Temporal changes in micronutrient intake among United States Adults, NHANES 2003 through 2018: A cross-sectional study

BACKGROUND

Changes in the United States food supply and food choices make examination of temporal changes in micronutrient intake and their effect on meeting nutrient recommendations necessary.

OBJECTIVES

This study aimed to examine 15-year trends of the contribution of foods and beverages (FB) and dietary supplements (DSs) to meeting nutrient recommendations among United States adults aged 19 y or older and compare usual mean intake distributions of FB alone with those of FB+DSs with dietary reference intakes [percentage below the estimated average requirement (%AI)].

METHODS

This cross-sectional study used food, beverage, and DSs intake data from NHANES 2003-2018 (N = 39,925) to determine usual mean intakes for 21 micronutrients. Changes in intakes from FB and from FB+DSs, by sex, were compared in a time-trend analysis of 2-y cycles. Changes in mean intake as %AI were determined.

RESULTS

Over the time studied, United States adults underconsumed vitamins A, C, D, E, and K; calcium; potassium; magnesium; and choline, even when DSs intake was included. Sodium was overconsumed. In males, there were significant increases in %

CONCLUSIONS

Although some progress has been made, nutrient intake and percentage of the population meeting nutritional recommendations among United States adults has changed little over the 15 y studied.

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Key Words

• adequate intake
• dietary recommendations
• dietary supplements
• estimated average requirement
• nutrient intake
• underconsumed nutrients

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MESH Headings

• Humans
• Micronutrients/administration & dosage
• Cross-Sectional Studies
• Adult
• Male
• Female
• United States
• Nutrition Surveys
• Middle Aged
• Young Adult
• Diet
• Dietary Supplements
• Aged

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100% Orange Juice Consumption is Associated with Socioeconomic Status, Improved Nutrient Adequacy, and Higher Bioactive Compounds Intake: Results from Brazilian National Dietary Survey 2017-2018

OBJECTIVE

The consumption of 100% orange juice (OJ) has been associated with nutrient adequacy and better diet quality. To date, there are few analyses exploring 100% OJ consumption patterns across populations, with no data from Brazil. We aimed to explore the associations between 100% OJ consumption, sociodemographic factors, and nutrient intake in a representative sample of the Brazilian general population aged 10 years or older.

METHODS

Data were obtained from the National Dietary Survey 2017-2018, a cross-sectional study including data on individual food intake of 46,164 subjects aged ≥10 years collected using two 24-h dietary recalls.

RESULTS

100% OJ was consumed by 11% of the population, with a mean intake of 43.0 ml/d. Males were more frequent consumers compared to females, and the percentage of consumers increased with education and income. 100% OJ consumption was associated with higher intakes of energy, vitamin C, folate, calcium, magnesium, potassium, polyphenols, and carotenoids. There is no significant difference in fiber intake between consumers and non-consumers. 100% OJ consumers had a higher percentage of the population meeting the Estimated Average Requirement for vitamin A, vitamin C, vitamin D, folate, calcium, and magnesium.

CONCLUSION

Our results suggest that 100% OJ could be a component of a healthy diet, helping individuals to achieve nutrient recommendations.

Urine Se concentration poorly predicts plasma Se concentration at sub-district scales in Zimbabwe, limiting its value as a biomarker of population Se status

Introduction

The current study investigated the value of urine selenium (Se) concentration as a biomarker of population Se status in rural sub-Saharan Africa.

Method

Urine and plasma Se concentrations were measured among children aged 6-59 months (n = 608) and women of reproductive age (WRA, n = 781) living in rural Zimbabwe (Murehwa, Shamva, and Mutasa districts) and participating in a pilot national micronutrient survey. Selenium concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS), and urine concentrations were corrected for hydration status.

Results

The median (Q1, Q3) urine Se concentrations were 8.4 μg/L (5.3, 13.5) and 10.5 μg/L (6.5, 15.2) in children and WRA, respectively. There was moderate evidence for a relationship between urine Se concentration and plasma Se concentration in children (p = 0.0236) and WRA (p = < 0.0001), but the relationship had poor predictive value. Using previously defined thresholds for optimal activity of iodothyronine deiodinase (IDI), there was an association between deficiency when indicated by plasma Se concentrations and urine Se concentrations among WRA, but not among children.

