Nutrient Intake Distributions Research Articles

Global estimation of dietary micronutrient inadequacies: a modelling analysis

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

Malnutrition Prevalence and Nutrient Intakes of Indonesian Older Adults in Institutionalized Care Setting: A Systematic Review of Observational Studies.

Data on the prevalence of malnutrition and nutrient intakes among Indonesian older adults in institutionalized care setting are scattered and scarce. Thus, we conducted a systematic review of published and gray literature to estimate (1) the prevalence of malnutrition, (2) the level and distribution of habitual energy and nutrient intakes, and (3) the prevalence of inadequacy of energy and nutrient intakes among hospitalized and institutionalized older adults in Indonesia. This systematic review was written following the PRISMA 2020 checklist. The population of this review was Indonesian older adults in institutionalized care settings, including hospital wards, orphanages, nursing homes, residential facilities, and rehabilitation centers. Malnutrition was assessed using body mass index, the Mini Nutritional Assessment (MNA) score, or the subjective global assessment (SGA) score. The dietary intakes (from food recalls, food records, or food frequency questionnaire) were compared with the Indonesian Recommended Dietary Allowances for people aged 65-80. The prevalence of inadequacy was calculated using two-thirds of the Recommended Dietary Allowance as a proxy for the estimated average requirement. The search yielded 330 studies from electronic databases, resulting in fifteen eligible studies. One report was obtained from an unpublished study. Based on the JBI criteria, most studies had low risk of bias and represented the target population. The prevalence of malnutrition in hospital, nursing home, and other institutionalized care ranged from 6.5% to 48.3% in hospitals and 3.2% to 61.0% in other institutionalized care units. In the hospital setting, there was a high prevalence of inadequacies for all nutrients, particularly protein (20%), calcium (more than 90%), and vitamin D intakes (more than 50%). In nursing homes, these proportions were exceptionally high for protein (66%) and calcium and vitamin D intakes (almost 100%). The high risk of malnutrition in Indonesian older adults in institutionalized care setting is pronounced, along with poor intakes of macronutrients and micronutrients in both settings.

Usual Nutrient Intake Distribution and Prevalence of Nutrient Intake Inadequacy among Japanese Children and Adults: A Nationwide Study Based on 8-Day Dietary Records.

In this cross-sectional study, we evaluated nutrient intake adequacy in 4450 Japanese people aged 1-79 years. Dietary data was collected through non-consecutive 8-day weighed dietary records. Usual nutrient intakes from foods and beverages were estimated using the Multiple Source Method. Participant proportions with intakes below and above the Japanese Dietary Reference Intakes (2020) were calculated. Usual intakes of most nutrients were below the Estimated Average Requirement; calcium showed a high percentage of inadequacy across all sex and age groups (29-88%), and iron showed a high inadequacy among females aged 12-64 years (79-95%). The percentages of energy from protein and carbohydrates, dietary fibre, and potassium were typically below the lower limit of the Tentative Dietary Goal for Preventing Lifestyle-related Diseases (DG). Furthermore, over 20% of the participants exceeded the upper limit of the DG for the percentages of energy from total and saturated fats, and over 88% exceeded the upper limit of the DG for sodium. Japanese children and adults could improve their nutrient intake by increasing calcium, iron, dietary fibre, and potassium and reducing total and saturated fats and sodium. These findings can inform policies and interventions to improve nutrient intake in Japan.

Correction: Moumin et al. Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0–24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021. Nutrients 2022, 14, 1381

The authors would like to correct an error in their recently published paper [...].

Advanced Dietary Analysis and Modeling: A Deep Dive into the National Cancer Institute Method

