Journal of the American College of Nutrition

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Defining Nutrient Density: Development and

Validation of the Nutrient Rich Foods Index

Adam Drewnowski

To cite this article: Adam Drewnowski (2009) Defining Nutrient Density: Development and
Validation of the Nutrient Rich Foods Index, Journal of the American College of Nutrition, 28:4,
421S-426S, DOI: 10.1080/07315724.2009.10718106

To link to this article: https://doi.org/10.1080/07315724.2009.10718106

Published online: 09 Jun 2013.

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Review

Defining Nutrient Density: Development and Validation

of the Nutrient Rich Foods Index

Adam Drewnowski, PhD

Center for Public Health Nutrition, University of Washington, Seattle, Washington
Key words: food analysis, nutrient profiling, nutrition value, nutrition requirements, food legislation, nutrient density

The 2005 Dietary Guidelines for Americans and U.S. Department of Agriculture’s MyPyramid made a clear
distinction between foods that were energy dense and those that were nutrient rich. Consumers were advised to
seek out nutrient-rich foods (NRF) in preference to discretionary calories. However, the concept of nutrient
density was not formally defined. The Nutrient Rich Foods (NRF) index is a formal metric of nutrient density
that has been extensively compared with other methods and validated with respect to a healthy diet. The NRF
index is based on 9 nutrients to encourage (protein; fiber; vitamins A, C, and E; calcium; iron; potassium; and
magnesium) and 3 nutrients to limit (saturated fat, added sugar, and sodium). The NRF9.3 algorithm is the
unweighted sum of percentage daily values (DVs) for 9 nutrients to encourage, minus the sum of percentage
maximum recommended values (MRVs) for 3 nutrients to limit, calculated per reference amount and capped at
100% DV. The NRF index successfully ranks foods based on their nutritional value and can be applied to
individual foods, meals, menus, and even the daily diet. Development of the NRF index followed scientific
guidelines for nutrient profiling and was accompanied by extensive testing and validation.

Key teaching points:

N The consumer is looking for a simple and at-a-glance index of the nutrient quality of foods.
N Translating the concept of nutrient density into a working algorithm can help consumers achieve a more nutrient-rich diet.
N The NRF index is the cornerstone of a comprehensive food guidance approach for healthy eating that is currently being tested with
consumers.

INTRODUCTION individual foods has become known as nutrient profiling [5–8].

Helping consumers select nutrient-rich foods (NRF) is one
strategy to improve the quality of the American diet [1]. That
was the message of the 2005 Dietary Guidelines for Americans
and the 2005 USDA MyPyramid [2,3]. Both sets of guidelines
made the key distinction between foods that were energy dense
and foods that were nutrient rich. Consumers were advised to
seek out NRF to meet nutrient requirements without exceeding
daily energy needs [4].
The concept of nutrient density was not formally defined.
Nutrient-dense foods were merely described as those that
provided ‘‘relatively more’’ nutrients than calories [1,3]. Since
then, the new science of calculating the nutrient density of
Nutrient profile models calculate the percentage requirements
for key nutrients in foods relative to the dietary energy that the
foods provide [1]. Each food is assigned a single score that best
reflects its nutritional quality. Those scores can then be ranked
and foods assigned into multiple classes or categories.
Ranking foods according to their nutritional quality poses
many challenges, both conceptual and technical [1]. The
selection of key nutrients, the basis of calculation, and the
testing and validation of the model algorithm need to be based
on criteria that are both objective and transparent [8]. Nutrient
profile models have been based on nutrients to encourage,
mostly vitamins and minerals; nutrients to limit, such as fat,
sugar, and sodium; or some combination of both [1,6,9–14].

Address correspondence to: Adam Drewnowski, 305 Raitt Hall 353410, University of Washington, Seattle, WA 98195-3410. E-mail: adamdrew@u.washington.edu
Presented in part at the American College of Nutrition Annual Meeting, October 4, 2008, Arlington, VA.
Financial interests: The Symposium was supported by the National Dairy Council.

