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Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach

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Jennifer Di Noia at William Paterson University
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Abstract

National nutrition guidelines emphasize consumption of powerhouse fruits and vegetables (PFV), foods most strongly associated with reduced chronic disease risk; yet efforts to define PFV are lacking. This study developed and validated a classification scheme defining PFV as foods providing, on average, 10% or more daily value per 100 kcal of 17 qualifying nutrients. Of 47 foods studied, 41 satisfied the powerhouse criterion and were more nutrient-dense than were non-PFV, providing preliminary evidence of the validity of the classification scheme. The proposed classification scheme is offered as a tool for nutrition education and dietary guidance.
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Volume 11 — June 05, 2014BRIEF
Defining Powerhouse Fruits and Vegetables: A Nutrient
Density Approach
Jennifer Di Noia, PhD
Suggested citation for this article: Di Noia J. Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach.
Prev Chronic Dis 2014;11:130390. DOI: http://dx.doi.org/10.5888/pcd11.130390 .
PEER REVIEWED
Abstract
National nutrition guidelines emphasize consumption of powerhouse fruits and vegetables (PFV), foods most strongly
associated with reduced chronic disease risk; yet efforts to define PFV are lacking. This study developed and validated
a classification scheme defining PFV as foods providing, on average, 10% or more daily value per 100 kcal of 17
qualifying nutrients. Of 47 foods studied, 41 satisfied the powerhouse criterion and were more nutrient-dense than
were non-PFV, providing preliminary evidence of the validity of the classification scheme. The proposed classification
scheme is offered as a tool for nutrition education and dietary guidance.
Objective
Powerhouse fruits and vegetables (PFV), foods most strongly associated with reduced chronic disease risk, are
described as green leafy, yellow/orange, citrus, and cruciferous items, but a clear definition of PFV is lacking (1).
Defining PFV on the basis of nutrient and phytochemical constituents is suggested (1). However, uniform data on food
phytochemicals and corresponding intake recommendations are lacking (2). This article describes a classification
scheme defining PFV on the basis of 17 nutrients of public health importance per the Food and Agriculture
Organization of the United Nations and Institute of Medicine (ie, potassium, fiber, protein, calcium, iron, thiamin,
riboflavin, niacin, folate, zinc, and vitamins A, B
6
, B
12
, C, D, E, and K) (3).
Methods
This cross-sectional study identified PFV in a 3-step process. First, a tentative list of PFV consisting of green leafy,
yellow/orange, citrus, and cruciferous items was generated on the basis of scientific literature (4,5) and consumer
guidelines (6,7). Berry fruits and allium vegetables were added in light of their associations with reduced risks for
cardiovascular and neurodegenerative diseases and some cancers (8). For each, and for 4 items (apples, bananas, corn,
and potatoes) described elsewhere as low-nutrient-dense (1), information was collected in February 2014 on amounts
of the 17 nutrients and kilocalories per 100 g of food (9). Because preparation methods can alter the nutrient content of
foods (2), nutrient data were for the items in raw form.
Second, a nutrient density score was calculated for each food using the method of Darmon et al (10). The numerator is
a nutrient adequacy score calculated as the mean of percent daily values (DVs) for the qualifying nutrients (based on a
2,000 kcal/d diet [11]) per 100 g of food. The scores were weighted using available data (Table 1) based on the
bioavailability of the nutrients (12): nutrient adequacy score = (Σ [nutrient
i
× bioavailability
i
)/DV
i
] × 100)/17. As some
foods are excellent sources of a particular nutrient but contain few other nutrients, percent DVs were capped at 100 so
that any one nutrient would not contribute unduly to the total score (3). The denominator is the energy density of the
food (kilocalories per 100 g): nutrient density score (expressed per 100 kcal) = (nutrient adequacy score/energy
density) x 100. The score represents the mean of percent DVs per 100 kcal of food.
