Preventing Chronic Disease | Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach (2023)

Volume 11 — June 05, 2014


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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:



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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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, B6, B12, C, D, E, and K) (3).

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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 [nutrienti × bioavailabilityi)/DVi] × 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 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 B6, B12, C, D, and E) (2,4).

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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).

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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.

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Author Information

Jennifer Di Noia, PhD, William Paterson University, 300 Pompton Rd, Wayne, NJ 07470. Telephone: 973-720-3714. E-mail:

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  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
  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. 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.

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Table 1. Bioavailability of Nutrientsa Used to Weight Nutrient Density Scores, 2014
NutrientBioavailability, %
Vitamin B675
Vitamin B1250
Vitamin C70–90
Vitamin K20

a 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 Scoresa, 2014
ItemNutrient Density Score
Chinese cabbage91.99
Beet green87.08
Leaf lettuce70.73
Romaine lettuce63.48
Collard green62.49
Turnip green62.12
Mustard green61.39
Dandelion green46.34
Red pepper41.26
Brussels sprout32.23
Iceberg lettuce18.28
Winter squash (all varieties)13.89
Grapefruit (pink and red)11.64
Sweet potato10.51
Grapefruit (white)10.47

a 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, B6, B12, 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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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

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How do fruits and vegetables reduce the risk of diseases? ›

A diet rich in vegetables and fruits can lower blood pressure, reduce the risk of heart disease and stroke, prevent some types of cancer, lower risk of eye and digestive problems, and have a positive effect upon blood sugar, which can help keep appetite in check.

How many grams of fruits and vegetables are recommended for the prevention of chronic disease? ›

Of note, the World Health Organization (WHO) recommends the daily consumption of >400 g of fruit and vegetables as part of a healthy diet low in fat, sugar, and salt (sodium chloride), in order to minimize the risk of certain non-communicable diseases like CVD and type 2 diabetes mellitus (12).

Are fruits and vegetables high in nutrient density? ›

Nutrient-dense foods are rich in vitamins, minerals and other nutrients important for health, without too much saturated fat, added sugars and sodium. We're talking fruits, vegetables, whole grains, non-fat and low-fat dairy, fish and seafood, unprocessed lean meat and skinless poultry, nuts and legumes.

What is an ANDI score? ›

The Aggregate Nutrient Density Index or ANDI is a scoring system that rates foods on a scale from 1 to 1000 based on nutrient content. Developed by Dr. Joel Fuhrman, ANDI is assigned to whole foods that contain the highest nutrients per calorie.

What chronic diseases can vegetables prevent? ›

(2) reported that there was compelling evidence that increased consumption of fruits and vegetables reduces the risk for coronary heart disease, stroke, and hypertension. They reported “probable evidence” that increased fruit and vegetable intake reduces the risk of cancer (generally).

Can fruits and vegetables help you cure diseases? ›

Thus, high-fiber foods like vegetables, beans, grains, and fruits help protect against disease, decrease inflammation, and boost your immune system ( 11 ). On the other hand, low-fiber diets are associated with an increased risk of illnesses, including colon cancer and stroke (12, 13 , 14 , 15 ).

What is the meaning of nutrient density? ›

“Nutrient density” is a term that describes this concept—it incorporates the balance of beneficial nutrients in a food (like vitamins, minerals, lean protein, healthy fats and fiber) compared with nutrients to limit (like saturated fat, sodium, added sugars and refined carbohydrates).

What is true about the concept of nutrient density? ›

The concept of nutrient density is virtually the opposite of empty calories. A nutrient-dense food is rich in nutrients compared to a calorie-dense food that is higher in calories. For example, a 1-cup serving of fresh broccoli contains about 30 calories.

Why are fruits considered nutrient-dense foods? ›

Fruit contains both water and fiber and is low-energy-density, high- nutrient- density food that contain a variety of healthful nutrients including fiber, vitamins, minerals and antioxidants that promote health with 60- 80 calories per serving.

Which foods does Dr Fuhrman recommend to avoid and why? ›

During the first six weeks on the Fuhrman Diet, you're prohibited from eating meat including beef, pork, chicken, turkey, veal and lamb. You won't be able to eat eggs either. Dr. Fuhrman recommends that you cut meat out of your diet because many options contain unhealthy saturated fats and large numbers of calories.