Discussion

Urine Se concentration poorly predicted plasma Se concentration at sub-district scales in Zimbabwe, limiting its value as a biomarker of population Se status in this context. Further research is warranted at wider spatial scales to determine the value of urine Se as a biomarker when there is greater heterogeneity in Se exposure.

Adjusting the Iodine Content of Iodized Salt to Meet the Recommended Intake for Females of Reproductive Age: A Simulation Study with a Reduced Sodium Scenario

BACKGROUND

The use of iodized salt is a key strategy to increase iodine intake worldwide. In many countries, including New Zealand, females of reproductive age are still at risk of being mildly iodine deficient.

OBJECTIVE

This study aimed to determine the level of iodization of salt needed to ensure that females aged 18 to 40 y have an adequate intake of iodine in 2 scenarios: current discretionary salt intake and reduced discretionary salt intake.

METHOD

Data from nonpregnant, nonlactating females aged 18 to 40 y (n = 795) who took part in the 2008/09 New Zealand Adult Nutrition Survey and completed a 24-h dietary recall were used. Iodine intake was determined from all foods except bread and discretionary salt, which are fortified with iodine. Iodine from bread and salt was estimated at different levels of salt iodization, starting at 25 mg iodine/kg salt and increasing incrementally by 5 mg/kg, and added to calculate total iodine intake. The simulation concluded when the appropriate iodine content in salt was found using the estimated average requirement (EAR) cut-point method.

RESULTS

In the 2 scenarios, current discretionary salt intake (i.e., 400 mg/d) and reduced discretionary salt intake (i.e., 304 mg/d), the iodine concentration of salt is required to be 55 mg/kg and 70 mg/kg for no more than 2% of females to have an iodine intake below the EAR of 100 μg of iodine/d, respectively. In both scenarios and at all levels of iodine concentration, no one was above the upper level of intake of iodine of 1100 μg/d.

CONCLUSIONS

This study found that females of reproductive age need to consume iodized salt at the higher end of the legislated range of 25 to 65 mg/kg. If strategies to reduce sodium intake were adopted, the range would need to increase, or iodized salt would need to be included in a wider range of staple foods.

Amino Acid Intake and Conformance With the Dietary Reference Intakes in the United States: Analysis of the National Health and Nutrition Examination Survey, 2001-2018

BACKGROUND

The lack of complete amino acid composition data in food composition databases has made determining population-wide amino acid intake difficult.

OBJECTIVES

This cross-sectional study characterizes habitual intakes of each amino acid and adherence to dietary requirements for each essential amino acid (EAA) in the US population.

METHODS

Food and Nutrient Database for Dietary Studies ingredient codes with missing amino acid composition data were matched to similar ingredients with available data so that amino acid composition could be determined for 100% of foods reported in the dietary intake assessment component of NHANES. Amino acid intakes during NHANES 2001-2018 (n = 72,831; ≥2 y) were calculated as relative (mg·kg of ideal body weight^-1·d^-1) intakes. Data from NHANES 2011-2018 were used to determine the percentage of population consuming less than that recommended by the DRIs for each EAA by age, sex, and race/ethnicity.

RESULTS

Relative intakes of EAAs and NEAAs were greatest in those 2-3 y and lowest in older individuals (≥71 y or ≥80 y). In females aged 2-18 y, relative intakes of EAAs were lowest in non-Hispanic White (NHW; histidine, lysine, threonine, methionine, and cysteine) and non-Hispanic Black (NHB; valine, isoleucine, leucine, phenylalanine, tryptophan, and tyrosine) populations and highest in the Asian population. In females aged ≥19 y, relative intakes were lowest in NHW (lysine and methionine only) and NHB populations and highest in the Asian population. In males aged 2-18 y, relative intakes of EAAs were lowest in the NHB population and highest in the Asian population. In males ≥19 y, relative intakes were lowest in NHB and NHW (lysine only) populations and highest in the Hispanic population. Less than 1% of individuals aged ≥19 y did not meet the Estimated Average Requirements for each EAA.