Third, nutrient-dense foods (defined as those with scores ≥10) were classified as PFV. The Food and Drug
Administration defines foods providing 10% or more DV of a
nutrient as good sources of the nutrient (3). Because
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there are no standards defining good sources of a combination of nutrients-per-kilocalories, the FDA threshold was
used for this purpose. The 4 low-nutrient-dense items were classified as non-PFV.
To validate the classification scheme, the Spearman correlation between nutrient density scores and powerhouse group
was examined. The robustness of the scheme with respect to nutrients beneficial in chronic disease risk also was
examined by comparing foods classified as PFV with those separately classified as such based on densities of 8
nutrients protective against cancer and heart disease (ie, fiber, folate, zinc, and vitamins B
6
, B
12
, C, D, and E) (2,4).
Results
Of 47 foods studied, all but 6 (raspberry, tangerine, cranberry, garlic, onion, and blueberry) satisfied the powerhouse
criterion (Table 2). Nutrient density scores ranged from 10.47 to 122.68 (median score = 32.23) and were moderately
correlated with powerhouse group (ρ = 0.49, P = .001). The classification scheme was robust with respect to nutrients
protective against chronic disease (97% of foods classified as PFV were separately classified as such on the basis of 8
nutrients protective against cancer and heart disease). For ease of interpretation, scores above 100 were capped at 100
(indicating that the food provides, on average, 100% DV of the qualifying nutrients per 100 kcal). Items in cruciferous
(watercress, Chinese cabbage, collard green, kale, arugula) and green leafy (chard, beet green, spinach, chicory, leaf
lettuce) groups were concentrated in the top half of the distribution of scores (Table 2) whereas items belonging to
yellow/orange (carrot, tomato, winter squash, sweet potato), allium (scallion, leek), citrus (lemon, orange, lime,
grapefruit), and berry (strawberry, blackberry) groups were concentrated in the bottom half (4–7).
Discussion
The proposed classification scheme is offered in response to the call to better define PFV and may aid in strengthening
the powerhouse message to the public. The focus on individual foods in terms of the nutrients they provide may
facilitate better understanding of PFV than green leafy, yellow/orange, citrus, and cruciferous food groups that are
emphasized. Messages might specify PFV to help consumers know what they are and choose them as part of their
overall fruit and vegetable intake. As numeric descriptors of the amount of beneficial nutrients PFV contain relative to
the energy they provide, the scores can serve as a platform for educating people on the concept of nutrient density.
Expressing the nutrient desirability of foods in terms of the energy they provide may help focus consumers on their
daily energy needs and getting the most nutrients from their foods. The rankings provide clarity on the nutrient quality
of the different foods and may aid in the selection of more nutrient-dense items within the powerhouse group.
Foods within particular groups were studied; thus, other nutrient-dense items may have been overlooked. Because it
was not possible to include phytochemical data in the calculation of nutrient density scores, the scores do not reflect all
of the constituents that may confer health benefits. Warranting study is the utility of approaches defining PFV based
on the presence (regardless of amount) of nutrients and phytochemicals. Although nutrient density differences by
powerhouse group were examined, a true validation of the classification scheme is needed. Future studies might
identify healthful diets and examine correlations with PFV or look for correlations between intake of PFV and health
outcomes (3).
This study is an important step toward defining PFV and quantifying nutrient density differences among them. On the
basis of the qualifying nutrients, 41 PFV were identified. The included foods may aid in improving consumer
understanding of PFV and the beneficial nutrients they provide.
Information
Jennifer Di Noia, PhD, William Paterson University, 300 Pompton Rd, Wayne, NJ 07470. Telephone: 973-720-3714. E
-mail: dinoiaj@wpunj.edu.
References
1. Nanney MS, Haire-Joshu D, Hessler K, Brownson RC. Rationale for a consistent “powerhouse” approach to
vegetable and fruit messages. J Am Diet Assoc 2004;104(3):352–6. CrossRef PubMed
2. World Cancer Research Fund. Food, nutrition, physical activity, and the prevention of cancer: a global
perspective. Washington (DC): American Institute for Cancer Research; 2007.