Which food group ranks highest in nutrient density? ›

Top 10 of the most nutrient-dense food groups
  • Vegetables.
  • Fruits.
  • Whole grains.
  • Beans.
  • Seafood,
  • Eggs.
  • Low-fat dairy products.
  • Lean meat and poultry.

WHO recommended fruit and vegetable intake? ›

The World Health Organisation and Food and Agriculture of the United Nation reports recommend adults to consume at least five servings of fruits and vegetables per day excluding starchy vegetables.

What is the recommended amount of fruits and vegetables per day? ›

Depending on their age and sex federal guidelines recommend that adults eat at least 1½ to 2 cups per day of fruit and 2 to 3 cups per day of vegetables as part of a healthy eating pattern.

What is the importance of fruits and vegetables for healthy life? ›

Fruit and vegetables are a good source of vitamins and minerals, including folate, vitamin C and potassium. They're an excellent source of dietary fibre, which can help to maintain a healthy gut and prevent constipation and other digestion problems. A diet high in fibre can also reduce your risk of bowel cancer.

Why do we need dietary changes to prevent chronic diseases? ›

Eat Healthy

Eating healthy helps prevent, delay, and manage heart disease, type 2 diabetes, and other chronic diseases. A balanced, healthy dietary pattern includes a variety of fruits, vegetables, whole grains, lean protein, and low-fat dairy products and limits added sugars, saturated fats, and sodium.

How can we prevent diseases and stay healthy? ›

Eight healthy choices to reduce your risk for disease
  1. Be a non-smoker and avoid second hand smoke. If you smoke, get help to quit. ...
  2. Be physically active everyday. ...
  3. Eat healthy foods. ...
  4. Achieve a healthy weight. ...
  5. Control your blood pressure. ...
  6. Limit your intake of alcohol. ...
  7. Reduce your stress. ...
  8. Be screened or tested regularly.
21 Jan 2011

Why is disease prevention important? ›

Preventing disease through routine vaccination can improve both health and economic stability. “Increased investments on immunization in low- and middle-income countries could avert up to 36 million deaths and 24 million cases of impoverishment due to medical costs,” UNICEF reports.

How does nutrition affect chronic disease? ›

Adults who eat a healthy diet live longer and have a lower risk of obesity, heart disease, type 2 diabetes, and certain cancers. Healthy eating can help people with chronic diseases manage these conditions and avoid complications.

What is a natural cure for chronic disease? ›

Eat a Healthy Diet
  1. Ensure generous consumption of fruits and vegetables and adequate folic acid intake. ...
  2. Consume cereal products in their whole-grain, high-fiber form. ...
  3. Limit consumption of sugar and sugar-based beverages. ...
  4. Limit excessive caloric intake from any source. ...
  5. Limit sodium intake.

Can you reverse chronic disease? ›

The reversal of chronic diseases is achievable with today's alternative medicine choices. Functional medicine is a modern alternative choice for patients who have one or more health issues.

Why is nutrient density important? ›

Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese.

How do you identify nutrient-dense foods? ›

Nutrient-dense foods often are lower in calories compared to other foods with fewer nutrients. For example, fruits, vegetables, whole grains, lean meats, nuts, beans, seeds and certain oils are all considered nutrient dense.

What is nutrient density measured in? ›

Therefore the nutrient density is expressed in terms of the amount of a specific nutrient (in weight) per 1000 calories or joules, e.g. the nutrient density of iron in eggs is 13.6 mg/1000 cal (according to Table 11.1) in comparison to 19.4 in meat and 150 in spinach.

Which of the following best describes nutrient density? ›

Answer. Which of the following statements best describes nutrient density? explanation --- Consume foods that have the most nutrition for their kcalories describes the Nutrient Density.

Are dense fruits healthier? ›

So, most nutrition experts will steer you towards nutrient-dense foods like fruits, vegetables and whole-grains. If you make a habit out of choosing nutrient-dense foods, they will displace the not-so-healthy items in your diet. Studies show that nutrient density is an accurate predictor of healthy diets.

Which of the following foods are considered to have a low nutrient density? ›

Candy, pastries, chips, bacon, and sugar-sweetened beverages are less nutrient dense. These foods contain added sugar, solid fats, and refined starch, and they provide few essential nutrients.

