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Scientific Rationale: TNT Scale Variables

The following nutrients are used in the Total Nutrition Truth (TNT) formula that generates a score for an individual food item.  Each food item is analyzed for its nutrient composition, using the Nutrition Data System for Research software version 2008, developed by the Nutrition Coordinating Center (NCC), University of Minnesota, Minneapolis, MN.  For each gram of a single nutrient in the food item, points were either added or deducted, as listed below.

Fiber = (+) 6 points/gram

The TNT scale gives dietary fiber a score of 6 points per gram, reflecting the numerous benefits of consuming a diet high in fiber. Fiber is a structural component of plant foods that cannot be digested and thus provides no calories. It aids in the passage of food through the colon and alleviates constipation. By binding cholesterol, slowing glucose absorption, and providing a feeling of fullness, fiber may lower risk of heart disease, diabetes, and obesity. In addition, studies show that a diet high in fiber from whole grains may decrease risk of colorectal cancer.

Supporting Articles:

  • Montonen, Jukka et. al. Whole-grain and fiber intake and the incidence of type 2 diabetes. American Journal of Clinical Nutrition, Vol. 77, No. 3, 622-629, March 2003
  • Wu, Huiyun et. al. Dietary fiber and progression of atherosclerosis: the Los Angeles Atherosclerosis Study. American Journal of Clinical Nutrition, Vol. 78, No. 6, 1085-1091, December 2003
  • Schatzkin, Arthur et. al. Dietary fiber and whole-grain consumption in relation to colorectal cancer in the NIH-AARP Diet and Health Study. American Journal of Clinical Nutrition, Vol. 85, No. 5, 1353-1360, May 2007.

Saturated Fat = (-) 6 points/gram

The TNT scale gives saturated fat a score of (-) 6 points per gram.  Strong evidence from numerous clinical trials shows that an increased intake of saturated fat can increase blood levels of both total cholesterol and LDL (bad) cholesterol. Due to its effect on blood lipid profiles, saturated fat intake increases risk of type 2 diabetes and heart disease.

Supporting Articles:

  • Griel AE. Kris-Etherton PM. Beyond saturated fat: the importance of the dietary fatty acid profile on cardiovascular disease. Nutrition Reviews. 64(5 Pt 1):257-62, 2006 May.
  • Upritchard JE. Zeelenberg MJ. Huizinga H. Verschuren PM. Trautwein EA. Modern fat technology: what is the potential for heart health? Proceedings of the Nutrition Society. 64(3):379-86, 2005 Aug.
  • Dimmitt SB. Recent insights into dietary fats and cardiovascular disease. Clinical & Experimental Pharmacology & Physiology. 22(3):204-8, 1995 Mar.

Monounsaturated Fat = (+) 2 points/gram

The TNT scale gives mono-unsaturated fat (MUFAs) a score of 2 points per gram.  Mono-unsaturated fat intake is inversely related to risk of coronary heart disease. This relationship is evident in studies of populations with moderately high total fat intake where saturated fats were replaced with mono-unsaturated fats.  A large body of evidence exists that demonstrates that mono-unsaturated fats decrease LDL (bad) cholesterol without also lowering HDL (good) cholesterol levels. MUFAs are considered “neutral” regarding heart disease but when replacing saturated fat, they provides a real health benefit.

Supporting Articles:

  • Griel AE. Kris-Etherton PM. Beyond saturated fat: the importance of the dietary fatty acid profile on cardiovascular disease. Nutrition Reviews. 64(5 Pt 1):257-62, 2006 May.
  • Upritchard JE. Zeelenberg MJ. Huizinga H. Verschuren PM. Trautwein EA. Modern fat technology: what is the potential for heart health? Proceedings of the Nutrition Society. 64(3):379-86, 2005 Aug.
  • Dimmitt SB. Recent insights into dietary fats and cardiovascular disease. Clinical & Experimental Pharmacology & Physiology. 22(3):204-8, 1995 Mar.

Polyunsaturated Fat = (+) 4 points/gram

The TNT scale gives poly-unsaturated fats (PUFAs) a score of 4 points per gram. A growing body of evidence demonstrates an inverse relationship between poly-unsaturated fat intake and the incidence of coronary heart disease (CHD).  Much of the recent attention has been focused on omega-3 and omega-6 fatty acids. Consuming fish, which is high omega-3 fatty acids, at least twice a week, is associated with dramatically lower rates of sudden cardiac death.  Other studies have shown that omega-3 fatty acids may protect against or improve symptoms of diseases such as inflammatory bowel disease, Crohn’s Disease, rheumatoid arthritis, and asthma.  Poly-unsaturated fats can also decrease blood clot formation and lower blood pressure. People with higher intakes of PUFAs versus saturated fat have a decreased risk of type 2 diabetes.  Nuts and vegetable oils contain high levels of PUFAs. 

