Lower Reference Nutrient Intake Research Articles

The impact of replacing milk with plant-based alternatives on iodine intake: a dietary modelling study.

Cow's milk is the primary source of iodine in the UK, but consumption of plant-based milk alternatives (PBMA) is increasing and these products are often not fortified with iodine. We evaluated the impact that replacing current milk consumption with PBMA would have on iodine intake. We used data from the National Diet and Nutrition Survey (2016-2019) for children (1.5-10years), girls 11-18years, and women of reproductive age (WRA). We used a dietary modelling approach with scenarios using brand-leveliodine-fortification data (0, 13, 22.5, 27.4 and 45µg/100mL). Relative to usual diet, we calculated change in iodine intake, and the proportion with intake below the Lower Reference Nutrient Intake (LRNI) or above the upper limit. For all groups, replacement with PBMA, either unfortified or fortified at the lowest concentration, resulted in a meaningful decrease in iodine intake, and increased the proportion with intake < LRNI; compared to usual diet, iodine intake reduced by 58% in children 1.5-3years (127 vs. 53µg/day) and the proportion with intake < LRNI increased in girls (11-18years;20% to 48%) and WRA (13% to 33%) if anunfortified PBMA was used. Replacement of milk with PBMA fortified at 27.4µg/100mL had the lowest impact. Replacing milk with commercially available PBMAs has potential to reduce population iodine intake, depending on the fortification level. PBMAs fortified with ≥ 22.5 and < 45µg iodine/100mL would be required to minimize the impact on iodine intake. Research is needed on the impact of total dairy replacement.

Approaches to setting dietary reference values for micronutrients, and translation into recommendations

Dietary reference values (DRV) are estimates of the daily amounts of nutrients or food energy that meet the needs of healthy people. In the UK, three terms are used to express these estimates, assuming a normal distribution of requirements in a population. These are the estimated average requirement, the lower reference nutrient intake and the reference nutrient intake. DRV are for use in a variety of settings, including the assessment of adequacy and safety of nutrient or energy intake in a population group, in the design of meal provision in care settings, in food labelling and in considering food fortification strategies. DRV, and other expressions of nutrient requirements, assume a relationship between the intake of a nutrient and some criterion of adequacy, the outcome. Estimates of requirements are based on a diverse range of measures of adequacy, according to available evidence. The Scientific Advisory Committee on Nutrition (SACN) is the body responsible for reviewing and setting DRV for the UK population. The work of SACN is guided by a framework of evidence that relates food and nutrients to health. There have been calls for the harmonisation of approaches used in the setting of nutrient requirements, globally, and an increased transparency in the decision-making process. Some progress has been made in this regard, but there is a great deal of work to be done.

Dietary micronutrient intakes among women of reproductive age in Mumbai slums

ObjectivesTo (1) describe micronutrient intakes among women of reproductive age living in Mumbai slums; (2) assess the adequacy of these intakes compared with reference values; (3) identify important dietary sources of micronutrients.Subjects/methodsParticipants were 6426 non-pregnant women aged 16–39 years, registered in a randomised controlled trial of a food-based intervention set in the Bandra, Khar and Andheri areas of Mumbai, India. Cross-sectional quantified food frequency questionnaire (FFQ) data were collected. Vitamin (n = 9) and mineral (n = 6) intakes were calculated and analysed in relation to dietary reference values (DRVs). Important dietary sources were identified for each micronutrient.ResultsMedian intakes of all micronutrients, except vitamin E, were below the FAO/WHO reference nutrient intake (RNI). Intakes of calcium, iron, vitamin A and folate were furthest from the RNI. For seven of the micronutrients, over half of the women had intakes below the lower reference nutrient intake (LRNI); this figure was over 75% for calcium and riboflavin. The majority of women (93%) had intakes below the EAR for 5 or more micronutrients, and 64% for 10 or more. Adolescents had lower intakes than women aged >19 years. Less than 1% of adult women and no adolescents met the EAR for all micronutrients. Animal source foods and micronutrient-rich fruit and vegetables were consumed infrequently.ConclusionsThese women had low intakes of multiple micronutrients, increasing their risk of insufficiency. There is a need to determine the factors causing poor intakes, to direct interventions that improve diet quality and nutritional sufficiency.

