Estimating national and subnational nutrient intake distributions of global diets

Assuming the "best-fit" shape of the usual nutrient intake distribution (with nutriR) does not affect prevalence estimates of nutrient intake inadequacy: results from a dietary intake survey in Ivorian school-age children

BACKGROUND

Common methods to assess nutrient intake inadequacy are the EAR cut-point method and the Probability of Adequacy (PA). It has been postulated that the shape of the intake distribution can have a significant impact on estimates of inadequacy. The "Nutritional intake functions for R" ("nutriR") package has been developed to address this.

OBJECTIVE

To assess the impact of assuming the "best-fit" shape of nutrient intake distributions (using nutriR) on prevalence estimates of inadequate nutrient intake, as compared to observed nutrient intake distributions with the EAR cut-point or PA method.

METHODS

A cross-sectional dietary intake survey was conducted among 443 Ivorian school-aged children (6-12 years) by 24-hour recall, with non-consecutive repeats for 13% of the population. Six methods to estimate prevalence of intake inadequacy for 11 nutrients were compared: methods 1-3 used single 24h recall data to either apply the EAR cut-point method (1), the PA method (2), or the nutriR method (3); and methods 4-6 applied the same methods after correction for within-person variation using the Statistical Program to Assess Usual Dietary Exposure (SPADE), which generates estimates of usual daily nutrient intake.

RESULTS

Nutrient intake distributions were right-skewed (skewness average 1.0, range: 0.4-2.0) and showed large variation (CV average 40%, range: 20-60%). The prevalence estimates of inadequate nutrient intake were similar across all methods, with an average difference of ±5 percent-point (range: 0-27 percent-point). The smallest average differences, 0.4 and 0.3 percent-point, were observed with usual intake data between nutriR and EAR cut-point (method 6 vs 4), and nutriR and PA (method 6 vs 5), respectively. Larger differences (∼12 percent-point) were observed when comparing single 24h recall data (methods 1-3) with usual intake (method 4-6).

CONCLUSIONS

Assuming nutrient intake distributions with the shape of "best-fit" to the observed intake distribution did not affect prevalence estimates of nutrient inadequacy in this population of Ivorian school-children.

CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE WHERE IT WAS OBTAINED

NCT06175130 www.

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The Two Dimensions of Nutrition for the Planet: Environment and Health

PURPOSE OF REVIEW

Protecting the planet is protecting the future. Food production systems are among the most important human activities threatening planetary health. Diet, food systems, the environment, and health are interconnected. Accordingly, this review aims to assess the effects of nutrition on the planet and the relationship between some types of diets defined as sustainable and the planet and human health.

RECENT FINDINGS

Many diets have been proposed to protect the planet and human health, but there is no consensus on which diet is best. It should not be forgotten that planetary health diets, plant-based diets, and vegetarian/vegan diets can reduce environmental pressure. Still, they cannot have the same effect in every country, and these diets may have different effects depending on the differences in the countries' income level, nutritional culture, and food systems. Moreover, it should not be overlooked that these diets may cause difficulties in terms of adaptation, cause deficiencies in some nutrients, and may not be suitable for all segments of society. Sustainable diets such as the Mediterranean and New Nordic, as well as Dietary Approaches to Stop Hypertension, are more flexible and acceptable. Instead of a globally recommended reference diet to protect the planet and human health, each country can analyze its food systems and choose the most appropriate food production methods and sustainable diet style to reduce environmental burden, improve health, and create policies accordingly, which can help achieve sustainable goals faster.

Association between provegetarian food patterns and micronutrient adequacy in preschoolers: the SENDO project

This study aims to examine the association between different versions of a provegetarian food pattern and micronutrient adequacy in a population of children from the SENDO Project. Children aged 4-5 years old were recruited and baseline information on diet, lifestyle and socio-demographic characteristics was collected through self-administered online questionnaires completed by their parents. Scores were calculated for overall, healthful, and unhealthful provegetarian food patterns (FP) using an a priori approach. Participants were categorized into tertiles according to their scores. Micronutrient adequacy was assessed using the Estimated Average Requirement (EAR) cut-off point. Multivariate analyses were performed to evaluate the relationship between tertiles of each provegetarian FP and the risk of inadequate micronutrient intake (failing to meet ≥ 3 requirements). Despite lower intakes of certain micronutrients, children with higher scores in the healthful provegetarian FP did not exhibit a higher prevalence of inadequacy. Children in the highest tertile of this index had 0.47-fold lower odds (95%CI 0.23-0.95) of having ≥ 3 inadequate micronutrient intakes than their peers in the lowest tertile, after adjusting for potential confounders. In contrast, children in the highest tertile of the unhealthful provegetarian FP had 20.06-fold higher odds (95%CI 9.19-43.79) of having ≥ 3 inadequate micronutrient intakes compared to children in the lowest tertile.