3. Drewnowski A. Concept of a nutritious food: toward a nutrient density score. Am J Clin Nutr 2005;82(4):721–32.
PubMed
4. Van Duyn MA, Pivonka E. Overview of the health benefits of fruit and vegetable consumption for the dietetics
professional: selected literature. J Am Diet Assoc 2000;100(12):1511–21. CrossRef PubMed
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5. Higdon JV, Delage B, Williams DE, Dashwood RH. Cruciferous vegetables and human cancer risk: epidemiologic
evidence and mechanistic basis. Pharmacol Res 2007;55(3):224–36. CrossRef PubMed
6. Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary
Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services.
Washington (DC): US Department of Agriculture, Agricultural Research Service; 2010.
7. Shaw A, Fulton L, Davis C, Hogbin M. Using the food guide pyramid: a resource for nutrition educators.
Alexandria (VA): US Department of Agriculture, Food, Nutrition, and Consumer Services, Center for Nutrition
Policy and Promotion; 2001.
8. Seeram NP. Recent trends and advances in berry health benefits research. J Agric Food Chem 2010;58(7):3869–
70. CrossRef PubMed
9. USDA national nutrient database for standard reference, release 26. Washington (DC): US Department of
Agriculture, Agricultural Research Service; 2013.
10. Darmon N, Darmon M, Maillot M, Drewnowski A. A nutrient density standard for vegetables and fruits: nutrients
per calorie and nutrients per unit cost. J Am Diet Assoc 2005;105(12):1881–7. CrossRef PubMed
11. A food labeling guide: guidance for industry. College Park (MD): Food and Drug Administration; 2013.
http://www.fda.gov/downloads/Food/GuidanceRegulation/UCM265446.pdf. Accessed February 12, 2013.
12. Otten JJ, Hellwig JP, Meyers LD, editors. Dietary reference intakes: the essential guide to nutrient requirements.
Washington (DC): National Academies Press; 2006.
Tables
Table 1. Bioavailability of Nutrients Used to Weight Nutrient Density
Scores, 2014
Nutrient Bioavailability, %
Iron 18
Riboflavin 95
Niacin 30
Folate 50
Vitamin B
6
75
Vitamin B
12
50
Vitamin C 70–90
Vitamin K 20
Values shown represent the bioavailability of naturally occurring forms of the nutrients. When a range of values was
reported, the lowest value in the range was used as the weighting factor.
Table 2. Powerhouse Fruits and Vegetables (N = 41), by Ranking of Nutrient
Density Scores , 2014
Item Nutrient Density Score
Watercress 100.00
Chinese cabbage 91.99
Chard 89.27
Beet green 87.08
Spinach 86.43
Chicory 73.36
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Item Nutrient Density Score
Leaf lettuce 70.73
Parsley 65.59
Romaine lettuce 63.48
Collard green 62.49
Turnip green 62.12
Mustard green 61.39
Endive 60.44
Chive 54.80
Kale 49.07
Dandelion green 46.34
Red pepper 41.26
Arugula 37.65
Broccoli 34.89
Pumpkin 33.82
Brussels sprout 32.23
Scallion 27.35
Kohlrabi 25.92
Cauliflower 25.13
Cabbage 24.51
Carrot 22.60
Tomato 20.37
Lemon 18.72
Iceberg lettuce 18.28
Strawberry 17.59
Radish 16.91
Winter squash (all varieties) 13.89
Orange 12.91
Lime 12.23
Grapefruit (pink and red) 11.64
Rutabaga 11.58
Turnip 11.43
Blackberry 11.39
Leek 10.69
Sweet potato 10.51
Grapefruit (white) 10.47
Calculated as the mean of percent daily values (DVs) (based on a 2,000 kcal/d diet) for 17 nutrients (potassium, fiber,
protein, calcium, iron, thiamin, riboflavin, niacin, folate, zinc, and vitamins A, B
6
, B
12
, C, D, E, and K) as provided by 100 g
of food, expressed per 100 kcal of food. Scores above 100 were capped at 100 (indicating that the food provides, on
average, 100% DV of the qualifying nutrients per 100 kcal).
