Average Requirement Cut-point Method Research Articles

Intake of micronutrients implicated in depression amongst young adults consuming vegetarian diets: a secondary analysis of the 2011-12 National Nutrition and Physical Activity Survey

Major depressive disorder (‘depression’) is significantly more prevalent amongst young adults in Australia relative to older ages. The inefficacy of current treatment options for many individuals(1) warrants investigation of additional approaches to alleviating the burden of this illness. Incidentally, diet often becomes unhealthier during the transition from adolescence to young adulthood(2). This can result in poorer micronutrient consumption, and there is a growing body of evidence indicating that an inverse relationship exists between intake of certain micronutrients and depressive symptoms(3). Given this, diet may be an important modifiable risk factor or adjunctive means of ameliorating depression for young adults. Young adult vegetarians in particular have an increased risk of some micronutrient deficiencies which have been implicated in depression(4). In combination, their age and dietary choice suggest they may be especially vulnerable to depression and therefore benefit from clear guidance to adequately meet their micronutrient requirements. The present study aimed to elucidate the need for such guidance by comparing the proportions of vegetarian and omnivorous young adult participants in the 2011-12 National Nutrition and Physical Activity Survey (NNPAS) who had inadequate intakes of micronutrients implicated in depression. The NNPAS collected the most recent nationally-representative data pertaining to the dietary intake (via two 24-h recalls) of Australians and included 2,397 young adults (18-34 years). Participants who were pregnant, lactating, or who mis-reported intakes according to Goldberg equation-derived cut-off values were excluded (n = 791). The dietary data were used to estimate usual intakes via the Multiple Source Method. Inadequate intakes were identified according to the Estimated Average Requirement (EAR) cut-point method for all micronutrients with an EAR except iron, for which the full-probability method was applied. Survey weights allocated for inference to the total Australian population were implemented throughout the analysis. The final sample was composed of 66 vegetarians (did not report any animal tissue consumption) and 1540 omnivores. The mean intake of long-chain omega-3 fatty acids (EPA, DPA, DHA) from both diet and supplementation was significantly lower in vegetarians compared to omnivores (96.3mg/day vs. 264.5mg/day, p<0.001). A significantly greater proportion of vegetarians compared to omnivores had inadequate total B12 (22.7% vs. 1.4%), iron (58.3% vs. 18.9%), selenium (30.8% vs. 3.5%) and zinc (58.8% vs. 33.3%) intakes (all p<0.05). These results suggest that young adult vegetarians are likely to have significantly lower consumption of long-chain omega-3 fatty acids and an increased risk of inadequately consuming vitamin B12, iron, selenium and zinc compared to their omnivorous counterparts. These findings support the notion that young adult vegetarians may have an increased risk of depression from a nutritional standpoint, and therefore stand to benefit from tailored dietary advice on a public and individual level designed to support their mental health.

Household food insecurity and associations with energy, nutrient intake, and sociodemographic characteristics in young New Zealand children

Although food insecurity affects a significant proportion of young children in New Zealand (NZ)(1), evidence of its association with dietary intake and sociodemographic characteristics in this population is lacking. This study aims to assess the household food security status of young NZ children and its association with energy and nutrient intake and sociodemographic factors. This study included 289 caregiver and child (1-3 years old) dyads from the same household in either Auckland, Wellington, or Dunedin, NZ. Household food security status was determined using a validated and NZ-specific eight-item questionnaire(2). Usual dietary intake was determined from two 24-hour food recalls, using the multiple source method(3). The prevalence of inadequate nutrient intake was assessed using the Estimated Average Requirement (EAR) cut-point method and full probability approach. Sociodemographic factors (i.e., socioeconomic status, ethnicity, caregiver education, employment status, household size and structure) were collected from questionnaires. Linear regression models were used to estimate associations with statistical significance set at p <0.05. Over 30% of participants had experienced food insecurity in the past 12 months. Of all eight indicator statements, “the variety of foods we are able to eat is limited by a lack of money,” had the highest proportion of participants responding “often” or “sometimes” (35.8%). Moderately food insecure children exhibited higher fat and saturated fat intakes, consuming 3.0 (0.2, 5.8) g/day more fat, and 2.0 (0.6, 3.5) g/day more saturated fat compared to food secure children (p<0.05). Severely food insecure children had lower g/kg/day protein intake compared to food secure children (p<0.05). In comparison to food secure children, moderately and severely food insecure children had lower fibre intake, consuming 1.6 (2.8, 0.3) g/day and 2.6 (4.0, 1.2) g/day less fibre, respectively. Severely food insecure children had the highest prevalence of inadequate calcium (7.0%) and vitamin C (9.3%) intakes, compared with food secure children [prevalence of inadequate intakes: calcium (2.3%) and vitamin C (2.8%)]. Household food insecurity was more common in those of Māori or Pacific ethnicity; living in areas of high deprivation; having a caregiver who was younger, not in paid employment, or had low educational attainment; living with ≥2 other children in the household; and living in a sole-parent household. Food insecure young NZ children consume a diet that exhibits lower nutritional quality in certain measures compared to their food-secure counterparts. Food insecurity was associated with various sociodemographic factors that are closely linked with poverty or low income. As such, there is an urgent need for poverty mitigation initiatives to safeguard vulnerable young children from the adverse consequences of food insecurity.