The National Cancer Institute (NCI) method has been used widely by researchers to make inferences about usual dietary intake distributions of foods and nutrients based on a limited number of 24-h dietary recalls (24-HRs). Although the NCI method does not provide individual estimates of usual intake, it can be used to address many research questions, including modeling effects of nutrition interventions on population distributions of usual intake. Software for implementing the NCI method, and corresponding code examples, is publicly available in the form of SAS macros but little formal guidance exists for conducting advanced analyses. We aim to present advanced techniques for working with NCI macros to conduct both basic and advanced dietary analyses and modeling. We first present the 3 basic building blocks of analyses using the NCI method: 1) data set preparation, 2) application of the MIXTRAN macro to estimate parameters of the usual intake distribution, including effects of covariates, after transformation of 24-HRs to approximate normality, and 3) application of the DISTRIB macro to estimate the distribution of usual nutrient intake. Then, we illustrate how researchers can employ these building blocks to answer questions beyond typical descriptive analyses. Researchers can adapt the building blocks to: 1) account for factors such as demographic changes or nutrition interventions such as food fortification, 2) estimate the prevalence of dietary inadequacy via the full probability method, 3) incorporate nutrient intake from sources not always captured by 24-HRs, such as dietary supplements and human milk, and 4) carry out multiple subgroup analyses. This article describes the theoretical basis and operational guidance for these techniques. With this article as a detailed resource, researchers can leverage the basic NCI building blocks to investigate a wide range of questions about usual dietary intake distribution.

Bone mineral density, nutrient intake, and physical activity among young women from Uganda.

Data describing bone mineral density (BMD), nutrient intake, and body composition among healthy, young women in sub-Saharan Africa are limited. Using baseline data from a cohort of young, healthy Ugandan women, we summarize bone health and associated risk factors for reduced bone mass. Using baseline data from Ugandan women ages 16-25 years who enrolled in an ongoing cohort study of bone health with concurrent use of injectable contraception and oral HIV pre-exposure prophylaxis, we describe the distribution of BMD, nutrient intake, physical activity, and body composition. The association of low BMD (1 or more standard deviations below the age, sex, and race-matched reference range from the USA) and calcium intake, vitamin D intake, physical activity, and body composition was estimated using multivariable logistic regression. In 496 healthy, Ugandan women with median age of 20 years (interquartile range [IQR] 19-21) and median fat:lean mass ratio of 0.55 (IQR 0.46-0.64), median lumbar spine and total hip BMD was 0.9g/cm2 (IQR 0.9-1.0) each. For lumbar spine, Z-score distributions were lower overall than the reference population and 9.3% and 36.3% of women had Z-score >2 and >1 standard deviations below the reference range, respectively. For total hip, Z-scores were similar to the reference population and 1.0% and 12.3% of women had Z-score >2 and >1 standard deviations below the reference range, respectively. In the week prior to enrollment, 41.1% of women consumed >7 servings of calcium, 56.5% had >7 servings of vitamin D, and 98.6% reported ≥2.5 h of physical activity. Having greater body fat was associated with greater frequency of low lumbar spine BMD (p<0.01 for fat:lean mass ratio, total body fat percentage, waist circumference, and BMI). Young Ugandan women exhibited healthy levels of BMD that were lower than the reference range population.

Usual nutrient intake and dietary quality of low‐income U.S. older adults

AbstractWe estimate nutrient intake from diet and total sources including dietary supplements (DS), and dietary quality of low‐income U.S. older adults (60+ years) using the 2007–2016 National Health and Nutrition Examination Survey. We apply the National Cancer Institute method to determine usual/habitual nutrient intake distributions. Our results reveal that low‐income older adults have poor nutrient intake and dietary quality. DS use reduces the risk of nutrient inadequacy but is not associated with statistically significantly better dietary quality. Future policies that would change access to nutrients through DS should consider the current DS contributions to nutrient intake among the low‐income, older population.

Estimating national and subnational nutrient intake distributions of global diets

ABSTRACTBackgroundAccess to high-quality dietary intake data is central to many nutrition, epidemiology, economic, environmental, and policy applications. When data on individual nutrient intakes are available, they have not been consistently disaggregated by sex and age groups, and their parameters and full distributions are often not publicly available.ObjectivesWe sought to derive usual intake distributions for as many nutrients and population subgroups as possible, use these distributions to estimate nutrient intake inadequacy, compare these distributions and evaluate the implications of their shapes on the estimation of inadequacy, and make these distributions publicly available.MethodsWe compiled dietary data sets from 31 geographically diverse countries, modeled usual intake distributions for 32 micronutrients and 21 macronutrients, and disaggregated these distributions by sex and age groups. We compared the variability and skewness of the distributions and evaluated their similarity across countries, sex, and age groups. We estimated intake inadequacy for 16 nutrients based on a harmonized set of nutrient requirements and bioavailability estimates. Last, we created an R package—nutriR—to make these distributions freely available for users to apply in their own analyses.ResultsUsual intake distributions were rarely symmetric and differed widely in variability and skewness across nutrients and countries. Vitamin intake distributions were more variable and skewed and exhibited less similarity among countries than other nutrients. Inadequate intakes were high and geographically concentrated, as well as generally higher for females than males. We found that the shape of usual intake distributions strongly affects estimates of the prevalence of inadequate intakes.ConclusionsThe shape of nutrient intake distributions differs based on nutrient and subgroup and strongly influences estimates of nutrient intake inadequacy. This research represents an important contribution to the availability and application of dietary intake data for diverse subpopulations around the world.

Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0-24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021.

(1) Background: Breastmilk provides all the nutrition an infant requires between 0–6 months. After that, complementary foods are needed to meet the child’s increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6– 24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children’s intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 90% and 20%, respectively, for infants aged 6–11.9 months. Low iron intake was also observed in one quarter of toddlers 12–24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed > 1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6–11.9 months and toddlers 12–24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension.

Usual Nutrient Intake of Older Adults in the U.S. Is Lower Among SNAP Participants Compared to Income-Eligible Non-Participants

ObjectivesPolicy proposals to limit use of the Supplemental Nutrition Assistance Program (SNAP) and to allow dietary supplement (DS) purchase with SNAP benefits draw attention to knowledge gap of usual nutrient intake and adherence to the Dietary Reference Intake recommendations from foods alone and with DS (total intake) among low-income older adults. To address this gap, the estimated distributions of usual nutrient intake (from foods alone and total) and risk of inadequate intake among U.S. older adults participating in SNAP were compared with income-eligible non-participants. MethodsData from 4,791 older adults (≥60 years) from the 2007–2016 National Health and Nutrition Examination Survey were used in this cross-sectional secondary analysis. DS data from an in-home inventory and dietary data from up to two 24-hour recalls were used to estimate usual nutrient intake distributions (total and from foods alone) and the proportion of the population below the Estimated Average Requirement (EAR) using an adapted National Cancer Institute method. Pairwise t-tests compared SNAP participants and eligible non-participants with significance set at P < 0.05. ResultsSNAP participants had lower usual intake from foods alone compared to eligible non-participants for vitamins B6 (P = 0.046) and E (P = 0.027); the risk of inadequate intake was higher among SNAP participants compared to eligible non-participants for vitamin E (P = 0.0004). Similarly, total usual nutrient intake was lower among SNAP participants compared to eligible non-participants for magnesium (P = 0.019), zinc (P = 0.0003), vitamin C (P = 0.02) and vitamin D (P = 0.0002) and the proportion not meeting the EAR was higher among SNAP participants compared to eligible non-participants for magnesium (P = 0.044). ConclusionsOlder adults participating SNAP had lower usual intake and meet the EAR less compared to eligible non-participants for certain nutrients. The proportion at risk of inadequate intake was lower when all nutrients sources were examined compared to foods alone. Future policies should focus on improving nutrient intake among food assistance participants and their food security. Funding SourcesSupported by University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Food and Nutrition Service, Contract Number 12319819C0006.

Impacts of an egg intervention on nutrient adequacy among young Malawian children.

Eggs are a rich source of multiple nutrients that support child growth and development. Provision of eggs as a complementary food may improve dietary adequacy among young children at risk for undernutrition. Our objective was to test the impact of an egg intervention on the adequacy of total nutrient intakes and micronutrient density among 6‐ to 15‐month‐old Malawian children. Children 6 to 9 months old, living in Mangochi District, Malawi, were randomly assigned to the intervention group (n = 331) receiving an egg per day or a control group (n = 329) consuming their usual diet. Dietary intakes of macronutrients, vitamins and minerals were assessed using 24‐h recalls at baseline, 3‐month midline and 6‐month endline, with repeat recalls in a subsample. Usual nutrient intake and micronutrient density distributions were modelled to estimate group means and prevalence of inadequacy. Group differences at midline and endline were tested using unequal variance t tests with bootstrapped standard errors. The egg intervention resulted in higher intakes of fat and protein and lower intakes of carbohydrates. The egg group had lower prevalence of inadequacy for selenium, vitamin A, riboflavin, vitamin B5, vitamin B12 and choline. Micronutrient density inadequacy was lower in the egg group for vitamin A and choline at midline and endline, riboflavin at midline and vitamin B5 at endline. Inadequacy of nutrient intakes or density remained highly prevalent in both groups for multiple micronutrients. Though the egg intervention increased intakes of protein and several micronutrients, total intakes and micronutrient density of multiple micronutrients remained far below recommendations.

