Effect of a Nutrient Rich Foods consumer education program: results from the nutrition advice study.

Background: 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.

Objective: 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.

Design: 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 education (n=61).

Participants/setting: Adult primary food shoppers and preparers with at least one child in the household aged 3 to 17 years.

Intervention: 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.

Statistical Analyses: Examined time-by-treatment interactions in outcome measures.

Results: 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.

Conclusions: 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.