The Influence of Lifestyle on High-Density Lipoprotein Concentration among Mexican Emerging Adults.

Previous studies have highlighted the role of lifestyle on HDL-C concentrations in adults. To our knowledge, the health and nutritional status of emerging adults have been understudied. The present study aimed to explore the most important lifestyle factors, including micronutrient intake adequacy and the percentage of energy from food processing, according to HDL-C concentrations in emerging adults. In this context, a cross-sectional analysis was conducted on 261 Mexican emerging adults who were apparently healthy. Lifestyle factors were collected through a structured survey and the prevalence of micronutrient intake inadequacy was estimated using the estimated average requirement cut-point method. The percentage of energy from ultra-processed foods was assessed using the NOVA system. HDL-C was determined using the enzymatic colorimetric method. Statistical analyses were conducted in SPSS. The results revealed that lifestyle factors do not differ according to HDL-C status. The participants showed a poor nutritional diet that was energy-dense and micronutrient-inadequate. Nearly half of their energy came from processed and ultra-processed foods. Most participants did not meet the recommendations for key nutrients (ϖ3 fatty acids and phytosterols) that promote a healthy lipid status. In conclusion, regardless of their HDL-C levels, emerging adults exhibited lifestyle-related risk factors. The persistence of these findings over time could contribute to the development of metabolic disorders in the future. It is crucial to increase understanding and to develop effective nutritional interventions during this critical phase of life.

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

BackgroundThe 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. ObjectiveThis 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. MethodData 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. ResultsIn 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. ConclusionsThis 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.

Association between selenium intake and cognitive function among older adults in the US: National Health and Nutrition Examination Surveys 2011-2014.

Cognitive decline occurs commonly as people age. Despite the complexity of cellular mechanisms, oxidative stress is a critical contributor to age-associated cognitive impairment. Selenium plays an important role in antioxidant defense systems. The purpose of the present study was to assess the correlation between selenium intake and cognitive function among older adults. The participants were individuals ≥65 years old (n=1681) who participated in the 2011-2014 National Health and Nutrition Examination Survey (NHANES), a country-wide cross-sectional survey. Dietary selenium intake and adequacy were evaluated with 2 d of 24-h recalls and the estimated average requirement (EAR) cut-point method, respectively. Cognitive function was assessed with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) score, which was significantly higher when selenium intake was adequate. After adjusting for energy intake, the association was no longer significant. Inadequate intake of selenium is rare in the US and dependent on caloric intake in older adults.

Usual Intake of Micronutrients and Prevalence of Inadequate Intake among Chinese Adults: Data from CNHS 2015-2017.

