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Table 2. Powerhouse Fruits and Vegetables (N = 41), by Ranking of Nutrient Density Scoresa, 2014 Di Noia J. Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach. Prev Chronic Dis 2014;11:130390. Submitted graphic.

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submitted by Matthew Welsh, Resource Conservationist, Natural Resources Conservation Service, USDA
September 28, 2022 marked the first White House Conference on hunger, nutrition, and health held in over 50 years. In fact, the last landmark summit occurred in 1969. With such a long gap between conferences the challenges facing national food and health care policies have evolved in the proceeding decades. In the First Opinion newsletter dated September 1, 2022, Dariush Mozaffarain & David Waters state “Poor diets are a leading cause of death, contributing to high rates of heart disease, diabetes, and some cancers” Within the Opinion Newsletter it is highlighted that 50% of the adults in the United States have diabetes or prediabetes and furthermore 75% are living overweight with a dramatic 90% not in ideal cardiometabolic health.  

The Mozaffarain & Waters Opinion Newsletter stresses the need to recognize that “better nutrition and access to healthy foods can help prevent and treat critical and chronic illnesses, improve health equity, and save money” They point to a need for recognizing “food is medicine” interventions which would bring food and the American diet out-front in addressing the nation’s health issues. According to Rodale Institute;  modern food contains less protein, calcium, phosphorus, iron, riboflavin, and vitamin C than food produced just half a century ago. The decline of nutrient density overtime has been also noted in studies cited in the book Dorito Effect by Mark Schatzker. In this book, a British Food Journal compared fruits and vegetables in the 1930s and 1980s and found calcium down 19%, iron down 22%, and potassium down by 14%. The same study also found that 1950s cauliflower had twice as much thiamin, Kale twice as much riboflavin, and asparagus had three times as much Vitamin C. Considering the documented dilution of nutrient concentration over time and complex socioeconomic factors limiting access to nutrient rich fresh fruits and vegetables the Mozaffarain & Waters Opinion Newsletter proclaims  “For the first time, the health care system - the single largest sector of the American economy - is entering the fight not only to get calories to people but also to ensure citizens’ diets are rich with nourishing foods to advance well-being, prevent sickness, and even treat disease”

Table 2 above illustrates the value of powerhouse fruits and vegetables. The Nutrient Density Score metric is a mean of % values for 17 nutrients. Defining all fruits and vegetables in the same category does not fully account for their differences in delivering essential nutrients within a diet. The top of the chart contains the five highest nutrient dense fruits and vegetables according to this research. In contrast the bottom five contain significantly lower nutrient concentrations of desired potassium, fiber, protein, calcium, iron, zinc, and essential vitamins. The term “empty calories” would best describe the disparity between these nutrient dense foods and lesser nutrient dense fruits and vegetables.

Mozaffarain & Waters describe in more detail how “Food is Medicine” can be used in the real world through medically tailored meal programs for individuals with severe and complex illnesses, these meals would be specifically designed for them and their health needs. Another approach cited in the Opinion Newsletter is using “Produce Prescriptions’ by which medical providers can work directly with patients to access fresh fruits and vegetables. These interventions are touted as a few strategies that can be implemented to the toolbox for addressing food and nutrition insecurity. The Opinion Newsletter cites “A National produce program could save $40 billion in health care costs and prevent nearly 2 million heart attacks, strokes, and other cardiovascular disease events over the lifetime of U.S. adults.” The monetary and prevention figures cited by Mozaffarain & Waters were found in an Article from National Library of Medicine.    

Mozaffarain & Waters conclude by advocating the importance of nutrition as a primary tool to treat the country’s health issues and how access to the highlighted medically tailored meals and produce prescriptions could be effective interventions to meet this objective.