CONCLUSIONS

EAA intakes in the US population exceed recommended minimum population requirements. Future studies can use the method described here to quantify amino acid intake and examine relationships with health and disease.

Trends in Iodine Status Among U.S. Children and Adults: A Cross-Sectional Analysis of National Health and Nutrition Examination Survey Data from 2001-2004 to 2017-2020

Background: Iodine nutrition is an important public health issue. Trends in iodine status over time among U.S. schoolchildren and adults and factors mediating changes of iodine status were examined. Methods: In this cross-sectional study of National Health and Nutrition Examination Survey (NHANES) data, we estimated trends in the U.S. population using linear regression analyses. Representative samples of U.S. children and adults were enrolled in NHANES 2001-2020. The NHANES cycles were categorized into 5 four-year periods: 2001-2004, 2005-2008, 2009-2012, 2013-2016, and 2017-2020. The final sample sizes of children and adults for analysis were 4288 and 19,661, respectively. The estimated average requirement (EAR) (based on guidelines from the Institute of Medicine), was used to estimate the prevalence rate of inadequate iodine intake. Binary logistic regression analyses were used to investigate the association between iodine status and contributing factors. Results: From 2001-2004 to 2017-2020, among children, urinary iodine concentration (UIC) decreased from 243 to 166 μg/L (p_trend = 0.0057) and prevalence of iodine intake below the EAR rose from 15.4% to 27.6%. In adults, the UIC decreased from 153 to 116 μg/L (p_trend < 0.001) and prevalence of iodine intake below the EAR rose from 15.0% to 17.9%. A higher prevalence rate of iodine intake below the EAR was observed in females compared with males (children, 24.0% vs. 16.5%, p < 0.001; adults, 20.0% vs. 11.1%, p < 0.001). Inadequate iodine intake was less frequent among non-Hispanic White and Hispanic compared with non-Hispanic Black in children and adults. Adults without thyroid problems had a higher prevalence of inadequate iodine intake than those with thyroid problems (16.0% vs. 13.0%, p = 0.001). Inadequate iodine intake was less likely in the children who "sometimes" and "often" consumed milk products compared with children who "never or rarely" consumed milk products (OR = 0.60 [CI 0.30-1.21] and OR = 0.24 [CI 0.13-0.43], respectively). The prevalence of inadequate iodine intake among adults reporting "sometimes" (OR = 0.70 [CI 0.58-0.83]) and "often" consuming milk products was lower than those who "never or rarely" consumed them (OR = 0.36 [CI 0.30-0.44]). Conclusions: In this weighted survey, the prevalence of inadequate iodine intake increased from 2001-2004 to 2017-2020 among U.S. school-age children and adults. Sex, race, thyroid problems, and a decreased intake of milk products were significantly associated with iodine intake below the EAR.

Adequate protein intake in older adults in the context of frailty: cross-sectional results of the Nutrition and Health Survey in Taiwan 2014-2017

BACKGROUND

Emerging evidence suggests that a dietary protein intake higher than the current recommended dietary allowance of 0.8 g/kg body weight (BW)/d may be needed to maintain optimal muscle mass, strength, and function in older adults. However, defining optimal protein intake in this age group remains a challenge.

OBJECTIVE

In this study we sought to describe the dietary protein intake in frail, prefrail, and robust older Taiwanese adults.

METHODS

Data for 1920 older adults were collected from the Nutrition and Health Survey in Taiwan from 2014 to 2017. Dietary intake was assessed using the 24-h recall method. Frailty was determined using the modified Fried's criteria. Body composition was assessed using DXA. Sex-specific dietary protein intakes, measured as values/kg of BW, fat-free mass (FFM), and lean mass (LM), were estimated for the 3 age groups (65-69, 70-79, and ≥80y) and the 3 frailty levels.

RESULTS

In both males (P for trend = 0.034) and females (P for trend = 0.015), there were significant downward trends for protein intake/kg of BW with the severity of frailty. The age-adjusted protein intake/kg of BW was still significant in males (P for trend = 0.009), but no longer in females. This phenomenon was also seen for protein intake at lunch and dinner but not at breakfast. Age-adjusted trends for protein intake/kg FFM or LM were not significant in either sex. The median protein intake in robust older males and females was 1.21 and 1.19 g/kg BW/d, respectively, and the mean intakes were even higher.