CONCLUSIONS

Adherence to a healthful provegetarian food pattern is associated with improved nutritional adequacy in preschoolers, while following an unhealthful pattern is detrimental to micronutrient adequacy. These results suggest that moderate reductions in animal food consumption within a healthy diet may not compromise micronutrient adequacy in young children. Further research is needed to explore the impact of diets reduced in animal food intake on the health of children.

WHAT IS KNOWN

• There's a notable trend towards plant-based diets due to health and sustainability concerns. • Research links plant-based diets in adults with lower risks of obesity, cardiovascular disease, and cancer.

WHAT IS NEW

• A new study examines how different versions of a provegetarian food pattern affect micronutrient adequacy in children, using a moderate and stepwise approach. • Following a healthful provegetarian food pattern enhances nutritional adequacy in preschoolers, whereas an unhealthful pattern negatively impacts micronutrient adequacy.

Comparative bioavailability of vitamins in human foods sourced from animals and plants

Vitamins are essential components of enzyme systems involved in normal growth and function. The quantitative estimation of the proportion of dietary vitamins, that is in a form available for utilization by the human body, is limited and fragmentary. This review provides the current state of knowledge on the bioavailability of thirteen vitamins and choline, to evaluate whether there are differences in vitamin bioavailability when human foods are sourced from animals or plants. The bioavailability of naturally occurring choline, vitamin D, vitamin E, and vitamin K in food awaits further studies. Animal-sourced foods are the almost exclusive natural sources of dietary vitamin B-12 (65% bioavailable) and preformed vitamin A retinol (74% bioavailable), and contain highly bioavailable biotin (89%), folate (67%), niacin (67%), pantothenic acid (80%), riboflavin (61%), thiamin (82%), and vitamin B-6 (83%). Plant-based foods are the main natural sources of vitamin C (76% bioavailable), provitamin A carotenoid β-carotene (15.6% bioavailable), riboflavin (65% bioavailable), thiamin (81% bioavailable), and vitamin K (16.5% bioavailable). The overview of studies showed that in general, vitamins in foods originating from animals are more bioavailable than vitamins in foods sourced from plants.

Global estimation of dietary micronutrient inadequacies: a modelling analysis

BACKGROUND

Inadequate micronutrient intakes and related deficiencies are a major challenge to global public health. Analyses over the past 10 years have assessed global micronutrient deficiencies and inadequate nutrient supplies, but there have been no global estimates of inadequate micronutrient intakes. We aimed to estimate the global prevalence of inadequate micronutrient intakes for 15 essential micronutrients and to identify dietary nutrient gaps in specific demographic groups and countries.

METHODS

In this modelling analysis, we adopted a novel approach to estimating micronutrient intake, which accounts for the shape of a population's nutrient intake distribution and is based on dietary intake data from 31 countries. Using a globally harmonised set of age-specific and sex-specific nutrient requirements, we then applied these distributions to publicly available data from the Global Dietary Database on modelled median intakes of 15 micronutrients for 34 age-sex groups from 185 countries, to estimate the prevalence of inadequate nutrient intakes for 99·3% of the global population.

FINDINGS

On the basis of estimates of nutrient intake from food (excluding fortification and supplementation), more than 5 billion people do not consume enough iodine (68% of the global population), vitamin E (67%), and calcium (66%). More than 4 billion people do not consume enough iron (65%), riboflavin (55%), folate (54%), and vitamin C (53%). Within the same country and age groups, estimated inadequate intakes were higher for women than for men for iodine, vitamin B12, iron, and selenium and higher for men than for women for magnesium, vitamin B6, zinc, vitamin C, vitamin A, thiamin, and niacin.

INTERPRETATION

To our knowledge, this analysis provides the first global estimates of inadequate micronutrient intakes using dietary intake data, highlighting highly prevalent gaps across nutrients and variability by sex. These results can be used by public health practitioners to target populations in need of intervention.

FUNDING

The National Institutes of Health and the Dutch Ministry of Foreign Affairs.