Previous studies have used the traditional average-value method to calculate the usual dietary intake of a population, but the results may be biased due to the measurement errors. The aim of this study was to provide an assessment of the usual micronutrient intake and estimate the prevalence of inadequate intake among Chinese adults. Data from the Chinese Nutrition and Health Surveillance 2015-2017 as well as a total of 72,231 subjects aged 18 years and older were included in the analysis. The 24 h recall method combined with the condiment weighing method were used for three consecutive days to collect daily food and condiments intake. The daily intake of 16 micronutrients was calculated based on the Chinese Food Component Tables. The National Cancer Institute (NCI) method was used to estimate the usual intake of micronutrients, and the prevalence of inadequate intake was estimated using the estimated average requirement (EAR) cut-point method. The results showed that, except for sodium, copper, iron (only for males), vitamin E, and phosphorus, the usual intake of micronutrients in Chinese adults was low, and the prevalence of inadequate intake ranged from 38.67 to 97.63%. The prevalence of inadequate calcium and riboflavin intake was more than 90%, and the proportion of individuals with a usual intake of thiamine, vitamin A, potassium, and selenium below EAR also reached 80%. Manganese, magnesium, vitamin C, and zinc were potentially deficient micronutrients, with the prevalence of inadequate intake ranging from 38.67% to 77.09%. However, usual sodium intake was extremely high with an average of 5139.61 mg/day, and only a quarter of Chinese adults were below the World Health Organization (WHO) recommended value. For most micronutrients, the usual dietary intake declined with age and the prevalence of inadequate intake increased with age. Except for zinc, vitamin A, and B-vitamins, the prevalence of micronutrient deficiencies was higher in females than in males in the same age group (p < 0.05). Therefore, Chinese adults do not receive enough micronutrients. Effective nutrition supplementary strategies and measures are needed to address these problems.

Healthful and unhealthful provegetarian food patterns and micronutrient intake adequacy in the SUN cohort.

To investigate the association between different versions of a provegetarian food pattern (FP) and micronutrient inadequacy. Cross-sectional analysis. Dietary intake was assessed at baseline through a validated 136-item FFQ. Participants were classified according to groups of different versions of a provegetarian FP: overall, healthful and unhealthful. The prevalence of inadequate intake of vitamins B1, B2, B3, B6, B12, C, A, D, E, folic acid, Zn, I, Se, Fe, Ca, K, P, Mg and Cr was evaluated using the estimated average requirement (EAR) cut-point method and the probabilistic approach. Logistic regression analyses were conducted to estimate the probability of failing to meet EAR for either ≥ 3 or ≥ 6 micronutrients. Seguimiento Universidad de Navarra (SUN) cohort. 17 825 Spanish adults. Overall, subjects in the highest group of the unhealthful provegetarian FP had the highest prevalence of inadequate dietary intake for every vitamin and mineral, compared to those in the lowest group. The adjusted OR of failing to meet ≥ 3 EAR (highest v. lowest group) was 0·65 (0·54, 0·69) for the overall, 0·27 (0·24, 0·31) for the healthful and 9·04 (7·57, 10·4) for the unhealthful provegetarian FP. A higher adherence to an overall and healthful provegetarian FP was inversely associated with the risk of failing to meet EAR values, whereas the unhealthful version was directly associated with micronutrient inadequacy. Provegetarian FP should be well planned, prioritising nutrient-dense plant foods and minimising ultra-processed and unhealthy ones.

Significant Loss of Skeletal Muscle Mass Occurs After High-Energy Trauma in Young Adults

ObjectivesSignificant loss of skeletal muscle mass occurs early after high-energy trauma, leading directly to prolonged functional limitations. As we investigate nutrition interventions to reduce loss of muscle mass, we need to quantify changes in muscle mass after these devastating injuries. The aim of this study was to characterize baseline nutrition and changes in muscle mass after high-energy trauma in a young adult population.MethodsWe enrolled patients 18–55 years old indicated for operative fixation of either, an open pelvic or extremity fracture, or ≥2 pelvic and/or extremity fractures due to a high-energy mechanism. Baseline assessment of body composition (Lean Body Mass [LBM], Skeletal Muscle Mass [SMM]), was measured within 72 hours of admission using bioelectrical impedance and repeated 6 weeks after injury. Results are reported as median (IQR). Changes in LBM and SMM were evaluated using Wilcoxon Signed Rank tests. Sarcopenia was defined by gender-specific cutoffs for appendicular skeletal mass index. Dietary intake was evaluated using food frequency questionnaires. Inadequate protein intake was classified using the Estimated Average Requirement cut-point method, while inadequate caloric intake was defined as intake below basal metabolic rate.ResultsSixteen subjects (14 male) age 38.4 ± 9.6 years were enrolled. At baseline, 3 reported inadequate protein intake and 5 reported inadequate caloric intake. Six weeks after injury participants experienced significant losses in LBM (−4.5kg (−8.8 to −1.4), P = 0.019) and SMM (−3.1kg (−5.6 to −0.3), P = 0.043). The injured extremity had significantly greater loss of LBM compared to the uninjured extremity (−4.0 (−17.1–3.5), P = 0.0495). Five were baseline sarcopenic, with one additional participant meeting the criteria by 6 weeks. Baseline protein and calorie deficiency was not significantly associated with muscle loss.ConclusionsThis study documented devastating loss of lean body mass and skeletal muscle mass after high-energy trauma in young adults. These losses are likely a combination of immobilization and catabolic response for wound and fracture healing. Understanding loss of muscle mass after injury is important to design impactful rehabilitative and nutrition interventions in this complicated patient population.Funding SourcesNone.