Supporting Articles:

  • Willett, WC. The Mediterranean diet: science and practice. Public Health Nutrition. 9(1A):105-10, 2006 Feb.
  • Mills, SC. Windsor AC. Knight SC. The potential interactions between polyunsaturated fatty acids and colonic inflammatory processes. [Review] [101 refs] Clinical & Experimental Immunology. 142(2):216-28, 2005 Nov.
  • Dimmitt SB. Recent insights into dietary fats and cardiovascular disease. Clinical & Experimental Pharmacology & Physiology. 22(3):204-8, 1995 Mar.

Total Fat (>20 grams) = (-)3 points per gram over 20

The TNT scale gives a score of (-1) point per gram of fat over 20 grams.  This is based on the well-established relationship between total fat content of food and cholesterol levels.  In addition, diets high in total fat are correlated with an increased incidence of cancers such as breast, colon, pancreatic, ovarian, endometrial, and prostate cancers. Diets high in fat are correlated with increased weight gain since fat provides 9 kcal/gram while protein and carbohydrates provide 4 kcal/gram.  Animal products and desserts are our biggest sources of total fat.

Supporting Articles:

  • Dietschy JM. Dietary fatty acids and the regulation of plasma low density lipoprotein cholesterol concentrations. Journal of Nutrition. 128(2 Suppl):444S-448S, 1998 Feb.
  • Rose DP. Dietary fatty acids and cancer. American Journal of Clinical Nutrition. 66(4 Suppl):998S-1003S, 1997 Oct.

Protein = (+) 3 points/gram (maximum 30)

The TNT scale gives protein a score of 3 points per gram, with an upper limit of 30 points for 10 grams. While protein provides satiety, the typical American diet usually provides enough protein to fulfill the body’s needs. While studies show protein restriction may lead to loss of lean body mass, consuming extra protein does not provide additional health benefits. The best sources of protein include some plant foods (beans, soy, nuts, some vegetables) and most animal products (meat, eggs, dairy). Unfortunately getting all your protein from animal sources will also increase your intake of saturated fat and cholesterol.     

Supporting Articles:

  • Food and Nutrition Board, Institute of Medicine: Macronutrient and Healthful Diets. In Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, D.C., The National Academies Press; 2002:609-696.  
  • Buis, Jeffrey et. al. Mre11 Nuclease Activity Has Essential Roles in DNA Repair and Genomic Stability Distinct from ATM Activation. Cell. Vol. 135, No. 1, 85-96. Oct. 2008.
  • Young, VR; Marchini, JS. Mechanisms and nutritional significance of metabolic responses to altered intakes of protein and amino acids, with reference to nutritional adaptation in humans. Am J Clin Nutr. 1990;51:270–89.

6 Vitamins/Minerals: Maximum of 2 points/vitamin

The TNT Scale gives each of six vitamins and minerals a maximum score of 2 points based on the percentage of recommended daily intake. While most adults often meet or exceed their caloric needs, they do not meet recommended intakes for many essential nutrients. Selecting foods that are rich in essential nutrients helps to promote health, support normal growth and development, and may reduce risk of chronic diseases. Based on recommendations by the Institute of Medicine and the nutrients highlighted by the USDA Dietary Guidelines, the TNT scale designates points for Vitamins A, C, E, B6, B12 and Calcium. Foods higher in these vitamins and minerals are usually high in nutrient density and lower in caloric density.

Vitamin A

Vitamin A plays essential roles in normal vision, gene expression, growth and development, reproduction, and immune function. Low intake has also been linked to weakened immune function and anemia.

Supporting Articles:

  • Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academy Press, Washington, DC, 2001.
  • Mahan, L. K., and Escott-Stump, S.  Krause's Food, Nutrition, and Diet Therapy.11th ed. Philadelphia, Pennsylvania: Elsevier. 2004.

Vitamin C

Vitamin C, or ascorbic acid, is required for the synthesis of collagen which provides the structural component for blood vessels, tendons, ligaments, and bone. Vitamin C acts as an antioxidant and is anti-inflammatory. Recent studies suggest that higher intakes of vitamin C may decrease heart disease and depression. 