Sustainable-use marine protected areas to improve human nutrition

Coral reef fisheries are a vital source of nutrients for thousands of nutritionally vulnerable coastal communities around the world. Marine protected areas are regions of the ocean designed to preserve or rehabilitate marine ecosystems and thereby increase reef fish biomass. Here, we evaluate the potential effects of expanding a subset of marine protected areas that allow some level of fishing within their borders (sustainable-use MPAs) to improve the nutrition of coastal communities. We estimate that, depending on site characteristics, expanding sustainable-use MPAs could increase catch by up to 20%, which could help prevent 0.3-2.85 million cases of inadequate micronutrient intake in coral reef nations. Our study highlights the potential add-on nutritional benefits of expanding sustainable-use MPAs in coral reef regions and pinpoints locations with the greatest potential to reduce inadequate micronutrient intake level. These findings provide critical knowledge given international momentum to cover 30% of the ocean with MPAs by 2030 and eradicate malnutrition in all its forms.

Development of a Population-Level Dichotomous Indicator of Minimum Dietary Diversity as a Proxy for Micronutrient Adequacy in Adolescents Aged 10-19 Y in the United States

BACKGROUND

Diversity is a key component of diet quality and health, but no indicator exists for adolescents under the age of 15 y.

OBJECTIVES

To establish a dichotomous indicator for population-level assessment of adolescent dietary diversity as a proxy for micronutrient adequacy.

METHODS

We used the probability approach to construct mean probability of adequacy (MPA) of 11 micronutrients from 2 d of 24-h dietary recall data from NHANES, 2007-2018. For each micronutrient, probability of adequacy (PA) was calculated using the best linear unbiased predictor of usual intake. Adolescent dietary diversity score (ADDS) was derived with a maximum score of 10 food groups. Generalized linear mixed models were used to examine associations between ADDS and MPA. Receiver operating characteristic analysis was used to establish a cutoff for minimum dietary diversity for adolescents (MDD-A) using an energy-adjusted logistic model with ADDS predicting MPA > 0.6.

RESULTS

PA was >80% for all nutrients except vitamin C (42.1%), folate (65.7%), and calcium (23.8%). Population MPA was 79.4%, and nearly 92% of adolescents had an MPA > 0.6. ADDS was positively associated with MPA, and energy was a significant confounder. The area under the curve was >0.8 on both days with sensitivity and specificity ranging from 0.71 to 0.80. The MDD-A cutoff was calculated as 5.12 and 5.10 food groups on days 1 and 2, respectively.

CONCLUSIONS

In U.S. adolescents, the best cutoff for a dichotomous indicator of dietary diversity as a proxy for micronutrient adequacy is 6 food groups in a given day. Future research could validate MDD-A and its associated cutoff for use across country contexts.

Analysis of global nutrient gaps and their potential to be closed through redistribution and increased supply

Global food systems are crucial for sustaining life on Earth. Although estimates suggest that the current production system can provide enough food and nutrients for everyone, equitable distribution remains challenging. Understanding global nutrient distribution is vital for addressing disparities and creating effective solutions for the present and future. This study analyzes global nutrient supply changes to address inadequacies in certain populations using the existing DELTA Model®, which uses aggregates of global food production to estimate nutrient adequacy. By examining the 2020 global food commodity and nutrient distribution, we project future food production in 2050 needs to ensure global adequate nutrition. Our findings reveal that while some nutrients appear to be adequately supplied on a global scale, many countries face national insufficiencies (% supply below the population reference intake) in essential vitamins and minerals, such as vitamins A, B12, B2, potassium, and iron. Closing these gaps will require significant increases in nutrient supply. For example, despite global protein supply surpassing basic needs for the 2050 population, significant shortages persist in many countries due to distribution variations. A 1% increase in global protein supply, specifically targeting countries with insufficiencies, could address the observed 2020 gaps. However, without consumption pattern changes, a 26% increase in global protein production is required by 2050 due to population growth. In this study, a methodology was developed, applying multi-decade linear convergence to sufficiency values at the country level. This approach facilitates a more realistic assessment of future needs within global food system models, such as the DELTA Model®, transitioning from idealized production scenarios to realistic projections. In summary, our study emphasizes understanding global nutrient distribution and adjusting minimum global nutrient supply targets to tackle country-level inequality. Incorporating these insights into global food balance models can improve projections and guide policy decisions for sustainable, healthy diets worldwide.