Association of Household Income Level with Vitamin and Mineral Intake

Appropriate nutrient intake is essential for maintaining health and resisting disease. The current study investigated the association between household income quintile and nutrient intake using data from KNHANES 2019. A total of 5088 South Korean adults were analyzed. The estimated average requirement cut-point method, extended to handle participants with intakes higher than the tolerable upper level, was utilized to determine the need for dietary modification. The suitability of overall vitamin, overall mineral, and individual nutrient intake was evaluated by logistic regression analysis. Subgroup analysis was performed on overall mineral intake suitability. None of the individual nutrients had an intake ratio of over 70%, with the ratio being under 30% for some nutrients. The intake of iron, phosphorus, vitamin B9, and vitamin C had a significant upward trend as household income rose. A subgroup analysis revealed sex differences in the trends of overall mineral intake. The results revealed that some nutrients are not consumed appropriately in the Korean population. Furthermore, they suggest that household income is significantly associated with the intake of overall minerals and several individual nutrients. These results suggest that nutritional assistance is required for certain vulnerable groups, and provide supplementary data for appropriate interventions or further research.

Trends in Vitamin B12 Supply and Prevalence of Inadequate Intake in Africa: Regional and Country-Specific Estimates.

In Africa, little is known about the epidemiological significance of vitamin B12 deficiency. To analyze regional and country-specific trends (1990-2017) in vitamin B12 supply in Africa and estimate the prevalence of inadequate intake. National food balance data compiled by Food and Agriculture Organization for 45 African countries were used. Per capita food supplies for 95 commodities were transformed into B12 contents (µg/capita/day) assuming no fortification and B12 density was determined per 1000 kcal. Estimated Average Requirement cut point method was used for estimating the prevalence of inadequate intake. Over the period, the mean per capita B12 supply in Africa significantly increased by 12.7% from 2.02 to 2.27 µg/capita/day (z = 5.27, P < .001). However, the B12 density remained below the reference goal of 0.8 µg/1000 kcal. In 2017, the B12 supplies (µg/capita/day) in Northern (3.52), Central (3.15), and Southern Africa (2.99) were considerably higher than Western (2.10) and Eastern Africa (1.36) regions. The supply in upper-middle- or high-income countries (3.21) was also substantially higher than low- (1.58) and low-middle-income (2.58) countries. In 2017, the B12 supplies ranged from 5.95 in Mauritius to 0.66 in Ethiopia. Similarly, the nutrient density extended from 1.88 in Gambia to 0.28 in Ethiopia. In Africa, the estimated prevalence of inadequate intake declined from 48.1% in 1990 to 29.9% in 2007 and resurged to 40.6% in 2017. In 2017, the prevalence of inadequate intake was nearly universal (> 90%) in 4 countries and exceeded 50% in 8 more countries. Many African countries have major deficits in vitamin B12 supply.

Assessment of the Nutritional Status of Four Selected Rural Communities in KwaZulu-Natal, South Africa.