Biofortified crops for tackling micronutrient deficiencies – what impact are these having in developing countries and could they be of relevance within Europe?

AbstractThe development of crops that by harvest have accumulated higher amounts of a particular micronutrient than standard crops is known as biofortification. Biofortified staple crops such as provitamin A‐biofortified sweet potato (‘orange sweet potato’), zinc‐biofortified rice (‘zinc rice’) and iron‐biofortified beans (‘iron beans’), developed by selective breeding, have been introduced into developing countries with the goal of reducing micronutrient deficiencies. In these settings, micronutrient deficiencies caused by low dietary intakes and exacerbated by inflammation and infection result in considerable morbidity and mortality worldwide. The aim of this review is twofold: (1) to describe the impact of biofortified crops on micronutrient intake, nutritional status and other biological endpoints in developing countries and (2) to consider the relevance of these nutritional effects in other parts of the world such as Europe. Regular consumption of biofortified crops in developing countries where micronutrient deficiency is common has been shown to increase micronutrient intakes and thus help meet the World Health Organization's dietary recommendations. In terms of micronutrient status, most research has been conducted using provitamin A‐biofortified crops (particularly orange sweet potato), with large 2‐ to 3‐year studies indicating increases in plasma retinol, though additional studies measuring change in body stores would provide more definitive evidence. There is some evidence to suggest that iron‐biofortified crops can increase iron status (measured by serum ferritin and total body iron), but further studies are required to demonstrate the efficacy of zinc‐biofortified foods. Intakes of some micronutrients are low in some UK population subgroups (in particular adolescents and young adult women), with sizeable proportions having intakes below the lower reference nutrient intake. There is also evidence of low status for some nutrients (e.g. iron and in particular vitamin D), although the prevalence of iron deficiency is much less, and therefore the consequences less severe, than seen in the developing world. The final part of the paper describes strategies used to improve micronutrient intake in Europe, such as fortification of bread flour post‐harvest and supplementation with vitamin D and folic acid, and discusses whether there is a role for biofortified crops in the UK.

Micronutrient Intakes of British Adults Across Mid-Life: A Secondary Analysis of the UK National Diet and Nutrition Survey.

Background: There is a tendency to report micronutrients intakes collectively for adults, with broad age ranges being used. This means that certain sub-population groups such as young adults are often overlooked. The objective of the present article was to derive and evaluate micronutrient intakes across UK adults in their twenties, thirties, forties and fifties.Methods: A secondary analysis of the UK National Diet and Nutrition Survey (years 1–6) was undertaken. Data from n = 3,238 adults was analyzed and micronutrient intakes from food sources (excluding supplements) derived as a percentage of the Reference Nutrient Intake (RNI) and percentage below the Lower Reference Nutrient Intake (LRNI) for males and females aged 20–29, 30–39, 40–49, and 50–59 years. Mean intakes were used in instances where this data was unavailable (for vitamins D and E).Results: Sizeable gaps were found for magnesium with 19% of young people in their twenties having intakes below the LRNI. Amongst UK females intakes of 9 micronutrients (riboflavin, vitamin B6, B12, folic acid, calcium, iron, magnesium, potassium, and iodine) were significantly lower than males aged 20–59 years (p < 0.001) expressed as a percentage of the RNI. Young adults in their twenties had significantly lower (p < 0.05) intakes of 8 micronutrients (vitamin A, riboflavin, folic acid, calcium, magnesium, potassium, iodine, and copper) expressed as a percentage of the RNI compared with adults in their thirties, forties and fifties. There were also considerable gaps in dietary selenium intakes with 50.3% females and 25.8% males having total intakes beneath the LRNI. A quarter of women had iron (25.3%) and potassium (24.3%) intakes below the LRNI.Conclusions: UK females and younger adults appear to be particularly vulnerable to micronutrient shortfalls from food sources alone. Clearly, improvements in dietary quality are needed across mid-life. Alongside this, fortification and supplementation strategies may be considered to help adults achieve dietary targets at this life-stage when they should be at their nutritional prime.

