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practice applicationsBUSINESS OF DIETETICS
It All Adds Up: Nutrition Analysis Software Can Open
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ecause HR 3590, the PatientProtection and Affordable CareAct, includes a mandate (Sec-
ion 4205) that calorie information beosted at the point of purchase forending machine snacks and stan-ard menu items at certain types ofestaurants (1)—specifically, chainestaurants with at least 20 machinesr establishments across the coun-ry—the nutrient values of restau-ant offerings and how they affect theaily diet are back in the spotlight.owever, at these early legislative
tages, this attention is mostly com-ng from government officials, healthnd nutrition professionals, and jour-alists, with the ultimate goal of cap-uring the attention of consumersnce these provisions are put into ac-ion.
As a result of this impending needor accurate nutrient information,egistered dietitians (RDs) may soonnd themselves asked to providehese data in a number of contexts,rom the restaurant that seeks to de-ermine calculations for its menuwhether by mandate or choice) to therivate client seeking to make sensef this information. Provision of suchnformation requires access to a reli-ble, robust, and accurate nutrientalculation software program. Butow does an RD go about selectinghe software program that best suitsis or her professional needs?
HE COMPLICATED TASK OF SOFTWAREELECTIONccording to Liz Marr, MS, RD—whoeads Liz Marr and Associates LLC, a
This article was written by KarenStein, MFA, a freelance writer inTraverse City, MI, consultanteditor for the Nutrition CareManual, and a former editor atthe Journal.
doi: 10.1016/j.jada.2010.12.00814 Journal of the AMERICAN DIETETIC ASSOCIATIO
ood and nutrition communicationsonsultancy outside Boulder, CO, androvides recipe development and nu-rition analysis information to foodompanies and restaurants—choosingny type of software can be dauntingecause of the number and variety ofvailable platforms (see the Figure).owever, conducting the research indvance will lead to more satisfactionith the purchased product.Note that many nutrient calcula-
ion software packages have the sameasic features and functions, includ-ng intake analysis, recipe creationnd analysis, client data tracking,nd report generation (2). It is there-ore necessary for potential users toave a strong sense of how they ex-ect to use the software in their prac-ice.
Marr says that it is important toave a clear idea of the most crucialunctions for one’s particular practiceetting before shopping around. Sheecommends creating a spreadsheeto rate the functions of various plat-orms.
“If you think about the end-products the services you are providing asn RD,” Marr says, “accuracy and re-orting capabilities are the two mostmportant attributes of nutrient anal-sis software.”Depending on work setting, Marr
ays, considerations may include in-egration into a larger platform withdditional functions—such as menuosting, medical nutrition therapy,nventory control, and others—or in-ormation technology standards, suchs client-server, Web-based, portabil-ty, security, and so forth.
Following are some questions anD might consider when evaluatingoftware packages (3):
Does the database contain all thefoods and nutrients of interest?Is the database complete for these
particular nutrients? aN © 2011
Are the foods in the database ade-quately specific for accurate nutri-ent assessment?Is the nutrient database main-tained for accuracy based on mar-ketplace and data-availability up-dates?Does the software manufacturercommunicate regularly with foodmanufacturers for updated infor-mation?How is accuracy ensured?
Although database currency is aaluable requirement, be aware thatwith 800 new products hitting theupermarket shelves every month,” its difficult for software manufacturerso be fully updated at all times (4).