Nutrient intake and dietary pattern among pregnant women visiting the tertiary level hospital of Nepal

Background: Pregnancy demands adequate nutritional requirements for foetal growth, good health of pregnant women and to avoid adverse effects during pregnancy. Women from developing countries with limited resources have inadequate consumption of nutritional diets. This paper assesses the nutrient intake and dietary pattern of Nepalese pregnant women compared with recommended nutrient intake. This paper also observes trimester wise nutrient intake among pregnant women in Nepal.Methodology: A descriptive cross-sectional study was conducted among 323 pregnant women who visited Gynaecology and Obstetrics Out-Patient Department (OPD) at Tribhuvan University Teaching Hospital (TUTH) for regular Antenatal Care (ANC) check-ups. Systematic random sampling methods were followed and data were collected from September 2016 to October 2016. Nutrient intake was evaluated with a 24-hour dietary recall method and compared with the Nepalese Food Composition Table 2017 for available nutrients. Face-to-face structured interviews were conducted to assess the nutrient intake of the respondents. The data were entered in Microsoft Excel 2007 and statistical analysis was carried out in SPSS v26. The descriptive analysis was done to identify the distribution of socio-demographic variables of pregnant women. The one-way Analysis of Variance (ANOVA) was used to compare the mean of nutrient intake distribution while Tukey’s post-hoc test was done to compare trimester-wise nutrient intakes.Results: Except for fat, the intake of nutrients were below the Nepalese Recommended Nutrient Intake. Carbohydrate and energy intake in the second and third trimester was significantly different from that in the first trimester (p = 0.006 and 0.004 respectively for carbohydrates and p = 0.009 and 0.002 respectively for energy intake). However, riboflavin intake was significantly lower only in the third trimester as compared to the first (p = 0.025) while there were no significant intake differences between the first and second trimester and second and third trimester. No significant trimester wise differences were observed for intake distribution of other nutrients. Cereal intake was found to be abundant in the diet of pregnant women followed by pulses, legumes, and other vegetables.Conclusion: The research concludes inadequate nutrient intake among pregnant women as compared to the national Recommended Nutrient Intake.&#x0D;

The Special Supplemental Nutrition Program for Women, Infants, and Children is Associated with Several Changes in Nutrient Intakes and Food Consumption Patterns of Participating Infants and Young Children, 2008 Compared with 2016

In 2009 the USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) updated the food packages provided to participants. This study investigates associations between WIC participation and nutrients and food groups consumed using data from the Feeding Infants and Toddlers Study's 2008 and 2016 nationwide, cross-sectional surveys of children <4 y,weighted to be representative of the US population. The study data included 2892 children aged 6-47.9mo in 2008 and 2635 in 2016. Differences were analyzed by WIC participation, survey year, and child age (infants 6-11.9mo old, toddlers 12-23.9mo old, preschoolers 24-47.9mo old). Usual nutrient intake distributions were estimated using National Cancer Institute methodology. Daily food group consumption differences were tested via multivariate regression. All analyses controlled for income. In 2016 18.6% of infants had iron intakes below the estimated average requirement (EAR), compared to 7.6% in 2008; 87% of WIC infants met the EAR, compared with 69% of non-WIC infants. In 2016 37% of WIC preschoolers met saturated fat guidelines, compared with 25% in 2008; in both years, fewer than one-third of non-WIC preschoolers met the guidelines. More WIC infants than non-WIC infants consumed infant cereals in 2016 (58%compared with 45%, respectively). More WIC infants ate vegetables daily in 2016 than in 2008 (74%compared with 59%, respectively). In 2016, as compared with 2008, more WIC infants consumed baby-food vegetables (55%compared with 29%, respectively) and fruits (56%compared with 41%, respectively). In 2016 47% of WIC preschoolers drank low-fat milk, compared with 19% of non-WIC preschoolers. Infant iron intakes are concerning, although more WIC infants meet the EAR. WIC infants' vegetable intakes have improved; baby-food vegetables have become important contributors to their intakes. In 2016 WIC children were more likely than non-WIC children to shift to lower-fat milks at 2 y of age, likely contributing to lower saturated fat intakes.