Associations between Red Meat Intakes and the Micronutrient Intake and Status of UK Females: A Secondary Analysis of the UK National Diet and Nutrition Survey.

Blanket health messages to lower red meat intakes are being communicated at present. These could have adverse implications on the micronutrient quality of women’s diets. The current paper evaluates the nutritional impact of lower red meat intakes on British women’s micronutrient intakes and status. A secondary analysis of the UK National Diet and Nutrition Survey was undertaken using data from years 2008/2009 to 2011/2012. This was comprised of dietary and blood analyte data from 1384 and 641 females aged 11 to 64 years. Females consuming less than 40 g total red meat daily were more likely to have micronutrient intakes below the Lower Reference Nutrient Intake (LRNI) for zinc, iron, vitamin B12 and potassium and have lower habitual vitamin D intakes than females consuming between 40 and 69 g daily. After adjusting data for energy intake, zinc (% below the LRNI) and vitamin D (μg/day) remained statistically significant (p < 0.001). No significant differences were observed for blood biomarkers. Females consuming diets lower in red meat, i.e., <40 g daily, appear to have reduced micronutrient intakes, especially in the case of zinc and vitamin D. This should be considered when giving blanket advice for whole populations to reduce red meat intakes.

Dietary Micronutrient Intake and Micronutrient Status in Patients With Chronic Stable Heart Failure: An Observational Study.

Observational studies suggest that patients with heart failure have a tendency to a reduced status of a number of micronutrients and that this may be associated with an adverse prognosis. A small number of studies also suggest that patients with heart failure may have reduced dietary intake of micronutrients, a possible mechanism for reduced status. The aims of this study were to assess dietary micronutrient intake and micronutrient status in a group of patients with heart failure. Dietary intake was assessed in 79 outpatients with chronic stable heart failure with a reduced ejection fraction using a validated food frequency questionnaire. Blood concentrations of a number of micronutrients, including vitamin D, were measured in fasting blood samples, drawn at the time of food frequency questionnaire completion. More than 20% of patients reported intakes less than the reference nutrient intake or recommended intake for riboflavin, vitamin D, vitamin A, calcium, magnesium, potassium, zinc, copper, selenium, and iodine. More than 5% of patients reported intakes less than the lower reference nutrient intake or minimum recommended intake for riboflavin, vitamin D, vitamin A, calcium, magnesium, potassium, zinc, selenium, and iodine. Vitamin D deficiency (plasma total 25-hydroxy-vitamin D concentration <50 nmol/L) was observed in 75.6% of patients. Vitamin D deficiency was common in this group of patients with heart failure. Based on self-reported dietary intake, a substantial number of individuals may not have been consuming enough vitamin D and a modest number of individuals may not have been consuming enough riboflavin, vitamin A, calcium, magnesium, potassium, zinc, copper, selenium, or iodine to meet their dietary needs.

Energy and nutrient intakes of young children in the UK: findings from the Gemini twin cohort.

Data on the diets of young children in the UK are limited, despite growing evidence of the importance of early diet for long-term health. We used the largest contemporary dietary data set to describe the intake of 21-month-old children in the UK. Parents of 2336 children aged 21 months from the UK Gemini twin cohort completed 3-d diet diaries in 2008/2009. Family background information was obtained from questionnaires completed 8 months after birth. Mean total daily intakes of energy, macronutrients (g and %E) and micronutrients from food and beverages, including and excluding supplements, were derived. Comparisons with UK dietary reference values (DRV) were made using t tests and general linear regression models, respectively. Daily energy intake (kJ), protein (g) and most micronutrients exceeded DRV, except for vitamin D and Fe, where 96 or 84 % and 70 or 6 % of children did not achieve the reference nutrient intake or lower reference nutrient intake (LRNI), respectively, even with supplementation. These findings reflect similar observations in the smaller sample of children aged 18-36 months in the National Diet and Nutrition Survey. At a population level, young children in the UK are exceeding recommended daily intakes of energy and protein, potentially increasing their risk of obesity. The majority of children are not meeting the LRNI for vitamin D, largely reflecting inadequate use of the supplements recommended at this age. Parents may need more guidance on how to achieve healthy energy and nutrient intakes for young children.

