Nutritional Scoring System Supported by Military Physicians

February 25, 2011

Military physicians here at Preventive Medicine 2011: Annual Meeting of the

American College of Preventive Medicine gave favorable reviews to the

groundbreaking nutritional scoring system, NuVal, developed by Katz,

MD, from Yale University School of Medicine in New Haven, Connecticut, and

associates. At sessions where the scientific basis and operational

simplicity of NuVal were discussed, military health providers were open and

frank with their opinions.

Jeff Short, MD, medical director of the Comprehensive Fitness Program under

the Chief of Staff of the Army in Washington, DC, explained his viewpoint to

*Medscape Medical News*: " In the military, we have not put much priority

into nutrition, " he said. " So I'm here to learn about the nutritional things

we can do better for the Army. If we could get the NuVal program into our

commissaries, our vending machines, and our dining halls, as well as our

[Department of Defense] schools, it would make a tremendous difference.

" What I'm trying to get through to the soldiers and their families is their

fitness is their choice and their own priority. And it's hard to make proper

food choices when you don't know what to look for. This would just

facilitate making proper choices, " Dr. Short said.

The NuVal system is a simple 1 to 100 scoring of food products; each

product's score is clearly displayed on its packaging. The higher the score,

the greater the nutritional value of a product. Broccoli and whole oats get

a score of 100; a beef hamburger gets a score of 4. The NuVal is printed in

large blue letters, surrounded by a distinctive honeycomb hexagon.

Nuval is based on a patented algorithm for measuring the nutritional value

of foods. Each food product rated in the NuVal system has its number

calculated based on the influence it has on overall dietary goals.

Dr. Katz believes his nutritional guidance system is by far the most

sophisticated nutrient profiling algorithm ever developed. He explains the

composition of the development team: " It was put together by a team of a

dozen top nutrition public health experts from the US and Canada, including

the chair of nutrition at Harvard, the president of the American Cancer

Society, the inventor of the glycemic index, and the past president of the

American Dietetic and Diabetes Association. And this group received support

from Yale-affiliated, not-for-profit Hospital, a community hospital

in Derby, Connecticut, which owns the NuVal algorithm. The scientific

advisory board is fully independent and walled off from the business side

that's putting the algorithm out there where the rubber hits the road, " Dr.

Katz explained.

The algorithm uses quantitative reference values from 2 sources: the

Institute of Medicine's Dietary Reference Intakes and the Department of

Health and Human Services Dietary Guidelines for Americans. Those reference

values quantify the presence of more than 30 nutrients, including vitamins,

minerals, fiber, antioxidants, salt, sugar, trans fat, saturated fat, and

cholesterol. It also incorporates measures for protein, fat, and

carbohydrates. Nutrients that have generally favorable effects on health are

placed in the numerator, nutrients with unfavorable effects are placed in

the denominator, and the score is calculated.

For example, trans fat has a very strong association with heart disease — a

highly prevalent and serious condition. Therefore, the NuVal System assigns

a " weighting coefficient " to trans fat, which substantially lowers the score

of foods containing it, Dr. Katz explained. NuVal also uses adjustors for

fat quality, protein quality, and glycemic load (a measure of carbohydrate

quality) to move a NuVal score higher or lower. The higher the quality, the

higher the score.

Dr. Katz explained the system further. " This is pure public health science.

In addition, it's proven public health science. In a Harvard study involving

more than 100,000 people, the NuVal scores of the foods they ate correlated

with cardiovascular disease, diabetes, body mass index, and all-cause

mortality. The higher their average NuVal diet scores, the lower their risk

of cardiovascular disease, the lower their risk of diabetes, the lower their

body mass index, and the lower their risk of dying prematurely of anything. "

Lt. Col. Benne, MD, chief of public health in Fort Riley, Kansas, had a

strong opinion on NuVal. " I'm impressed by it, he told *Medscape Medical

News*. " It seems to be very user-friendly, very well-thought-out from a

scientific standpoint. It does take away all the interpretation needed when

you looking at a nutrition label and trying to figure that out. For me as a

physician, it's easier to relate that to a patient. "

Dr. Benne explained that, " in the military, we're not unlike the rest of the

country in the struggle against weight. We care about soldiers and their

families' health. We want to keep them healthy their entire life, we cover

their medical benefits for their whole life, so there's a lot of return for

us to have that group healthy and happy. "

Dr. Katz calls his NuVal system a global positioning system for the food

supply. " I think people desperately need something that makes it unfailingly

simple to find your way to better food choices, " he said. " If you're willing

to acknowledge that giving advice to people to eat more fruits and

vegetables has not resulted in anyone actually eating more fruits and

vegetables, and [that] we need to do something new and different to help

people get there from here...you really ought to care about NuVal. "

Dr. Katz continued, " It's all very important to treat disease, but the real

power of prevention resides in lifestyle, and diet is certainly one of the

cornerstones. So I think we must rally around the destination, and the means

to get there, so we can put the power of lifestyle to work for better

health. "

Dr. Short found the NuVal system to have great utility for his Army

patients. " I think the simplicity of the NuVal system makes it perfect for

our kind of thing, " he told *Medscape Medical News*. " When you're trying to

look at a label now and decide whether you should to go for less calories or

more fiber, or less salt, it's a very difficult decision. But as long as

they've properly weighted this score, using proper evidence — which it

sounds like they have — this will make it so much easier. "

Dr. Short used an example to demonstrate NuVal's usefulness. " As a doctor,

when I'm trying to make a lifestyle prescription for my patients, I can say,

'Do you know about the NuVal system? Have you looked at it as you go through

the store?' If they have a choice of breads, " he explained, " I can tell them

to just pick the highest number. People want to make good choices. It's just

so hard now. I think we would have fewer patients if we had more people

using the NuVal system as a lifestyle and preventive medicine tool. I think

this is going to make a tremendous difference. "

*The speakers have disclosed no relevant financial relationships.*

Preventive Medicine 2011: Annual Meeting of the American College of

Preventive Medicine. Presented February 18, 2011.

www.medscape.com

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

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February 28, 2011

anyone remember dressing with " Garanimal " outfits when young (Kmart)? All the

outfits with a gorilla matched each other, and the lion tops and bottoms matched

other lion tagged clothing - just don't put on the kangaroo top. A rating system

is nice but a nutrition professional has more to offer than 'pick the highest

number'. I'm sure an unhealthy, out of balance diet is possible with high Nuval

number food choices, too.

R Vajda, R.D.

________________________________

To: RD-USA <rd-usa >

Sent: Fri, February 25, 2011 4:54:06 PM

Subject: Nutritional Scoring System Supported by Military Physicians