Selection criteria based on softwareeatures may include the following:
Foodservice management capabili-tiesNutrition assessment capabilitiesNutrient analysis capabilitiesReferenceMenu production and managementcapabilitiesData regarding specialty popula-tionsFitness programming capabilitiesFunctionality on a portable digitalassistantSmartphone compatibility
Personal selection criteria may in-lude factors such as cost, user friend-iness, and product quality:
ostost is frequently a factor when pur-hasing any type of product, evenrom something as simple as a pack-ge of ballpoint pens to something asomplex as an insurance package.utrient calculation software costs
an run from close to $100 to approx-mately $700, and frequently theserices are for access for a single usernd don’t include additional fees such
s for updates and upgrades. Butby the American Dietetic Association
F
BUSINESS OF DIETETICS
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Axxya Systems (Stafford, TX) ● Nutrient analysis of diets, recipes, and menus● Corporate wellness consulting● Food labels
www.axxya.com
BioEx Systems (Smithville, TX) ● Nutrition analysis for outpatient and consumers’fitness modules
www.bioexsystems.com
CBORD (Ithaca, NY) ● Catering● Foodservice management● Inventory and delivery● Menu management● Nutrition analysis● Nutrition assessment
www.cbord.com
Computrition (Chatsworth, CA) ● Food safety guidelines● Foodservice management● Inventory control● Menu management● Nutrition analysis● Nutrition care management
www.computrition.com
CyberSoft NutriBase (Phoenix, AZ) ● Exercise tracking● Labels● Menu management● Nutrition analysis● Nutrition assessment
www.nutribase.com
DFM Technologies (Clive, IA) ● Foodservice management● Menu management● Nutrition analysis● Nutrition assessment
www.dfmsoft.com
DietMaster Systems (Rochester, MN) ● Foodservice management● Menu management● Nutrition analysis● Nutrition assessment
www.dietmaster.com
ESHA Research (Salem, OR) ● Client management● Exercise tracking● Food labels● Nutrition analysis● Menu management
www.esha.com
CBORD GeriMenu (Ithaca, NY) ● Food labels● Menu management● Nutrition analysis● Nutrition assessment● Long-term care
www.gerimenu.com
The Nutrition Company FoodWorks(Long Valley, NJ)
● moc.ocnoitirtun.wwwsisylananoitirtuN
Nutritional Computing ConceptsComputer Planned Nutrition(Zionsville, IN)
● Diabetes support● Food and meds tracking● Food labels● Nutrition analysis● For individuals and professionals
www.ncconcepts.com
Hopkins Technology EZMealTracker(Hopkins, MN)
● Menu management● Nutrition analysis
www.ezmealtracker.com
SureQuest Systems (Carrollton, TX) ● Menu management● Nutrition analysis
www.surequest.com
Vision Software Technologies(Goodlettsville, TN)
● Menu management● Nutrition analysis● Nutrition assessment
www.vstech.com
igure. Information on nutrition software manufacturers and their products’ applications. Adapted from reference (5).
February 2011 ● Journal of the AMERICAN DIETETIC ASSOCIATION 215
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BUSINESS OF DIETETICS
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hile it may be tempting to purchaseased on savings, like most products,f fewer dollars are paid for nutrientalculation software, then fewer fea-ures are offered. For example, al-hough an RD may feel sticker shockhen considering the higher-end soft-are packages such as ESHA Re-
earch’s (Salem, OR) Food ProcessorQL, CyberSoft’s (Phoenix, AZ) Nu-riBase 7, and Axxya Systems’ (Staf-ord, TX) Nutritionist Pro 4, it is bestf he or she also takes practice needsnto account: the pricier bundles onverage profess a greater number ofoods in the database and nutrientsnalyzed and availability of a down-oadable trial (5). However, not all nu-rition professionals will need a pro-ram as robust as these.Marr advises RDs to factor the soft-are costs into the annual budgetith the understanding that “becausef ongoing database and program-ing updates (a highly desirable fea-
ure), the software is not going to be ane-time expense but rather a license
ith periodic charges.” a16 February 2011 Volume 111 Number 2
For that reason, RDs should beareful not to “overbuy” a softwareackage beyond the needs of the prac-ice; however, by that same token,underbuying” a software package orrying to make do with free softwareill not have a successful outcome.
You get what you pay for, and youeed to be able to stand by your ser-ices,” Marr says.
ser Friendlinessase of use is a frequent criterion foroftware selection of any kind. Al-hough new software applications fre-uently take some getting used to, es-ecially if one is accustomed to anotherormat, manufacturers’ demos are veryseful in determining how comfortable
t is to work in a given program. Whileome manufacturers provide would-besers a mini-tour, other companies al-
ow full access to the program’s func-ions for a restricted time period (2).