Nutrient adequacy and imbalance among young children aged 1–3 years in the UK

AbstractToddlers and young children in the second and third years of life (12–35 months) may be nutritionally vulnerable, especially if they eat a limited range of foods or consume a diet that is energy rich but nutrient poor. We compared dietary intakes among children aged 18–35 months from the National Diet and Nutrition Survey (2008–2011) and children aged 12–18 months from the Diet and Nutrition Survey of Infants and Young Children (2011) with UK Dietary Reference Values (DRVs) to assess potential nutrient excess or inadequacy. Multiple criteria were used [reference nutrient intake (RNI), estimated average requirements (EAR) and lower reference nutrient intake (LRNI)], and where the LRNI or EAR were unavailable they were estimated as 75% of the EAR or RNI, respectively. Compared to current recommendations, there appear to be significant shortfalls in intakes of vitamin D in young children in the UK, and supplementation, although recommended by government, is not addressing the problem because take‐up is low (9–11%). Vitamin D intakes (including supplements) averaged only 55% of the RNI among children aged 12–18 months and 33% of the RNI for those aged 18–35 months, while 64% and 87% of the younger and older group, respectively, had intakes below the LRNI (estimated). Endogenous synthesis of vitamin D may be insufficient to fulfil requirements, especially in winter. Iron intakes are also suboptimal among some groups. Based on the EAR cut‐point method, the estimated population prevalence of dietary inadequacy for children aged 18–35 months was 91% for vitamin D and 31% for iron. Zinc, vitamin A and iodine had estimated levels of dietary inadequacy ranging from 5% to 19%. Mean energy intakes were below the 1991 DRV for energy but above the most recent DRV issued in 2011, while protein intakes in both surveys were in excess of the RNI. Further work is warranted to identify dietary patterns associated with low micronutrient intakes and status, and to assess the best strategies for ensuring adequacy, especially among vulnerable groups. Parents and healthcare professionals should be informed as to how to minimise the risks of both nutrient deficiency and excessive energy intakes for the young children in their care. Government can facilitate provision of appropriate advice via the healthcare system and encourage provision of appropriate foods and supplements via enabling legislation. The food industry also has a role in the responsible provision of fortified foods and drinks that can address nutrient inadequacy.

Mapping low intake of micronutrients across Europe.

Achieving an understanding of the extent of micronutrient adequacy across Europe is a major challenge. The main objective of the present study was to collect and evaluate the prevalence of low micronutrient intakes of different European countries by comparing recent nationally representative dietary survey data from Belgium, Denmark, France, Germany, The Netherlands, Poland, Spain and the United Kingdom. Dietary intake information was evaluated for intakes of Ca, Cu, I, Fe, Mg, K, Se, Zn and the vitamins A, B₁, B₂, B₆, B₁₂, C, D, E and folate. The mean and 5th percentile of the intake distributions were estimated for these countries, for a number of defined sex and age groups. The percentages of those with intakes below the lower reference nutrient intake and the estimated average requirement were calculated. Reference intakes were derived from the UK and Nordic Nutrition Recommendations. The impact of dietary supplement intake as well as inclusion of apparently low energy reporters on the estimates was evaluated. Except for vitamin D, the present study suggests that the current intakes of vitamins from foods lead to low risk of low intakes in all age and sex groups. For current minerals, the study suggests that the risk of low intakes is likely to appear more often in specific age groups. In spite of the limitations of the data, the present study provides valuable new information about micronutrient intakes across Europe and the likelihood of inadequacy country by country.

Infant feeding in the second 6 months of life related to iron status: an observational study

Objective:To investigate the relationship between iron status in infancy and type of milk and weaning solids consumed.Design:An observational cohort study.Setting:928 term infants from the Avon Longitudinal Study of Parents and...