CONCLUSION

Median protein intake in robust Taiwanese older adults was approximately 1.2 g/kg BW/d, with higher mean values. The protein adequate intake in Taiwanese older adults was higher than the current recommended daily allowance (RDA) level but within the RDA range derived from the state-of art indicator amino acid oxidation technique.

Diet Quality and Micronutrient Intake among Long-Term Weight Loss Maintainers

Inadequate vitamin and mineral intake is documented among individuals with obesity, but is unknown among long-term weight loss maintainers (WLM). This study examined dietary quality and micronutrient adequacy among WLMs in a commercial weight management program. Participants were 1207 WLM in Weight Watchers (WW) who had maintained a 9.1 kg or greater weight loss (29.7 kg on average) for 3.4 years and had a body mass index (BMI) of 28.3 kg/m². A control group of weight stable adults with obesity (controls; N = 102) had a BMI of 41.1 kg/m². Measures included the Diet History Questionnaire-II, Healthy Eating Index-2015 (HEI), and Dietary References Intakes. WLM versus controls had a 10.1 point higher HEI score (70.2 (69.7–70.7) vs. 60.1 (58.4–61.8); p = 0.0001) and greater odds of meeting recommendations for copper (OR = 5.8 (2.6–13.1)), magnesium (OR = 2.9 (1.8–4.7)), potassium (OR = 4.7 (1.4–16.5)), vitamin A (OR = 2.8 (1.7–4.8)), vitamin B6 (OR = 2.9 (1.6–5.2)), and vitamin C (OR = 5.0 (2.8–8.8)). WLM, compared to controls, also reported higher percentages of calories from carbohydrates (50.3% (49.7–50.8) vs. 46.7% (44.8–48.7); p = 0.0001) and protein (18.2% (18.0–18.5) vs. 15.9% (15.1–16.6); p = 0.0001) and lower calories from fat (32.3% (31.9–32.8) vs. 37.4% (35.8–38.9); p = 0.0001). Long-term weight loss maintenance in a widely used commercial program was associated with a healthier diet pattern, including consuming foods with higher micronutrient density.

Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study

BACKGROUND

The health benefits and risks of dietary supplement use are controversial.

OBJECTIVE

To evaluate the association among dietary supplement use, levels of nutrient intake from foods and supplements, and mortality among U.S. adults.

DESIGN

Prospective cohort study.

SETTING

NHANES (National Health and Nutrition Examination Survey) data from 1999 to 2010, linked to National Death Index mortality data.

PARTICIPANTS

30 899 U.S. adults aged 20 years or older who answered questions on dietary supplement use.

MEASUREMENTS

Dietary supplement use in the previous 30 days and nutrient intake from foods and supplements. Outcomes included mortality from all causes, cardiovascular disease (CVD), and cancer.

RESULTS

During a median follow-up of 6.1 years, 3613 deaths occurred, including 945 CVD deaths and 805 cancer deaths. Ever-use of dietary supplements was not associated with mortality outcomes. Adequate intake (at or above the Estimated Average Requirement or the Adequate Intake level) of vitamin A, vitamin K, magnesium, zinc, and copper was associated with reduced all-cause or CVD mortality, but the associations were restricted to nutrient intake from foods. Excess intake of calcium was associated with increased risk for cancer death (above vs. at or below the Tolerable Upper Intake Level: multivariable-adjusted rate ratio, 1.62 [95% CI, 1.07 to 2.45]; multivariable-adjusted rate difference, 1.7 [CI, -0.1 to 3.5] deaths per 1000 person-years), and the association seemed to be related to calcium intake from supplements (≥1000 mg/d vs. no use: multivariable-adjusted rate ratio, 1.53 [CI, 1.04 to 2.25]; multivariable-adjusted rate difference, 1.5 [CI, -0.1 to 3.1] deaths per 1000 person-years) rather than foods.

LIMITATIONS

Results from observational data may be affected by residual confounding. Reporting of dietary supplement use is subject to recall bias.