Keep in mind, however, that demos
re frequently abbreviated versions of fhe software and may not accuratelyeflect the extensiveness of the data-ase; therefore, would-be purchasersre encouraged to look beyond therial versions for assessing databaseapabilities (3).However, “user friendliness” may
lso refer to how helpful the manufac-urer is if problems should arise. Con-acting a software manufacturer’s in-ormation line with pre-purchaseuestions will provide a useful glimpsento the quality of its customer servicend indicate whether it provides clearupport or is unhelpful (2).
While considering the actual inter-ction with customer support repre-entatives, if there are budgetary con-erns, it is also worthwhile to makeote of any additional costs that comeith customer support—some compa-ies may opt to not provide a toll-freehone number, and some might offernly a limited number of free helplinealls before charges are imposed (2).RDs who use a Mac (Apple Inc, Cu-
ertino, CA) should note that options
or Mac users are limited (6); however,
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BUSINESS OF DIETETICS
orkarounds, such as personal com-uter emulators, are available (7).Whether via their Web site or upon
onsumer request, many softwareanufacturers provide information
egarding recent updates, softwareatches (to fix glitches), and other im-ortant software-related news.Also important is the venue inhich the RD seeks to use the soft-are. Marr notes that several soft-are packages are available in a cli-nt-server configuration, whereasthers are designed for standaloneomputers that are not networked,nd yet others are available via theeb; thus, the RD’s practice need will
nform which version or installationethod is most suitable.
roduct QualityDs may learn a lot about the qualityf a given software package by re-earching the available programs orontacting the manufacturers directlyo ask product-related queries of cus-omer service. For example, the profes-ional background of the individualsonsulting on product creation “gets athe credibility and potentially the reli-bility of the data as well as the func-ionality of the software,” says Marr.owever, the software’s intended ap-
lication will determine who best serveshe product development team. Whereasany software products might haveDs or food scientists on the team, forxample, “For software systems gearedrimarily toward foodservice, involve-ent of individuals in other disciplines,
uch as chefs and operations managers,ould be important.”For RDs unsure of what to askhen attempting to discern a prod-ct’s quality via a customer serviceepartment, Marr recommends theollowing questions:
What type of training do you pro-vide initially and, if there are per-sonnel changes, in the future?How often do you provide databaseand program updates?Are software updates available forWeb-based downloads?For larger operations and softwareplatforms, what level of onsite or re-mote software support do you offer?How do you address database er-rors reported by customers?
The number of items in the data-
ase itself may not be a useful tool for ietermining the comprehensive qual-ty of a software package, becausesome systems include separate data-ase entries for different forms of theame food (eg, solid, cubed, andrated cheeses), for different prepara-ions of the same food (eg, fried,aked, or breaded chicken), or for theame food with amounts expressed inifferent units” (3).Food manufacturers avail softwareanufacturers of their products’ nu-
rient data for incorporation into theatabase. Yet, despite the continuousvolution of these products—in ear-ier iterations of nutrition calculationoftware, for example, ethnic foodsnd vegetarian options were less com-only included in the databases (3)—
nformation gaps do still exist. “That’shere an RD’s knowledge comes intolay,” says Marr. “Being able to makenformed judgments for substitutionss important.”
OFTWARE PACKAGES FOR DIFFERENTRACTICE TYPESs noted previously, different types ofietetics practice will be best servedy different types of nutrient calcula-ion software programs. According toarr, examples of practices benefit-
ng from specific types of software in-lude the following:
For RDs who plan menus forschools participating in the US De-partment of Agriculture SchoolMeals program, only certain soft-ware programs have been approvedfor such use.*Some nutrient information analysissoftware is part of a broader soft-ware platform that allows integra-tion of data, which have applica-tions in larger food and/or nutritionservices systems. The software mayallow for medical nutrition therapymanagement, diet planning, menuplanning, recipe development, andindexing as well as nutrient informa-tion analysis of menu items; how-ever, the programs may also includebusiness planning and operations
*The list of approved programs isvailable at: http://healthymeals.al.usda.gov/nal_display/index.hp?info_center�14&tax_level�&tax_subject�234&level3_id�&level4_id�0&level5_id�0&topic_
md�2689&&placement_default�0.
