tpvdrrotrdHsiantot

frfitft(poiach

practice applicationsBUSINESS OF DIETETICS

It All Adds Up: Nutrition Analysis Software Can Open

the Door to Professional Opportunities

th

TSAhfcptcabaHaw

tbiaafhpt

hfsrtf

aapiy

stacifai

This article is reprinted from the Feb-ruary 2011 issue of the Journal (2011;111:214-218).

Because 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 selecting

This article was written by KarenStein, MFA, a freelance writer inTraverse City, MI, consultanteditor for the Nutrition CareManual, and a former editor atthe Journal.STATEMENT OF POTENTIALCONFLICT OF INTEREST: Seepage S34.

doi: 10.1016/j.jada.2011.03.005

© 2011 by the American Dietetic Associat

he 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, aood 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 an

ion Supplement to the Journa

RD might consider when evaluatingsoftware packages (3):

● Does the database contain all thefoods and nutrients of interest?

● Is the database complete for theseparticular nutrients?

● 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 avaluable requirement, be aware that“with 800 new products hitting thesupermarket shelves every month,” itis difficult for software manufacturersto be fully updated at all times (4).

Selection criteria based on softwarefeatures may include the following:

● Foodservice management capabili-ties

● Nutrition assessment capabilities● Nutrient analysis capabilities● Reference● Menu production and management

capabilities● Data regarding specialty popula-

tions● Fitness programming capabilities● Functionality on a portable digital

assistant● Smartphone compatibility

Personal selection criteria may in-clude factors such as cost, user friend-liness, and product quality:

CostCost is frequently a factor when pur-chasing any type of product, evenfrom something as simple as a pack-

age of ballpoint pens to something as

l of the AMERICAN DIETETIC ASSOCIATION S31

BUSINESS OF DIETETICS

Figure. Information on nutrition software manufacturers and their products’ applications. Adapted from reference (5).

S32 May 2011 Suppl 1 Volume 111 Number 5

BUSINESS OF DIETETICS

complex as an insurance package.Nutrient calculation software costscan run from close to $100 to approx-imately $700, and frequently theseprices are for access for a single userand don’t include additional fees suchas for updates and upgrades. Butwhile it may be tempting to purchasebased on savings, like most products,if fewer dollars are paid for nutrientcalculation software, then fewer fea-tures are offered. For example, al-though an RD may feel sticker shockwhen considering the higher-end soft-ware packages such as ESHA Re-search’s (Salem, OR) Food ProcessorSQL, CyberSoft’s (Phoenix, AZ) Nu-triBase 7, and Axxya Systems’ (Staf-ford, TX) Nutritionist Pro 4, it is bestif he or she also takes practice needsinto account: the pricier bundles onaverage profess a greater number offoods in the database and nutrientsanalyzed and availability of a down-loadable trial (5). However, not all nu-trition professionals will need a pro-gram as robust as these.

Marr advises RDs to factor the soft-ware costs into the annual budgetwith the understanding that “becauseof ongoing database and program-ming updates (a highly desirable fea-ture), the software is not going to be aone-time expense but rather a licensewith periodic charges.”

For that reason, RDs should becareful not to “overbuy” a softwarepackage beyond the needs of the prac-tice; however, by that same token,“underbuying” a software package ortrying to make do with free softwarewill not have a successful outcome.“You get what you pay for, and youneed to be able to stand by your ser-vices,” Marr says.

User FriendlinessEase of use is a frequent criterion forsoftware selection of any kind. Al-though new software applications fre-quently take some getting used to, es-pecially if one is accustomed to anotherformat, manufacturers’ demos are veryuseful in determining how comfortableit is to work in a given program. Whilesome manufacturers provide would-beusers a mini-tour, other companies al-low full access to the program’s func-tions for a restricted time period (2).

Keep in mind, however, that demosare frequently abbreviated versions of

the software and may not accurately

reflect the extensiveness of the data-base; therefore, would-be purchasersare encouraged to look beyond thetrial versions for assessing databasecapabilities (3).

However, “user friendliness” mayalso refer to how helpful the manufac-turer is if problems should arise. Con-tacting a software manufacturer’s in-formation line with pre-purchasequestions will provide a useful glimpseinto the quality of its customer serviceand indicate whether it provides clearsupport or is unhelpful (2).