CONCLUSION

Use of dietary supplements is not associated with mortality benefits among U.S. adults.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Iodine Status Assessment in South African Adults According to Spot Urinary Iodine Concentrations, Prediction Equations, and Measured 24-h Iodine Excretion

The iodine status of populations is conventionally assessed using spot urinary samples to obtain a median urinary iodine concentration (UIC) value, which is assessed against standard reference cut-offs. The assumption that spot UIC reflects daily iodine intake may be flawed because of high day-to-day variability and variable urinary volume outputs. This study aimed to compare iodine status in a sample of South African adults when determined by different approaches using a spot urine sample (median UIC (MUIC), predicted 24 h urinary iodine excretion (PrUIE) using different prediction equations) against measured 24 h urinary iodine excretion (mUIE). Both 24 h and spot urine samples were collected in a subsample of participants (n = 457; median age 55 year; range 18⁻90 year) in the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 in South Africa, in 2015. Kawasaki, Tanaka, and Mage equations were applied to assess PrUIE from predicted urinary creatinine (PrCr) and spot UIC values. Adequacy of iodine intake was assessed by comparing PrUIE and mUIE to the Estimated Average Requirement of 95 µg/day, while the MUIC cut-off was.

Micronutrient Intakes in 553 Dutch Elite and Sub-Elite Athletes: Prevalence of Low and High Intakes in Users and Non-Users of Nutritional Supplements

This study investigated whether athletes meet micronutrient recommendations and whether the adequacy of their intake is related to the use of dietary supplements, sport nutrition products or a combination. Micronutrient intakes of 553 Dutch (sub-) elite athletes were assessed using web-based 24-h dietary recalls with accompanying nutritional supplement questionnaires. In the majority of both users and non-users of dietary supplements, vitamin D intake was below the estimated average requirement (AR) if supplements were not included in the analysis. Including dietary supplements improved vitamin D intake, but still a part of the athletes, both men and women, reported an intake below the AR. Non-users of dietary supplements were particularly at risk for low intakes of vitamins B1, B2, B3 and vitamins A, C and selenium. Mean iron intake was reported below the AR in a substantial group of women, both users and non-users. The use of sport nutrition products contributed only slightly to micronutrient intake. A small prevalence of athletes using dietary supplements showed intakes of some micronutrients above the Upper Level. In conclusion, both users and non-users of nutritional supplements reported inadequate intake of micronutrients. For most micronutrients, use of nutritional supplements does not completely compensate for intakes below AR. Athletes should consider making better food choices and the daily use of a low-dosed multivitamin supplement.

Older adults need guidance to meet nutritional recommendations

OBJECTIVE

The purpose of this study was to compare the diet of healthy, free-living senior volunteers to the dietary reference intakes (DRIs) and Food Guide Pyramid recommendations.

METHODS

This study was a cross-sectional assessment of dietary habits, as measured using a standardized food frequency questionnaire, among 1,740 healthy Southwestern U.S. adults, aged 51 to 85 years. Assessment of independently-living volunteers to chemoprevention trials provides an efficient mechanism to profile typical dietary habits among the older adult population.

RESULTS

Daily estimated macronutrient intakes exceeded recommended proportions of protein and fat. In contrast, more than 60% of this senior population reported dietary vitamin D, vitamin E, folate and calcium intakes below estimated average requirements (EAR). Based on the Food Guide Pyramid recommendations, fewer than 10% of the older adults consumed the recommended daily dairy and grain servings. More females than males consumed recommended vegetable (49% versus 40%) and fruit (53% versus 48%) servings (p < 0.05). More males consumed recommended grain (11% versus 7%) and protein (78% versus 73%) servings (p < 0.05) than females.

CONCLUSIONS

Mean micronutrient intakes compared well with DRIs, although fewer than one-half of these older adults consumed recommended levels for vitamin D, vitamin E, folate, and calcium or daily food servings of dairy, grains, vegetables or fruits. Since the beneficial aspects of foods are not limited to essential nutrients, nutrition recommendations to older adults may be improved by emphasizing daily servings of nutrient-dense choices within the Food Pyramid.