Intake of Vitamins and Minerals From Voluntarily Fortified Foods and/or Dietary Supplements in School Adolescents in Central-Eastern Poland.

Background: The key issue is whether voluntarily fortified foods and vitamin/mineral supplements available on the market serve public health needs. The study aim was to estimate nutrient intakes from voluntarily fortified foods and vitamin/mineral supplements in relation to the Dietary Reference Intake (DRI) in adolescents (n = 759) aged 13–19 who attended public secondary schools in Central-Eastern Poland.Methods: Data on the consumption of voluntarily fortified foods were collected using a semi-quantitative food frequency questionnaire containing 58 food items. Data on the use of dietary supplements were assessed via an open-ended question. The content of nutrients was estimated using the producer's labeling declaration. The distribution of nutrient intakes according to the percentage of DRI categories (<20%, 20–39.9%, 40–59.9%, 60–79.9%, 80–99.9%, 100–119%, or >120%) was estimated.Results: Consumption of voluntarily fortified foods was a common behavior in adolescents (86.7% of participants), while vitamin/mineral supplements were used by less than one-fifth of them (17.7%). The amounts of nutrient intakes from fortified foods and/or supplements were at different levels: (I) vitamins A, D, calcium, magnesium (>50% of adolescents did not exceed 20% of DRI); (II) vitamins E, B12, iron (>50% of respondents consumed at least 20% of DRI); (III) niacin and pantothenic acid (>50% of respondents consumed at least 40% of DRI); IV) vitamins C, B1, B2, B6, folate, biotin (>50% of participants consumed at least 60% of DRI). In a subgroup of respondents who used fortified foods and supplements simultaneously (n = 126), some nutrients (i.e., vitamins C, B1, B2, B6, niacin, and biotin) were consumed in amounts ≥150% of DRI. Intake above the Tolerable Upper Intake Levels was observed for niacin, vitamin A, B6 and folic acid in individual cases (up to 1.1% of respondents); a higher risk of overconsumption was associated with using vitamin/mineral supplements than voluntarily fortified foods.Conclusion: Adolescents should be educated on how to reasonably use fortified foods and dietary supplements to help to overcome the potential deficiency of nutrients without causing excessive consumption.

Food and Nutrient Intake of Filipinos with Diabetes

Diabetes is considered as a worldwide public health problem and its prevalence in the Philippines has been increasing throughout the past decade. Dietary intake is a leading factor that affects diabetes development. Thus, the aim of the study is to analyze the food and nutrient intakes of Filipino adults with type 2 diabetes and to determine the underlying relationship between diabetes and dietary intake. The participants were 1,087 Filipinos with diabetes, ages 18 years and over from the 2013 National Nutrition Survey. In this study, two non-consecutive 24-hour dietary recalls were administered through face-to-face interviews by registered nutritionist-dietitians. The amount of consumed foods and beverages were estimated through standard household measures or food weighing. The energy and nutrient content of foods were assessed by utilizing the FNRI-Individual Dietary Evaluation System (IDES). Mean and usual energy and nutrient intake distributions were assessed using software established by Iowa State University (PC-SIDE version 1.02) and the evaluation of each macronutrient’s percentage contribution to total energy intake was done using the Acceptable Macronutrient Distribution Ranges (AMDR). Results of the study showed that Filipinos with diabetes have inadequate protein intake (53%) as well as micronutrient intake, including vitamin C (96%), thiamin (78%), riboflavin (85%), folate (87%), calcium (96%) and vitamin A (66%). Major sources of energy were mainly from carbohydrates (70.1%) consisting of rice, sugar-sweetened beverages, bread and sugar. A weak positive correlation was found between energy, macronutrient intake and fasting blood glucose. Findings of the study indicate that diabetes is affected by one’s dietary intake yet further research is required to define the role of micronutrients in diabetes management.