While considering the actual inter-action with customer support repre-sentatives, if there are budgetary con-cerns, it is also worthwhile to makenote of any additional costs that comewith customer support—some compa-nies may opt to not provide a toll-freephone number, and some might offeronly a limited number of free helplinecalls before charges are imposed (2).

RDs who use a Mac (Apple Inc, Cu-pertino, CA) should note that optionsfor Mac users are limited (6); however,workarounds, such as personal com-puter emulators, are available (7).

Whether via their Web site or uponconsumer request, many softwaremanufacturers provide informationregarding recent updates, softwarepatches (to fix glitches), and other im-portant software-related news.

Also important is the venue inwhich the RD seeks to use the soft-ware. Marr notes that several soft-ware packages are available in a cli-ent-server configuration, whereasothers are designed for standalonecomputers that are not networked,and yet others are available via theWeb; thus, the RD’s practice need willinform which version or installationmethod is most suitable.

Product QualityRDs may learn a lot about the qualityof a given software package by re-searching the available programs orcontacting the manufacturers directlyto ask product-related queries of cus-tomer service. For example, the profes-sional background of the individualsconsulting on product creation “gets atthe credibility and potentially the reli-ability of the data as well as the func-tionality of the software,” says Marr.However, the software’s intended ap-plication will determine who best serves

the product development team. Whereas

May 2011 ● Supplement to the Journa

many software products might haveRDs or food scientists on the team, forexample, “For software systems gearedprimarily toward foodservice, involve-ment of individuals in other disciplines,such as chefs and operations managers,would be important.”

For RDs unsure of what to askwhen attempting to discern a prod-uct’s quality via a customer servicedepartment, Marr recommends thefollowing 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-base itself may not be a useful tool fordetermining the comprehensive qual-ity of a software package, because“some systems include separate data-base entries for different forms of thesame food (eg, solid, cubed, andgrated cheeses), for different prepara-tions of the same food (eg, fried,baked, or breaded chicken), or for thesame food with amounts expressed indifferent units” (3).

Food manufacturers avail softwaremanufacturers of their products’ nu-trient data for incorporation into thedatabase. Yet, despite the continuousevolution of these products—in ear-lier iterations of nutrition calculationsoftware, for example, ethnic foodsand vegetarian options were less com-monly included in the databases (3)—information gaps do still exist. “That’swhere an RD’s knowledge comes intoplay,” says Marr. “Being able to makeinformed judgments for substitutionsis important.”

SOFTWARE PACKAGES FOR DIFFERENTPRACTICE TYPESAs noted previously, different types ofdietetics practice will be best servedby different types of nutrient calcula-tion software programs. According toMarr, examples of practices benefit-ing from specific types of software in-

clude the following:

l of the AMERICAN DIETETIC ASSOCIATION S33

BUSINESS OF DIETETICS

● 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 operationsmanagement 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 incorporate

*The list of approved programs isavailable at: http://healthymeals.nal.usda.gov/nal_display/index.php?info_center�14&tax_level�2&tax_subject�234&level3_id�0&level4_id�0&level5_id�0&topic_

id�2689&&placement_default�0.

S34 May 2011 Suppl 1 Volume 111 Number 5

self-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 S35 formore detailed information about nu-trient calculation software for RDsworking with restaurants.

CONTINUED PRODUCT EVOLUTIONNutrient calculation software is con-stantly evolving. In the mid-1980s,before widespread computer network-ing or Internet capabilities wereavailable, the nutrient calculationsoftware was disk operating system–based and for standalone PCs, notesMarr, who adds previous versioningof the software that was being testedwas not computerized. Rather, it wasbased on hand-calculations. Since itsinception, the software has evolved“in many ways, from search and cal-culation speed to database size, to cli-ent-server, to cloud-based, to PDAs,to integration with other food-relatedfunctions, and the innovation contin-ues,” Marr says. “But one thing re-mains constant: the importance ofhaving reliable food and nutrientdata, which goes back to continuedsupport for food composition re-search.”

As far as future applications, saysMarr, “Expect to see growth in cloud-based (Web-based) and portable deviceapplications; incorporation of nu-tragenomics into programs for clinicalsettings; and continued improvements

in speed, functionality, and reporting.

STATEMENT OF POTENTIAL CON-FLICT OF INTEREST: No potentialconflict of interest was reported by theauthor.

