In his bestseller, Malcolm Gladwell describes a tipping point as the magic moment when an idea crosses a threshold and spreads like wildfire. At that pivotal moment, people see the world through new lenses. Nutrition needs a tipping point.
 
Since the 1980s, the USDA has collected information on food production. Interest in food consumption was stimulated when agricultural surpluses began after World War I. During World War II, governments began estimating per capita food availability. The National Health Survey Act in 1956 established national surveys to obtain data on the amount, distribution and effects of illness and disability in the U.S. In 1970, the National Health and Nutrition Evaluation Survey (NHANES) was established to measure the nutritional status of the U.S. population. The primary measure of nutritional status was to estimate nutrient intake from dietary intake by interviews and individual recall.
 
Dietary records are fraught with error. Do you remember what you ate last weekend and the days preceding (or after)? Can you accurately recall the size of the portion? How much salt did you add at the table or in a recipe? If you ate a packaged food, do you remember which brand? Was the milk low-fat and enriched in protein and calcium? Was it fortified with vitamin D? How much was added?
 
Dietary databases are incomplete. The USDA National Nutrient Database has nutrient information on over 8,000 foods. According to the Food Marketing Institute (FMI), the average supermarket carries 43,844 items.  Each year new products enter the market and others exit. According to Datamonitor, 21,528 new food and beverage products were introduced in 2010. Every year IRI announces the most successful consumer packaged goods – New Product Pacesetters. There were 9,500 new brand launches in 2013 creating an almost impossible turnover to keep food databases current. Without accurate food databases, it is impossible to determine nutrient intakes from dietary records or food frequency questionnaires (FFQ).
 
Nutrition needs a tipping point. As part of NHANES, the Centers for Disease Control and National Center for Environmental Health measure blood and urine concentrations of nutritional indicators with health relevance. This biochemical approach measures levels of nutrition indicators present in people. The prevalence of nutrient deficiencies hasn’t changed between 1999 to 2006 (Fig 1). While some may claim success when 10% or less of the general U.S. population are clinically deficient for selected indicators, this is not a high standard. The goal needs to be set higher. Nutrition can help prevent chronic disease but the result depends upon achieving optimal nutrition status.
 
The tipping point for nutrition is to shift the focus from a preoccupation with estimating nutrient intake with a false sense of security to measuring nutrient status of individuals. Using biochemical data, nutrient gaps can be addressed at the individual and metrics can be applied to measure effectiveness of policy at the population level. We need to stop wasting money estimating nutrient status from food intakes and conducting interventions in well-nourished people. Hopefully, this is a concept that will spread like wildfire.