"Nutritional Data Mining: measuring household grocery quality
for clinical and public health applications
Low burden, scalable tools to improve
dietary health
John F. Hurdle, MD, PhD
Philip J. Brewster, PhD
Valli Chidambaram, MS
Le-Thuy Tran, PhD
Department Biomedical Informatics
Patricia Guenther, PhD, RD
Debra Scammon PhD
Kris C. Jordan PhD, RD
Department of Nutrition and Carrie M. Durward, PhD, RDMarketing, Eccles School
of Business
Integrative Physiology
Heidi Leblanc, MS
University of Utah
Paula Scott, MS
Department of Nutrition, Dietetics, and Food Sciences
QualMART
Utah State University
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Diet-related morbidity and mortality
• Really, do I need to make the point that
poor diet is bad for us?
CDC. Diabetes Interactive Atlas. [cited May 2013]; Available from:
QualMART
http://www.cdc.gov/diabetes/atlas/obesityrisk/atlas.html.
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Let’s start at the end…
Personalized
Recommendations
USDA Food
Plans
Based on
expenditure
share
UPC and
expenditure data
by household
The Really Big Precision
Medicine Idea
-Coupons
-Txt
-email
Menus
-shopping
lists
-App
Retrospective & Prospective
Grocery Sales Data
Expenditure
share
$-Incentives-$
+
Food Quality
Index & Recommendation Compliance
from QualMART
QualMART
Compliance
3
From the Food Marketing Institute 2013
The largest retail grocery association in the
U.S. (+40,000 retailers)
USDA Economic Research Service argues
Americans can eat healthy foods on a budget
Partly because
we are deniers…
This is where
QualMART comes
in!
QualMART
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What we do and what we don’t
• We don’t measure dietary intake
• We do model the quality of the home food
environment
• We don’t focus on individuals
• We do focus on households (estimated 6070% calories come from retail grocery)
• We don’t pick ad hoc/black box nutrition
standards
• We do use good nutrition science from USDA
QualMART
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Conceptual Model of the Food Environment
Credit goes to Phil Brewster for grounding our
work in a conceptual model
Glanz K, Sallis JF, Saelens BE, Frank LD. Healthy nutrition environments: concepts
and measures. Am J Health Promot. 2005 May-Jun;19(5):330-3, ii.
Our first attempt at using grocery data
•Kristina
Brinkerhoff
PhD 2012
•Studied 50
high-volume
Smith’s
households
•FFQ and
household
inventory
•Hand mapped
UPCs to
USDA SR
•Showed us
there was a
signal…
Credit goes to Dr. Ed Clark, who hated doing
NHANE interviews as a young doctor
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About our
So grocery
what tomodel
do? dataset
Where the grocery data came from:
~144,000 households shopping at Kroger
stores, 15 months, four marketing regions
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About our grocery model dataset
base_upc_desc
frequency
The grocery item distribution, by count, is
highly skewed2,258,952
The top ten nationally: BANANAS
AVOCADOS HASS TP RPC
STRAWBERRIES CLMSHL
RPC
918,009
CUCUMBERS
729,003
CORN YELLOW RPC
572,580
LIMES
PEPPERS BELL GREEN XL
RPC
571,032
KRO LOWFAT 2% PLAS
ONIONS YELLOW JUMBO
1015
502,586
QualMART
748,997
544,167
495,311
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Models we have developed based on Dietary Guidelines
for Americans, 2010
USDA Food
Plans
Grocery
Sales
Database
29 food
categories,
based on
expenditures
QualMART
Food
Mapping
Tools
Household
preferences
and
patterns
QualMART
Recommender
Tool
Healthy
Eating
Index
-2010
Up to 12
food
components
Future work:
recommendations to
improve household food
quality and study healthrelated outcomes
USDA Food Plan
Grains:
breads
Smith’s
Sales
Database
Grains:
rice and
pasta
QualMART
UPC-Food
Plan Map
Credit goes to Phil Brewster for design and
implementation
Fruits:
citrus,
melons,
berries,
juices
Meats:
beef, pork,
veal, lamb,
game
Other:
sugars,
sweets,
candies
.