Nutrition in pregnancy

Nutrition in pregnancy

Dietary calcium and health

Dietary calcium and health

The nutrient intakes of mothers of low birth weight babies – a comparison of ethnic groups in East London, UK

The objective of this paper was to compare the nutrient intakes of mothers of different ethnic origins after they had given birth to a low birth weight (LBW) baby (< 2.5 kg). A total of 165 participants from East London, UK completed a prospective 7-day diet diary using household measures, between 8 and 12 weeks post-partum. The data were originally collected as baseline data prior to two separate nutrition intervention studies and were combined and re-interrogated for the purpose of this paper. Folate and iron intakes were low in all ethnic groups compared to the Reference Nutrient Intakes (RNI). Half did not meet the RNI for folate and 88% did not meet the RNI for iron. Nearly a quarter of the group did not achieve the Lower Reference Nutrient Intake (LRNI) for iron. The mean vitamin D and calcium intakes were significantly different between the ethnic groups (P = 0.007, P = 0.001, respectively). African women had the highest vitamin D intakes (4.72 microg d(-1)) and Caucasians and Asians the lowest (2.4 microg d(-1)). Caucasians had the highest calcium intakes (780 mg d(-1)) and Africans the lowest (565 mg d(-1)). Over two-thirds of African, Asian and African-Caribbean women did not meet the RNI for calcium. Thirty-one per cent of Africans did not meet the LRNI for calcium. Our data show a high prevalence of inadequate nutrition among women who deliver LBW babies with differences in nutrient intake between ethnic groups. This information can be used to target specific appropriate dietary advice to ethnic minorities for the prevention or repetition of LBW.

Public health aspects of food fortification: a question of balance

Micronutrient malnutrition is widespread throughout the world, with important health and economic consequences. Tools to address this situation include food fortification, supplementation and dietary diversification, each having different and complementary roles. Fortification (mandatory and voluntary) has been practised over several decades in Western countries as well as in developing countries. Iodised salt was introduced in the USA in 1924 to reduce severe I deficiency. In 1938 voluntary enrichment of flours and breads with niacin and Fe was initiated to reduce the incidence of pellagra and Fe-deficiency anaemia respectively. Micronutrient intakes in European countries appear to be generally adequate for most nutrients. However, a number of population subgroups are at higher risk of suboptimal intakes (below the lower reference nutrient intake) for some micronutrients, e.g. folate, Fe, Zn and Ca in children, adolescents and young women. Dietary surveys indicate that fortified foods play a role in mitigating such risks for several important nutrients. The number of foods suited to fortification are considerably limited by several factors, including technological properties (notably moisture, pH and O2 permeability), leading to unacceptable taste and appearance, as well as cost and consumer expectations. In countries in which voluntary fortification is widely practised micronutrient intakes are considerably below tolerable upper intake levels. Concerns about safety are addressed in relation to the potentially increased level or proportion of fortified foods (e.g. following potential EU legislation), for nutrients with relatively low tolerable upper intake levels and where the potential benefit and risks are in different subpopulations (e.g. folic acid). Recent models for assessing these issues are discussed.

New Year's resolutions needed to help defuse the health time bomb?

New Year's resolutions needed to help defuse the health time bomb?

Risk factors for low iron intake and poor iron status in a national sample of British young people aged 4-18 years.

To examine the prevalence and dietary, sociodemographic and lifestyle risk factors of low iron intake and poor iron status in British young people. National Diet and Nutrition Survey of young people aged 4-18 years. Great Britain, 1997. In total, 1699 young people provided 7-day weighed dietary records, of which 11% were excluded because the participant reported being unwell with eating habits affected. Blood was obtained from 1193 participants, with iron status indicated by haemoglobin, serum ferritin and transferrin saturation. Iron intakes were generally adequate in most young people aged 4-18 years. However, low iron intakes (below the Lower Reference Nutrient Intake) occurred in 44% of adolescent girls (11-18 years), being less prevalent with high consumption of breakfast cereals. Low haemoglobin concentration (<115 g l-1, 4-12 years; <120 or <130 g l-1, 13+ years for girls and boys, respectively) was observed in 9% of children aged 4-6 years, pubertal boys (11-14 years) and older girls (15-18 years). Adolescent girls who were non-Caucasians or vegetarians had significantly poorer iron status than Caucasians or meat eaters, independent of other risk factors. The three iron status indices were correlated significantly with haem, but not non-haem, iron intake. Adolescent girls showed the highest prevalence of low iron intake and poor iron status, with the latter independently associated with non-Caucasian ethnicity and vegetarianism. Risk of poor iron status may be reduced by consuming (particularly lean red) meat or enhancers of non-haem iron absorption (e.g. fruit or fruit juice) in vegetarians.