References1. 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.

2. Prestwood E. Shopping for nutrition soft-ware. Today’s Dietitian. 2005;7:44.

3. 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

4. Nutrition software: 101 questions to ask be-fore you buy. Today’s Dietitian. 2000;2(2).

5. 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.

6. Aronson D. Before you buy, get the lowdownon nutrition software. ADA Times. Mar/Apr2008.

7. 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.

BUSINESS OF DIETETICS

NUTRIENT CALCULATION AND RESTAURANT MENU LABELING GUIDELINESLiz Marr, MS, RDSection 4205 of H.R. 3590 may lead to a windfall of career opportunities

for RDs, as smaller restaurants and vending machine operators seek toadhere to the rules regulating menu postings for calories and provision ofadditional nutrient data upon requesta. But is it acceptable for RDs to usenutrient calculation software to determine these values?

Under the Patient Protection and Affordable Care Act (Affordable CareAct), the analysis can be performed by nutrient information analysis soft-ware rather than laboratory analysis. However, some regulatory detailsremain specific to the foodservice setting, including potential variation ofserving size and menu item formulation, training of foodservice workers,ingredient variation, and so on. Software with a large, reliable database isvery important and so is being able to enter user-generated values, providedthe RD can obtain complete data for required nutrients.

In response to the Patient Protection and Affordable Care Act signed intolaw in 2010, the US Food and Drug Association (FDA) solicited public com-ments regarding development of regulations for restaurant and vending ma-chine menu labeling.b Included in the request for information was “determi-nation of calorie content of foods” looking at issues such as the followingc:

● Information about standardization of recipes and methods of preparation● Information about variation in serving size and formulation of menu

items● The role of inadvertent human error● Information about training of foodservice workers● Information about variations in ingredients● Any other relevant factors.

So more specific guidance can be expected when the final rules are issued.However, an FDA regulation in place since 1996 stipulates that, specific torestaurant menu labeling, “nutrient levels may be determined by nutrientdatabases, cookbooks, or analyses, or by other reasonable bases that provideassurance that the food or meal meets the nutrient requirements for theclaim.”d The Affordable Health Care Act refers to that regulatione.

aThis applies particularly to restaurants that opt to voluntarily comply with the legislation andsmaller chains and vending machine operators just at or over the threshold for 20 restaurants/machines. The larger national chains already have nutrient calculation software and staffdetermining the nutrient values. Source: Stein K. Making wellness delicious: Building a Health-ier Chicago’s FIT City program. J Am Diet Assoc. 2010;110:1620-1625.bThe comment period closed October 12, 2010.cFederal Register/Vol. 75, No. 129/Wednesday, July 7, 2010/Notices pg. 39028.d“Section 4205 [of the Affordable Health Care Act] states that a restaurant or similar retail foodestablishment shall have a reasonable basis for its nutrient content disclosures, including nutrientdatabases, cookbooks, laboratory analyses, and other reasonable means, as described in Title 21Code of Federal Regulations, section 101.10. (Section 403(q)(5)(H)(iv) of FFDCA).” http://www.gpo.gov/fdsys/pkg/CFR-2010-title21-vol2/xml/CFR-2010-title21-vol2-part101.xml#seqnum101.9.Accessed October 14, 2010.e101.10 Nutrition labeling of restaurant foods: “Nutrition labeling in accordance with § 101.9shall be provided upon request for any restaurant food or meal for which a nutrient content claim(as defined in § 101.13 or in subpart D of this part) or a health claim (as defined in § 101.14 andpermitted by a regulation in subpart E of this part) is made, except that information on thenutrient amounts that are the basis for the claim (e.g., “low fat, this meal provides less than 10grams of fat”) may serve as the functional equivalent of complete nutrition information asdescribed in § 101.9. Nutrient levels may be determined by nutrient databases, cookbooks, oranalyses, or by other reasonable bases that provide assurance that the food or meal meets thenutrient requirements for the claim. Presentation of nutrition labeling may be in various forms,including those provided in § 101.45 and other reasonable means. [61 FR 40332, Aug. 2, 1996].”http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/

FoodLabelingNutrition/ucm223266.htm. Accessed October 14, 2010.

May 2011 ● Supplement to the Journal of the AMERICAN DIETETIC ASSOCIATION S35