to limit (LIM) were saturated fat, added sugar, and sodium. Affordability was defined as the ratio of energy and/or nutrient density of foods and retail price per 100 kcal. Foods were classified as minimally processed (n = 106), processed (n = 188), ultra-processed (n = 286), and culinary ingredients (n = 11). Nutrient density was positively linked to per 100 kcal food cost. Ultra-processed foods (UPF) contained more energy, fat, sugar, and salt and had lower NRF scores compared to minimally processed (MPF) foods. UPF was also less expensive than MPF foods. Nutrient-rich foods below the median per 100 kcal costs included MPF foods, but also processed foods (PF) and UPF. Affordable nutrient-rich foods can be found in the different categories of the NOVA classification.