Under- and over-nutrition co-exist as the double burden of malnutrition that poses a public health concern in countries of the developing regions, including South Africa (SA). Vulnerable groups such as pregnant women and children under five years are the most affected by malnutrition, especially in rural areas. Major contributing factors of malnutrition include food and nutrition insecurity, poverty, and unhealthy lifestyles. The current study aimed to assess the nutritional status, using selected anthropometric indices and dietary intake methods (repeated 24 h recall and food frequency), of four rural communities in KwaZulu-Natal (SA). Purposive sampling generated a sample of 50 households each in three rural areas: Swayimane, Tugela Ferry, and Umbumbulu and 21 households at Fountain Hill Estate. The Estimated Average Requirement cut-point method was used to assess the prevalence of inadequate nutrient intake. Stunting (30.8%; n = 12) and overweight (15.4%; n = 6) were prevalent in children under five years, whilst obesity was highly prevalent among adult females (39.1%; n = 81), especially those aged 16–35 years. There was a high intake of carbohydrates and a low intake of fibre and micronutrients, including vitamin A, thus, confirming the need for a food-based approach to address malnutrition and micronutrient deficiencies, particularly vitamin A deficiency.

Selenium Intake and Glycemic Control in Young Adults With Normal-Weight Obesity Syndrome.

Numerous endogenous functions related to antioxidant processes, reproduction, and thyroid metabolism, as well as actions related to glycemic control, have been attributed to selenium. This study aimed to evaluate whether dietary selenium consumption is associated with variables of glycemic control in a sample of young Brazilian adults with Normal-Weight Obesity (NWO) syndrome. This was a cross-sectional study that evaluated 270 individuals with adequate body weight and excess body fat, who had their body composition assessed by dual-energy X-ray absorptiometry. Socioeconomic, health, and lifestyle questionnaires and three 24-h food records were applied. Glycemic control markers were also evaluated. The prevalence of inadequate selenium intake was analyzed by the Estimated Average Requirement (EAR) cut-point method. The prevalence of disturbances in glycemic control markers according to selenium consumption was compared by either the chi-square or the Fisher's exact test, with individuals classified according to the EAR values for selenium. The associations were evaluated by multiple linear regressions, using the backward strategy. The mean ± standard deviation (SD) age was 23.7 ± 3.3 years, and the mean ± SD daily selenium intake was 59.2 ± 26.4 μg. The overall prevalence of inadequate selenium intake was 59.2%. Individuals with selenium intakes below the EAR (≤45 μg/day) showed higher concentrations of glycated hemoglobin (HbA1c) (P = 0.002) and a higher prevalence of disturbances in HbA1c than those with selenium intakes above the EAR (>45 μg/day) (P = 0.001). Dietary selenium intake was directly associated with female sex (β = 19.95, 95% CI 5.00 to 34.89; P = 0.001) and weight (β = 6.69, 95% CI 0.56 to 12.81; P = 0.010), and inversely associated with the percentage of total body fat (β = −0.80, 95% CI −1.56 to −0,04; P = 0.010) and HbA1c (β = −7.41, 95% CI −13.06 to −1.75; P = 0.010). Considering the noticeable young age of the individuals evaluated and the high frequency of disturbances in HbA1c concentrations in those with selenium consumption below the recommendation, it is suggested that adequate dietary intake or supplementation of this micronutrient should be guaranteed to prevent future possible complications associated with glycemic control disturbances.

Introduction to the SIMPLE Macro, a Tool to Increase the Accessibility of 24-Hour Dietary Recall Analysis and Modeling

BackgroundInformation on long-term dietary intake is often required for research or program planning, but surveys routinely use short-term assessments such as 24-h recalls (24HRs). Methods to reduce the impact of within-person variation in 24HRs, such as the National Cancer Institute (NCI) method, typically require extensive training and skill. ObjectivesWe introduce the Simulating Intake of Micronutrients for Policy Learning and Engagement (SIMPLE) macro, a new tool to increase the accessibility of 24HR analysis. We explain the underlying theory behind the tool and provide examples of potential applications. MethodsThe SIMPLE macro connects the core NCI statistical code to estimate usual intake distributions and includes additional code to enable advanced analyses such as predictive modeling. The related SIMPLE-Iron macro applies the full probability method to estimate inadequate iron intake, and the SIMPLE-1D macro is used for descriptive or modeling analyses of data with a single 24HR per person. The macros and associated documentations are freely available. We analyzed data from the US National Health and Nutrition Examination Survey (NHANES) and the Cameroon National Micronutrient Survey to compare the SIMPLE macro to 1) the core NCI code using the Estimated Average Requirement cut point method, and 2) the IMAPP software for iron only, and to demonstrate the applications of the SIMPLE macro for estimating usual intake and predictive modeling. ResultsThe SIMPLE macro generates identical results to the core NCI code. The SIMPLE-Iron macro also produces estimates of inadequate iron intake comparable to the IMAPP software. The examples demonstrate application of the SIMPLE macro to 1) descriptive analyses of nutrient intake from food and supplements (NHANES), and 2) analyses accounting for breast-milk nutrient intake and modeling fortification and supplementation programs (Cameroon). ConclusionsThe SIMPLE macros may facilitate the analysis and modeling of dietary data to inform nutrition research, programs, and policy.