29 food
.
categories
in
Food .Plans
QualMART
- Based on USDA Food
Plans
- Can be budget neutral
- Designed for four
USDA-defined levels of
food budget
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The Healthy Eating Index is most widely used
metric in nutrition research;
scale invariant
Good
Quality
Shopper
Avenues
NHANES-based
HEI estimator model
Low
Quality
Shopper
Moab
Credit goes to Le-Thuy Tran for overall
design and implementation
QualMART
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The Utah Food Quality Measurement and
Recommendation Toolset (QualMART)
About our data
~90% automatic mapping
10% hand mapped
Various
USDA
databases
~100,000 UPC
and PLU codes
HEI Model
QualMART
Food Plan
Model
New
models
-DASH
-Medit.
Diet
-Focus
on
added
sugars
.
.
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QualMART Pros
• Operates on entire market basket, not select
foods
• Can be adapted to any diet quality measure
(Mediterranean Diet, DASH…)
• Operates over time any span
• Painless for patients
• Unbiased by recall
• Retrospective and prospective monitoring
• Cheap: stores collect UPC data anyway
• Scalable: virtually all stores collect UPC data
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QualMART Cons
• We only see grocery data, not all foods
– Still, ~60-70% of food calories come from retail
grocery
• We only have one grocery partner for now
– Kroger, the largest grocery chain in the
country
• We know what to recommend, we don’t
know yet how best to recommend
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Our Collaborators
•
•
•
•
•
Kroger, Inc (via 84.51)
UU Wellness Programs (exploratory)
UU Health Plans (exploratory)
U Pediatric Clinic (early stage, kids 80%BMI)
UU Diabetes, Obesity, and Metabolism
Service Line (exploratory)
• TVC (disclosure filed, active effort to
commercialize)
• USDA and USU
QualMART
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Our two USDA funded studies
• USDA Grant 1: studies 65 Hispanic and 65 nonHispanic SNAP participants, assessing select food
quality variables
• USDA Grant 2: much larger, multi-state study of 1,744
SNAP-eligible participants to assess multiple food
quality variables, to determine if USDA nutrition
education classes affect shopping habits
Retrospective
grocery
quality
(12 months)
USDA
Snap-Ed
& EFNEP
classes
Prospective
grocery quality
(12 months)
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The Utah Food Quality Measurement and
Recommendation Toolset (QualMART)
Two classes of Apps
One for Patients
• ‘At a glance’ to
monitor recent
progress and
milestones
• …and rewards?
• Display:
– smart phone
– Pad
– MyChart
One for Clinicians
• More clinical content
• Long-term progress
•[forSuggestions
for shared
illustration only]
decision making
• Display:
– Standoff app
– Epic (?)
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Some fun public view views
Estimated overall HEI by store in SLC
Credit goes to
Le-Thuy Tran for
her HEI estimator
Avenues Smith’s
Smith’s Gas and
Convenience
Store!
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Some fun public view views
Salt Lake
Dairy
Atlanta
Dairy
Seattle
Dairy
QualMART
Credit goes to
Le-Thuy Tran for
her HEI estimator
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Results-Scores
American Society for Nutrition
Experimental Biology 2015
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Results-Total Score
Credit goes to
Phil Brewster
for his food plan
model used
here
American Society for Nutrition
Experimental Biology 2015
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Next Steps
• Refine current models
• Find new metrics of interest, like DASH
• Add more grocers
– Means finding efficient ways to add new
UPCs …the lesson of Greek Yogurt (Valli
project)
• Brainstorm with partners what they from
household food quality data
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qDIET for nutritional epdemiologists
Credit goes to Thuy Tran and Valli Chidambaram for design
and implementation
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Caloric heat map to ease mapping
Credit goes to Valli Chidambaram for design and
implementation
http://public.tableausoftware.com/profile/#!/vizhome/sugarvssodium/Dashboard1
http://public.tableausoftware.com/profile/#!/vizhome/micronutrients/micro
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The Utah Food Quality Measurement and
Recommendation Toolset (QualMART)
Questions?
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QualMART
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The Utah Food Quality Measurement and
Recommendation Toolset (QualMART)
Potential Clients
•
•
•
•
•
•
Health plans
Corporate wellness programs
Grocery chains
Healthcare systems (large and small)
Private PCP clinics
Individuals
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What we do and what we don’t
• We don’t measure dietary intake
• We do model the quality of the home food
environment
• We don’t focus on individuals
• We do focus on households (estimated 6070% calories come from retail grocery)
• We don’t pick ad hoc/black box nutrition
standards
• We do use good nutrition science from USDA
QualMART
29