Journal of the American College of Nutrition, Vol. 28, No. 4, 421S–426S (2009)
Published by the American College of Nutrition

421S
Defining Nutrient Density
Table 1. Nutrients to Encourage and Nutrients to Limit in Selected NRn and LIM Subscores
Model Macronutrients Vitamins
NR6 Protein, fiber A, C Ca,
NR9 Protein, fiber A, C, E
NR11 Protein, fiber A, C, E, B12
NR15 Protein, fiber, monounsaturated A, C, D, E, thiamin,
fatty acids riboflavin, B12, folate
LIM
LIMt
The basis of calculation typically has been 100 g or 100 kcal of
food, or sometimes both [15]. In some cases, food rankings
generated by such models have been compared with expert
opinion [7,16,17]; in fewer cases, model scores were validated
with respect to measures of a healthy diet [18].
The Nutrient Rich Food approach is unique because it is
conceptualized as a comprehensive food guidance system
rather than a rating, numbering, or labeling system. Consumers
make critical decisions about food choices at many points
during the day: the NRF approach provides a useful tool for
education and guidance. Extensive consumer research is being
conducted to ensure that consumers will find the NRF
approach appealing and useful in selecting NRF and building
nutritious meals and more healthful diets. Not limited to
individual foods only, the NRF algorithm can be applied to
food groups, meals, menus, and total diets. Describing the
science that helps consumers make informed decisions about
their food choices—both inside and outside the store—is the
purpose of this review.
What Is Nutrient Density?
The concept of nutrient density is built around the amounts
of key nutrients contained in 100 kcal of a given food [19,20].
Whereas some foods contain ‘‘empty’’ calories, NRF are those
that contain relatively fewer calories than nutrients. The
selection of nutrients for inclusion in the NRF index was based
on current regulatory frameworks and dietary guidance
[21,22]. The 2005 Dietary Guidelines for Americans [2]
identified fiber; vitamins A, C, and E; calcium; potassium; and
magnesium as underrepresented in the U.S. diet. For children
and adolescents, nutrients of concern were fiber, vitamin E,
calcium, potassium, and magnesium. Vitamin B12, iron, folic
acid, and vitamin D were nutrients of concern for some
population subgroups. More formally, the U.S. Food and Drug
Administration (FDA) bases its definition of healthy foods on
their content of protein, fiber, vitamins A and C, calcium, and
iron. The credit side of the nutrient density equation typically
includes protein and fiber and a range of vitamins and
minerals.
Fat, sugar, and sodium are key nutrients to limit based on
multiple authoritative sources. For example, foods are
422S
Minerals Nutrients to Limit
Fe
Ca, Fe, Mg, K
Ca, Fe, Mg, Zn, K
Ca, Fe, Zn, K
Saturated fat, added sugar, Na
Saturated fat, total sugar, Na
disqualified from nutrition and health claims by the FDA if
they contain above-specified amounts of fat, saturated fat, trans
fat, cholesterol, and sodium. European Union regulations
include sugar on the list of nutrients to limit, although without
specifying if the sugar was added or total. Models developed in
the United Kingdom and in France have used energy, saturated
fat, total sugar, and sodium [5,6] or saturated fats, added
sugars, and sodium [12], respectively.
Since fat and sugar are highly correlated with energy density,
all nutrient profiles award high scores to foods that provide little
dietary energy per unit volume. In other words, energy density
and nutrient density of foods are inversely linked.
Development of the NRF Index
Table 1 shows the initial development and testing of the
NRF family of scores. First to be tested were the NRn
subscores, based on nutrients to encourage, where the number
n of nutrients could vary from 5 to as many as 15 [1,23,24].
The NR6 model was based on the 6 nutrients that the FDA uses
to define healthy foods. The NR9 model added a further 3
nutrients of concern as identified by the Dietary Guidelines for
Americans (vitamin E, magnesium, and potassium). The NR11
model added another additional 5 nutrients of concern for at
least a subset of the population (vitamin E, magnesium,
potassium, vitamin B12, and zinc). The NR15 model was the
original Naturally Nutrient Rich score, based on protein; fiber;
vitamins A, C, D, E, B1, B2, and B12; folate; calcium; iron;
potassium; and zinc [1]. Two subscores based on nutrients to
limit were the LIM score, based on saturated fat, added sugar
and sodium, and the LIMt score, based on total fat, total sugar,
and sodium [12].
All nutrient amounts were converted to percentage daily
values (%DV) per specified reference amount of food.
Percentage DVs were capped at 100% so that foods containing
very large amounts of a single nutrient would not obtain a
disproportionately high index score [1]. For nutrients to limit,
maximum recommended values were 20 g for saturated fat,
125 g for total sugar, 50 g for added sugar, and 2400 mg for
sodium in a 2000-kcal/d diet, as based on a variety of sources
[12]. Reference daily values for use on nutrition labels are
summarized in Table 2 [21,22].
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 Defining Nutrient Density