What are the most nutrient-dense fruits and vegetables? ›

Top 10 Nutrient-Dense Fruits and Vegetables to Grow
  1. Kale.
  2. Garlic. ...
  3. Blueberries. ...
  4. Raspberries. ...
  5. Broccoli. ...
  6. Sweet Peppers. ...
  7. Tomatoes. ...
  8. Kiwi Fruits. ...
14 Jul 2017

What foods are high in nutrient density? ›

Here are the 11 most nutrient-dense foods on the planet.
  1. Salmon. Not all fish are created equal. ...
  2. Kale. Of all the leafy greens, kale is the king. ...
  3. Seaweed. The sea has more than just fish. ...
  4. Garlic. Garlic really is an amazing ingredient. ...
  5. Shellfish. ...
  6. Potatoes. ...
  7. Liver. ...
  8. Sardines.

Do fruits prevent illness? ›

Eating a diet rich in fruits and vegetables can help reduce the risk of many leading causes of illness and death, such as cardiovascular disease, type 2 diabetes, some cancers, and obesity.

What major diseases does eating enough fiber help prevent? ›

But foods containing fiber can provide other health benefits as well, such as helping to maintain a healthy weight and lowering your risk of diabetes, heart disease and some types of cancer.

WHO recommended fruit and vegetable intake? ›

The World Health Organisation and Food and Agriculture of the United Nation reports recommend adults to consume at least five servings of fruits and vegetables per day excluding starchy vegetables.

Why is it important to eat whole grains? ›

Grains are naturally high in fiber, helping you feel full and satisfied — which makes it easier to maintain a healthy body weight. Whole grains are also linked to a lower risk of heart disease, diabetes, certain cancers and other health problems.

Why are fruits and vegetables important for your health? ›

Fruit and vegetables are a good source of vitamins and minerals, including folate, vitamin C and potassium. They're an excellent source of dietary fibre, which can help to maintain a healthy gut and prevent constipation and other digestion problems. A diet high in fibre can also reduce your risk of bowel cancer.

What happens if you eat too much fruit? ›

"Risks associated with excess fruit intake include stomach discomfort, diarrhea, bloating, heartburn, and potential nutrient deficiencies if excess fruit is replacing other important nutrients in the diet," she says.

What is the healthiest vegetable in the world? ›

1. Spinach. This leafy green tops the chart as one of the most nutrient-dense vegetables. That's because 1 cup (30 grams) of raw spinach provides 16% of the Daily Value (DV) for vitamin A plus 120% of the DV for vitamin K — all for just 7 calories ( 1 ).

What fruit has the most fiber? ›

Raspberries win the fiber race at 8 grams per cup. Exotic fruits are also good sources of fiber: A mango has 5 grams, a persimmon has 6, and 1 cup of guava has about 9.

What diseases can fiber help improve? ›

A high-fiber diet appears to reduce the risk of developing various conditions, including heart disease, diabetes, diverticular disease, constipation and colon cancer. Fiber is important for the health of the digestive system and for lowering cholesterol.

Who needs a high fiber diet? ›

A high fiber diet changes the bacterial makeup of the colon toward a more favorable balance. For instance, it is known that those people with obesity, diabetes type 2 and inflammatory bowel disease have a predominance of bad bacteria in the colon.

What is the number 1 healthiest food in the world? ›

So, having scoured the full list of applicants, we have crowned kale as the number 1 healthiest food out there. Kale has the widest range of benefits, with the fewest drawbacks when stacked up against its competitors.

What is the healthiest diet in the world? ›

Mediterranean Diet, DASH Diet, and Flexitarian Diets Remain the Best Diets of 2022. All three diets are also highly recommended by doctors because of their known health benefits. “The Mediterranean eating plan doesn't have a set calorie range or portion guidelines, which is why it can fit almost anyone's needs.

What is the healthiest diet for humans? ›

A healthy diet includes the following: Fruit, vegetables, legumes (e.g. lentils and beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat and brown rice). At least 400 g (i.e. five portions) of fruit and vegetables per day (2), excluding potatoes, sweet potatoes, cassava and other starchy roots.

Is rice better than bread? ›

Whether you should choose rice or bread depends on your nutritional goals, as rice provides more vitamins and minerals but bread is lower in calories and carbohydrates. Whichever you choose, opt for the whole-grain version for the best health results.

What can I eat instead of grains? ›

Starchy vegetables like potatoes, squash, and fresh corn are good, carb-rich alternatives to grains. Protein-rich animal products. This category includes meat, fish, seafood, eggs, and dairy products like milk, cheese, and yogurt. Protein-rich plant foods.


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