From: Goldbaum-Kolin, Ellen

Sent: Friday, October 14, 2016 10:03 AM

To: 'SChristmann^buffnews.com' <SChristmann@buffnews.com>
Subject: Buffalo News inquiry for Leonard Epstein

Hi Samantha:
Below are Dr. Epstein's detailed responses to your questions. Please note that as he says below, he
is not one of the creators of the NuVal but served on their scientific advisory board.

Please identify him as:

Leonard H. Epstein, PhD, SUNY Distinguished Professor and chief of behavioral medicine,
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences at UB.

I nope you find these helpful.

Sincerely, Ellen

Ellen Goldbaum
1 Senior Medical Editor
University at Buffalo
Office of University Communications
330 Crofts Hall, Buffalo NY 14260
Phone: 716-645-4605
Fax: 716-645-3765
http://www.buffalp.edu/news
twitter: @ubmednews

Hi Samantha:
I am not one of the creators of NuVal, but rather was a member of their scientific advisory board. As
with any of the scientific advisory boards, sometimes the leadership takes your advice and
sometimes the leadership does not take your advice. David Katz from Vale created the system, not
me or any other members of the advisory board. I'm sure each of us agrees with some aspects of
NuVal and not with others.

1) How do you respond to people who say the NuVal system is outdated and "fatally flawed"?

NuVal is one among many nutrient profiling systems. The idea of a nutrient profiling system became
popular because most consumers have a very difficult time making sense of information on the
nutrition label when purchasing food, so different groups attempted to simplify decision making by
using numbers (either continuous or categorical) or color-based systems. There is still quite a lot of
activity in this area.

Each nutrient profiling system uses different criteria for rating foods. NuVal does not publish the full
algorithm but does indicate what characteristics of foods increase the rating, and what
characteristics of foods decrease the ratings. The secret, that no one outside of NuVal knows, is the
specific weights given to characteristics of foods. If you don't believe in the criteria that NuVal uses,
then the algorithm would not work to guide you to healthier eating. The criteria they use is based
on the general USDA recommendations, but if you were eating a paleo diet NuVal would not be
useful, for example. Guidelines for healthy eating and what types of foods to avoid evolve as new
research is published. I have not been involved on the scientific board of NuVal for many years, but
it is my impression that the algorithm has been changing to keep track of the science, but that :s
something you would have to check with NuVal.

2) How is it that brownies and ice cream can be scored higher than canned fruits and
vegetables?

There are two ways to use any nutrient profling system, whether it is NuVal or another system.
First, these systems can help you choose among foods within a cass of foods. For example, if you
were going to buy cereal, NuVal might be hepful in ident'fying a low-fat, low-sugar cereal that is
nutrent dense. Similarly, if you were going to buy yogurt, or ice cream, NuVal could help you
identify the healthiest option based on the criteria they use to rate foods within that class of foods.
In terms of your question, can NuVal help identify the healthiest ice cream, or the healthiest fruit or
vegetables. Once again, if you believe the criteria they are using is correct, then the NuVal rating
wou d be he pful.

In addition, NuVal could help consumers make dec'sions about whether they wanted to increase
purchasing of a class of foods versus another class. For example, if you wanted animal protein as the
centerpiece of a meal, NuVal could help decide whether fish, fowl or red meat were better choices.
Even within one category, like fish, NuVal could help you decde what type of fish is the healthiest.

Since NuVal scores many foods, there may be some brownies or ice cream that score higher than
some canned fruits or vegetables, but that does not mean that as a category brownies or ice cream
are healthier than canned fruits or vegetables. The backlash in 2012 against NuVal was for brownie
mix, but not brownies. There are also variations of low-fat, low-sugar ice milks that are better
choices than standard ice cream, and could have higher scores than canned vegetables in syrup that
has a lot of sugar, or canned vegetables that have a lot of salt. There are also many canned fruits not
in syrup or canned vegetables with low amounts of sodium that would have higher scores.

When comparing brownie mix with NuVal score of 22 and mandarin oranges in syrup with score of
7, neither of these are very healthy choices for dessert or a snack, and trying to make distinctions
between them will not lead to a healthier diet. A much better choice than mandarin oranges in
syrup would be an actual mandarin orange, or an orange. You would see large differences in NuVal
or any nutrient profile score for that, more relevant, comparison. .

The question of
3) Do you still stand behind the system you helped create?

Once again, I was on the scientific advisory board, and provided advice to Katz and his group, some
of which they took and some of which they did not take. I did not agree with all of their decisions. If
it had been my creation, I would have done things (very) differently.

A more relevant question is whether I think nutrient profiling systems are useful. I do, but only when
I agree with the assumptions of the algorithm. Nutrition science is continually evolving, and nutrient
profiling systems need to evolve with the science. A good example is the shift in emphasis from fat
in the diet to added sugar in the diet.

I don't think any nutrient profiling system is perfect, and you will find anomalies of the type you
noted above in any system (how can this food rate higher than that food - not in my book). They
were designed to help consumer make healthier choices, and that should be the final arbiter of
whether they are useful. Do consumers who use a specific nutrient profiling system purchase
healthier foods that consumers who just use the nutrition label? These systems can help, but they
can also be improved.