Table 2. Reference Daily Values for Nutrients, Based on 2000- regulatory structure of the FDA. Serving sizes, officially
kcal Diet described as the reference amounts customarily consumed
(RACC), are the basis of calculating nutrient %DVs on the
Nutrient Reference Daily Value
FDA Nutrition Facts panel. RACC values are related to the
Protein 50 g energy density of foods and are lower for sugar (4 g) and fats
Fiber 25 g
and oils (15 g) than for cheese (30 g), meats (85 g), vegetables
Monounsaturated fatty 20 g
acids and fruit (120 g), or milk, juices, and other beverages (240 g).
Vitamin A 5000 IU Models based on U.S. serving sizes may not find universal
Vitamin C 60 mg applications. In the European Union, for example, govern-
Vitamin D 400 IU (10 mg)
ment-mandated serving sizes do not as yet exist, and dietary
Vitamin E 30 IU (20 mg)
Thiamin 1.5 mg information is provided per 100 g [15,23]. The nutrient-
Riboflavin 1.7 mg profiling scheme developed by the British Food Standards
Vitamin B12 6 mg Agency (FSA) is based on 100 g, whereas the SAIN,LIM
Folate 400 mg scheme developed for the equivalent French agency AFSSA is
Calcium 1000 mg
based on a combination of 100 g and 100 kcal.
Iron 18 mg
Zinc 15 mg Although a system based on 100 g would seem to have
Potassium 3500 mg universal appeal, model profiles based on 100 g of foods make
Magnesium 400 mg no allowances for the fact that different foods and beverages
Fat 65 g
are consumed in very different amounts. Models in which
Saturated fat 20 g (10% energy of 2000-kcal diet)
Monounsaturated fat 20 g (10% energy of 2000-kcal diet) saturated fat, added sugar, and sodium are calculated per 100 g
Cholesterol 300 mg of food or beverage tend to penalize energy-dense foods
Sugars, total 125 g/50 g* consumed in small quantities (nuts, dried fruit, cheese) while
Sugars, added 50 g (10% energy of 2000-kcal diet) giving overly favorable scores to sugared beverages. A system
Sodium 2400 mg
based on 100 g can be very lenient toward caloric beverages
* 125 g from Institute of Medicine report; 50 g from World Health Organization unless special provisions are made. To account for these
report.
discrepancies between the 100 g standard and the larger
beverage portions normally consumed, the latest version of the
Table 3 summarizes the algorithms for selected families of British FSA score multiplies the negative subscore for
models. Raw NRF9.3 scores were unweighted sums of beverages by a factor of 2 [16]. This approximates calculations
reference %DVs for 9 nutrients to encourage minus the sum based on RACC in which added sugar is calculated per 245 g
of maximum %MRVs for 2 nutrients to limit. reference amount.
Calculations based on 100 kcal best reflected the original
concept of nutrient density of foods, defined as the ratio of
Basis of Calculation: 100 g, 100 kcal, or Serving Size?
nutrients to calories. One caution is that the 100-kcal base of
Three different bases of calculating nutrient density were calculations leads to 100 kcal and tends to give overly high
used in developing the NRF model: 100 g, 100 kcal, and scores to very low-energy-density salad greens, such as
serving size. Serving sizes were defined based on the current spinach, lettuce, endive, watercress, and cabbage. This is

Table 3. Algorithms for NRn and LIM Subscores and the NRF Index Score, Calculated per 100 kcal

Reference
Model Algorithm Amount Comment

Subscores NRn
P
NRn_100kcal 1{n (Nutrienti =DVi )=ED|100 100 kcal Nutrienti 5 content of nutrient i in 100-g edible portion;
DVi 5 daily values for nutrient i (see Table 1); n 5 the
number of nutrients; ED 5 energy density
Subscores LIM
P
LIM_100kcal 1{3 (Li =MRVi )=ED|100 100 kcal Li 5 content of limiting nutrient i in 100 g of edible portion
of food, I 5 1 to 3; ED 5 energy density
Composite models, NRF
NRFn.3_100kcal NRn_100kcal 2 LIM_100kcal 100 kcal Difference between sums
MRV 5 maximum recommended value; NRF 5 nutrient rich food; LIM 5 limited nutrient score.

JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 423S

Defining Nutrient Density
Fig. 1. A plot of median NRF9.3 scores (x-axis) shown in relation to energy density of foods (ED 5 kcal/100 g) by major USDA food group.
because 100 kcal of lettuce, with an energy density of 0.1 kcal/
g, translates into 1 kg of greens by weight. In excess of any
portion size, the 1 kg amount is then used to calculate the
amounts of vitamins and minerals. However, calculations
based on the 100-kcal reference amount led to the highest
percentage of variance accounted for in validation studies.
Alternative NRF9.3 Algorithms
Alternative NRF models were then validated against
independent measures of a healthy diet. The present diet quality
measure was based on the revised Healthy Eating Index scores
[25] that were calculated for participants in the 1999–2002
NHANES dietary survey. The best validation results were
obtained for the NRF9.3 model composed of a positive subscore
based on protein; fiber; vitamins A, C, and E; calcium; iron;
potassium; and magnesium and a negative subscore based on
saturated fat, added sugar, and sodium [26]. The composite
algorithm tracked diet quality better than metrics based
exclusively on nutrients to avoid, a finding that may have
implications for nutrition education and dietary guidance. The
composite NRF9.3 model based on nutrients to encourage and
nutrients to limit performed better than the negative LIM
subscore based on saturated fat, added sugars, and sodium only.
The preferred algorithms were those that were based on
subtracting the negative from the positive subscore (NRn 2
LIM), rather than a ratio between the two (NRn/LIM). The
ratio model, in particular, yielded a nonnormal distribution and
had least discriminating power. Ratio-based algorithms
exaggerated small differences and gave unrealistically high
424S
scores whenever the negative component tended toward zero.
Based on model performance, the optimal NRF9.3 algorithm
was the unweighted sum of %DVs for 9 nutrients to encourage,
minus the sum of %MRVs for nutrients to limit.
Fig. 1 summarizes how the NRF algorithm ranks foods
across and within food groups. The range of scores extends
from sugar to spinach. Most important, the NRF approach does
not make distinctions between good and bad foods; all foods
fall along a continuum. Their place on the continuum depends
on their nutrient content in relation to calories.
Consumer Applications
Helping the consumer to identify the most NRF at the point
of sale is one application of nutrient profiling. Depending on
the system chosen, individual foods have been awarded from 0
to 3 stars (effectively a 4-point scale) or were ranked from 0 to
100 points to denote their nutritional value. Another proposal
is to label foods with nutrition symbols and logos based on
their content of sugar and fat. In an alternative system,
launched by the National Heart Lung and Blood Institute,
foods are assigned into Go, Slow, and Whoa categories based
on their perceived sugar and fat content [27].
The NRF approach to food guidance stands apart from the
conventional nutrient-profiling systems. First, the NRF index
focuses on nutrients to encourage, while taking into account
three key nutrients to limit. Second, the NRF algorithm can be
applied to individual foods, meals, menus, and the total diet.
The NRF approach can therefore assist food choice decisions
at different places and times during the day, not only in the
VOL. 28, NO. 4

supermarket. Showing how specific food choices combine to
create a nutrient-rich meal or a nutrient-rich eating pattern is
one key element of the NRF approach.
An early application of the NRF scoring system showed how
meal quality improved when french fries were replaced with apple
slices and sweetened beverages were replaced with milk. Meals
designed by dietitians that feature NRF can also be subjected to
NRF evaluations [4]. Another important feature is that the NRF
approach can help consumers identify the best nutrition for the
food dollar. The NRF approach lends itself exceptionally well to
calculating nutrients per calorie and nutrients per unit cost.
Ensuring access to healthy, affordable foods has emerged as a
federal strategy for obesity prevention.
The consumer is looking for a more nuanced yet simple and
at-a-glance index of the nutrient quality of foods [24,28]. It
remains to be seen whether this approach will change food-
purchasing patterns, leading to measurable changes in diet
quality. Translating the concept of nutrient density into a
working algorithm that can help consumers achieve a more
nutrient-rich diet is the main challenge of nutrient profile design.
CONCLUSION
The emerging science of nutrient profiling needs to follow
basic scientific principles [9]. Some specific recommendations
are as follows. (1) The index nutrients need to be relevant to
dietary needs and, preferably, limited in number. Good nutrient
composition databases will be indispensable for this research.
(2) The reference amounts ought to be based on an
authoritative source and linked to food labeling. (3) The
algorithm ought to be both simple and transparent. Public
health has no need for profiling models that are patented or
proprietary. (4) The chosen models must be validated against
independent measures of a healthy diet and, ideally, against
health outcomes. (5) The models chosen need to be weighed
against food cost and food enjoyment. Finally, consumer
research is an integral part of this process. The ultimate test is
whether nutrient profile models will communicate nutrition
information in a way that is both appealing and valuable to the
consumer. One question is whether shelf labels or front-of-
pack labels or logos created in this manner will, in themselves,
be sufficient to promote better diets, or whether nutrient
profiling will be most effective when used in conjunction with
a more comprehensive educational program.
ACKNOWLEDGMENTS
This research was carried out with the financial support of
the National Dairy Council and the Beef Checkoff through the
National Cattlemen’s Beef Association.
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
Defining Nutrient Density
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