An Analysis of Four Proposed Measures for Estimating Distributions of Total Usual Vitamin D Intake Among Adults Using National Health and Nutrition Examination Survey Data

Abstract Objectives To estimate distributions of total usual vitamin D intakes from foods and supplements among U.S. adults, using four different methods of assessment. Usual intake is defined as long-term average daily intake. Methods Distributions of total usual vitamin D intakes were estimated from data provided by 9954 adults (≥19 y) from the 2011–2014 NHANES. Dietary and dietary supplement (DS) data were collected using two 24-hour recalls (24HR), and DS data were also collected via an in-home inventory that ascertained participants’ DS use in the past 30 days. The four methods used included: combined “add then shrink” (Method 1); combined “shrink then add” (Method 2); stratified “shrink then add” (Method 3); three-part (Method 4). Briefly, Method 1 analyzes DS users and nonusers together and includes DS use as a covariate in the model. Nutrient intake from foods and DS are “added” prior to applying usual intake procedures to “shrink” the total intake distribution. Method 2 combines DS users and nonusers identically, but “shrinks” the nutrient intake distribution from foods prior to incorporating nutrient intake from DS to produce total usual intakes. Method 3 also follows the “shrink then add” framework but stratifies DS users and nonusers separately in the model. Method 4 also stratifies DS users and nonusers but computes total usual intakes in three parts: 1) usual intake from foods for DS nonusers; 2) usual intake from foods for DS users; and 3) usual intake from DS for DS users. Results All methods following the “shrink then add” framework (i.e., methods 2- 4) resulted in similar estimated distributions of total usual vitamin D intakes; but Method 1, the “add then shrink” method, resulted in distributions that were wider as a result of inflated within-person variation. Among the “shrink then add” methods, the main differences existed between methods 2 and 3 vs. method 4, partly due to differences in modeling of DS intake information reported on 24HRs vs. the in-home inventory. Conclusions Currently, no consensus exists on the best method for incorporating DS nutrients into usual intake models designed to estimate intake from foods and beverages. These findings support the notion that the “shrink then add” methods are more amenable to modeling when compared to “add then shrink.” Funding Sources This work was supported by a grant from the National Institutes of Health.

How does a simplified recipe collection procedure in dietary assessment tools affect the food group and nutrient intake distributions of the population.

Technology advancements have driven the use of self-administered dietary assessment methods in large-scale dietary surveys. Interviewer-assisted methods generally have a complicated recipe recording procedure enabling the adjustment from a standard recipe. In order to decide if this functionality can be omitted for self-administered dietary assessment, this study aimed to assess the extent of standard recipe modifications in the Dutch National Food Consumption Survey and measure the impact on the food group and nutrient intake distributions of the population when the modifications were disregarded. A two-scenario simulation analysis was conducted. Firstly, the individual recipe scenario omitted the full modifications to the standard recipes made by people who knew their recipes. Secondly, the modified recipe scenario omitted the modifications made by those who partially modified the standard recipe due to their limited knowledge. The weighted percentage differences for the nutrient and food group intake distributions between the scenarios and the original data set were calculated. The highest percentage of energy consumed through mixed dishes was 10 % for females aged 19-79 years. Comparing the combined scenario and the original data set, the average of the absolute percentage difference for the population mean intakes was 1·6 % across all food groups and 0·6 % for nutrients. The soup group (-6·6 %) and DHA (-2·3 %) showed the largest percentage difference. The recipe simplification caused a slight underestimation of the consumed amount of both foods (-0·2 %) and nutrients (-0·4 %). These results are promising for developing self-administered 24-hour recalls or food diary applications without complex recipe function.

Malnutrittion among Dutch children? Results of the Dutch national food consumption survey 2012–2016