Supporting Articles:

  • Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. American Journal of Clinical Nutrition.1999;69(6):1086-1107.
  • Simon JA, Hudes ES. Serum ascorbic acid and gallbladder disease prevalence among US adults: the Third National Health and Nutrition Examination Survey (NHANES III). Archives of Internal Medicine. 2000;160(7):931-936.
  • Osganian SK, Stampfer MJ, Rimm E, et al. Vitamin C and risk of coronary heart disease in women. Journal of the American College of Cardiology. 2003;42(2):246-252.

Vitamin B12

Vitamin B12 is responsible for the normal metabolism of all cells. B12 deficiencies may be associated with increased risk of cardiovascular disease and cancer. Vitamin B12 is naturally found in animal sources such as liver and kidney, fish, eggs, milk, and dairy products. Plant-based foods do not provide vitamin B12. Thus, vegans and strict vegetarians may need to supplement their diet with vitamin B12. The elderly are often low in Vitamin B12 due to poor absorption which can contribute to decreased cognitive function. 
 
Supporting Articles:                 

  • Quinlivan EP, McPartlin J, McNulty H, et al. Importance of both folic acid and vitamin B12 in reduction of risk of vascular disease. Lancet. 2002;359(9302):227-228.
  • Wu K, Helzlsouer KJ, Comstock GW, Hoffman SC, Nadeau MR, Selhub J. A prospective study on folate, B12, and pyridoxal 5'-phosphate (B6) and breast cancer. Cancer Epidemiology Biomarkers and Prevention. 1999;8(3):209-217. 

Vitamin B6

Vitamin B6 is crucial for proper functioning of the nervous and immune systems. Vitamin B6 may also play a role in decreasing risk for cardiovascular disease.

Supporting Articles:

  • Food and Nutrition Board, Institute of Medicine. Vitamin B6. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington D.C.: National Academies Press; 1998:150-195
  • Bender DA. Novel functions of vitamin B6. The Proceedings of the Nutrition Society. 53:625-30. 1994.
  • Folsom AR, Nieto FJ, McGovern PG, et al. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 1998;98(3):204-210

Vitamin E

Vitamin E is a potent antioxidant. Its main role is to protect cells by neutralizing the damaging effects of free radicals.

Supporting Articles:

  • Can, C, et. al. Vascular endothelial dysfunction associated with elevated serum homocysteine levels in rat adjuvant arthritis: effect of vitamin E administration. Life Sciences, 71:401-410. 2002.
  • Fairfield, KM, et. al. Vitamins for chronic disease prevention in adults: scientific review. JAMA 287:3116-3126. 2002.
  • Malmberg KJ, et. al. A short term dietary supplementation of high doses of vitamin E increases T helper 1 cytokine production in patients with advanced colorectal cancer. Clinical Cancer Research. 8:1772-1778. 2002.

Calcium

Calcium is the most abundant mineral in the human body. More than 99% of total body calcium is stored in the teeth and bones. The remaining 1% is found in the blood and extracellular fluid where it plays a role in maintaining heart rate, blood clotting, and muscle function.  The presence of vitamin D increases the uptake of calcium in the intestine. Low dietary intake may cause calcium to be leached from your bones and can eventually lead to osteoporosis. Conversely, adequate calcium intake may reduce risk of cancers and help control blood pressure.

Supporting Articles:

  • Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. Washington DC: The National Academies Press, 1997.
  • Huncharek, M, et. al. Colorectal cancer risk and dietary intake of calcium, vitamin D, and dairy products: a meta-analysis of 26,335 cases from 60 observational studies. Nutrition and Cancer. 2009;61(1):47-69.
  • Allender, PS, et. al. Dietary Calcium and Blood Pressure: A Meta-Analysis of Randomized Clinical Trials. Annals of Internal Medicine. 1996;124(9):825-831.

Carbohydrates = (-) 0.5 points/gram

The TNT scale gives carbohydrates a score of negative 0.5 points per gram. Carbohydrates are the primary form of energy used by the body, and are therefore essential to any diet. However, not all carbohydrates are created equal. Some consist of long chains of sugar molecules (complex carbohydrates) and some consist of only two sugar molecules (simple carbohydrates). Foods that are high in simple carbohydrates, such as refined grain products, may cause spikes in blood sugar, which can reduce satiety and promote insulin resistance, a precursor to Type 2 diabetes. In addition, studies show that excessive consumption of refined carbohydrates increases the risk of heart disease. The TNT scale does not distinguish between simple and complex carbohydrates because foods that are high in complex carbohydrates are almost always high in fiber, and thus will receive a good overall score. High carbohydrate foods that are low in fiber (white bread, white pasta, white rice) are low in nutrient density and cause a spike in blood glucose similar to that which is seen when consuming sugar.