February 2011 ● Journa
management components such as in-ventory control, purchasing, order-ing, sales, menu and recipe costingand pricing, and so on. Computrition(Chatsworth, CA) is an example ofsuch a program with applicationsfor health care settings, whereasChefTec (Boulder, CO) is used forrestaurants and foodservice systems.Some software is designed to meetthe food labeling regulations andcreate food labels, whereas somesoftware is primarily for nutrientanalysis of consumers’ food intake.For example, ESHA Research’sFood Processor is primarily for nu-trition and fitness but includes arecipe analysis component, whereasGenesis R&D, also from ESHA Re-search, is used for product develop-ment and menu labeling.Private practice RDs working di-rectly with consumers may use soft-ware for nutrient and physical activ-ity tracking, diet and physicalactivity goal setting, and menu plan-ning. Some software packages mayhave more detailed options for phys-ical activity, diabetes exchanges, My-Pyramid servings, and so on. RDsshould consider which analysis andreporting options are most importantfor the types of clients in particularpractice settings. Behavior modifica-tion approaches may incorporateself-assessment tools, such as havingclients monitor their own food intake.RDs may want to explore the variouslow-cost personal digital assistant(PDA) applications available to con-sumers as well as Web-based pro-grams that may be integrated with orcompletely separate from profes-sional software packages.Because of the legal implicationscreated by Section 4205, RDs work-ing with restaurants on nutrientcalculations will likely need topainstakingly document how theycomputed these values. Just aboutall nutrient calculation softwarepackages are based on the US De-partment of Agriculture’s NutrientDatabase for Standard Reference,but RDs working in the menu label-ing context may require softwarethat also provides source informa-tion, sample count, and standarderror of the mean for all items inthe database (4).
See the textbox on page 218 for
ore detailed information about nu-l of the AMERICAN DIETETIC ASSOCIATION 217
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BUSINESS OF DIETETICS
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rient calculation software for RDsorking with restaurants.
ONTINUED PRODUCT EVOLUTIONutrient calculation software is con-
tantly evolving. In the mid-1980s,efore widespread computer network-ng or Internet capabilities werevailable, the nutrient calculationoftware was disk operating system–ased and for standalone PCs, notesarr, who adds previous versioning
f the software that was being testedas not computerized. Rather, it wasased on hand-calculations. Since itsnception, the software has evolvedin many ways, from search and cal-ulation speed to database size, to cli-nt-server, to cloud-based, to PDAs,o integration with other food-relatedunctions, and the innovation contin-es,” Marr says. “But one thing re-ains constant: the importance ofaving reliable food and nutrientata, which goes back to continuedupport for food composition re-earch.”As far as future applications, saysarr, “Expect to see growth in cloud-
ased (Web-based) and portable devicepplications; incorporation of nu-ragenomics into programs for clinicalettings; and continued improvementsn speed, functionality, and reporting.
eferences. Library of Congress. Bill Summary & Status:
H.R. 3590, Patient Protection and AffordableCare Act. http://thomas.loc.gov/cgi-bin/bdquery/z?d111:H.R.3590:. Accessed October 4, 2010.
. Prestwood E. Shopping for nutrition soft-ware. Today’s Dietitian. 2005;7:44.
. Buzzard IM, Price KS, Warren RA. Consider-ations for selecting nutrient-calculation soft-ware: Evaluation of the nutrient database.Am J Clin Nutr. 1991;54:7-9
. Nutrition software: 101 questions to ask be-fore you buy. Today’s Dietitian. 2000;2(2).
. American Dietetic Association. Computer soft-ware resources by name. American Dietetic As-sociation Web site. http://www.eatright.org/Members/content.aspx?id�6442452368. Ac-cessed December 8, 2010.
. Aronson D. Before you buy, get the lowdownon nutrition software. ADA Times. Mar/Apr2008.
. Axxya Systems. NutritionistPro Diet Analy-sis General Frequently Asked Questions.NutritionistPro.com Web site. http://www.nutritionistpro.com/dietanalysis_general_faq.php. Accessed December 8, 2010.