Multiomics: Functional Molecular Biomarkers of Micronutrients for Public Health Application

Adequate micronutrient intake and status are global public health goals. Vitamin and mineral deficiencies are widespread and known to impair health and survival across the life stages. However, knowledge of molecular effects, metabolic pathways, biological responses to variation in micronutrient nutriture, and abilities to assess populations for micronutrient deficiencies and their pathology remain lacking. Rapidly evolving methodological capabilities in genomics, epigenomics, proteomics, and metabolomics offer unparalleled opportunities for the nutrition research community to link micronutrient exposure to cellular health; discover new, arguably essential micronutrients of microbial origin; and integrate methods of molecular biology, epidemiology, and intervention trials to develop novel approaches to assess and prevent micronutrient deficiencies in populations. In this review article, we offer new terminology to specify nutritional application of multiomic approaches and encourage collaboration across the basic to public health sciences to advance micronutrient deficiency prevention.

Mandatory large-scale food fortification programmes can reduce the estimated prevalence of inadequate zinc intake by up to 50% globally

Large-scale food fortification (LSFF) can increase dietary micronutrient intake and improve micronutrient status. Here we used food balance sheet data from the Food and Agriculture Organization of the United Nations to estimate current country-specific prevalences of inadequate zinc intake. We assessed the potential effects of improving existing LSFF programmes for cereal grains or implementing new programmes in 40 countries where zinc deficiency is a potential public health problem. Accounting for LSFF programmes as currently implemented, 15% of the global population (1.13 billion individuals) is estimated to have inadequate zinc intake. In countries where zinc deficiency is a potential public health problem, the implementation of high-quality mandatory LSFF programmes that include zinc as a fortificant would substantially increase the availability of zinc in the national food supply, reducing the estimated prevalence of inadequate zinc intake by up to 50% globally. Investments in strong LSFF programmes could have a substantial impact on population zinc status.

Assessment of the prevalence of inadequate iron intakes in premenopausal females based on the reference values of the European Food Safety Authority using cross-sectional food consumption data

BACKGROUND

The iron intake requirement distribution for premenopausal females is not symmetric, which invalidates the EAR cut-point approach for assessing the prevalence of iron inadequacy. Therefore, Beaton's Full Probability Approach (PA) must be used. Although the PA requires information on the entire iron intake requirement distribution, the European Food Safety Authority (EFSA) only provided the EAR (50th percentile), 90th, 95th (population reference intake), and 97.5th percentiles.

OBJECTIVES

This study aimed to reliably estimate the prevalence of iron inadequacy in premenopausal females using the PA, based on the intake requirements established by EFSA, and compare the results with those obtained from the EAR cut-point method.

METHODS

Habitual iron intakes were calculated using the statistical program to assess dietary exposure with data from 484 females (20-45 y) from the Dutch National Food Consumption Survey 2012-2016. Iron requirements of EFSA (including additionally obtained information) were applied. Results from the PA were compared to results obtained with the EAR cut-point method. Sensitivity analyses examined the impact of lower iron intake distributions on differences in estimated inadequate intakes between PA and EAR cut-point methods.

RESULTS

A 2-fold higher prevalence of iron inadequacy among Dutch premenopausal females was observed when employing the PA compared to the EAR cut-point method, using EFSA's reference values. Sensitivity analysis showed that the EAR cut-point method could also result in large overestimations for populations with lower intake distributions.

CONCLUSIONS

This study provided an example of using the PA method by using additionally derived information on the full requirement distribution underlying EFSA's reference values. Results showed once more the unsuitability of the EAR cut-point method to calculate the prevalence of iron inadequacy in premenopausal females. Hence, we recommend that institutions deriving dietary reference values provide all the information needed to use the correct method to determine inadequate intakes in the population.

Dietary Inflammatory Indices Are Not Associated With Inflammatory Bowel Disease Incidence and Progression

Empirical dietary inflammatory pattern and the dietary inflammatory index are dietary inflammation indices, both previously associated with risk of inflammatory bowel disease. We show in the UK Biobank a null association between these indices and incident inflammatory bowel disease; we challenge the current ways in which these dietary indices are derived and interpreted. The need to account for the effects of food processing as well as the raw ingredients is emphasized as a confounding variable.