Supporting Articles:

  • Liu, S. et. al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. American Journal of Clinical Nutrition, Vol. 71, No. 6, 1455-1461, June 2000.

Added Sugar =  (-) 2.5 points/gram

The TNT scale gives added sugars a score of negative 2.5 points per gram. Added sugars are sugars or syrups that are added to foods during processing and cooking (as opposed to sugars that are found naturally in foods). They provide calories but no other nutritional benefits, such as vitamins or minerals. Because they are simple carbohydrates, added sugars can cause unhealthy spikes in blood sugar. The scale specifies added sugars, because sugars found naturally in plant foods are paired with fiber, which slows their absorption, and also usually contain other essential nutrients that promote health.

Supporting Articles:

  • Malik, VS, Schulze, MB, and Hu, FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. American Journal of Clinical Nutrition, Vol. 84, No. 2, 274-288, August 2006
  • Schulze, MB. et. al. Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women. JAMA. 2004;292:927-934.

Cholesterol: (-) 1 point for every 50 mg

The TNT scale gives cholesterol a score of negative 1 points for every 50 mg of cholesterol.  Dietary intake of cholesterol is associated with higher blood levels of bad cholesterol.  Elevated blood levels of bad cholesterol are associated with higher rates of heart disease.

Supporting Articles:

  • Dietschy JM. Dietary fatty acids and the regulation of plasma low density lipoprotein cholesterol concentrations. Journal of Nutrition. 128(2 Suppl):444S-448S, 1998 Feb.
  • Dietschy JM. Dietary fatty acids and the regulation of plasma low density lipoprotein cholesterol concentrations. [Review] [27 refs] Journal of Nutrition. 128(2 Suppl):444S-448S, 1998 Feb.

Serving Size: (-) 1 point for every 50 calories over appropriate serving size

  • Breakfast entrée: 350 calories
  • Lunch/Dinner entrée: 550 calories
  • Side dish/Dessert/Snack: 200 calories
  • Beverage: 100 calories

The TNT scale deducts 1 point for every 50 calories above a certain limit. Our calorie limits are based on a 2,000-calorie diet that includes 3 meals and 1-2 snacks per day. This intake is generally the intake of females of normal weight (18-50y) while men of average weight consume ~2800kcal/day. To keep daily calorie intake at or below 2,000 calories, we suggest that each meal, snack, or beverage remain under the calorie limits listed above.

Supporting Articles:

  • Rolls BJ, Morris EL, Roe LS. Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr 2002; 76: 1207–13.
  • Ello-Martin JA, Ledikwe JH, Rolls BJ. The influence of food portion size and energy density on energy intake: implications for weight management. Am J Clin Nutr. 2005;82:S236–41.

Bonus Points

  • 5 points for fruit 1 (most fruits)
  • 2.5 points for fruit 2 (pineapple, grapes, raisins, banana, watermelon, mango, cantaloupe, honey dew melon)
  • 10 points for vegetable 1 (most vegetables)
  • 5 for vegetable 2 (corn, peas, cucumber, mushrooms, avocado)
  • 0 points for vegetable 3 (iceberg lettuce, potato)

-To receive bonus points, a food item must contain at least 1 full serving of a fruit and/or vegetable (one serving is ½ cup).
-A single food item can only receive one bonus score.
-A food item receives the score of its highest-scoring ingredient for which there is a full serving.

Description: The bonus points allotted to fruits and vegetables reflect the importance of making fruits and vegetables the largest part of your diet. Numerous studies link high consumption of fruits and vegetables to lower risks for cancer, heart disease, diabetes, and other chronic health disorders. Fruits and vegetables are generally nutrient-dense, meaning that they have a high proportion of vitamins and minerals in relation to their caloric content. In addition, they contain phytochemicals –plant-based compounds that may protect cells, improve memory, prevent cancer, and provide other health benefits.

Supporting Articles:

  • Riboli, E and Norat, T. Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. The American Journal of Clinical Nutrition. 2003, vol. 78, no 3, SUP (174 p.) pp. 559S-569S.
  • Liu, S et. al. Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study. American Journal of Clinical Nutrition, Vol. 72, No. 4, 922-928, October 2000
  • Liu, RH. Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals. Am J Clin Nutr. 2003 Sep;78(3 Suppl):517S-520S.