The Nutrient Rich Foods (NRF) approach to eating uses the NRF Index, a nutrient profiling
metric to help consumers choose foods that contain more vitamins, minerals, and other
nutrients per kilocalorie. Research is needed to test the efficacy of dietary guidance
using nutrient profiling systems to rank foods.
To examine whether nutrition education and supporting materials would increase understanding
of the NRF approach and improve food shopping, meal planning, consumption of nutrient-rich
foods, and diet quality.
Unbalanced randomized controlled trial conducted in February to May 2009 with participants
assigned to NRF education group (n=128) or control group receiving standard nutrition
Adult primary food shoppers and preparers with at least one child in the household
aged 3 to 17 years.
Group education session and support tools (pocket guide, shopping list, refrigerator
magnet, weekly e-mail messages, and biweekly mailings).
Main outcome measures
Surveys of knowledge, attitudes, and behaviors and two 24-hour telephone dietary recalls
at baseline and after an 8-week intervention period.
Examined time-by-treatment interactions in outcome measures.
Compared to controls, NRF participants increased meal planning (+24.2% vs −4.9%; P<0.01), ability to identify nutrient-rich foods (+60.2% vs +24.6%; P<0.001), and use of shopping lists (+14.1% vs +3.3%; nonsignificant trend), and consumed
more vegetables and fruits (P<0.05). NRF participants improved overall diet quality as shown by their scores on
the Healthy Eating Index (P=0.04) and NRF scale scores (nonsignificant trend). Significant improvements were
observed in Healthy Eating Index component scores for total fruit; whole fruit; whole
grains; saturated fat; and energy from solid fats, alcohol, and added sugars.
Findings of this study showed that a consumer education program increased participants'
use of the NRF approach and improved diet quality. Larger and longer-term studies
are needed to confirm the findings and better understand processes of change.