Assessment of salt intake to consider salt as a fortification vehicle for thiamine in Cambodia.

Thiamine deficiency is a public health issue in Cambodia. Thiamine fortification of salt has been proposed; however, the salt intake of lactating women, the target population, is currently unknown. We estimated salt intakes among lactating women (<6 months postpartum) using three methods: repeat observed‐weighed intake records and 24‐h urinary sodium excretions (n = 104), and household salt disappearance (n = 331). Usual salt intake was estimated by adjusting for intraindividual intakes using the National Cancer Institute method, and a thiamine salt fortification scenario was modeled using a modified estimated average requirement (EAR) cut‐point method. Unadjusted salt intake from observed intakes was 9.3 (8.3–10.3) g/day, which was not different from estimated salt intake from urinary sodium excretions, 9.0 (8.4–9.7) g/day (P = 0.3). Estimated salt use from household salt disappearance was 11.3 (10.7–11.9) g/person/day. Usual (adjusted) salt intake from all sources was 7.7 (7.4–8.0) g/day. Assuming no stability losses, a modeled fortification dose of 275 mg thiamine/kg salt could increase thiamine intakes from fortified salt to 2.1 (2.0–2.2) mg/day, with even low salt consumers reaching the EAR of 1.2 mg/day from fortified salt alone. These findings, in conjunction with future sensory and stability research, can inform a potential salt fortification program in Cambodia.

Iodine nutrition: Disorders, monitoring and policies.

Iodine is an essential mineral nutrient and an integral component of thyroid hormones. Iodine deficiency is typically associated with goiter, but can have more serious health implications. Adequate iodine status is important for normal brain development. Iodine deficiency in utero or in early life can cause severe neurological and cognitive impairment. Over the last three decades, global efforts have reduced the prevalence of iodine deficiency disorders (IDD) in many areas of the world with implementation of nutrition policies and programs such as "salt" iodization. However, in a number of areas iodine deficiency is still widespread. Iodine deficiency in remote regions with high poverty will be more difficult to eradicate. Efforts to eliminate IDD in affected areas and sustaining successful iodine programs will be a priority given the substantial public health and economic benefits. A key component will be periodic monitoring of population iodine status to ensure sufficient intakes and the absence of excessive intakes. Median urinary iodine concentration (UIC), a validated biomarker for assessing population iodine status, will facilitate monitoring. Research validating "usual" UIC for use in combination with the Estimated Average Requirement cut-point method will expand its utility and allow accurate determination of the prevalence of inadequate intakes in populations. Further research on the development of biomarkers for assessment of individual iodine status for routine patient care will be important.

Exploring trajectories in dietary adequacy of the B vitamins folate, riboflavin, vitamins B6 and B12, with advancing older age: a systematic review.