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For Questions About This Article Contact pcdeditor@cdc.gov
Page last reviewed: June 05, 2014
Page last updated: June 05, 2014
Content source: National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA
30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
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or the authors' affiliated institutions.
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Article
  • Oct 2005
The American diet is said to be increasingly energy-rich but nutrient-poor. To help improve the nutrient-to-energy ratio, the 2005 Dietary Guidelines for Americans recommend that consumers replace some foods in their diets with more nutrient-dense options. Such dietary guidance presupposes the existence of a nutrient density standard. However, a review of the literature shows that the concept of a nutritious food is not based on any consistent standards or criteria. In many cases, healthful foods are defined by the absence of problematic ingredients-fat, sugar, and sodium-rather than by the presence of any beneficial nutrients they might contain. Past attempts to quantify the nutrient density of foods have been based on a variety of calories-to-nutrient scores, nutrients-per-calorie indexes, and nutrient-to-nutrient ratios. The naturally nutrient rich (NNR) score, which is based on mean percentage daily values (DVs) for 14 nutrients in 2000 kcal food, can be used to assign nutrient density values to foods within and across food groups. Use of the NNR score allows consumers to identify and select nutrient-dense foods while permitting some flexibility where the discretionary calories are concerned. This approach has implications for food labeling, nutritional policy making, and consumer education. The Food and Drug Administration has considered approving nutrient claims based on the ratio of a beneficial nutrient to the food's energy content, as opposed to a specified minimum amount of a nutrient per serving size. Given the current dietary trends, the nutrient density approach can be a valuable toot for nutrition education and dietary guidance.
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Recent Trends and Advances in Berry Health Benefits Research
Article
  • Dec 2009
  • J AGR FOOD CHEM
Recent advances have been made in our scientific understanding of how berries promote human health and prevent chronic illnesses such as some cancers, heart disease, and neurodegenerative diseases. Cancer is rapidly overtaking heart disease as the number one killer disease in developed countries, and this phenomenon is coupled with a growing aging population and concomitant age-related diseases. Therefore, it is not surprising that consumers are turning toward foods with medicinal properties as promising dietary interventions for disease prevention and health maintenance. Among fruits, berries of all colors have emerged as champions with substantial research data supporting their abilities to positively affect multiple disease states. Apart from several essential dietary components found in berries, such as vitamins, minerals, and fiber, berries also contain numerous bioactives that provide health benefits that extend beyond basic nutrition. Berry bioactives encompass a wide diversity of phytochemicals (phytonutrients) ranging from fat-soluble/lipophilic to water-soluble/hydrophilic compounds. Recent research from laboratories across the globe has provided useful insights into the biological effects and underlying mechanisms of actions resulting from eating berries. The cluster of papers included here represents a cross section of topics discussed at the 2009 International Berry Health Benefits Symposium. Together, these papers provide valuable insight into recent research trends and advances made into evaluating the various health benefits that may result from the consumption of berries and their derived products.
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Overview of the Health Benefits of Fruit and Vegetable Consumption for the Dietetics Professional: Selected Literature
Article
  • Jan 2001
  • J AM DIET ASSOC
Epidemiologic evidence of a protective role for fruits and vegetables in cancer prevention is substantial. The strength of this scientific base guides US national policymaking in diet and health issues and facilitates community and local programs that address national dietary goals to increase fruit and vegetable consumption. Current scientific evidence also suggests a protective role for fruits and vegetables in prevention of coronary heart disease, and evidence is accumulating for a protective role in stroke. In addition, a new scientific base is emerging to support a protective role for fruits and vegetables in prevention of cataract formation, chronic obstructive pulmonary disease, diverticulosis, and possibly, hypertension. This article provides an overview of the health benefits associated with fruit and vegetable consumption for each of these conditions, including brief discussions of underlying protective mechanisms, identifies key scientific findings regarding the health benefits of fruit and vegetable consumption, and outlines applications of these findings for dietetics professionals. The evidence reviewed provides additional support for increased consumption of a wide variety of vegetables, in particular, dark-green leafy, cruciferous, and deep-yellow-orange ones, and a wide variety of fruits, in particular, citrus and deep-yellow-orange ones. Continued attention to increasing fruit and vegetable consumption is a practical and important way to optimize nutrition to reduce disease risk and maximize good health.
