Research Topic

Food-Based Dietary Guidelines: The Relevance of Nutrient Density and a Healthy Diet Score

About this Research Topic

Foods consist of many different nutrients that work together, rather than in isolation; often their effects will not develop when the intakes of other nutrients are suboptimal. As an example, intervention studies have indicated that the metabolic effects of whole dairy may be different from single dairy constituents when considering the effects on body weight, cardiometabolic disease risk, and bone health. So when looking at the healthiness of a diet, a nutrient density or whole diet scores would be more useful, but is such a score applicable to different age-groups and countries? Should such a score include e.g. the amino acid composition instead of the total protein of a product. Should the score be included in judging sustainability of a food, to be able to create a food supply capable of supporting the world population's nutritional requirements? Last but not least, what can the consumer do with all this info?

A few overall diet scores exists, composed of beneficial nutrients, and/or nutrients to limit. One of them is the NRF9.3. The features of the NRF9.3 makes it a suitable tool to study the contribution of naturally nutrient-dense foods to adequate nutrient intake levels and overall health outcomes. However, the NRF9.3 is a measure developed for the total population. In order to increase the applicability of the NRF9.3 score to diets of the elderly, it might be worthwhile to include e.g. vitamin D, vitamin B12, folate.

In addition to a nutrient-density score, a specific diet-disease score was recently developed; the BMD-Diet Score. Together with population growth and ageing, the prevalence of physical disabilities is increasing dramatically with age, and therefore it might be of more value to develop an overall mobility-Diet score by extending the BMD-Diet Score with muscle and joint measure.

Recently, adherence to the WHO dietary recommendations and mortality from CVD was associated with reduced CVD mortality, but only in the southern EU cohorts and in the US cohort. The authors speculated that the composition of PUFAs within a dietary pattern may be more important in the context of CVD mortality, instead of just taken into account the total amount of fat or PUFA’s. The same might be true for protein when looking at sarcopenia or osteoporosis; total protein or essential amino acids?

For some nutrients, it is difficult to assess intake and therefore status markers are preferred. Matrix Gla protein (MGP) is an extrahepatic protein, and its activation depends on vitamin K. Desphospho-uncarboxylated-MGP is its dysfunctional form and has been associated with increased arterial calcification and stiffness, and described as vitamin K status marker. When looking at CVD, the question is whether in the development of a diet score should take into account this vitamin K status marker.

Besides these discussions, it is important to describe the value of nutrient density for the global sustainability issue. Removing animals from agriculture would reduce agricultural emissions, but what would a lower animal food intake mean for e.g. the vitamin B12 status?

Last but not least, what consequences are there for the recommendations and for the adherence of the consumer when looking at overall diets instead of nutrients. How can such measures be communicated to the consumer and adherence to a high nutrient density diet be improved?

In other words, this book is about applicable science related to whole diet measures in relation to sustainability and health of consumers.


Keywords: Nutrient density, Healthy eating index, Elderly, Vitamins, Protein


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Foods consist of many different nutrients that work together, rather than in isolation; often their effects will not develop when the intakes of other nutrients are suboptimal. As an example, intervention studies have indicated that the metabolic effects of whole dairy may be different from single dairy constituents when considering the effects on body weight, cardiometabolic disease risk, and bone health. So when looking at the healthiness of a diet, a nutrient density or whole diet scores would be more useful, but is such a score applicable to different age-groups and countries? Should such a score include e.g. the amino acid composition instead of the total protein of a product. Should the score be included in judging sustainability of a food, to be able to create a food supply capable of supporting the world population's nutritional requirements? Last but not least, what can the consumer do with all this info?

A few overall diet scores exists, composed of beneficial nutrients, and/or nutrients to limit. One of them is the NRF9.3. The features of the NRF9.3 makes it a suitable tool to study the contribution of naturally nutrient-dense foods to adequate nutrient intake levels and overall health outcomes. However, the NRF9.3 is a measure developed for the total population. In order to increase the applicability of the NRF9.3 score to diets of the elderly, it might be worthwhile to include e.g. vitamin D, vitamin B12, folate.

In addition to a nutrient-density score, a specific diet-disease score was recently developed; the BMD-Diet Score. Together with population growth and ageing, the prevalence of physical disabilities is increasing dramatically with age, and therefore it might be of more value to develop an overall mobility-Diet score by extending the BMD-Diet Score with muscle and joint measure.

Recently, adherence to the WHO dietary recommendations and mortality from CVD was associated with reduced CVD mortality, but only in the southern EU cohorts and in the US cohort. The authors speculated that the composition of PUFAs within a dietary pattern may be more important in the context of CVD mortality, instead of just taken into account the total amount of fat or PUFA’s. The same might be true for protein when looking at sarcopenia or osteoporosis; total protein or essential amino acids?

For some nutrients, it is difficult to assess intake and therefore status markers are preferred. Matrix Gla protein (MGP) is an extrahepatic protein, and its activation depends on vitamin K. Desphospho-uncarboxylated-MGP is its dysfunctional form and has been associated with increased arterial calcification and stiffness, and described as vitamin K status marker. When looking at CVD, the question is whether in the development of a diet score should take into account this vitamin K status marker.

Besides these discussions, it is important to describe the value of nutrient density for the global sustainability issue. Removing animals from agriculture would reduce agricultural emissions, but what would a lower animal food intake mean for e.g. the vitamin B12 status?

Last but not least, what consequences are there for the recommendations and for the adherence of the consumer when looking at overall diets instead of nutrients. How can such measures be communicated to the consumer and adherence to a high nutrient density diet be improved?

In other words, this book is about applicable science related to whole diet measures in relation to sustainability and health of consumers.


Keywords: Nutrient density, Healthy eating index, Elderly, Vitamins, Protein


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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16 February 2019 Manuscript

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Manuscripts can be submitted to this Research Topic via the following journals:

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Submission Deadlines

16 February 2019 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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