Maintaining nutritional adequacy contributes to successful ageing. B vitamins involved in one-carbon metabolism regulation (folate, riboflavin, vitamins B6 and B12) are critical nutrients contributing to homocysteine and epigenetic regulation. Although cross-sectional B vitamin intake in ageing populations is characterised, longitudinal changes are infrequently reported. This systematic review explores age-related changes in dietary adequacy of folate, riboflavin, vitamins B6 and B12 in community-dwelling older adults (≥65 years at follow-up). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases (MEDLINE, Embase, BIOSIS, CINAHL) were systematically screened, yielding 1579 records; eight studies were included (n 3119 participants, 2–25 years of follow-up). Quality assessment (modified Newcastle–Ottawa quality scale) rated all of moderate–high quality. The estimated average requirement cut-point method estimated the baseline and follow-up population prevalence of dietary inadequacy. Riboflavin (seven studies, n 1953) inadequacy progressively increased with age; the prevalence of inadequacy increased from baseline by up to 22·6 and 9·3 % in males and females, respectively. Dietary folate adequacy (three studies, n 2321) improved in two studies (by up to 22·4 %), but the third showed increasing (8·1 %) inadequacy. Evidence was similarly limited (two studies, respectively) and inconsistent for vitamins B6 (n 559; −9·9 to 47·9 %) and B12 (n 1410; −4·6 to 7·2 %). This review emphasises the scarcity of evidence regarding micronutrient intake changes with age, highlighting the demand for improved reporting of longitudinal changes in nutrient intake that can better direct micronutrient recommendations for older adults. This review was registered with PROSPERO (CRD42018104364).

Trends in the national food supply of absorbable zinc in Ethiopia: 1990-2017.

This study analysed trends (1990-2017) in the availability of absorbable Zn in the national food supply of Ethiopia. The supply statistics of ninety-five food groups were obtained from the Ethiopian Food Balance Sheets compiled by FAO. Zn and phytate contents were determined using multiple composition databases and absorbable Zn estimated via the 'Miller' equation. Estimated average requirement cut-point method was performed to estimate proportions at risk of inadequate intake. Physiological Zn requirements set by Institute of Medicine (IOM) and International Zinc Nutrition Consultative Group (IZiNCG) were applied. Time trend was tested using Mann-Kendall statistics and Z-score and P-values are provided. Ethiopia. NA. Between 1990 and 2017, the supply of total dietary Zn was increased by 33 % from 9·8 to 13·0 mg/person/d (Z = 6·46, P < 0·001). However, that of absorbable Zn remained constant around 2·7 mg/person/d (Z = 1·87, P > 0·05). Over the period, the phytate supply was increased by 48 % from 1415 to 2095 mg/person/d (Z = 6·50, P < 0·001) and fractional Zn absorption declined from 27·0 to 20·9 % (Z = -6·62, P < 0·001). The contribution of animal source foods for bioavailable Zn was reduced by 45 % and the share of cereals raised by 11·3 %. Over the period, prevalence of inadequate Zn intake estimated using IZiNCG and IOM requirements remained constant around 10 and 50 %, respectively. Between 1990 and 2017, Ethiopia considerably increased the total supply of Zn; however, meaningful changes in bioavailable Zn and prevalence of deficiency were not observed due to proportional rise in phytate and concomitant decline in Zn absorption.

Dietary Intake Nutritional Status and Lifestyle of Adolescent Vegetarian and Nonvegetarian Girls in New Zealand (The SuNDiAL Project): Protocol for a Clustered, Cross-Sectional Survey

BackgroundAnecdotally, vegetarian eating patterns seem to be increasing in parallel with growing concerns about environmental sustainability. While this pattern of eating is widely believed to be associated with benefits for the planet and individual health, it may increase the risk of inadequate intakes and nutrient deficiency if not planned carefully. Adolescent girls may be particularly at risk, as they have increased requirements for nutrients such as iron, zinc, calcium, and vitamin B12 during growth and development.ObjectiveThe objective of the SuNDiAL Project (Survey of Nutrition, Dietary Assessment, and Lifestyles) is to compare the dietary intakes and habits, nutrition status, motivations, attitudes, and physical activity of a sample of vegetarian and nonvegetarian adolescent girls in New Zealand.MethodsA clustered, cross-sectional, nationwide study of adolescents aged 15-18 years was conducted. Secondary schools were recruited throughout New Zealand, and pupils (n=290) were invited to participate in data collection in either the first (February to April) or third (August to October) school term of 2019 (New Zealand schools operate on a 4-term year). Sociodemographic and health information; vegetarian status; dietary habits; and attitudes, motivations, and beliefs regarding food choices were assessed via an online self-administered questionnaire. Dietary intakes were collected via two 24-hour diet recalls on nonconsecutive days and will be adjusted for within-person variation using the Multiple Source Method, to represent usual intakes. Nutrient adequacy will be assessed by the estimated average requirement cut-point method or probability approach as appropriate. Height and weight were measured, and blood and urine samples collected for micronutrient status assessment. Participants wore an accelerometer for 7 days to assess 24-hour activity patterns (time spent asleep, sedentary, or engagement in light-intensity or moderate-to-vigorous intensity physical activity).ResultsRecruitment and data collection were conducted in 2019. Data are currently being cleaned and analyzed, with publication of the main results anticipated at the end of 2020.ConclusionsThe SuNDiAL Project will provide a meaningful and timely description of diet, nutrition status, and motivational factors associated with vegetarianism and identify any risks this pattern of eating may pose for female adolescents. The results of this study will support the development of targeted recommendations and interventions aimed at enhancing the health, growth, and development of adolescent girls.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12619000290190; https://tinyurl.com/yaumh278International Registered Report Identifier (IRRID)DERR1-10.2196/17310