Opportunities for Consistent and Holistic Metrics to Support Food Systems Transformation: A Summary of a Symposium Presented at Nutrition 2023

There is an urgent need for global food systems transformation to realize a future where planetary health reaches its full potential. Paramount to this vision is the ability of stakeholders across sectors to understand how foods and dietary patterns impact food systems inclusive of all domains of sustainability-environmental, nutrition/health, economic and social. This article is a synopsis of presentations by 3 food systems experts to share the latest science in a session entitled "How do you measure sustainability? Opportunities for consistent and holistic metrics to support food systems transformation" at the American Society for Nutrition's 2023 annual conference. As summarized here, global population data showing widespread malnutrition underscore the important role of dietary diversity through a balance of plant- and animal-source foods to achieve nutritionally adequate diets and reduce risk of noncommunicable diseases. Yet, recent international audits of countries, companies, and organizations and their sustainability targets largely demonstrate an underrepresentation of robust nutrition/health metrics to support public nutrition and health progress. Addressing limitations in diet-sustainability modeling systems provides a viable opportunity to accurately reflect the important contributions and trade-offs of diets across all domains of sustainability to ultimately support evidence-based decision making in advancing healthy food systems.

Exploring Diet and Nutrient Insufficiencies across Age Groups: Insights from a Population-Based Study of Brazilian Adults

Assessing dietary inadequacies can contribute to understanding the nutritional vulnerabilities of a country. This study aimed to investigate nutrient intakes and micronutrient inadequacies in the Brazilian adult population, with an interest in different age subgroups. We conducted a cross-sectional study with 1812 individuals aged 19 to 65 years from a population-based study with a representative sample of Brazilian adults. Dietary intake was assessed by two 24 h food recalls, and the probabilities of inadequate intake were estimated using the Dietary Reference Intake targets. Adequate macronutrient intake was over 99% for proteins, 84.7% for carbohydrates, and 80.7% for total fats. There was a high probability of inadequacy (above 90%) for vitamins D and E, but vitamin D inadequacy was very similar between the sexes. In contrast, vitamin E was more likely to be inadequately consumed among women. A high probability of inadequacies (above 85%) of calcium and magnesium were found in the population, regardless of age group. Except for iron, the probability of an inadequacy of other minerals increased with age. The results showed a relevant proportion of nutrient inadequacies, with those most at risk being women and older individuals, helping with the better targeting and monitoring of public-health policies that address nutritional problems in the population.

Minimum Dietary Diversity for Adolescents: Multicountry Analysis to Define Food Group Thresholds Predicting Micronutrient Adequacy among Girls and Boys Aged 10-19 Years

Background

Adolescents' diets have been overlooked in nutrition information systems, interventions, and policies. The minimum dietary diversity for women (MDD-W) indicator has been validated to signal greater micronutrient adequacy among nonpregnant women from low- and middle-income countries, but there is limited evidence for valid food group thresholds among boys or nonpregnant nonlactating girls.

Objective

To define a food group threshold that reflects minimum dietary diversity for adolescents.

Methods

This multicountry study evaluated the test characteristics of a 10-point food group diversity score (FGDS)-underlying MDD-W-and food group thresholds to predict the micronutrient adequacy of diets from single 24-h recalls or food diaries (24-HRs) among 83,935 adolescents aged 10-19 y and repeated 24-HRs among 75,480 adolescents from upper-middle and high-income countries.

Results

FGDS was lowest among adolescents in lower-middle countries (3.5 ± 1.1) and greatest in high-income countries (5.4 ± 1.3 points). Using single 24-HRs, 1-point increments in FGDS performed identically to predict a higher mean adequacy ratio among boys and girls (5.1 percentage points; 95% confidence interval: 5.0, 5.2; P < 0.001). MDD-W (i.e., ≥5 food groups) performed well in predicting a mean adequacy ratio of >0.60 among adolescents from upper-middle and high-income countries, whereas a ≥4 food group cutoff showed a superior balance between sensitivity, specificity, and percentage correctly classified in low (only girls) and lower-middle-income countries (boys and girls). In contrast, using repeated 24-HRs, the mean probability of adequacy levels among adolescents were too high and homogeneous (i.e., all mean probability of adequacies > 0.60) to define an optimal food group threshold.

Conclusions

MDD-W can be extended to boys and girls aged 10-19 y from upper-middle and high-income countries. Furthermore, an adapted indicator using a ≥4 food group threshold signals higher micronutrient adequacy in low and lower-middle-income countries. Food group cutoffs to predict the micronutrient adequacy of usual intakes should be validated using repeated 24-HRs in populations where a lower proportion of adolescents meet mean dietary requirements.

Do Global Dietary Nutrient Datasets Associate with Human Biomarker Assessments? A Regression Analysis

BACKGROUND

To assess the state and trends of global nutrition, our best tools are nationally representative assessments using human biomarker assays, yet these are expensive and logistically challenging. We instead often rely on more easily produced global nutrient datasets-measures of nutrients provided by the diet-as a proxy for nutritional intake and deficiency, due to their greater geographic and temporal coverage. However, the accuracy of global nutrient datasets is questionable.