The association between red and processed meat consumption and iron intakes and status among British adults.

To examine the association between consumption of red and processed meat (RPM) and iron intakes and status in adults. Further analysis of the Dietary and Nutritional Survey of British Adults, a cross-sectional study of 2197 adults aged 16-64 years carried out in 1986/7. Adults (836 men and 838 women) with serum ferritin measurements, who were not taking iron supplements, were classified into four groups according to RPM consumption (from 7-day weighed records). Iron absorbed was estimated from equations based on haem and non-haem iron and the influence of iron stores. Women who ate least meat (<90 g day-1) had three times the risk of a low iron intake (below the Lower Reference Nutrient Intake) compared with high consumers of RPM (>140 g day-1). Men who ate no RPM also had a higher risk of low iron intake. Using an estimate of minimal values for iron losses, there was a twofold difference in the potential risk of negative iron balance between women non-RPM consumers and high RPM consumers. Status measurements indicated that, among women, anaemia was least prevalent (6%) among high consumers compared with 12-14% among average RPM consumers. Inverse trends were also observed for serum ferritin in both sexes. Low consumption of RPM has implications for iron intakes and iron status in men and women, since the risk of negative iron balance and its consequences are increased. Dietary messages must consider these implications and provide appropriate advice.

Food provision and the nutritional implications of food choices made by young adult males, in a young offenders' institution.

The nutritional adequacy of diets provided by a prison was assessed by analysis of the kitchen menu for 1 week of a 4-week cycle. Dietary intakes were determined using a predefined 7-day diet diary in which prisoners indicated what they had eaten, and how much. A total of 159 prisoners took part in the study. The food provided by the prison kitchen was broadly in line with current dietary recommendations. Vitamin content exceeded recommendations, with the exception of niacin in the vegetarian menu (12.6 mg compared with the reference nutrient intake of 16.8 mg). Selenium content was low in all menus, but particularly in the vegetarian menu in 1997 where it equalled the lower reference nutrient intake (LRNI) (39.5 microg). Food choices made by prisoners resulted in a wide variation in dietary intakes. Fat intake (as a proportion of energy) exceeded the recommended 35% in 82% of diets in 1996, and 64% of diets in 1997. In 1996, 34% of prisoners had intakes above 40% energy as fat. High fat intakes were largely the result of consuming items from the prison shop. Vitamin D intakes were low (3.4 and 3.3 microg in 1996 and 1997, respectively) compared with the recommendation (10 microg) for those with limited exposure to sunlight. Intakes of a number of minerals fell below recommendations, with some prisoners barely meeting the LRNI. This was particularly notable for selenium where 35% of prisoners in 1996, and 60% of prisoners in 1997 had intakes below the LRNI.

Dietary intake after pancreatectomy.

Nutritional intake after pancreatectomy may be impaired. The extent of the problem and the effect on intake of specific nutrients is unknown. A 1-week weighed dietary food intake (using digital scales and a food diary) was studied in 15 patients, a median of 4 (range 1-30) months after pancreatectomy. Results were expressed as a percentage of estimated average requirement (EAR), reference nutrient intake (RNI) or lower RNI (LRNI) values. The median energy intake was 1914 (range 1154-2804) kcal/day, representing a median of 88 (56-154) per cent of EAR. Fat intake was low (72 (60-123) g/day); protein intake was adequate (139 (99-219) per cent of RNI). Deficiencies were observed in the intake of vitamin D (17 (6-56) per cent of LRNI) and, in some patients, selenium (107 (19-203) per cent of LRNI). Nutritional intake in the months after pancreatectomy could be improved by increasing fat intake (with enzyme supplements as appropriate). This 7-day study also suggests that these patients may require vitamin D and possibly selenium supplementation.