18 February 2011 Volume 111 Number 2
NUTRIENT CALCULATION AND RESTAURANLiz Marr, MS, RDSection 4205 of H.R. 3590 may lea
for RDs, as smaller restaurants anadhere to the rules regulating menuadditional nutrient data upon requenutrient calculation software to dete
Under the Patient Protection andAct), the analysis can be performedware rather than laboratory analysremain specific to the foodservice seserving size and menu item formulaingredient variation, and so on. Softvery important and so is being able tothe RD can obtain complete data for
In response to the Patient Protectilaw in 2010, the US Food and Drugments regarding development of reguchine menu labeling.b Included in thenation of calorie content of foods” look
● Information about standardization● Information about variation in s
items● The role of inadvertent human e● Information about training of foo● Information about variations in i● Any other relevant factors.
So more specific guidance can be exHowever, an FDA regulation in placrestaurant menu labeling, “nutrientdatabases, cookbooks, or analyses, orassurance that the food or meal meclaim.”d The Affordable Health Care
aThis applies particularly to restaurants that osmaller chains and vending machine operatorsmachines. The larger national chains alreaddetermining the nutrient values. Source: Steinier Chicago’s FIT City program. J Am Diet AssbThe comment period closed October 12, 2010.cFederal Register/Vol. 75, No. 129/Wednesday,d“Section 4205 [of the Affordable Health Care Aestablishment shall have a reasonable basis fordatabases, cookbooks, laboratory analyses, andCode of Federal Regulations, section 101.10. (gpo.gov/fdsys/pkg/CFR-2010-title21-vol2/xml/CAccessed October 14, 2010.e101.10 Nutrition labeling of restaurant foodsshall be provided upon request for any restaura(as defined in § 101.13 or in subpart D of this ppermitted by a regulation in subpart E of thnutrient amounts that are the basis for the clagrams of fat”) may serve as the functionaldescribed in § 101.9. Nutrient levels may beanalyses, or by other reasonable bases that prnutrient requirements for the claim. Presentatincluding those provided in § 101.45 and otherhttp://www.fda.gov/Food/GuidanceComplianFoodLabelingNutrition/ucm223266.htm. Acces
T MENU LABELING GUIDELINES
d to a windfall of career opportunitiesd vending machine operators seek topostings for calories and provision of
sta. But is it acceptable for RDs to usermine these values?Affordable Care Act (Affordable Careby nutrient information analysis soft-is. However, some regulatory detailstting, including potential variation oftion, training of foodservice workers,
ware with a large, reliable database isenter user-generated values, providedrequired nutrients.
on and Affordable Care Act signed intoAssociation (FDA) solicited public com-lations for restaurant and vending ma-request for information was “determi-
ing at issues such as the followingc:
of recipes and methods of preparationerving size and formulation of menu
rrordservice workersngredients
pected when the final rules are issued.e since 1996 stipulates that, specific tolevels may be determined by nutrientby other reasonable bases that provideets the nutrient requirements for theAct refers to that regulatione.
pt to voluntarily comply with the legislation andjust at or over the threshold for 20 restaurants/
y have nutrient calculation software and staffK. Making wellness delicious: Building a Health-oc. 2010;110:1620-1625.
July 7, 2010/Notices pg. 39028.ct] states that a restaurant or similar retail food
its nutrient content disclosures, including nutrientother reasonable means, as described in Title 21
Section 403(q)(5)(H)(iv) of FFDCA).” http://www.FR-2010-title21-vol2-part101.xml#seqnum101.9.
: “Nutrition labeling in accordance with § 101.9nt food or meal for which a nutrient content claimart) or a health claim (as defined in § 101.14 and
is part) is made, except that information on theim (e.g., “low fat, this meal provides less than 10
equivalent of complete nutrition information asdetermined by nutrient databases, cookbooks, orovide assurance that the food or meal meets theion of nutrition labeling may be in various forms,reasonable means. [61 FR 40332, Aug. 2, 1996].”
ceRegulatoryInformation/GuidanceDocuments/