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Drewnowski A. Concept of a nutritious food: toward a nutrient density score. Am J Clin Nutr 82, 721-732
Article
  • Nov 2005
The American diet is said to be increasingly energy-rich but nutrient-poor. To help improve the nutrient-to-energy ratio, the 2005 Dietary Guidelines for Americans recommend that consumers replace some foods in their diets with more nutrient-dense options. Such dietary guidance presupposes the existence of a nutrient density standard. However, a review of the literature shows that the concept of a nutritious food is not based on any consistent standards or criteria. In many cases, healthful foods are defined by the absence of problematic ingredients-fat, sugar, and sodium-rather than by the presence of any beneficial nutrients they might contain. Past attempts to quantify the nutrient density of foods have been based on a variety of calories-to-nutrient scores, nutrients-per-calorie indexes, and nutrient-to-nutrient ratios. The naturally nutrient rich (NNR) score, which is based on mean percentage daily values (DVs) for 14 nutrients in 2000 kcal food, can be used to assign nutrient density values to foods within and across food groups. Use of the NNR score allows consumers to identify and select nutrient-dense foods while permitting some flexibility where the discretionary calories are concerned. This approach has implications for food labeling, nutritional policy making, and consumer education. The Food and Drug Administration has considered approving nutrient claims based on the ratio of a beneficial nutrient to the food's energy content, as opposed to a specified minimum amount of a nutrient per serving size. Given the current dietary trends, the nutrient density approach can be a valuable tool for nutrition education and dietary guidance.
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Higdon JV, Delage B, Williams DE, Dashwood RHCruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacol Res 55: 224-236
Article
  • Apr 2007
Cruciferous vegetables are a rich source of glucosinolates and their hydrolysis products, including indoles and isothiocyanates, and high intake of cruciferous vegetables has been associated with lower risk of lung and colorectal cancer in some epidemiological studies. Glucosinolate hydrolysis products alter the metabolism or activity of sex hormones in ways that could inhibit the development of hormone-sensitive cancers, but evidence of an inverse association between cruciferous vegetable intake and breast or prostate cancer in humans is limited and inconsistent. Organizations such as the National Cancer Institute recommend the consumption of five to nine servings of fruits and vegetables daily, but separate recommendations for cruciferous vegetables have not been established. Isothiocyanates and indoles derived from the hydrolysis of glucosinolates, such as sulforaphane and indole-3-carbinol (I3C), have been implicated in a variety of anticarcinogenic mechanisms, but deleterious effects also have been reported in some experimental protocols, including tumor promotion over prolonged periods of exposure. Epidemiological studies indicate that human exposure to isothiocyanates and indoles through cruciferous vegetable consumption may decrease cancer risk, but the protective effects may be influenced by individual genetic variation (polymorphisms) in the metabolism and elimination of isothiocyanates from the body. Cooking procedures also affect the bioavailability and intake of glucosinolates and their derivatives. Supplementation with I3C or the related dimer 3,3'-diindolylmethane (DIM) alters urinary estrogen metabolite profiles in women, but the effects of I3C and DIM on breast cancer risk are not known. Small preliminary trials in humans suggest that I3C supplementation may be beneficial in treating conditions related to human papilloma virus infection, such as cervical intraepithelial neoplasia and recurrent respiratory papillomatosis, but larger randomized controlled trials are needed.
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to the Secretary of Agriculture and the Secretary of Health and Human Services
  • Jan 2010
Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington (DC): US Department of Agriculture, Agricultural Research Service; 2010.