Micronutrient intakes and their food sources among Greek children and adolescents.

To assess the usual dietary intake of twenty micronutrients and to identify their food sources in a representative sample of Greek children and adolescents. Cross-sectional data from the Hellenic National Nutrition and Health Survey (HNNHS). Vitamin and mineral intakes were estimated from two 24 h dietary recalls by sex and age groups. Estimates were calculated using the National Research Council method and the statistical software package Stata13 to account for within- and between-person variations. The prevalence of nutrients' inadequacy among sample was estimated using the estimated average requirement (EAR) cut-point method. The contribution of food groups to nutrient intake was estimated to identify micronutrients food sources. Greece. Children and adolescents aged 1-19 years (n 577) who provided sufficient and plausible 24-h recalls. A substantial percentage of children and adolescents had insufficient intakes of numerous micronutrients. Usual intake of vitamins D, K and potassium was inadequate in practically all individuals. Vitamin A, folate, Ca and Mg were also insufficient to a considerable percentage, especially in girls aged 14-18 years. Pantothenic acid was highlighted as nutrient of interest since only one out of ten boys 9-13 years and girls 14-19 years had intake above the EAR. Data demonstrated that food groups highly ranked in energy contribution were not necessarily important sources of micronutrients. Results suggest that micronutrient density of Greek children and adolescents' diet should be improved. These findings might be used by public health policy-makers to help young people optimise their food choices in Greece.

Dietary Intake and Diet Quality of Hematopoietic Stem Cell Transplantation Survivors.

Hematopoietic stem cell transplantation (HCT) survivors are burdened by a high prevalence and early onset of chronic diseases. Healthy dietary patterns have been associated with lower risks of chronic health conditions in the general population. HCT survivors are susceptible to multiple complications that may result in chronic illness. Unfortunately, no study to date has comprehensively documented the adherence of HCT survivors to the Dietary Guidelines for Americans (DGA), which are designed specifically to provide guidance for making healthy food choices. The primary aim of this study was to evaluate diet quality and nutrient intake adequacy of HCT survivors. A secondary aim was to assess these survivors' willingness to take part in a future dietary intervention. The dietary intake of adults who had undergone autologous or allogeneic HCT for a hematologic disease and were at least 1 year post-transplantation was assessed using the Block 2014 food frequency questionnaire, and diet quality was estimated using the Healthy Eating Index 2015. Nutrient intake adequacies of the group were estimated by the estimated average requirement cutpoint method. Survivors' (n=90) HEI-2015 scores averaged 61.6 ± 1.1. Adherence to a good-quality diet was reported by only 10% of survivors. Intakes of vitamins A, C, and D, as well as magnesium and calcium, suggested inadequacy. Fiber intake at 8.9 g per 1000 kcal/day fell below the recommended adequate intake. "Change in taste" was associated with lower quality of diet (P=.02). HCT survivors within 2 years post-transplantation were more receptive than survivors beyond 2 years to participating in a dietary intervention (95% versus 65%; P=.0013). Adult HCT survivors reported less-than-optimal adherence to the 2015-2020 DGA and had numerous shortfall nutrient intakes; however, their willingness to participate in a dietary intervention was relatively high. These findings reinforce the need to incorporate nutrition into HCT survivor care.