AbstractIntroduction:An adequate and balanced intake of energy and nutrients is important for growth of children and prevention of diseases. The aim of this study was to get insight in the prevalence of low and high intakes of micronutrients and its association with overweight among Dutch children. This insight can contribute to the development of policy on healthy diet and specific nutritional information.Materials and methods:Food and supplement consumption data of children 1–18 years (n = 2.235) were collected in 2012–2016 with two independent 24-hr recalls. Body Mass Index (BMI) was based on measured body height and weight for 1–15 year-olds, and self-reported values for 16–18 year–olds. Using the Dutch food and supplement composition tables, the habitual nutrient and energy intake distribution were estimated and evaluated with the dietary reference values of the Dutch Health Council. Analyses were performed for the total group as well as for classes of BMI.Results:The intake of most micronutrients was sufficient for the children until the age of 13. No statement on this can be made for the intake of iron and vitamin D (girls). For the Dutch teenagers, low intakes of vitamin A (43%), iron (10% of the boys and 77% of the girls) and vitamin C (18%) were observed. For many other nutrients (calcium, potassium, magnesium, iron, zinc, vitamins B1, B2, B6, D, K1 and folate) the risk of low intakes among (subgroups of) teenagers were evaluated as ‘unknown’, as the median intakes were lower than the adequate intakes. In all age groups, the intakes of copper and vitamins B3 and B12 were sufficient.At the same time, the majority of the children (72% of the boys and 50% of the girls) had a high intake of sodium and a small number of children had high intakes of zinc (7%), copper (3%) or vitamin A (4% of the boys).17% of the children had overweight or obesity and for 9% the weight was evaluated as underweight. The prevalence of low intakes of vitamins A, D and iron was associated with BMI.Discussion:This study suggests that the food consumption of Dutch children can be improved with a more balanced intake of energy and nutrients to prevent obesity and low and high intakes. However, not for all nutrients the health impact is clear. So, more research on the nutrient requirements among children and the related health impact is necessary.

Inadequate nutrient intakes in Filipino schoolchildren and adolescents are common among those from rural areas and poor families.

BackgroundAdequate nutrition during childhood and adolescence is essential to promote growth and development.ObjectiveThis study evaluated usual energy and nutrient intakes of Filipino schoolchildren and adolescents.DesignFood and beverage intakes were collected from a nationally representative sample of schoolchildren aged 6–9 and 10–12 years (n = 3,594 and n = 2,971, respectively) and adolescents aged 13–18 years (n = 5,447) using 24-h dietary recalls. The distributions of usual energy and nutrient intakes and the prevalence of inadequate intakes, which is defined as the percent of children with intakes less than estimated average requirements or acceptable macronutrient distribution ranges, were estimated using the Personal Computer Software for Intake Distribution Estimation (PC-SIDE) program.ResultsThe results showed that the mean energy intakes were 19–35% lower than estimated energy requirement. High prevalence of inadequate intakes was found for most macro- and micronutrients. Prevalence of inadequacies was as follows: protein 12–47%, total fat (as percentage of energy) 38–52%, calcium 92–94%, iron 75–90%, vitamin C 68–96%, folate 61–93%, vitamin A 58–81%, riboflavin 58–91%, thiamin 27–75%, and phosphorus 18–91%.ConclusionsGenerally, prevalence of inadequacy of key nutrients were relatively high among adolescents and schoolchildren, especially those from poor families and rural areas. This study demonstrated that nutrient intakes of Filipino schoolchildren and adolescents were highly inadequate, particularly among the poor and those living in rural areas.

Importance of details in food descriptions in estimating population nutrient intake distributions

BackgroundNational food consumption surveys are important policy instruments that could monitor food consumption of a certain population. To be used for multiple purposes, this type of survey usually collects comprehensive food information using dietary assessment methods like 24-h dietary recalls (24HRs). However, the collection and handling of such detailed information require tremendous efforts. We aimed to improve the efficiency of data collection and handling in 24HRs, by identifying less important characteristics of food descriptions (facets) and assessing the impact of disregarding them on energy and nutrient intake distributions.MethodsIn the Dutch National Food Consumption Survey 2007–2010, food consumption data were collected through interviewer-administered 24HRs using GloboDiet software in 3819 persons. Interviewers asked participants about the characteristics of each food item according to applicable facets. Food consumption data were subsequently linked to the food composition database. The importance of facets for predicting energy and each of the 33 nutrients was estimated using the random forest algorithm. Then a simulation study was performed to determine the influence of deleting less important facets on population nutrient intake distributions.ResultsWe identified 35% facets as unimportant and deleted them from the total food consumption database. The majority (79.4%) of the percent difference between percentile estimates of the population nutrient intake distributions before and after facet deletion ranged from 0 to 1%, while 20% cases ranged from 1 to 5% and 0.6% cases more than 10%.ConclusionWe concluded that our procedure was successful in identifying less important food descriptions in estimating population nutrient intake distributions. The reduction in food descriptions has the potential to reduce the time needed for conducting interviews and data handling while maintaining the data quality of the survey.