OBJECTIVE

We aimed to test whether estimates of inadequate dietary intake derived from existing global nutrient datasets reliably associate with biophysical deficiency.

DESIGN

We performed linear regressions of estimates of inadequate dietary nutrient intake derived from three global nutrient datasets-Global Dietary Database, Global Nutrient Database, and Global Expanded Nutrient Supply (GENuS) model-against the existing suite of nationally representative biomarker survey data for three key nutrients of global concern in two vulnerable demographic groups: zinc, folate, and vitamin A in females of childbearing age; and zinc and vitamin A in children younger than 5 y.

RESULTS

We found significant associations (P < 0.1) for only 3 of 22 regressions between global nutrition datasets and biophysical deficiency: zinc for females of childbearing age from GENuS and Global Dietary Database, and zinc for children under 5 y from GENuS. Folate and vitamin A show no reliable relationship between nutrient datasets and independent biomarker surveys. Applying the successful models for zinc to the accompanying full datasets yield estimates of global zinc deficiency of 31%-37% for these demographic groups.

CONCLUSIONS

We found that few estimates of nutritional inadequacy from global dietary datasets are associated with more direct measures of biophysical deficiency from biomarker studies. Researchers and policymakers must be cautious when applying global nutrient datasets to questions of global health and use them for limited applications.

New Food Frequency Questionnaire to Estimate Vitamin K Intake in a Mediterranean Population

Vitamin K is a multifunctional micronutrient essential for human health, and deficiency has been linked to multiple pathological conditions. In this study, we aimed to develop and validate a new food frequency questionnaire (FFQ) to estimate total vitamin K intake, over the course of a 30-day interval, in a Portuguese, Mediterranean-based, population. We conducted a prospective study in a non-random sample of 38 healthy adult volunteers. The FFQ was designed based on a validated Portuguese FFQ used in nationally representative studies and on literature reviews, to include foods containing ≥5 μg of vitamin K/100 g and foods with a lower vitamin K content, yet commonly included in a Mediterranean diet. Vitamin K intake was estimated from 24 h recalls and six days of food records. The final FFQ included 54 food items which, according to regression analyses, explains 90% of vitamin K intake. Mean differences in vitamin K intake based on food records (80 ± 47.7 μg/day) and on FFQ (96.5 ± 64.3 μg/day) were statistically non-significant. Further, we found a strong correlation between both methods (r = 0.7; p = 0.003). Our results suggest that our new FFQ is a valid instrument to assess the last 30 days of vitamin K intake in the Portuguese Mediterranean population.

Estimated micronutrient shortfalls of the EAT-Lancet planetary health diet

Unhealthy diets are a major contributor to the global burden of disease, and food systems cause substantial environmental destruction. To lay out how to achieve healthy diets for all, within planetary boundaries, the landmark EAT-Lancet Commission proposed the planetary health diet, which includes a range of possible intakes by food group and substantially restricts the intake of highly processed foods and animal source foods globally. However, concerns have been raised about the extent to which the diet provides adequate essential micronutrients, particularly those generally found in higher quantities and in more bioavailable forms in animal source foods. To address these concerns, we matched each food group point estimate within the respective range with globally representative food composition data. We then compared the resulting dietary nutrient intakes with globally harmonised recommended nutrient intakes for adults and women of reproductive age for six micronutrients that are globally scarce. To fill the dietary gaps that were estimated for vitamin B12, calcium, iron, and zinc, we suggest modifications to the original planetary health diet to achieve micronutrient adequacy (without fortification or supplementation) for adults, which included increasing the proportion of animal source foods and reducing foods high in phytate.

Limitations of the Food Compass Nutrient Profiling System

Nutrient Profiling Systems provide frameworks to assess the healthfulness of foods based on food composition and are intended as inputs into strategies to improve diets. Many Nutrient Profiling Systems are founded on a reductionist assumption that the healthfulness of foods is determined by the sum of their individual nutrients, with no consideration for the extent and purpose of processing and its health implications. A novel Nutrient Profiling System called Food Compass attempted to address existing gaps and provide a more holistic assessment of the healthfulness of foods. We propose that the chosen algorithm is not well justified and produces results that fail to discriminate for common shortfall nutrients, exaggerate the risks associated with animal-source foods, and underestimate the risks associated with ultraprocessed foods. We caution against the use of Food Compass in its current form to inform consumer choices, policies, programs, industry reformulations, and investment decisions.